| Objectives1.To investigate the prevalence of sarcopenia in patients with liver cirrhosis and analyze the relevant influencing factors.2.To develop an advanced exercise program tailored for patients with liver cirrhosis and sarcopenia based on the findings from the investigation.3.To conduct a preliminary evaluation of the effectiveness of the advanced exercise program in patients with liver cirrhosis and sarcopenia.MethodsThis study is divided into three parts.Part Ⅰ:Analysis of the prevalence and influencing factors of sarcopenia in patients with liver cirrhosisUsing a convenience sampling method,patients with liver cirrhosis who visited the First Affiliated Hospital of Soochow University between September 2021 and June 2022 were selected as study participants.Sarcopenia diagnostic criteria were used to determine the presence of sarcopenia.Concurrently,a researcher-designed general information questionnaire(including demographic data,disease-related data,anthropometric measurements,blood ammonia levels,systemic immune inflammation index,etc.),Subjective Global Assessment(SGA),and International Physical Activity Questionnaire Short Form(IPAQ-SF)were used for data collection.IBM SPSS Statistics 26.0 software was used for data analysis to investigate the prevalence of sarcopenia in patients with liver cirrhosis and identify the relevant influencing factors.Part Ⅱ:Development of an advanced exercise program for patients with liver cirrhosis and sarcopeniaBased on the initial survey findings,a systematic database search was conducted to screen and assess the quality of relevant literature.Intervention measures with potential guidance for exercise programs were extracted,and a preliminary draft of an advanced exercise program for patients with liver cirrhosis and sarcopenia was developed.The draft of the exercise program was refined and enhanced through Delphi expert consultations.Part Ⅲ:Preliminary application of the advanced exercise regimen in patients with liver cirrhosis and sarcopeniaUsing a quasi-experimental study design,32 patients with liver cirrhosis and sarcopenia who were treated at the First Affiliated Hospital of Suzhou University from September to December 2022 were selected as study participants through a convenience sampling method.They were divided into a control group(16 cases)and an intervention group(16 cases).The control group received routine care during hospitalization and maintained their original lifestyle unchanged after discharge,while the intervention group adopted the advanced exercise program developed in the second part of the study.Prior to the intervention,general data(demographic data,disease-related data)for both groups were collected.The following indicators were measured before and after the intervention:(1)muscle mass:L3 Skeletal Muscle Index(L3-SMI),(2)muscle strength:grip strength,(3)physical function:6-meter walking speed,(4)quality of life:Chronic Liver Disease Questionnaire(CLDQ).These measurements aimed to verify the program’s effectiveness in improving muscle mass,muscle strength,physical function,and quality of life in patients with liver cirrhosis and sarcopenia.Concurrently,exercise record diaries were collected from the intervention group to evaluate participants’ engagement and adherence to the program.ResultsPart Ⅰ:(1)A total of 205 questionnaires were distributed in this survey,with 202 valid questionnaires and a valid response rate of 98.53%.(2)Finally,202 study participants were included,comprising 117 male patients and 85 female patients,with 85 patients diagnosed with sarcopenia,resulting in a prevalence of 42.08%.(3)Logistic regression analysis revealed that older age,diabetes,hyperammonemia,and malnutrition were risk factors for myopenia in patients with cirrhosis,while physical activity served as a protective factor against the development of sarcopenia in patients with liver cirrhosis.Part Ⅱ:(1)Based on the synthesis of the initial survey results,literature screening,and literature quality assessment were conducted,ultimately including 1 expert consensus,11 randomized controlled trials,and 2 experimental studies for extracting a preliminary draft of the exercise intervention plan for this study.(2)The initial draft was revised through two rounds of Delphi expert consultation,involving a total of 10 experts.The effective response rate for both rounds of expert consultation questionnaires was 100%,and the expert authority coefficient was 0.895.The first round of expert consultation had a coefficient of variation range of 0.10-0.27,while the second round of expert consultation had a coefficient of variation range of 0.06-0.16.Following two rounds of expert consultation,the final draft of the advanced exercise program for patients with liver cirrhosis and sarcopenia was established,consisting of 5 primary items,16 secondary items,and 35 tertiary items.Part Ⅲ:(1)General information:A total of 32 patients with liver cirrhosis and sarcopenia were included in this study.The intervention group consisted of 16 individuals,with an average age of(42.56±9.95)years old.Among them,there were 9 male patients(56.25%)and 7 female patients(43.75%).The control group consisted of 16 individuals,with an average age of(53.75±10.66)years old.Among them,there were 11 male patients(68.75%)and 5 female patients(31.25%).There were no significant statistical differences(P>0.05)between the two groups regarding gender,age,etiology,course of liver cirrhosis,and Child-Pugh grading,indicating comparability.(2)Muscle mass:Before the intervention,the L3-SMI of the intervention group and the control group were(33.36±6.96)cm2/m2 and(34.63±6.61)cm2/m2,respectively,with no statistically significant difference between the two groups(P>0.05).After the intervention,the L3-SMI(39.08±6.79)cm2/m2 in the intervention group was significantly higher than that in the control group(33.81 ±5.52)cm2/m2.Intragroup comparison showed a significant increase in L3-SMI in the intervention group after the intervention(P<0.05),and there was no significant difference in the control group.(3)Muscle strength:Before the intervention,the grip strength of the intervention group and the control group were(22.52±3.30)kg and(21.37±3.78)kg,respectively,with no statistically significant difference between the two groups(P>0.05).After the intervention,the grip strength of the intervention group(24.16±2.92)kg was significantly higher than that of the control group(20.80±3.16)kg.Intragroup comparison showed a significant increase in grip strength in the intervention group after the intervention(P<0.05),while there was no significant difference in the control group.(4)Physical function:Before the intervention,the pace of the intervention group and the control group were(1.05±0.21)m/s and(1.13±0.07)m/s,respectively,with no statistically significant difference between the two groups(P>0.05).After the intervention,the pace of the intervention group(0.94±0.10)m/s was significantly faster than that of the control group(1.10±0.11)m/s.Intragroup comparison showed that the pace of the intervention group significantly accelerated after the intervention(P<0.05),and there was no significant difference in the control group.(5)Quality of life:Before the intervention,the total CLDQ scores of the intervention group and the control group were(5.42±0.17)and(5.46±0.08),respectively,with no statistically significant difference between the two groups(P>0.05).After the intervention,the total CLDQ score(5.93±0.10)of the intervention group was significantly higher than that of the control group(5.46±0.10).Intragroup comparison showed that the total CLDQ score of the intervention group increased significantly after the intervention(P<0.05),and there was no significant difference in the control group.(6)Exercise compliance in the intervention group:16 participants were enrolled,and ultimately,all 16 participants completed the entire exercise program,resulting in a participation rate of 100%.ConclusionThe prevalence of sarcopenia in patients with liver cirrhosis is high.Influenced by factors such as age,diabetes,blood ammonia levels,nutrition,and physical activity,clinical medical staff should pay greater attention to liver cirrhosis patients with sarcopenia.The advanced exercise program for patients with liver cirrhosis and sarcopenia,developed based on a literature review and the Delphi expert consultation method,is scientifically sound,safe,simple,and feasible.The advanced exercise program is easily accepted by patients and can effectively improve muscle mass,muscle strength,physical function,and quality of life in patients with liver cirrhosis and sarcopenia.The training intensity is appropriate,and the program demonstrates good safety,compliance,and feasibility.Therefore,this exercise regimen is suitable for promotion and implementation among patients with liver cirrhosis and sarcopenia. |
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