Liver cirrhosis: Repercussions of sarcopenia and reduced physical capacity on functionality

Abstract

Introduction: Liver cirrhosis is a chronic condition associated with systemic changes that can compromise nutritional status, body composition, and functionality. Key among these changes are sarcopenia and reduced physical capacity, which may involve a decline in muscle mass and strength, poorer physical performance, and functional limitations, potentially impacting patients' quality of life and clinical outcomes. Objective: To analyze available evidence regarding the impact of sarcopenia and reduced physical capacity on the functionality of individuals with liver cirrhosis—considering their relationships with muscle mass and strength, physical performance, functional capacity, and quality of life—and to synthesize evidence concerning intervention strategies aimed at improving or preserving muscle mass, strength, physical performance, and functional capacity in this population. Methods: This is an integrative literature review of a qualitative and descriptive nature. The search was conducted on September 30, 2026, in the PubMed/MEDLINE, SciELO, and Virtual Health Library (VHL) databases, using controlled descriptors and free-text terms related to liver cirrhosis, sarcopenia, muscle mass and strength, functional capacity, physical performance, and exercise. Studies published in Portuguese or English were considered—with no restrictions on publication date—provided the full text was accessible for free or via institutional access. Various study designs were included, ranging from observational studies and clinical trials to systematic reviews. Selection was performed by two independent reviewers, and data extraction was carried out by one reviewer and verified by a second. Findings were analyzed descriptively, comparatively, and qualitatively, focusing on themes related to muscle alterations, physical capacity and performance, clinical and prognostic manifestations, and the effects of interventions. No formal assessment of methodological quality or risk of bias was performed. Results: A total of 70 records were identified, 20 of which were duplicates. After screening 50 records, 30 full-text articles were evaluated, and 11 studies comprised the final sample. Findings indicated that sarcopenia in cirrhosis is associated with impairments in muscle mass and strength, physical performance, exercise tolerance, and functional capacity, as well as links to clinical and prognostic outcomes, although these associations were not uniform across all evaluated indicators. Physical exercise yielded predominantly favorable results regarding components of physical and functional capacity, whereas nutritional interventions showed more variable responses. Heterogeneity in study designs, populations, sarcopenia definitions, assessment methods, and intervention protocols—along with potential overlap between primary studies included in secondary reviews—limited the direct comparability of results. Conclusion: Sarcopenia and reduced physical capacity have significant repercussions on the functionality of individuals with liver cirrhosis. The findings underscore the importance of considering muscle mass, strength, physical performance, and functional capacity in an integrated manner, without assuming equivalence among these components. Physical exercise offers potential benefits for various functional outcomes, whereas evidence regarding nutritional interventions remains less consistent. Methodological limitations of the review and the heterogeneity of the evidence call for caution when interpreting results and highlight the need for more standardized and methodologically robust studies.