Review Effectiveness of Exercise Interventions on Body Composition, Exercise Capacity, Fatigue, and QoL in Patients with Liver Cirrhosis:... 2024 Hsieh et al

Abstract

Background
Diminished muscle protein synthesis in cirrhosis leads to reduced strength and mass, impacting daily activities and overall quality of life.

Aims
This study aimed to examine the effectiveness of exercise intervention in body composition, exercise capacity, fatigue, and quality of life in patients with liver cirrhosis.

Methods
A systematic search of medical databases, including PubMed, Embase, Cochrane, and CINAHL, was executed from their inception to November 2022. The inclusion criteria were randomized controlled trials comparing exercise interventions with a control group that did not receive exercise interventions.

Results
From the initially identified 2,565 articles, eight studies with a total of 220 patients were eligible for inclusion in this meta-analysis. According to the meta-analysis, exercise significantly improved the six-minute walk distance (6MWD) by 68.93 m (95% CI 14.29–123.57) compared to the control group. Furthermore, the subgroup analysis revealed that combing exercise with amino acid supplementation had a greater positive effect on the 6MWD (MD = 144.72, 95% CI 87.44–202.01). Exercise also significantly increased thigh circumference (MD = 1.26, 95% CI 0.12–2.39) and the thigh ultrasound average compression index (MD = 0.07, 95% CI 0.00–0.14). Moreover, exercise significantly decreased fatigue levels by 0.7 points in patients with liver cirrhosis (95% CI 0.38–1.03). However, no significant effects were observed on body mass index (BMI), fat mass, fat-free mass, and quality of life.

Conclusions
Exercise can improve exercise capacity, thigh muscle thickness, and fatigue in patients with cirrhosis, but it does not have a significant impact on fat mass, BMI, or quality of life.

Paywall, https://link.springer.com/article/10.1007/s10620-024-08447-0

 

So without a significant impact on quality of life, exercise doesn't seem to be an effective medicine for this patient group.

 

Which again emphasizes how unreliable the instruments they are using are, but also the inability to question them or the models they use when real-world data comes out nonsensical. It should be absurd to anyone that improvements in fatigue does not improve quality of life, it can only mean that the numbers are not reliable. Unless it's an insignificant level of fatigue, which then should not show up on any assessment. Impossible to say whether they notice or are bothered by it, being behind a paywall.

It doesn't say what they used to assess fatigue, just that it reduced it "significantly" by 0.7, but without any mention of what the scale is. 0.7 would be barely significant on a 5-point scale because there is so much fuzziness, and it's likely to be a larger one, so there is clearly a problem with what significant even means, and probably explains why a "significant" decrease in fatigue has no effect on quality of life, even though fatigue has a very significant effect on quality of life.

There are a few references to study on chronic fatigue syndrome.