Pulmonary Rehabilitation in End-Stage Liver Disease

Participants will be randomized into two groups. The Pulmonary Rehabilitation group will
undergo exercise under a supervised setting for a total duration of 12 weeks. Patients will
perform endurance (treadmill or cycle ergometer), strength (weight resistance) and
flexibility training twice a week for a period of an hour per session. Exercises will be
supervised by physiotherapists or exercise physiologists. Compliance and performance will be
monitored by the trainer. They will receive a pedometer for home use. The Home based program
group will perform REST for 10 minutes daily, increasing to 20 minutes daily, after the
second week, in their home environment. The total duration of the intervention will be 12
weeks. Patients will be provided with pedometers, REST video and binder, with instructions on
how to perform exercises, and resistance bands.

Inclusion Criteria:

- wait listed for liver transplantation with poor 6 MWT

Exclusion Criteria:

- age < 18 years

- recent hospitalization (within 14 days) due to decompensation, variceal bleeding in
the previous 1 month

- large esophageal varices without primary prophylaxis

- active excessive alcohol intake (in the previous 3 months)

- current overt uncontrolled hepatic encephalopathy

- hepatopulmonary syndrome with uncontrolled hypoxia

- portopulmonary hypertension

- inability to perform exercise

- marked symptomatic comorbidities (cardiac, pulmonary, renal).