Scientists looked at 23 studies with over 1,500 people who had liver disease and muscle loss (called sarcopenia). They found that exercise combined with protein and special amino acid supplements worked best for building muscle. Exercise alone also helped, but taking protein or amino acid supplements without exercise didn’t build muscle at all. This research shows that people with liver disease who are losing muscle need to stay active, not just take supplements, to get stronger and healthier.

The Quick Take

  • What they studied: Whether exercise, protein supplements, or special amino acids help people with liver disease build muscle and get stronger
  • Who participated: 1,525 people with liver disease (cirrhosis) who were losing muscle mass across 23 different studies
  • Key finding: Exercise combined with protein and amino acid supplements was twice as effective at building muscle compared to other treatments
  • What it means for you: If you have liver disease and muscle loss, staying active is essential - supplements alone won’t help, but exercise plus good nutrition works best

The Research Details

This was a network meta-analysis, which means researchers gathered data from 23 separate high-quality studies and combined the results to get a bigger picture. They looked at different treatments: exercise programs, protein supplements, branched-chain amino acid (BCAA) supplements, and combinations of these approaches. The studies measured three things: muscle size, muscle strength, and how well people could move around and do daily activities.

By combining multiple studies, researchers could compare treatments that were never directly tested against each other in the same study. This gives us more reliable answers about what works best because the findings come from many different groups of people rather than just one small study.

All 23 studies were randomized controlled trials, which are considered the gold standard for medical research. The large total sample size of over 1,500 people makes the results more trustworthy than smaller individual studies.

What the Results Show

The combination of exercise with both protein and amino acid supplements showed the strongest results for building muscle mass, with more than twice the effect of most other treatments. Exercise by itself also significantly increased muscle mass and improved physical performance. People who only took protein or amino acid supplements without exercising showed no meaningful muscle gains. When researchers looked at physical performance - like walking speed and ability to do daily tasks - exercise programs consistently helped people improve, while supplements alone did not.

Exercise combined with protein supplements was clearly better than protein supplements alone for improving physical performance. The research on amino acid supplements and muscle strength showed mixed results, making it unclear whether these supplements actually help people get stronger. Different types of exercise weren’t compared, so we don’t know if resistance training, walking, or other activities work better.

These findings support what nutrition scientists have known for healthy people - that exercise is essential for building muscle, and nutrition alone isn’t enough. This research extends that knowledge to people with liver disease, showing the same principles apply even when the liver isn’t working properly.

The studies used different ways to measure muscle mass and strength, which made some comparisons difficult. Most studies were relatively short-term, so we don’t know about long-term effects. The research also didn’t identify which specific types of exercise work best for people with liver disease.

The Bottom Line

If you have liver disease and muscle loss, focus on staying physically active rather than just taking supplements. Exercise appears essential for any muscle-building program. Adding protein and amino acid supplements to an exercise routine may provide extra benefits, but they won’t help without the exercise component.

People with cirrhosis or other liver diseases who are experiencing muscle loss should discuss these findings with their healthcare team. The research specifically studied people with liver disease, so results may not apply to muscle loss from other causes.

Most studies in this analysis lasted 8-24 weeks, suggesting that consistent exercise and nutrition changes over several months are needed to see meaningful muscle improvements.

Want to Apply This Research?

  • Track weekly exercise sessions (aim for 3-4 per week) and daily protein intake, monitoring changes in physical activities like walking speed or stair climbing ability
  • Start with gentle resistance exercises or walking programs while ensuring adequate protein intake throughout the day, rather than relying solely on supplements
  • Log exercise consistency, protein intake, and functional improvements like energy levels and ability to perform daily tasks over 3-6 month periods

This information is for educational purposes only and should not replace medical advice. People with liver disease should consult their healthcare provider before starting any exercise or supplement program, as individual medical conditions may require specific modifications to ensure safety.