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June 27, 2026Cureus0 citationsOpen Access

Impact of Integrated Exercise Interventions on Muscle Mass and Functional Outcomes in Patients With Decompensated Liver Cirrhosis and Sarcopenia: A Systematic Review

RPRushikesh S Patil PDPoovishnu T Devi JBJanhavee S Brahmadande

Key Points

This review aims to evaluate the effects of integrated exercise interventions on muscle mass and functional outcomes in patients with decompensated liver cirrhosis and sarcopenia.
Comprehensive literature search from 2012 to 2026 using various databases.
Included randomized controlled trials, observational studies, and meta-analyses focusing on exercise and nutritional interventions.
Risk of bias assessed using RoB 2 tool and AXIS for study design.
Integrated exercise interventions significantly improved muscle strength and functional performance.
Nutritional interventions, including branched-chain amino acid supplementation, positively impacted muscle mass.
Most included studies had moderate to high quality with minimal bias.

Abstract

Sarcopenia is a common and serious complication in patients with decompensated liver cirrhosis and is linked with reduced muscle mass, impaired functional capacity, poor physical performance, and decreased quality of life. Exercise-based rehabilitation and nutritional interventions have emerged as important non-pharmacological approaches for improving clinical and functional outcomes in this population. This comprehensive analysis sought to appraise the outcome of integrated exercise training programs on muscle mass, functional capacity, and quality of life in sarcopenic individuals with decompensated liver cirrhosis. There was an extensive search of the literature using PubMed, Google Scholar, Scopus, ScienceDirect, and Web of Science, published between 2012 and 2026. Randomized controlled trials (RCTs), clinical trials, observational studies, cross-sectional studies, and meta-analyses focusing on exercise, rehabilitation, and nutritional interventions were included. Risk of bias was checked using the Risk of Bias 2 (RoB 2) tool and the Appraisal Tool for Cross-Sectional Studies (AXIS) according to the study design. A total of 10 studies were found. Findings demonstrated that integrated exercise interventions, in addition to aerobic workouts, resistance training, balance training, and home-based rehabilitation programs, significantly enhance muscle strength, functional performance, aerobic capacity, body composition, and health-related quality of life. Nutritional interventions, such as branched-chain amino acid supplementation, also showed positive effects on muscle mass and maintenance of liver function. Most of the studies demonstrated moderate to high caliber with minimal potential for bias. The review concludes that integrated exercise training programs are safe and effective for increasing muscle mass, functional capacity, and quality of life for sarcopenic individuals with decompensated liver cirrhosis. Combined rehabilitation and nutritional strategies may play a vital part in the multidisciplinary management of cirrhosis-associated sarcopenia.

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