Impact of physical activity on clinical outcomes in patients with liver cirrhosis: a prospective observational cohort study

Physical activity (PA) is a recognized determinant of outcomes in chronic diseases, yet its prognostic role in cirrhosis remains incompletely understood. To evaluate the relationship between habitual PA and liver disease severity, sarcopenia, and mortality in cirrhosis, and to develop a clinically applicable risk stratification model. In this prospective cohort study, 116 patients with cirrhosis were assessed for PA using the International PA Questionnaire–Short Form (IPAQ-SF), from which a PA Index (PAI; 0–7 scale) was derived. Clinical, laboratory, nutritional, imaging, and outcome data were obtained from routinely collected hospital electronic medical records and prospectively verified during scheduled follow-up visits. Predictors of 12-month mortality were identified using Cox proportional hazards models, and a risk-tiered classification system incorporating PAI was generated. Lower PAI was significantly associated with higher Child–Pugh scores (ρ = −0.28, p = 0.002), higher INR (p = 0.005), and lower albumin (p = 0.018). Sarcopenia was most prevalent among patients with low PAI (p < 0.001). Independent predictors of mortality included low PAI (HR = 2.12, 95% CI 1.22–3.68, p = 0.008), Child–Pugh class C, older age, hypoalbuminemia, sarcopenia, and sarcopenic obesity. The proposed risk-tiered model effectively discriminated against 1-year survival (low risk: 89.2%; moderate risk: 64.7%; high risk: 42.5%; very high risk: 18.2%; p < 0.001). The IPAQ-SF–derived PAI independently predicts mortality in cirrhosis and, when integrated with established prognostic factors, enhances risk stratification. Incorporating routine PA assessment into cirrhosis management may refine surveillance intensity, optimize transplant prioritization, and guide individualized prehabilitation strategies.