The influence of prehabilitation in patients with liver cirrhosis before liver transplantation: a randomized clinical trial.

BACKGROUND: The high prevalence of liver cirrhosis in Slovakia leads to a great need for transplant treatment. The outcome of liver transplantation is influenced by several factors. AIM: The main objective of this study is to test the effectiveness of prehabilitation compared to standard of care. DESIGN: Prospective, double-arm, randomized, open-registry study. SETTING: Patient in F. D. Roosevelt Teaching Hospital, Slovakia, Banská Bystrica. POPULATION: The participants consisted of patients with liver cirrhosis (55 men, 25 women). METHODS: The patients were randomized to the active prehabilitation group (N.=39) or the standard of care group (SOC) (N.=41). SOC represents the standard of care for patients prior to liver transplantation, consisting of a formal oral interview lasting 30 minutes. In addition to SOC, each patient with decompensated liver cirrhosis also underwent a prehabilitation intervention that included rehabilitation and nutrition support. Patients completed the exercises under the supervision of a physician during hospitalisation. RESULTS: After one month, the liver frailty index improved in the prehabilitation group (P=0.05). No improvement in MELD (Model of End Stage Liver Disease) was found in the group that underwent the prehabilitation program (P=0.28), and no improvement was found in the Child-Pugh score after one month (P=0.13). In the prehabilitation groups compared with the SOC group, differences were not found in the MELD score (P=0.11). Better clinical outcomes according to the Child-Pugh score was found for the prehabilitation group compared with the SOC group (P=0.02). According to LFI, there was no difference between the groups (P=0.26). Very low adherence was found after three months. Only three patients in the SOC group and six patients in the prehabilitation group came to the check-up. Due to low adherence after 3 months in patients with liver cirrhosis, it is not possible to make an adequate comparison between groups after three months. CONCLUSIONS: Despite the great effort to maintain adherence, it was not possible to draw a conclusion about the effectiveness of prehabilitation in patients before liver transplantation compared to standard of care because the main problem in Slovak patients with liver cirrhosis is low adherence. More studies are needed to identify the barriers that lead to low adherence in patients with liver cirrhosis. CLINICAL REHABILITATION IMPACT: A promising result was found due to improvement of the Liver Frailty Index and the Child-Pugh Score after one month in the prehabilitation group.

Yoga Breathing (Maheshwarananda's Modified Bhujangini Pranayama): A Randomized Study in Hypobaric Hypoxemia at 3,650 m Elevation.

Hypobaric hypoxemia represents a risk factor for body integrity and challenges its homeostasis. We examined whether practicing Maheshwarananda's modified bhujangini pranayama yoga breathing technique would influence hypobaric hypoxemia at an altitude of 3,650 m. An international randomized two-period, two-sequence crossover intervention study was conducted in September 2019 in the Himalayas. We compared 5-minute testing periods of pranayama breathing with normal resting breathing in 20 subjects divided randomly into two groups of 10 individuals; all had a daily practice of Maheshwarananda's modified bhujangini pranayama and were nonsmokers, lacto vegetarians, and alcohol abstainers. We measured the arterial saturation by pulse oximetry (SpO2; our primary outcome variable), end-tidal carbon dioxide partial pressure (EtCO2), respiratory rate, and heart rate at two altitudes: (1) 378 m (T0); and (2) 3,650 m (T1 = 2nd day, T2 = 4th day at the camp) immediately after finishing each testing period. We also monitored the presence of acute mountain sickness using the Lake Louise Scoring System. Mean SpO2 at 3,650 m increased right after the yoga breathing exercise from 88.60% to 90.35% at T1, and from 88.35% to 90.60% at T2 (T1 p = 0.007, T2 p = 0.004). No significant changes were observed in heart rate or EtCO2. The mean rate of normal control resting breathing was 13/min; the mean rate was 7/min during the yoga breathing. Right after Maheshwarananda's modified bhujangini pranayama hypobaric hypoxemia decreased as measured by SpO2, whereas EtCO2 and heart rate stayed comparable with the control resting breathing.

Yogic breathing in hypobaric environment: breathing exercising and its effect on hypobaric hypoxemia and heart rate at 3,650-m elevation.

High altitude sojourn is a risk factor for hypobaric hypoxemia and subsequent altitude sickness. The aim of this study was to analyze the effect of new type of yogic breathing-Maheshwarananda's new Modified Bhujangini Pranayama performed by active yoga practitioners-on the arterial haemoglobin saturation of oxygen (measured by the pulse oximetry - SpO2) and the heart rate compared to normal spontaneous resting breathing. A pilot prospective study was conducted in the Himalayas at an altitude of 3,650 m. We monitored SpO2 and pulse rate in 34 experienced yoga practitioners. Within the 3 measurement days at the altitude of 3,650 m, the mean value of SpO2 increased from 89.11± 4.78 to 93.26±4.44 (P<0.001) after the yogic breathing exercise. No significant changes were observed in pulse rate (P<0.230) measured before and after yogic breathing. The new Yogic breathing-Maheshwarananda's Modified Bhujangini Pranayama-is increasing the arterial haemoglobin saturation compared to normal resting spontaneous breathing. The heart rate was not affected by this type of yogic breathing.