{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T06:32:40Z","timestamp":1786689160913,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Physical exercise may improve muscle mass and functional capacity in cirrhosis. This randomized controlled trial evaluates the impact of an exercise\u2010based regimen versus standard medical therapy (SMT) on frailty scores, clinical outcomes, body composition analysis (BCA), and myokines in children with cirrhotic liver disease (CLD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Children (9\u201318 years of age) with CLD with five Fried's frailty criteria score &gt;5 were randomly assigned to groups that received exercise training\u2009+\u2009SMT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200923) or SMT alone (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200923). Exercise regimen included aerobic and resistance exercises for a total of at least 50\u2009min\/day for 3\u20135 days per week for 24 weeks. Frailty assessment was done at baseline, 12 and 24 weeks while myokines levels and BCA was evaluated at baseline and after 12 weeks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At 12 and 24 weeks, the delta change in frailty scores was significantly greater in the exercise group compared to the SMT group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Frailty score &lt;5 was achieved by 60% and 85% of the exercise group at 12 and 24 weeks, compared to 32% and 37% in the SMT group. At 12 weeks, the exercise group showed a significant delta reduction in myostatin levels compared to the SMT group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Significant improvements were observed in skeletal muscle mass (SMM) and phase angle in the exercise group at 12 weeks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this pilot trial, exercise regimen significantly improved frailty scores and SMM compared to the SMT. Larger trials are warranted to further evaluate the long\u2010term benefits of exercise in pediatric cirrhotic population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70529","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:53:47Z","timestamp":1786510427000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of structured exercise\u2010based regimen on frailty in pediatric cirrhosis: A randomized controlled trial"],"prefix":"10.1002","author":[{"given":"Deepika","family":"Yadav","sequence":"first","affiliation":[{"name":"Department of Pediatric Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaya","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukriti","family":"Baweja","sequence":"additional","affiliation":[{"name":"Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5024-4084","authenticated-orcid":false,"given":"Vikrant","family":"Sood","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bikrant Bihari","family":"Lal","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeev","family":"Khanna","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32049"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpn3.12457"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15203"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27830"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.01.025"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1688"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.24958"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.07.058"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15491"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13917"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003674"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.2466\/pms.1994.79.3f.1451"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002443"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2017.10.066"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.04.016"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/ctg.2016.38"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000245"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0151652"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-18320-y"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28992"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2008.01880.x"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/jep.12629"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.15455"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-022-02147-7"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v11.i9.1356"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.1996.v111.pm8898644"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012774"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21103607"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-201X.2005.01406.x"}],"container-title":["Journal 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