Effect of the exercise therapy on patients withcirrhosis with the hepatocellular carcinoma~ Approach of the liver rehabilitation ~○ Hayato Narao1), Yuta Manako1), Hiroaki Nagamatu2)

1) Division Rehabilitation, Public Yame General Hospital2) Division of Gastroenterology, Juntendo University Clinic

ＪＤＤＷ ＣＯＩ Disclosure
All Presenters： Hayato Narao 1) , Yuta Manako 1) , Hiroaki Nagamatu 2)
Affiliated Organizations：1) Division Rehabilitation,PublicYameGeneralHospital2) Division of Gastroenterology, Juntendo University Clinic

There are no COI with regard to this presentation.

【Background】＊１

Ｎｏ Ｓａｒｃｏｐｅｎｉａ

Ｓａｒｃｏｐｅｎｉａ＊２- There is a correlation between
muscle mass and life prognosis.
- Treatment of HCC for about
2 weeks decreases the muscle
mass of the lower limbs andtrunk.
- Intervention of exercise therapy
for patients with liver disease
is expected.
- There are few reports about
the effects of exercise therapy
and load setting for patientswith liver disease, and there isan urgent need to accumulate
evidence.

＊１： Montano-Loza AJ,et at:Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol 10:166-173,2012＊２：Muto, Kawaguchi et al. kurumeikaisi, 2011;74:115-121

【Aim】
To investigate the effects of exercise therapy on
liver function, muscle mass, and motor function
in patients with cirrhosis hospitalized for HCCtreatment.

【Subjects】
19 patients with HCC who were hospitalized from January 2017
to September 2017 for TACE/Solafenib.

Age (years):77.2±6.2
 Sex (male/female):13/6
 Hospitalization (days):10.8±5.7
 The exercise therapy enforcement days (days) :5.8±2.4
 HBV/HCV/NonBC:3/15/1
 TNM stage (Ⅰ/Ⅱ/Ⅲ/Ⅳ):1/16/1/1
 Child-Pugh class (A/B/C):15/3/1
 Treatment (TACE/Sorafenib):17/2
 AFP (ng/mL):133.7±309.3
 PIVKA-II (mAU/mL):175.9±187.7
mean±SD【Methods①】●Statistical analysis- We compared liver function, muscle mass, the motor
function before and after the exercise therapy.

- The test method was Wilcoxon rank sum test,with a significance level of 5%.

●Liver function evaluation- Biochemical tests(AST, ALT, LDH, ALP, γ‐GTP, Albumin, Total bililrubin, PT％, Platelet count )- Child-Pugh score（PMI：psoas muscle index）●Muscle mass evaluation- Computed tomography （CT）
Measuring method：
Measure muscle area by CT (Use ImageJ)
Measuring muscle:
Trunk muscle, Iliopsoas muscle,
Abdominal muscle group, Back group
Measurement position： L3 region（SMI：skeletal muscle mass index）

【Methods②】●Motor function evaluation『Muscle strength』- Quadriceps maximum muscle strength- Grip strength『Activities of daily living (ADL)
ability』- Functional Independence Measure (FIM)- 30-seconds chair stand test （CS-30）

【Methods③】●Exercise therapy
Type of the exercise

Exercise therapy

Exercise intensity

frequency

・Combit CB-１
（Quadriceps exercise）

60%MVC

2,3days/week

・Standing stepping
exercise

Body weight

5days/week

・Calf raise

Body weight

5days/week

・Half squat

Body weight

5days/week

Stretching・Stretch exercise

Painless strength

3days/week

Aerobic exercise

・Walking movement（Voluntary walk）

every dayBorg scale 11～13（Fairly light～
Somewhat hard）

Resistance training＊ACSM（American College of Sports Medicine) Guidelines for Exercise Testing and Prescription Eighth Edition 2011.159-187

【Methods④】『Resistance training』

Standing stepping
exerciseCalf raise

Half squat

Combit CB-1

『Stretching』

Stretch exercise『Aerobic exercise 』

Walking movement

【Results①】Comparison of the liver function (n=19)
BeforeAfterP：40.4±17.0 ：42.2±20.9 0.888
AST (U/L)：31.2±15.5 ：42.6±26.4 0.083
ALT (U/L)：225.2±46.0 ：212.3±58.2 0.301
LDH (U/L)：416.1±179.4 ：378.1±105.1 0.154
ALP (U/L)：53.6±41.9 ：59.9±43.8 0.305＊
γ-GTP (U/L)：3.3±0.5：3.6±0.60.002
Albumin (g/dL)：0.9±0.5
0.831＊
Total bililrubin (mg/dL) ：0.9±0.6：78.7±13.3 ：73.2±10.7 0.020
PT (％)：14.4±9.20.868
Platelet count (×10４/μL) ：12.6±6.4：6.4±1.2
0.112
Child-Pugh score (point) ：5.9±1.8
Wilcoxon, mean±SD, ＊：p＜0.05

【Results②】Comparison of the muscle mass (n=19)
BeforeAfterP：99.3±19.0 ：98.3±22.1 0.314
Trunk muscle area (cm2)
Iliopsoas muscle area (cm2) ：12.0±2.8 ：13.2±4.8 0.133
Abdominal muscle area (cm2) ：46.8±9.6 ：46.1±9.6 0.572：38.9±11.8 ：38.3±11.4 0.287
Back area (cm2)：39.8±6.3 ：39.4±7.4 0.473
CT area SMI (cm2/m2)：4.8±0.9
CT area PMI (cm2/m2)：5.2±1.6
0.199

Wilcoxon, mean±SD, ＊：p＜0.05

【Results③】Comparison of the motor function (n=19)(kgf)

P=0.001＊(kgf)

5050

40

40

P=0.001

＊

N.S.

(kg)
40
35

33.1

30

3030

31.6

20

27.6

2725

2020

15

10101025

25.6

5000Right Quadriceps MVC(times/30s)

P=0.008

Left Quadriceps MVC＊20(point)132

P=0.017Grip strength

＊130
15128
13.2

1011.3

126
124
122

5123.9122.91201180CS30

FIMWilcoxon, mean±SD, ＊：p＜0.05

【Conclusions】
・Effect of the exercise therapy① Muscle mass

Maintained② Motor function

Improved(Muscle strength・ADL)③ Liver function

No change in Child-Pugh score

・Load setting (Resistance training)→ It became clear that there was no deteriorationof liver function when the exercise load was up to60% of the maximum muscle strength.