A Study to assess whether Nutrition and Structured Exercise Improve Physical Strength and Quality of life in People With Chronic Liver Disease Who Are at risk of Becoming Weak or Are Already Weak

INTERVENTION: Intervention1: Nutrition and Structured exercise along with standard Medical therapy for CLD for 12 weeks: Nutritional Supplementation: for 12 weeks Protein intake‐1.5 g/kg/day Caloric intake individualized based on effective body weight: Compensated cirrhosis: 30 kcal/kg/day Obese cirrhosis: 20 25 kcal/kg/day Malnourished: 35 40 kcal/kg/day Distribution of Nutrients‐ Carbohydrates ‐60 percent Protien 20percent Fats‐20percent Diet plans supervised by a dietician Structured Exercise:For 12 weeks Aerobic training: Walking 15 20 minutes/day, 3 5 days/week Resistance training: Progressive cuff weights and theraband exercises starting at 1 set of 10 reps, increased incrementally to 4 5 sets by week 12 Along with standard medical therapy for 12 weeks Intervention2: Standard medical Therapy for Chronic Liver Disease: Participants will receive standard medical therapy as per institutional protocol but no structured exercise or dietician‐supervised nutritional plan. Control Intervention1: Standard medical Therapy for Chronic Liver Disease for 12 weeks: Participants will receive standard medical therapy as per institutional protocol but no structured exercise or dietician‐supervised nutritional plan for 12 weeks CONDITION: Health Condition 1: K746‐ Other and unspecified cirrhosis ofliver PRIMARY OUTCOME: 1. Cirrhosis‐related complications Such as Ascites requiring paracentesis or hospitalization, hepatic encephalopathy , spontaneous bacterial peritonitis, variceal bleed ; ; 2.All‐cause mortalityTimepoint: at 12 weeks SECONDARY OUTCOME: Liver fraility inde X; Muscle thickness of Biceps and quadriceps at mid point of Muscle belly ; Grip Strength By dynamometer ; Quality of Life by CLDQ questionnaire ; Nutritional indices including Body weight,BMITimepoint: at Baseline and 12 weeks INCLUSION CRITERIA: Adult patients with chronic liver disease with Child Turcotte Pugh class A, B or C with a Child Turcotte Pugh score of 10 or less. Patients who are prefrail or frail according to the Liver Frailty Index. Prefrail is defined as a Liver Frailty Inde Xscore from 3.2 to 4.4. Frail is defined as a Liver Frailty Inde Xscore of 4.5 or more. Patients whose previous Child Turcotte Pugh score was more than 10 due to bilirubin, prothrombin time INR,tense ascites or hepatic encephalopathy may be included if their score subsequently improves to 10 or less before enrolment. Patients must be able to follow instructions, participate in the intervention, complete scheduled follow up, and provide written informed consent.