Skip to main content
Top
Published in: Digestive Diseases and Sciences 8/2014

01-08-2014 | Original Article

Randomized Pilot Study: Effects of an Exercise Programme and Leucine Supplementation in Patients with Cirrhosis

Authors: Eva Román, Mª Teresa Torrades, Mª Josep Nadal, Guillem Cárdenas, Juan Camilo Nieto, Sílvia Vidal, Helena Bascuñana, Cándido Juárez, Carlos Guarner, Juan Córdoba, Germán Soriano

Published in: Digestive Diseases and Sciences | Issue 8/2014

Login to get access

Abstract

Background

Physical exercise could improve functional limitations, muscle mass, and health-related quality of life (HRQoL) in patients with cirrhosis.

Aim

The purpose of this study was to evaluate the efficacy and safety of an exercise programme and leucine supplementation to increase exercise capacity, muscle mass, and HRQoL in patients with cirrhosis.

Patients and Methods

Seventeen outpatients with cirrhosis were randomized to an exercise group (n = 8) or a control group (n = 9) in a pilot study. The programme of moderate exercise was performed for 12 weeks under supervision of a physiotherapist. All patients received oral leucine (10 g/day) during the study. At baseline and at the end of the study, we determined exercise capacity (6-min walk and 2-min step tests), anthropometric measurements, and HRQoL by Short Form-36 (SF-36) questionnaire. We also analyzed safety regarding complications of cirrhosis, liver and renal function, inflammatory response and oxidative stress.

Results

In the exercise group, exercise capacity improved, as shown by the increase in the 6-min walk test from 365 (160–420) to 445 m (250–500) (p = 0.01), and in the 2-min step test (p = 0.02). Lower thigh circumference also increased, from 41 (34–53) to 46 cm (36–56) (p = 0.02), and the domains of SF-36 general health (p = 0.03), vitality (p = 0.01) and social function (p = 0.04) improved significantly. In the control group, no statistically significant changes were observed in any of the parameters. We did not observe complications of cirrhosis in either group during the study.

Conclusions

A programme of moderate physical exercise together with leucine supplements in patients with cirrhosis is safe and improves exercise capacity, leg muscle mass and HRQoL.
Appendix
Available only for authorised users
Literature
1.
go back to reference Alberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17:445–450.PubMedCrossRef Alberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17:445–450.PubMedCrossRef
2.
go back to reference Montano-Loza AJ, Meza-Junco J, Prado CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10:166–173.PubMedCrossRef Montano-Loza AJ, Meza-Junco J, Prado CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10:166–173.PubMedCrossRef
3.
go back to reference Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transpl. 2012;18:146–151.PubMedCrossRef Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transpl. 2012;18:146–151.PubMedCrossRef
4.
go back to reference Kachaamy T, Bajaj JS, Heuman DM. Muscle and mortality in cirrhosis. Clin Gastroenterol Hepatol. 2012;10:100–102.PubMedCrossRef Kachaamy T, Bajaj JS, Heuman DM. Muscle and mortality in cirrhosis. Clin Gastroenterol Hepatol. 2012;10:100–102.PubMedCrossRef
5.
go back to reference Terziyski K, Andonov V, Marinov B, Kostaniev S. Exercise performance and ventilatory efficiency in patients with mild and moderate liver cirrhosis. Clin Exp Pharmacol Physiol. 2008;35:135–140.PubMed Terziyski K, Andonov V, Marinov B, Kostaniev S. Exercise performance and ventilatory efficiency in patients with mild and moderate liver cirrhosis. Clin Exp Pharmacol Physiol. 2008;35:135–140.PubMed
6.
go back to reference Alameri HF, Sanai FM, Al Dukhayil M, et al. Six minute walk test to assess functional capacity in chronic liver disease patients. World J Gastroenterol. 2007;13:3996–4001.PubMed Alameri HF, Sanai FM, Al Dukhayil M, et al. Six minute walk test to assess functional capacity in chronic liver disease patients. World J Gastroenterol. 2007;13:3996–4001.PubMed
7.
go back to reference Román E, Córdoba J, Torrens M, et al. Falls and cognitive dysfunction impair health-related quality of life in patients with cirrhosis. Eur J Gastroenterol Hepatol. 2013;25:77–84.PubMedCrossRef Román E, Córdoba J, Torrens M, et al. Falls and cognitive dysfunction impair health-related quality of life in patients with cirrhosis. Eur J Gastroenterol Hepatol. 2013;25:77–84.PubMedCrossRef
8.
go back to reference Carey EJ, Steidley DE, Aqel BA, et al. Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transpl. 2010;16:1373–1378.PubMedCrossRef Carey EJ, Steidley DE, Aqel BA, et al. Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transpl. 2010;16:1373–1378.PubMedCrossRef
10.
go back to reference Olde Damink SW, Jalan R, Redhead DN, et al. Interorgan ammonia and amino acid metabolism in metabolically stable patients with cirrhosis and TIPSS. Hepatology. 2002;36:1163–1171.PubMedCrossRef Olde Damink SW, Jalan R, Redhead DN, et al. Interorgan ammonia and amino acid metabolism in metabolically stable patients with cirrhosis and TIPSS. Hepatology. 2002;36:1163–1171.PubMedCrossRef
11.
go back to reference Hunter GR, McCarthy JP, Bamman MM. Effects of resistance training in older adults. Sports Med. 2004;34:329–348.PubMedCrossRef Hunter GR, McCarthy JP, Bamman MM. Effects of resistance training in older adults. Sports Med. 2004;34:329–348.PubMedCrossRef
12.
go back to reference Tabet JY, Meurin P, Driss AB, et al. Benefits of exercise training in chronic hearth failure. Arch Cardiovasc Dis. 2009;102:721–730.PubMedCrossRef Tabet JY, Meurin P, Driss AB, et al. Benefits of exercise training in chronic hearth failure. Arch Cardiovasc Dis. 2009;102:721–730.PubMedCrossRef
13.
14.
go back to reference Dereli EE, Yaliman A. Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme in quality of life in patients with Parkinson’s disease. Clin Rehabil. 2010;24:352–362.PubMedCrossRef Dereli EE, Yaliman A. Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme in quality of life in patients with Parkinson’s disease. Clin Rehabil. 2010;24:352–362.PubMedCrossRef
15.
go back to reference Duarte-Rojo A, Torres-Vega MA, Villamil-Ramírez H, et al. Changes in peripheral blood mononuclear cells glutamine synthetase mRNA after exercise in healthy volunteers: exploring an alternative proposal for non hepatic ammonia metabolism. Rev Invest Clin. 2012;64:164–172.PubMed Duarte-Rojo A, Torres-Vega MA, Villamil-Ramírez H, et al. Changes in peripheral blood mononuclear cells glutamine synthetase mRNA after exercise in healthy volunteers: exploring an alternative proposal for non hepatic ammonia metabolism. Rev Invest Clin. 2012;64:164–172.PubMed
16.
go back to reference Ploeger HE, Takken T, de Greef MH, Timmons BW. The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. Exerc Immunol Rev. 2009;15:6–41.PubMed Ploeger HE, Takken T, de Greef MH, Timmons BW. The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. Exerc Immunol Rev. 2009;15:6–41.PubMed
17.
go back to reference Guarner C, Soriano G. Bacterial translocation and its consequences in patients with cirrhosis. Eur J Gastroenterol Hepatol. 2005;17:27–31.PubMedCrossRef Guarner C, Soriano G. Bacterial translocation and its consequences in patients with cirrhosis. Eur J Gastroenterol Hepatol. 2005;17:27–31.PubMedCrossRef
18.
go back to reference García-Pagán JC, Santos C, Barberá JA, et al. Physical exercise increases portal pressure in patients with cirrhosis and portal hypertension. Gastroenterology. 1996;111:1300–1306.PubMedCrossRef García-Pagán JC, Santos C, Barberá JA, et al. Physical exercise increases portal pressure in patients with cirrhosis and portal hypertension. Gastroenterology. 1996;111:1300–1306.PubMedCrossRef
19.
go back to reference Bandi JC, García-Pagán JC, Escorsell A, et al. Effects of propranolol on the hepatic hemodynamic response to physical exercise in patients with cirrhosis. Hepatology. 1998;28:677–682.PubMedCrossRef Bandi JC, García-Pagán JC, Escorsell A, et al. Effects of propranolol on the hepatic hemodynamic response to physical exercise in patients with cirrhosis. Hepatology. 1998;28:677–682.PubMedCrossRef
20.
go back to reference Saló J, Guevara M, Fernández-Esparrach G, et al. Impairment of renal function during moderate physical exercise in cirrhotic patients with ascites: relationship with the activity of neurohormonal systems. Hepatology. 1997;25:1338–1342.PubMedCrossRef Saló J, Guevara M, Fernández-Esparrach G, et al. Impairment of renal function during moderate physical exercise in cirrhotic patients with ascites: relationship with the activity of neurohormonal systems. Hepatology. 1997;25:1338–1342.PubMedCrossRef
21.
22.
go back to reference Mergener M, Martins MR, Antunes MV, et al. Oxidative stress and DNA damage in older adults that do exercise regularly. Clin Biochem. 2009;42:1648–1653.PubMedCrossRef Mergener M, Martins MR, Antunes MV, et al. Oxidative stress and DNA damage in older adults that do exercise regularly. Clin Biochem. 2009;42:1648–1653.PubMedCrossRef
23.
go back to reference Jalan R, Kapoor D. Reversal of diuretic-induced hepatic encephalopathy with infusion of albumin but not colloid. Clin Sci. 2004;106:467–474.PubMedCrossRef Jalan R, Kapoor D. Reversal of diuretic-induced hepatic encephalopathy with infusion of albumin but not colloid. Clin Sci. 2004;106:467–474.PubMedCrossRef
24.
go back to reference Lee KC, Yang YY, Wang YW, et al. Increased plasma malondialdehyde in patients with viral cirrhosis and its relationship to plasma nitric oxide, endotoxin and portal pressure. Dig Dis Sci. 2010;55:2077–2085.PubMedCrossRef Lee KC, Yang YY, Wang YW, et al. Increased plasma malondialdehyde in patients with viral cirrhosis and its relationship to plasma nitric oxide, endotoxin and portal pressure. Dig Dis Sci. 2010;55:2077–2085.PubMedCrossRef
25.
go back to reference Ritland S, Petlund CF, Knudsen T, Skrede S. Improvement of physical capacity after long-term training in patients with chronic active hepatitis. Scand J Gastroenterol. 1983;18:1083–1087.PubMedCrossRef Ritland S, Petlund CF, Knudsen T, Skrede S. Improvement of physical capacity after long-term training in patients with chronic active hepatitis. Scand J Gastroenterol. 1983;18:1083–1087.PubMedCrossRef
26.
go back to reference Campillo B, Fouet P, Bonnet JC, Atlan G. Submaximal oxygen consumption in liver cirrhosis. Evidence of severe functional aerobic impairment. J Hepatol. 1990;10:163–167.PubMedCrossRef Campillo B, Fouet P, Bonnet JC, Atlan G. Submaximal oxygen consumption in liver cirrhosis. Evidence of severe functional aerobic impairment. J Hepatol. 1990;10:163–167.PubMedCrossRef
27.
go back to reference Pattullo V, Duarte-Rojo A, Soliman W, et al. A 24-week dietary and physical activity lifestyle intervention reduces hepatic insulin resistance in the obese with chronic hepatitis C. Liver Int. 2013;33:410–419.PubMedCrossRef Pattullo V, Duarte-Rojo A, Soliman W, et al. A 24-week dietary and physical activity lifestyle intervention reduces hepatic insulin resistance in the obese with chronic hepatitis C. Liver Int. 2013;33:410–419.PubMedCrossRef
28.
go back to reference Konishi I, Hiasa Y, Tokumoto Y, et al. Aerobic exercise improves insulin resistance and decreases body fat and serum levels of leptin in patients with hepatitis C virus. Hepatol Res. 2011;41:928–935.PubMedCrossRef Konishi I, Hiasa Y, Tokumoto Y, et al. Aerobic exercise improves insulin resistance and decreases body fat and serum levels of leptin in patients with hepatitis C virus. Hepatol Res. 2011;41:928–935.PubMedCrossRef
29.
go back to reference Kawaguchi T, Izumi N, Charlton MR, Sata M. Branched-chain amino acids as pharmacological nutrients in chronic liver disease. Hepatology. 2011;54:1063–1070.PubMedCrossRef Kawaguchi T, Izumi N, Charlton MR, Sata M. Branched-chain amino acids as pharmacological nutrients in chronic liver disease. Hepatology. 2011;54:1063–1070.PubMedCrossRef
30.
go back to reference Les I, Doval E, García-Martínez R, et al. Effects of branched chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy. Am J Gastroenterol. 2011;106:1081–1088.PubMedCrossRef Les I, Doval E, García-Martínez R, et al. Effects of branched chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy. Am J Gastroenterol. 2011;106:1081–1088.PubMedCrossRef
31.
go back to reference Walker DK, Dickinson JM, Timmerman KL, et al. Exercise, amino acids and aging in the control of human muscle protein synthesis. Med Sci Sports Exerc. 2011;43:2249–2258.PubMedCentralPubMedCrossRef Walker DK, Dickinson JM, Timmerman KL, et al. Exercise, amino acids and aging in the control of human muscle protein synthesis. Med Sci Sports Exerc. 2011;43:2249–2258.PubMedCentralPubMedCrossRef
32.
go back to reference ATS Committee on Proficiency Standards for Clinical Pulmonary. Function laboratories. ATS statement: guideline for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–117. ATS Committee on Proficiency Standards for Clinical Pulmonary. Function laboratories. ATS statement: guideline for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–117.
33.
go back to reference Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001;34:768–773.PubMedCrossRef Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001;34:768–773.PubMedCrossRef
34.
go back to reference Romero-Gómez M, Córdoba J, Jover R, et al. Red Nacional de Investigación de Encefalopatía Hepática. Normality tables in the Spanish population for psychometric tests used in the diagnosis of minimal hepatic encephalopathy. Med Clin (Barc). 2006;127:246–249.CrossRef Romero-Gómez M, Córdoba J, Jover R, et al. Red Nacional de Investigación de Encefalopatía Hepática. Normality tables in the Spanish population for psychometric tests used in the diagnosis of minimal hepatic encephalopathy. Med Clin (Barc). 2006;127:246–249.CrossRef
35.
go back to reference Kircheis G, Wettstein M, Timmermann L, Schnitzler A, Häussinger D. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology. 2002;35:357–366.PubMedCrossRef Kircheis G, Wettstein M, Timmermann L, Schnitzler A, Häussinger D. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology. 2002;35:357–366.PubMedCrossRef
36.
go back to reference Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384–1387.PubMedCrossRef Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384–1387.PubMedCrossRef
37.
38.
go back to reference Lukaski H. Sarcopenia: assessment of muscle mass. J Nutr. 1997;127:994S–997S.PubMed Lukaski H. Sarcopenia: assessment of muscle mass. J Nutr. 1997;127:994S–997S.PubMed
39.
go back to reference Wang J, Thornton JC, Kolesnik S, Pierson RN Jr. Anthropometry in body composition. An overview. Ann NY Acad Sci. 2000;904:317–326.PubMedCrossRef Wang J, Thornton JC, Kolesnik S, Pierson RN Jr. Anthropometry in body composition. An overview. Ann NY Acad Sci. 2000;904:317–326.PubMedCrossRef
40.
go back to reference Alonso J, Prieto L, Antó JM. The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clin (Barc). 1995;104:771–776. Alonso J, Prieto L, Antó JM. The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clin (Barc). 1995;104:771–776.
41.
go back to reference Pina IL, Apstein CS, Balady GJ, et al. Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation. 2003;107:1210–1225.PubMedCrossRef Pina IL, Apstein CS, Balady GJ, et al. Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation. 2003;107:1210–1225.PubMedCrossRef
42.
go back to reference Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–1413.PubMedCrossRef Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–1413.PubMedCrossRef
44.
go back to reference Beyer N, Aadahl M, Strange B, et al. Improved physical performance after orthotopic liver transplantation. Liver Transpl Surg. 1999;5:301–309.PubMedCrossRef Beyer N, Aadahl M, Strange B, et al. Improved physical performance after orthotopic liver transplantation. Liver Transpl Surg. 1999;5:301–309.PubMedCrossRef
45.
go back to reference Hughes VA, Roubenoff R, Wood M, Frontera WR, Evans WJ, Fiatarone Singh MA. Anthropometric assessment of 10-y changes in body composition in the elderly. Am J Clin Nutr. 2004;80:475–482.PubMed Hughes VA, Roubenoff R, Wood M, Frontera WR, Evans WJ, Fiatarone Singh MA. Anthropometric assessment of 10-y changes in body composition in the elderly. Am J Clin Nutr. 2004;80:475–482.PubMed
46.
go back to reference Kotoh K, Nakamuta M, Fukushima M, et al. High relative fat-free mass is important for maintaining serum albumin levels in patients with compensated liver cirrhosis. World J Gastroenterol. 2005;11:1356–1360.PubMed Kotoh K, Nakamuta M, Fukushima M, et al. High relative fat-free mass is important for maintaining serum albumin levels in patients with compensated liver cirrhosis. World J Gastroenterol. 2005;11:1356–1360.PubMed
47.
go back to reference Packer N, Hoffman-Goetz L, Ward G. Does physical activity affect quality of life, disease symptoms and immune measures in patients with inflammatory bowel disease? A systematic review. J Sports Med Phys Fit. 2010;50:1–44. Packer N, Hoffman-Goetz L, Ward G. Does physical activity affect quality of life, disease symptoms and immune measures in patients with inflammatory bowel disease? A systematic review. J Sports Med Phys Fit. 2010;50:1–44.
48.
go back to reference Stroth S, Hille K, Spitzer M, Reinhardt R. Aerobic endurance exercise benefits memory and affect in young adults. Neuropsychol Rehabil. 2009;19:223–243.PubMedCrossRef Stroth S, Hille K, Spitzer M, Reinhardt R. Aerobic endurance exercise benefits memory and affect in young adults. Neuropsychol Rehabil. 2009;19:223–243.PubMedCrossRef
49.
go back to reference Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc. 2011;86:876–884.PubMedCentralPubMedCrossRef Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc. 2011;86:876–884.PubMedCentralPubMedCrossRef
50.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
51.
go back to reference Wilkinson DJ, Hossain T, Hill DS, et al. Effects of leucine and its metabolite β-hydroxy-β-methylbutyrate on human skeletal muscle protein metabolism. J Physiol. 2013;591:2911–2923.PubMedCentralPubMed Wilkinson DJ, Hossain T, Hill DS, et al. Effects of leucine and its metabolite β-hydroxy-β-methylbutyrate on human skeletal muscle protein metabolism. J Physiol. 2013;591:2911–2923.PubMedCentralPubMed
52.
go back to reference Salerno F, Borroni G, Moser P, et al. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol. 1993;88:514–519.PubMed Salerno F, Borroni G, Moser P, et al. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol. 1993;88:514–519.PubMed
53.
go back to reference Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;10:CD005305.PubMed Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;10:CD005305.PubMed
54.
go back to reference Heran BS, Chen JM, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;7:CD001800.PubMed Heran BS, Chen JM, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;7:CD001800.PubMed
55.
go back to reference Román E, Córdoba J, Torrens M, et al. Minimal hepatic encephalopathy is associated with falls. Am J Gastroenterol. 2011;106:476–482.PubMedCrossRef Román E, Córdoba J, Torrens M, et al. Minimal hepatic encephalopathy is associated with falls. Am J Gastroenterol. 2011;106:476–482.PubMedCrossRef
56.
go back to reference Soriano G, Román E, Córdoba J, et al. Cognitive dysfunction is associated with falls. A prospective study. Hepatology. 2012;55:1922–1930.PubMedCrossRef Soriano G, Román E, Córdoba J, et al. Cognitive dysfunction is associated with falls. A prospective study. Hepatology. 2012;55:1922–1930.PubMedCrossRef
57.
go back to reference Michael YL, Whitlock EP, Lin JS, et al. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153:815–825.PubMedCrossRef Michael YL, Whitlock EP, Lin JS, et al. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153:815–825.PubMedCrossRef
58.
go back to reference Francoz C, Glotz D, Moreau R, Duran F. The evaluation of renal function and disease in patients with cirrhosis. J Hepatol. 2010;52:605–613.PubMedCrossRef Francoz C, Glotz D, Moreau R, Duran F. The evaluation of renal function and disease in patients with cirrhosis. J Hepatol. 2010;52:605–613.PubMedCrossRef
59.
go back to reference Cervoni JP, Thévenot T, Weil D, et al. C-reactive protein predicts short-term mortality in patients with cirrhosis. J Hepatol. 2012;56:1299–1304.PubMedCrossRef Cervoni JP, Thévenot T, Weil D, et al. C-reactive protein predicts short-term mortality in patients with cirrhosis. J Hepatol. 2012;56:1299–1304.PubMedCrossRef
Metadata
Title
Randomized Pilot Study: Effects of an Exercise Programme and Leucine Supplementation in Patients with Cirrhosis
Authors
Eva Román
Mª Teresa Torrades
Mª Josep Nadal
Guillem Cárdenas
Juan Camilo Nieto
Sílvia Vidal
Helena Bascuñana
Cándido Juárez
Carlos Guarner
Juan Córdoba
Germán Soriano
Publication date
01-08-2014
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 8/2014
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-014-3086-6

Other articles of this Issue 8/2014

Digestive Diseases and Sciences 8/2014 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.