New Years’ resolution: 8 reports on exercise for improved liver health

Overweight and obesity are significant risk factors for liver disease, especially fatty liver disease. Weight loss and exercise can not only decrease the risk for developing fatty liver but also improve outcomes after liver transplantation, protect and reverse hepatic steatosis, and improve kidney function in patients with nonalcoholic steatohepatitis.

The following are several reports on how exercise and physical activity — whether simple resistance training, moderate, or high intensity — can potentially provide improved outcomes for patients with liver disease.

Liver transplant patients benefit from moderate, high intensity exercise

Combined resistance and aerobic training at moderate to high intensity improved aerobic capacity, maximal strength and health-related quality of life in liver transplant patients, according to a recently published study.

“An adequate recovery together with an improvement in the patient fitness and indirect understanding of the relevance of exercise in [health-related quality of life] may result in the long-term in a reduced incidence of metabolic complications,” Diego Moya-Nájera, MsC, from the University of Valencia, Spain, and colleagues wrote. “Indeed, diseases associated with metabolic complications are emerging as the first cause of death after liver transplantation.” Read more

Physical activity protects against, reverses hepatic steatosis

Physical activity prevented or reversed the progression of hepatic steatosis among patients with nonalcoholic fatty liver disease, according to a recently published study. Researchers also observed a protective factor among patients without NAFLD.

“The protective role of [physical activity levels] was evident in subjects that remained physically active from baseline to follow-up as well as in subjects that were not physically active in the beginning, but became physically active at follow-up,” Aline Mendes Gerage, from the Federal University of Santa Catarina, Brazil, and colleagues wrote. “These results are important clinically and suggest that even a relatively moderate-term physical activity regimen of about 31 months imparts beneficial effects that are sufficient to impact the severity of [hepatic steatosis (HS)].” Read more

Regular physical activity may reduce NAFLD in adults with overweight, obesity

In adults with overweight or obesity, daily, habitual physical activity — even if not moderate to vigorous intensity — was shown to reduce nonalcoholic fatty liver disease, according to findings presented at the European Congress on Obesity.

“In these individuals, sedentary behavior and daily step counts are important determinants of the amount of liver fat and, in turn, of metabolic health status,” Kelly Bowden-Davies, MSc, a PhD student at the Institute of Ageing and Chronic Disease at the University of Liverpool, United Kingdom, and colleagues said in a press release. “These findings reinforce the role of avoiding sedentary behavior even in the absence of increased [moderate to vigorous physical activity].” Read more

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Metabolic fitness programs viable therapeutic option for fatty liver disease

Patients with fatty liver disease reduced their BMI and alanine aminotransferase levels following a regimented health education, nutrition and exercise program, according to study results presented at Emerging Trends in Non-Alcoholic Fatty Liver Disease.

“Highly structured lifestyle programs with regimented diet and exercise components often have the highest efficacy for weight loss,” Monica Konerman, MD, MSc, of the department of gastroenterology and hepatology at the University of Michigan, said during her presentation. “The reason that’s important is ... that approximately a 10% reduction in body weight is usually required to see histologic improvement. Many of the existing regimented lifestyle programs are targeting towards patients with either cardiac or endocrine disease, but these types of programs likely represent potential therapeutic options for patients with NAFLD.” Read more

Lifestyle modifications may improve kidney function in patients with NASH

Improved liver histology due to lifestyle modifications was associated with improved renal function among patients with nonalcoholic steatohepatitis, according to published findings.

“The exact mechanism to explain these findings have not yet been entirely elucidated; however, it may be a reflection of the improvement in oxidative stress, insulin sensitivity, inflammation, and vascular endothelial function and permeability that may contribute to positive changes in kidney function,” Naga P. Chalasani, MD, FACG, professor of gastroenterology and hepatology at Indiana University School of Medicine, said in a press release. Read more

Home-based exercise improves aerobic power in patients with cirrhosis

Home-based endurance exercise improved peak aerobic power, suggesting it may improve overall survival in patients with cirrhosis, according to results of a pilot study presented at ACG 2016.

Puneeta Tandon, MD, MSc(Epi), of the University of Alberta, Canada, and colleagues randomly assigned 40 patients with cirrhosis to either an 8-week regimen of home-based endurance exercise training (HET; n = 20) or usual care (control group; n = 20) to determine if 8 weeks HET was safe and had any positive effect on peak aerobic power (VO2). Read more

Progressive resistance training shows no effect on liver fat in adults with obesity

Progressive resistance training did not greatly reduce liver fat in adults who are overweight or have obesity compared with placebo, according to results of a randomized clinical trial published in Hepatology Research.

“To our knowledge there are 10 studies which have looked at some form of resistance-based exercise on liver steatosis in a range of populations,” Nathan Johnson, PhD, ESSAM AEP, of the Faculty of Health Sciences & Charles Perkins Centre, University of Sydney, Australia, told Healio.com/Hepatology. “Half of these have suggested a benefit, whereas the other half have not. Our study investigated the effect of resistance exercise, using the dose currently recommended in exercise guidelines and gold standard methods.” Read more

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No difference between moderate and vigorous exercise for patients with NAFLD

For patients with nonalcoholic fatty liver disease, no difference was found between moderate and vigorous exercise in reducing liver fat, according to recent findings published in JAMA Internal Medicine.

“Nonalcoholic fatty liver disease (NAFLD) has reached epidemic proportions worldwide and is the most common cause of chronic liver disease,” Hui-Jie Zhang, MD, PhD, study co-author and postdoctoral research fellow in the department of epidemiology at Tulane University School of Public Health and Tropical Medicine, and colleagues wrote. “This study indicated that vigorous exercise at 65% to 80% of the maximum heart rate and moderate exercise at 45% to 55% of the maximum heart rate for 150 minutes per week are equally effective in reducing the [intrahepatic triglyceride (IHTG)] content among patients with central obesity and NAFLD.” Read more

Exercise beneficial in decreasing fatty liver development

Varying levels of physical activity decreased the risk for developing new fatty liver and assisted in resolution of existing fatty liver within 5 years of follow up.

“In short duration studies, lifestyle changes that have focused on diet and exercise modification have shown promise in decreasing liver fat as a manifestation of early disease in [non-alcoholic fatty liver disease]. However, guidelines from specialist societies regarding recommendations for amounts and intensity of exercise/physical activity in NAFLD are variable,” Ki-Chul Sung, MD, PhD, from the division of cardiology and department of medicine at Kangbuk Samsung Hospital and Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, and colleagues wrote. “Thus, at present it is unclear how much exercise is needed or how intense that exercise should be to prevent development of new fatty liver or to resolve existing fatty liver. We have utilized a retrospective study design of an occupational cohort ... to assess relationships between exercise and change in fatty liver status over time.” Read more

Aerobic exercise improves some parameters in postmenopausal women with NAFLD

Undergoing a 6-month aerobics program improved waist circumference, cardiopulmonary fitness and other variables in postmenopausal women with nonalcoholic fatty liver disease, according to new study data published in Menopause.

“Nonalcoholic fatty liver disease, which is more common in postmenopausal women due to decreases in estrogen levels, is the build-up of extra fat in liver cells. A liver with more than 5-10% fat is considered a fatty liver. ... Prevention is key,” JoAnn V. Pinkerton, MD, NCMP, executive director of the North American Menopause Society, told Healio.com/Hepatology. “This study shows the benefit of counseling women at risk of diagnosis with fatty liver disease about the benefits of increased physical activity, including less fat around the middle, improvement in good cholesterol and improved ability to exercise.” Read more