Walking exercise through smartphone application plus branched-chain amino acid supplementation benefits skeletal muscle mass and strength in liver cirrhosis: A prospective control trial

Abstract

Introduction and objectives Whether a combination of exercise and branched-chain amino acid (BCAA) supplementation was more beneficial than those given alone in sarcopenia related to liver cirrhosis (LC) is unknown. Widely used smartphone applications provide continuous and easily expandable management of chronic liver disease (CLD). This study is to investigate the effects of unsupervised walking exercise using WeChat combined with BCAA supplementation on skeletal muscle mass and strength in LC.

Materials and Methods The 127 LC patients of Child–Pugh A/B were assigned to group A (BCAA supplements, n=42), group B (walking exercise, n=43) and group C (walking exercise plus BCAA supplements, n=42). Laboratory data, average daily steps, serum BCAA, skeletal muscle mass index (SMI) and grip strength were analyzed pre- and 3 months after interventions.

Results Of the 124 patients who completed interventions, albumin and daily steps were significantly increased in all groups (p=0.0001). Post-intervention BCAA were significantly elevated in group A (A vs B, p=0.001) and C (C vs B, p=0.012;). While post-intervention daily steps in group B (B vs A, p=0.0001) and C (C vs A, p=0.0001) were higher. Grip strength (C vs A, p=0.020; C vs B, p=0.036) and SMI (C vs A, p=0.035; C vs B, p=0.012) were increased in group C. Prevalence of sarcopenia was significantly decreased in group C (p=0.015).

Conclusions A combination of unsupervised walking exercise using smartphone applications and BCAA supplementation might be an effective and safe treatment for cirrhosis patients with Child–Pugh A/B to improve skeletal muscle mass and strength or to prevent progress of sarcopenia.

Zusammenfassung

Einleitung und Ziele Es ist nicht bekannt, ob die Kombination von Bewegung und Supplementierung mit verzweigtkettigen Aminosäuren (BCAA) vorteilhafter war als die alleinige Verabreichung bei Sarkopenie im Zusammenhang mit Leberzirrhose (LC). Die von uns verwendeten Smartphone-Anwendungen bieten eine kontinuierliche und leicht erweiterbare Behandlung von chronischen Lebererkrankungen (CLD). Diese Studie soll die Auswirkungen von unbeaufsichtigten Gehübungen mit WeChat in Kombination mit einer BCAA-Supplementierung auf die Skelettmuskelmasse und -kraft bei LC untersuchen.

Material und Methoden Die 127 LC-Patienten nach Child-Pugh A/B-Kriterien wurden der Gruppe A (BCAA-Supplemente, n=42), der Gruppe B (Gehübung, n=43) und der Gruppe C (Gehübungen plus BCAA-Supplemente, n=42) zugeordnet. Labordaten, durchschnittliche Tagesschritte, Serum-BCAA, Skelettmuskelmasse-Index (SMI) und Griffkraft wurden vor und 3 Monate nach den Eingriffen analysiert.

Ergebnisse Bei den 124 Patienten, die die Interventionen durchführten, waren Albumin und tägliche Schritte in allen Gruppen signifikant erhöht (p=0,0001). Nach der Intervention waren die BCAAs in Gruppe A (A vs. B, p=0,001) und C (C vs. B, p=0,012) signifikant erhöht; während die täglichen Schritte nach der Intervention in Gruppe B (B vs. A, p=0,0001) und C (C vs. A, p=0,0001) höher waren. Griffstärke (C vs. A, p=0,020; C vs. B, p=0,036) und SMI (C vs. A, p=0,035; C vs. B, p=0,012) waren in Gruppe C erhöht. Die Prävalenz von Sarkopenie war signifikant verringert in Gruppe C (p=0,015).

Schlussfolgerungen Die Kombination von unbeaufsichtigten Gehübungen mit Smartphone-Anwendungen und BCAA-Supplementierung könnte eine wirksame und sichere Behandlung für Zirrhose-Patienten mit Child-Pugh A/B sein, um die Skelettmuskelmasse und -kraft zu verbessern oder das Fortschreiten der Sarkopenie zu verhindern.

Keywords

sarcopenia - liver cirrhosis - exercise - branched-chain amino acid - smartphone application

Schlüsselwörter

Sarkopenie - Leberzirrhose - Bewegung - verzweigtkettige Aminosäure - Smartphone-Anwendung

Publication History

Received: 30 September 2022

Accepted after revision: 11 April 2023

Article published online:
23 May 2023

• References

• 1 Hiraoka A, Michitaka K, Ueki H. et al. Sarcopenia and two types of presarcopenia in Japanese patients with chronic liver disease. Eur J Gastroenterol Hepatol 2016; 28: 940-947 DOI: 10.1097/MEG.0000000000000661.
• 2 Zhao MY, Zhou XS, Yuan CY. et al. Association between serum irisin concentrations and sarcopenia in patients with liver cirrhosis: a cross-sectional study. Sci Rep 2020; 10: 16093 DOI: 10.1038/s41598-020-73176-z.
• 3 Lai JC, Tandon P, Bernal W. et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 74: 1611-1644 DOI: 10.1002/hep.32049.
• 4 Ismaiel A, Bucsa C, Farcas A. et al. Effects of branched-chain amino acids on parameters evaluating sarcopenia in liver cirrhosis: Systematic review and meta-analysis. Front Nutr 2022; 9: 749969 DOI: 10.3389/fnut.2022.749969.eCollection.
• 5 Hanai T, Shiraki M, Nishimura K. et al. Sarcopenia impairs prognosis of patients with liver cirrhosis. Nutrition 2015; 31: 193-199 DOI: 10.1016/j.nut.2014.07.005.
• 6 Toshikuni N, Arisawa T, Tsutsumi M. Nutrition and exercise in the management of liver cirrhosis. World J Gastroenterol 2014; 20: 7286-7297 DOI: 10.3748/wjg.v20.i23.7286. (PMID: 24966599)
• 7 Nishida Y, Ide Y, Okada M. et al. Effects of home-based exercise and branched-chain amino acid supplementation on aerobic capacity and glycemic control in patients with cirrhosis. Hepatol Res 2017; 47: E193-200 DOI: 10.1111/hepr.12748.
• 8 Berzigotti A, Albillos A, Villanueva C. et al. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology 2017; 65: 1293-1305 DOI: 10.1002/hep.28992.
• 9 Román E, Torrades MT, Nadal MJ. et al. Randomized pilot study: effects of an exercise programme and leucine supplementation in patients with cirrhosis. Dig Dis Sci 2014; 59: 1966-1975 DOI: 10.1007/s10620-014-3086-6.
• 10 Poitras VJ, Gray CE, Borghese MM. et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab 2016; 41: S197-239 DOI: 10.1139/apnm-2015-0663.
• 11 Lyu KX, Zhao J, Wang B. et al. Smartphone application WeChat for clinical follow-up of discharged patients with head and neck tumors: A randomized controlled trial. Chin Med J 2016; 129: 2816-2823 DOI: 10.4103/0366-6999.194635.
• 12 Louissaint J, Lok AS, Fortune BE. et al. Acceptance and use of a smartphone application in cirrhosis. Liver Int 2020; 40: 1556-1563 DOI: 10.1111/liv.14494. (PMID: 32343467)
• 13 Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Consensus on the diagnosis and treatment of hepatic fibrosis (2019). J Dig Dis 2020; 21: 127-138 DOI: 10.1111/1751-2980.12854. (PMID: 31576089)
• 14 Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Gastroenterology, Chinese Medical Association. Clinical guidelines on nutrition in end-stage liver disease. Zhonghua Gan Zang Bing Za Zhi 2019; 27: 330-342 DOI: 10.3760/cma.j.issn.1007-3418.2019.05.003.
• 15 Hari A. Muscular abnormalities in liver cirrhosis. World J Gastroenterol 2021; 27: 4862-4878 DOI: 10.3748/wjg.v27.i29.4862. (PMID: 34447231)
• 16 Ebadi M, Bhanji RA, Mazurak VC. et al. Sarcopenia in cirrhosis: from pathogenesis to interventions. J Gastroenterol 2019; 54: 845-859 DOI: 10.1007/s00535-019-01605-6.
• 17 Krähenbühl L, Lang C, Lüdes S. et al. Reduced hepatic glycogen stores in patients with liver cirrhosis. Liver Int 2003; 23: 101-109 DOI: 10.1034/j.1600-0676.2003.00805.x.
• 18 Trivedi HD, Tapper EB. Interventions to improve physical function and prevent adverse events in cirrhosis. Gastroenterol Rep 2018; 6: 13-20 DOI: 10.1093/gastro/gox042. (PMID: 29479438)
• 19 Ney M, Haykowsky MJ, Vandermeer B. et al. Systematic review: pre- and post-operative prognostic value of cardiopulmonary exercise testing in liver transplant candidates. Aliment Pharmacol Ther 2016; 44: 796-806 DOI: 10.1111/apt.13771. (PMID: 27539029)
• 20 Aamann L, Dam G, Borre M. et al. Resistance training increases muscle strength and muscle size in patients with liver cirrhosis. Clin Gastroenterol Hepatol 2020; 18: 1179-1187.e6 DOI: 10.1016/j.cgh.2019.07.058.
• 21 Zhang SH, Zeng XF, Ren M. et al. Novel metabolic and physiological functions of branched chain amino acids: A review. J Anim Sci Biotechnol 2017; 8: 10 DOI: 10.1186/s40104-016-0139-z. (PMID: 28127425)
• 22 Benjamin D, Colombi M, Moroni C. et al. Rapamycin passes the torch, a new generation of mTOR inhibitors. Nat Rev Drug Discov 2011; 10: 868-880 DOI: 10.1038/nrd3531. (PMID: 22037041)
• 23 Dasarathy S, Hatzoglou M. Hyperammonemia and proteostasis in cirrhosis. Curr Opin Clin Nutr Metab Care 2018; 21: 30-36 DOI: 10.1097/MCO.0000000000000426. (PMID: 29035972)
• 24 Davuluri G, Allawy A, Thapaliya S. et al. Hyperammonaemia induced skeletal muscle mitochondrial dysfunction results in cataplerosis and oxidative stress. J Physiol 2016; 594: 7341-7360 DOI: 10.1113/JP272796. (PMID: 27558544)
• 25 Holecek M, Kandar R, Sispera L. et al. Acute hyperammonemia activates branched-chain amino acid catabolism and decreases their extracellular concentrations: different sensitivity of red and white muscle. J Physiol 2016;594:7341–7360. . DOI: 10.1007/s00726-010-0679-z.
• 26 Ábrigo J, Elorza AA, Riedel CA. et al. Role of oxidative stress as key regulator of muscle wasting during cachexia. Oxid Med Cell Longev 2018; 2018: 2063179 DOI: 10.1155/2018/2063179.
• 27 Michitaka K, Hiraoka A, Kume M. et al. Amino acid imbalance in patients with chronic liver diseases. Hepatol Res 2010; 40: 393-398 DOI: 10.1111/j.1872-034X.2009.00614.x.
• 28 Kim HK, Suzuki T, Saito K. et al. Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. J Am Geriatr Soc 2012; 60: 16-23 DOI: 10.1111/j.1532-5415.2011.03776.x. (PMID: 22142410)
• 29 Yoo SZ, No MH, Heo JW. et al. Role of exercise in age-related sarcopenia. J Exerc Rehabil 2018; 14: 551-558 DOI: 10.12965/jer.1836268.134. (PMID: 30276173)
• 30 Meyer F, Bannert K, Wiese M. et al. Molecular mechanism contributing to malnutrition and sarcopenia in patients with liver cirrhosis. Int J Mol Sci 2020; 21: 5357 DOI: 10.3390/ijms21155357.
• 31 Dietrich R, Bachmann C, Lauterburg BH. Exercise-induced hyperammonemia in patients with compensated chronic liver disease. Scand J Gastroenterol 1990; 25: 329-334 DOI: 10.3109/00365529009095494. (PMID: 2336543)
• 32 Biolo G, Tipton KD, Klein S. et al. An abundant supply of amino acids enhances the metabolic effect of exercise on muscle proteins. Am J Physiol 1997; 273: E122-E129 DOI: 10.1152/ajpendo.1997.273.1.E122.