Efeito do programa de exercícios físicos na capacidade funcional, força muscular periférica, força muscular respiratória e qualidade de vida de pacientes com diagnóstico de cirrose hepática

Abstract

The aim of this article was to investigate the effect of a physical exercise program on functional capacity, peripheral muscle strength, respiratory muscle strength, and quality of life of patients diagnosed with liver cirrhosis (HC). Physical exercise can improve quality of life, which motivated the first study, a systematic review with meta-analysis, with the aim of verifying the effect of physical exercise on the quality of life of patients with HC. This study, with 153 participants with HC, of which 83 were in the physical exercise group and 70 in the control group, showed that the experimental group that performed physical exercise significantly increased quality of life by 0.46 [0.09 to 0.84] points; P = 0.02. The level of evidence of this meta-analysis was considered high. Functional capacity was another stage studied, motivating the second study, a systematic review with meta-analysis, with the aim of verifying the effect of physical exercise on the functional capacity of patients with HC. This study, with 220 participants with CH, of which 113 were in the physical exercise group and 107 in the control group, showed that the experimental group that did physical exercise significantly increased functional capacity by 0.57 [0.01 to 1.13]; P = 0.05. The subgroup analysis due to I2 = 72% (P = 0.0003) proportion to the severity of CH as an explanation for this I2. The level of evidence of the meta-analysis was considered moderate. The two aforementioned reviews provided knowledge of the state of the art on physical exercise and CH, pointing out the severity of CH as a variable probability of confounding, the lack of reliability studies of the 6-minute walk test (6MWT) and the absence of inspiratory muscle training (IMT) in the exercise programs performed by this population. Thus, a third cross-sectional study was conducted to investigate the reliability of the 6MWT in people with CH and an RCT that controlled for CH severity, included IMT in the exercise program, and used the 6MWT to measure functional capacity. The reliability study showed that the 6MWT was a test with excellent reliability, safe, easy to administer, and inexpensive, which can be implemented in routine practice without loss of diagnostic accuracy in estimating the functional capacity of patients with CH. Finally, the RCT that aimed to evaluate the effect of a physical exercise program that includes inspiratory muscle training on functional capacity, peripheral muscle strength, respiratory muscle strength, and quality of life of patients with a diagnosis and the same severity of CH showed that 30 sessions of a physical exercise program significantly improved functional capacity from the 10th session; peripheral muscle strength of the right hand, inspiratory muscle strength, and quality of life from the 20th session. However, there was no effect of the physical exercise program on peripheral muscle strength of the left hand and expiratory muscle strength