Effects of early strength training program on functional level in liver transplant cases

This study was conducted to investigate the effects of early strength training on exercise capacity, physical performance, fatigue, quality of life, peripheral and respiratory muscle strength in adult liver recipients. The study included 30 subjects randomly assigned to a training group (TG, n=15) or control group (CG, n=15), who underwent liver transplantation by the Organ Transplantation Committee in Memorial Ataşehir Hospital. The CG received pulmonary physiotherapy consisting of preoperative patient education, breathing exercises, airway clearance techniques, active/active assisted exercises and early mobilization; while the TG received a progressive resistive strength training for the major muscles (deltoid/quadriceps) using theraband, along with pulmonary physiotherapy. The training program was applied for 8 weeks (2 sessions/day, 5 days/week). Exercise capacity, physical performance, fatigue perception, quality of life, peripheral and respiratory muscle strength were evaluated preoperatively and 2, 4 and 8 weeks post-surgery. Baseline data showed a homogeneous distribution in the between-group comparisons. Among these following parameters which improved in both groups in the within-group analysis; EG showed higher improvements in physical performance and fatigue perception, and CG in disease-specific quality of life (p<0.05). The TG showed eight-week improvements in exercise capacity, peripheral muscle strength and maximal inspiratory and expiratory pressures (p<0.05), while CG remained unchanged (p>0.05). In the between-group analysis; the improvements indicated significant differences in deltoid strength and fatigue perception, in favor of the TG (p<0.05). There was no statistically significant difference in health-related quality of life (p>0.05). A change of 0.9 kg in peripheral muscle strength and >37.8 m in 6MWD was determined, representing clinically significant improvement in liver recipients. Early strength training along with pulmonary physiotherapy program may improve muscle strength, exercise capacity, physical performance, and fatigue perception in liver recipients. The estimated minimal clinically important differences are meaningful to clinicians in setting liver transplanted patient-specific goals.