Physical Activity and Nonalcoholic Fatty Liver Disease: A Roundtable Statement from the American College of Sports Medicine

Abstract

Although physical activity (PA) is crucial in the prevention and clinical management of nonalcoholic fatty liver disease, most individuals with this chronic disease are inactive and do not achieve recommended amounts of PA. There is a robust and consistent body of evidence highlighting the benefit of participating in regular PA, including a reduction in liver fat and improvement in body composition, cardiorespiratory fitness, vascular biology, and health-related quality of life. Importantly, the benefits of regular PA can be seen without clinically significant weight loss. At least 150 min of moderate or 75 min of vigorous intensity PA are recommended weekly for all patients with nonalcoholic fatty liver disease, including those with compensated cirrhosis. If a formal exercise training program is prescribed, aerobic exercise with the addition of resistance training is preferred. In this roundtable document, the benefits of PA are discussed, along with recommendations for 1) PA assessment and screening; 2) how best to advise, counsel, and prescribe regular PA; and 3) when to refer to an exercise specialist.

How to Write an Exercise Prescription to Treat Metabolic Dysfunction-Associated Steatotic Liver Disease for the Busy Clinician

“…According to a recent clinical practice guidance from the American College of Sports Medicine (ACSM), all individuals with MASLD should be screened for physical activity at every visit with their healthcare providers (5). At first glance, this seems like a lofty statement given the vast number of individuals affected with this chronic liver disease; however, if the busy clinician employs a structured framework for screening, this can readily be completed in 2 minutes or less.…”

Exploring exercise-driven inhibition of pyroptosis: novel insights into treating diabetes mellitus and its complications

“…In DCM, exercise preserves endothelial function, improves antioxidant defenses, ameliorates mitochondrial dysfunction, and reduces cardiovascular mortality ( 88 – 90 ). Among NAFLD patients, exercise alleviated diet-induced intrahepatic lipid content, hepatic steatosis, content inflammation, and fibrosis ( 91 – 93 ). Moreover, higher levels of physical activity were associated with a reduced prevalence of abnormal retinal conditions ( 94 ).…”

Sweating it out: How physical activity can combat high genetic risk for nonalcoholic fatty liver disease

“…Nonalcoholic fatty liver disease (NAFLD) continues to be a leading cause of chronic liver disease worldwide of great public health interest 1 . Because physical inactivity and sedentary behaviour contribute heavily to disease pathogenesis, lifestyle modification with increased physical activity is a key intervention against NAFLD 2,3 . However, physical inactivity and other environmental factors do not act in isolation; rather, there is a complex interaction between environmental factors and a genetic predisposition that we are beginning to understand 4 .…”

“…1 Because physical inactivity and sedentary behaviour contribute heavily to disease pathogenesis, lifestyle modification with increased physical activity is a key intervention against NAFLD. 2,3 However, physical inactivity and other environmental factors do not act in isolation; rather, there is a complex interaction between environmental factors and a genetic predisposition that we are beginning to understand. 4 Genome-wide association studies have allowed for the creation of polygenic risk scores for hepatic fat content.…”