Impact of Home-Based Aerobic and Resistance Training in Chronic Liver Disease: a Randomized Control Trial

The goal of this clinical trial is to evaluate whether home-based exercise interventions, including aerobic exercise (AE) and a combination of aerobic and resistance exercise (ARE), can improve physical and health-related outcomes in patients with chronic liver disease (CLD). The primary population includes adult patients with CLD experiencing complications such as sarcopenia, malnutrition, and fatigue. The main questions it aims to answer are: Does home-based ARE improve oxygen consumption, muscle strength, and physical frailty more effectively than AE or no exercise? Can home-based exercise reduce fatigue and improve quality of life and health-related behaviors? Researchers will compare the outcomes of three groups: Home-based AE group Home-based ARE group Control group (physical activity counselling) Participants will: Perform an 8-week home-based exercise program based on their group allocation (either AE or ARE). Undergo evaluations before and after the intervention, including: Oxygen consumption (via cardiopulmonary exercise testing) Muscle strength (using a hand dynamometer and respiratory muscle strength tests) Body composition (via bioelectrical impedance analysis and skinfold thickness measurements) Quadriceps muscle thickness and cross-sectional area (using muscle ultrasound) Muscle oxygenation Fatigue levels (using the Fatigue Severity Scale) Physical frailty (using the Liver Frailty Index) Quality of life (using the Chronic Liver Disease Questionnaire) Health-related lifestyle behaviors (using the Health-Promoting Lifestyle Profile II)

Inclusion Criteria: * Being followed up for chronic liver disease or listed on the liver transplant waiting list at the Hacettepe University Department of Internal Medicine, Division of Gastroenterology. * Owning and being able to use a smartphone. * Aged between 18 and 70 years. * Receiving primary prophylactic treatment for gastroesophageal varices. * Willingness to participate in the study. Exclusion Criteria: * Inability to own or use a smartphone. * Participation in an exercise training program within the last year. * Previous liver transplantation. * High-risk varices without beta-blocker treatment. * Presence of persistent hepatic encephalopathy. * Hepatic hydrothorax. * Pulmonary vascular complications of portal hypertension. * Chronic renal failure requiring dialysis. * Hemoglobin level below 10 g/dL. * Creatinine level above 2 mg/dL. * Human Immunodeficiency Virus (HIV) infection. * Presence of hepatocellular carcinoma (HCC). * Recent acute myocardial infarction. * Uncontrolled arrhythmias causing symptomatic hemodynamic instability. * Contraindications to maximal exercise testing. * Physical or orthopedic conditions preventing home-based exercise training. * Lack of willingness to participate in the study.