Walking exercise through smartphone application plus branched-chain amino acid supplementation benefits skeletal muscle mass and strength in liver cirrhosis: A prospective control trial

Introduction and objectives Whether a combination of exercise and branched-chain amino acid (BCAA) supplementation was more beneficial than those given alone in sarcopenia related to liver cirrhosis (LC) is unknown. Widely used smartphone applications provide continuous and easily expandable management of chronic liver disease (CLD). This study is to investigate the effects of unsupervised walking exercise using WeChat combined with BCAA supplementation on skeletal muscle mass and strength in LC.Materials and Methods The 127 LC patients of Child-Pugh A/B were assigned to group A (BCAA supplements, n=42), group B (walking exercise, n=43) and group C (walking exercise plus BCAA supplements, n=42). Laboratory data, average daily steps, serum BCAA, skeletal muscle mass index (SMI) and grip strength were analyzed pre- and 3 months after interventions.Results Of the 124 patients who completed interventions, albumin and daily steps were significantly increased in all groups ( p =0.0001). Post-intervention BCAA were significantly elevated in group A (A vs B, p =0.001) and C (C vs B, p =0.012;). While post-intervention daily steps in group B (B vs A, p =0.0001) and C (C vs A, p =0.0001) were higher. Grip strength (C vs A, p =0.020; C vs B, p =0.036) and SMI (C vs A, p =0.035; C vs B, p =0.012) were increased in group C. Prevalence of sarcopenia was significantly decreased in group C ( p =0.015).Conclusions A combination of unsupervised walking exercise using smartphone applications and BCAA supplementation might be an effective and safe treatment for cirrhosis patients with Child-Pugh A/B to improve skeletal muscle mass and strength or to prevent progress of sarcopenia.