The assessment of physical frailty and physical activity in end-stage liver disease

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Williams, Felicity Rhian ORCID: https://orcid.org/0000-0001-5189-4073 (2023). The assessment of physical frailty and physical activity in end-stage liver disease. University of Birmingham. Ph.D.

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Abstract

Physical frailty in end-stage liver disease (ESLD) is prevalent across North America and has a negative impact on clinical outcomes, yet little is known about the prevalence of physical frailty in ESLD within the United Kingdom (UK). Physical activity and exercise-based interventions seem a plausible option to improve physical frailty, yet there is limited understanding of current habitual physical activity levels in ESLD. Consequently, research studies to date have based interventions around well recognised National guidelines designed for healthy individuals or those with other chronic diseases. Effectiveness of, and adherence to, these interventions have been varied, limiting the translation of research findings into clinical practice.

Through a prospective UK-based observational cohort study, I identified high prevalence (80%) of, and the clinical characteristics (i.e. age and hyponatraemia) that predict, physical frailty in ESLD. Furthermore, the quick and simple to use outcome measures, Liver Frailty Index (LFI) and Duke Activity Status Index, were validated for overall and waiting list mortality in patients assessed for liver transplantation (LT).

Understanding the volume and intensity distribution of physical activity in those with ESLD will help guide future study interventions. As part of our wider observational case-control sarcopenia study, I highlighted the negative discrepancy between volume, and distribution of activity intensity, by using remotely-monitored wrist-worn accelerometery of patients with well-characterised ESLD compared to age/sex matched healthy controls. In particular, those with ESLD did not sustain activity at a moderate intensity for longer than one minute indicating that current exercise advice for those with ESLD (5-10min bouts of moderate intensity physical activity) may be too ambitious. To enable targeted exercise therapy to those most in need, I investigated the clinical predictors of low physical activity levels. Older age and the presence of refractory ascites were independent predictors of low physical activity, with the LFI being the most robust and clinically useful physical frailty measure to predict low physical activity. Intensity, rather than volume of physical activity was associated with lower physical frailty levels indicating a message of “when you move, move with intensity” may be most beneficial to patients with ESLD. Further research studies should focus on delivering short bursts of higher intensity activity within their exercise interventions to evaluate impact of physical activity on reducing physical frailty in ESLD.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

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