1 Internal Medicine Residency Program, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA.
2 Donald W. Reynolds Institute on Aging, Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
3 Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR.
4 Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, UPMC, Pittsburgh, PA.
5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Stanford University Medical Center, Palo Alto, CA.
Moderate-to-vigorous exercise increases blood ammonia concentrations, potentially contributing to the development of hepatic encephalopathy (HE). Patients with end-stage liver disease (ESLD) often suffer from frailty or physical deconditioning as a result of sarcopenia, fluid overload/ascites, obesity and concomitant diseases. Exercise is therefore recommended for ESLD patients to reverse or halt progression of frailty/sarcopenia, as these conditions contribute to increased mortality.