Exercise-Based Interventions Combined with Branched-Chain Amino Acid Supplementation for the Prevention and Management of Sarcopenia in Liver Cirrhosis: A Scoping Review

Sarcopenia is a common and clinically relevant complication of liver cirrhosis, associated with impaired physical function, reduced quality of life (QOL) , and increased morbidity and mortality. Various nutritional and exercise strategies, including branched-chain ami-no acid (BCAA) supplementation, have been proposed to mitigate muscle loss; however, evidence on their combined effects remains heterogeneous. This review aimed to map the existing evidence on the effects of physical activity combined with BCAA supplementa-tion on muscle mass, muscle strength, and physical performance in patients with liver cirrhosis. A scoping review was conducted to map the available evidence on structured exercise interventions combined with BCAA supplementation in adults with liver cirrho-sis. Electronic searches were performed in PubMed, Cochrane Library, and Web of Science to identify relevant studies reporting muscle related or functional outcomes. Data were charted and synthesized narratively to describe intervention characteristics, outcome measures, and overall trends in the literature. Five studies met the inclusion criteria. Inter-ventions consisted mainly of walking-based exercise or combined aerobic and resistance training programs lasting 8–12 weeks, along with oral BCAA supplementation. Physical activity was consistently associated with improvements in muscle strength, physical performance, or frailty-related outcomes, while effects on muscle mass were more variable. Exercise based rehabilitation appears to be a central component in the management of sarcopenia in liver cirrhosis. BCAA supplementation may provide supportive benefits when combined with physical activity; however, its independent effects remain incon-sistent.