1 Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
2 Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada.
3 Département de nutrition, Faculté de médecine, Université de Montréal, Montreal, Canada.
4 Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.
Sarcopenia and malnutrition are common features in patients with hepatic encephalopathy. Ammonia, a factor implicated in the pathophysiology of hepatic encephalopathy, may be cleared by the muscle via the enzyme glutamine synthetase when the liver function is impaired. Hence, optimizing muscle mass in patients suffering from hepatic encephalopathy is a potential strategy to decrease ammonia levels. Exercise could be an efficient therapeutic approach to optimize muscle mass and therefore potentially reduce the risk of hepatic encephalopathyin patients with chronic liver disease. This review reports the current evidence regarding exercise and hepatic encephalopathy from animal and human studies. After defining concepts such as frailty, sarcopenia, and malnutrition, the present knowledge regarding exercise as potential therapy in cirrhotic patients with or without hepatic encephalopathy is discussed. Recommendations and future aspects are also considered.