The IPAQ-SF-derived Physical Activity Index independently predicts mortality in cirrhosis and, when integrated with established prognostic factors, enhances risk stratification.
Key Findings
Results
Lower Physical Activity Index (PAI) was significantly associated with greater liver disease severity as measured by Child-Pugh scores.
The association between PAI and Child-Pugh scores was statistically significant (ρ = -0.28, p = 0.002)
PAI was also significantly associated with higher INR (p = 0.005) and lower albumin (p = 0.018)
PA was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), from which a PAI on a 0–7 scale was derived
Study included 116 patients with cirrhosis in a prospective cohort design
Results
Sarcopenia was most prevalent among patients with low PAI.
The association between low PAI and sarcopenia prevalence was highly significant (p < 0.001)
Sarcopenia was identified as an independent predictor of 12-month mortality in Cox proportional hazards models
Sarcopenic obesity was also identified as an independent predictor of mortality
Clinical, laboratory, nutritional, imaging, and outcome data were obtained from hospital electronic medical records and prospectively verified during scheduled follow-up visits
Results
Low PAI was an independent predictor of 12-month mortality in patients with liver cirrhosis.
Low PAI was associated with a hazard ratio of 2.12 (95% CI 1.22–3.68, p = 0.008) for mortality
Other independent predictors of mortality included Child-Pugh class C, older age, hypoalbuminemia, sarcopenia, and sarcopenic obesity
Predictors were identified using Cox proportional hazards models
Follow-up period was 12 months
Results
A proposed risk-tiered classification model incorporating PAI effectively discriminated 1-year survival across four risk categories.
1-year survival rates by risk tier were: low risk 89.2%, moderate risk 64.7%, high risk 42.5%, and very high risk 18.2%
Differences across risk tiers were highly significant (p < 0.001)
The model integrated PAI with established prognostic factors including Child-Pugh class, age, albumin, and sarcopenia measures
The model was described as a 'clinically applicable risk stratification model'
Conclusions
The authors propose that routine PA assessment in cirrhosis management could refine surveillance intensity, optimize transplant prioritization, and guide individualized prehabilitation strategies.
The IPAQ-SF was used as the assessment tool, described as a practical instrument for deriving PAI in a clinical setting
The study authors note that the prognostic role of PA in cirrhosis had previously been 'incompletely understood'
Incorporating PAI into existing prognostic frameworks was suggested to enhance risk stratification beyond traditional markers alone
The study was conducted as a prospective observational cohort with 116 cirrhosis patients
What This Means
This research suggests that how physically active a person with liver cirrhosis is can meaningfully predict their risk of dying within a year. The researchers followed 116 patients with cirrhosis and measured their physical activity levels using a standardized questionnaire (the IPAQ-SF), converting the responses into a numerical Physical Activity Index (PAI). They found that patients who were less physically active tended to have more severe liver disease, worse blood clotting, lower protein levels in their blood, and a higher likelihood of having lost dangerous amounts of muscle mass (sarcopenia). Importantly, low physical activity predicted death independently of other well-known risk factors.
Using these findings, the research team developed a four-tier risk classification model that combined physical activity levels with other clinical markers. This model showed striking differences in one-year survival: patients in the lowest-risk group had an 89.2% survival rate, while those in the highest-risk group had only an 18.2% survival rate. This suggests that adding a simple physical activity questionnaire to standard clinical assessments could substantially improve doctors' ability to identify which cirrhosis patients are most at risk.
This research suggests that physical activity assessment could become a routine part of managing patients with liver cirrhosis, potentially helping clinicians decide how closely to monitor patients, when to prioritize them for liver transplantation, and how to design personalized exercise or rehabilitation programs before procedures. Because the tool used (IPAQ-SF) is brief and straightforward, it could realistically be integrated into routine clinical visits without significant burden.
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Elsabaawy M, Eissa M, Atef M, Rizk S, Awad H, Masoud B, et al.. (2026). Impact of physical activity on clinical outcomes in patients with liver cirrhosis: a prospective observational cohort study.. Scientific reports. https://doi.org/10.1038/s41598-026-55248-8