Fatores associados à percepção dos benefícios e barreiras para atividade física em pacientes com cirrose hepática

Abstract

Cirrhosis is the end stage of several chronic liver diseases, bringing consequences to the musculoskeletal system. Although there is evidence of muscle improvement from an exercise program, adherence to physical activity practice by these individuals is still low. The purpose of this study was to analyze the factors associated with perceived benefits and barriers to physical activity in patients with liver cirrhosis. A cross-sectional study was carried out between January and July 2018 at the Hepatology outpatient clinic of the University Hospital of the University of Juiz de Fora. Participants who met criteria for inclusion, diagnosis of cirrhosis and age between 18 and 80 years, of both sexes, were selected from the attendance agenda and invited, in person, to participate in the research. The patients answered sociodemographic and clinical questionnaires, Exercise Benefits and Barriers Scale and had their manual grip strength measured by the Jamar® dynamometer. In order to test the possible associations between the subcategories of EBBS, Benefits and Barriers, and the independent variables was used generalized linear regression analysis using gamma distribution and logarithmic link function. Of the 102 patients, 62 were men (60,8%), the mean age was 59 (± 10,58), patients with Child A were 59 (57,8%) and 43 (42,2%) Child B / C. Of those, 48% had esophageal varices and 29,4% had ascites decompensation. Diabetes and systemic arterial hypertension was present in 43,1% and 57,8%, respectively. The handgrip strength was 30,16 (± 10,41) Child A and 25,54 (± 9,16) Child B/C. The univariate generalized linear analysis identified association between ascites and EBBS Benefits (95% CI [-0,079; 0,03], β=-0,038, P =0,066) and Barriers (95% CI [0,003; 0,217], β=0,110, P=0,045). In the group that presented decompensation in ascites, the manual grip strength was associated with both EBBS Benefits (95% CI [0,001; 0,009], β=0,005, P=0,019) and Barriers (95% CI [-0,027; -0,003], β=0,109, P=0,016). In the group without, total bilirubin values were associated with EBBS Barriers (95% CI [-0,098; -0,007], β=-0,053, P=0,023) and cardiovascular risk factors for EBBS (95% CI [0,005; 0,096], β=0,05, P=0,03). Patients with ascitic decompensation, manual grip strength was associated with both barriers and perceived benefits for physical activity. While in the non-decompensated group, total bilirubin values were associated with barriers, and cardiovascular risks (diabetes and / or arterial hypertension) to perceived benefits for physical activity. Patients with liver cirrhosis should be followed up with strengthmeasures and guidelines on the practice of physical activity should be established.