{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:46:41Z","timestamp":1788864401998,"version":"build-2803163510"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Minufiya University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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\u2013Short Form (IPAQ-SF), from which a PA Index (PAI; 0\u20137 scale) was derived. Clinical, laboratory, nutritional,\u00a0imaging, 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\u2013Pugh scores (\u03c1 = \u22120.28,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002), higher INR (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.005), and lower albumin (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.018). Sarcopenia was most prevalent among patients with low PAI (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Independent predictors of mortality included low PAI (HR\u2009=\u20092.12, 95% CI 1.22\u20133.68,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008), Child\u2013Pugh 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%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). The IPAQ-SF\u2013derived 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.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-55248-8","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T09:37:05Z","timestamp":1780911425000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of physical activity on clinical outcomes in patients with liver cirrhosis: a prospective observational cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Maha","family":"Elsabaawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Eissa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Atef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soad","family":"Rizk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hend","family":"Awad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basam M.","family":"Masoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amira M.","family":"Badawy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madiha","family":"Naguib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"issue":"1","key":"55248_CR1","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1002\/hep.30272","volume":"69","author":"SK Asrani","year":"2019","unstructured":"Asrani, S. K., Devarbhavi, H., Eaton, J. & Kamath, P. S. Burden of liver diseases in the world. Hepatology 69 (1), 349\u2013359. https:\/\/doi.org\/10.1002\/hep.30272 (2019).","journal-title":"Hepatology"},{"issue":"3","key":"55248_CR2","doi-asserted-by":"publisher","DOI":"10.3390\/livers5030028","volume":"5","author":"A Battle","year":"2025","unstructured":"Battle, A., Mudd, J., Ahlenstiel, G. & Kalo, E. Liver cirrhosis: Evolving definitions, and recent advances in diagnosis, prevention and management. Livers 5(3), 28. https:\/\/doi.org\/10.3390\/livers5030028 (2025).","journal-title":"Livers"},{"issue":"2","key":"55248_CR3","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1002\/cld.555","volume":"8","author":"P Tandon","year":"2016","unstructured":"Tandon, P. & Duarte-Rojo, A. Prognostic evaluation in cirrhosis: Beyond the Child-Pugh and MELD scores. Clin Liver Dis (Hoboken) 8(2), 33\u201337. https:\/\/doi.org\/10.1002\/cld.555 (2016).","journal-title":"Clin Liver Dis (Hoboken)"},{"issue":"24","key":"55248_CR4","doi-asserted-by":"publisher","first-page":"e653","DOI":"10.1161\/CIR.0000000000000461","volume":"134","author":"R Ross","year":"2016","unstructured":"Ross, R. et al. Importance of assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical vital sign: A scientific statement from the American Heart Association. Circulation 134(24), e653\u2013e699. https:\/\/doi.org\/10.1161\/CIR.0000000000000461 (2016).","journal-title":"Circulation"},{"issue":"6","key":"55248_CR5","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1152\/japplphysiol.00798.2019","volume":"128","author":"A Bellar","year":"2020","unstructured":"Bellar, A., Welch, N. & Dasarathy, S. Exercise and physical activity in cirrhosis: opportunities or perils. J. Appl. Physiol. 128 (6), 1547\u20131567 (2020).","journal-title":"J. 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This study was approved by the Ethics Committee of the National Liver Institute, Menoufia University as unique research and not a part of an approved student thesis. Informed consent was obtained from all patients or their legal representatives before the study\u2019s enrolment.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"17681"}}