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Physical Activity Promotion to Improve Quality of Life Among Patients with End-Stage Liver Disease
Dissertation

Physical Activity Promotion to Improve Quality of Life Among Patients with End-Stage Liver Disease

Audrey Somers-Flack
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: The effects of end-stage liver disease (ESLD) lead to progressive debilitation and decreased quality of life (QoL). Routine care may not offer sufficient guidance to patients with ESLD on how best to maintain their functional status. Current literature supports physical activity as a safe and effective intervention to support QoL for patients with ESLD. Purpose: This project aimed to implement and evaluate a clinic-based physical activity program to improve patient-reported QoL. Objectives included integrating physical activity promotion into the standard visit workflow, evaluating changes in patients’ participation in physical activity, and assessing trends in patients’ health-related QoL. Methods: This project was designed and implemented using the Iowa Model for evidence-based practice. Participants received physical activity education and resources during a regular visit. They were then asked to keep an activity log to be collected and reviewed at each appointment. The effects of the intervention on patients’ QoL were evaluated using a validated questionnaire (the SF-36). Findings: Of the patients with ESLD seen regularly in the clinic, 12 were deemed appropriate to participate. Project implementation took place over 16 weeks. Program delivery adherence improved over the course of data collection, reaching 81% overall. Returned activity logs reflected low levels of participation in physical activity but demonstrated an upward trend over the duration. Across the initial and final surveys, participants reported poor or below-average QoL in multiple domains without statistically significant change. Discussion: This evidence-based practice project met the targeted rates of program delivery, increased participation in physical activity, and led to clinically significant improvement in QoL for some participants. The absence of significant decline is a positive outcome given the progressive nature of ESLD and supports integrating physical activity promotion as part of holistic ESLD care.
 end stage liver disease functional status quality of life evidence-based practice exercise patient reported outcome measures

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