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Exercise intervention for NAFLD shows promise if adherence maintained

VIENNA — Patients with nonalcoholic fatty liver disease who underwent a 12-week aerobic exercise intervention showed significant improvements in hepatic and extrahepatic parameters after review of paired biopsies, according to a study presented at the International Liver Congress 2019.

“There are limited pharmacological interventions for the treatment of NAFLD, so lifestyle modifications are the first line of treatment,” Philip O’Gorman, from the University of Dublin in Ireland, said during his presentation. “However, many studies report that individuals with NAFLD struggle to meet or maintain weight loss guidelines, so this poses a problem for these individuals.”

O’Gorman and colleagues designed to study to examine the benefits of a 12-week aerobic exercise intervention on hepatic and extrahepatic outcomes in NAFLD and the sustainability of the benefits after completion. Pre-exercise assessments included liver biopsies and review of controlled attenuation parameter (CAP), liver stiffness scores, cardiovascular fitness, physical activity levels, and frailty measures.

“In the general patient population, exercise therapy can have multiple extrahepatic benefits such as improvements in physical activity and improved vascular health by reducing rates of hypertension and endothelial disfunction,” O’Gorman said. “This is important for individuals with NAFLD, as cardiovascular disease is the number one cause of mortality in these individuals.”

The intervention consisted of two supervised and three unsupervised aerobic exercise sessions per week with increasing intensity (45%-75% heart rate reserve) and duration (24-45 minutes).

Sixteen patients and nine controls completed the intervention with 96% mean adherence. Among the exercise group at the end of the 12 weeks, the researchers observed significant regression in fibrosis (P = .025) corresponding with reductions in CAP (P = .015) and liver stiffness score (P = .022), reductions in BMI (P = .01), fat mass (P = .001), waist circumference (P < .0001), HbA1c (P = .047) and self-reported (P = .034) and test-based frailty measures (P = .025).

Additionally, the researchers observed increases in cardiovascular fitness (P = .034), physical activity levels (P = .022) and the number of individuals who achieved WHO physical activity guidelines (P = .046).

During a 12-week follow-up post-intervention, the CAP score (P = .005), BMI (P = .04) and waist circumference (P = .001) remained significantly improved but the other improvements were not sustained.

The loss of certain improvements at follow-up “poses a challenge clinically on how to promote lifelong adherence to exercise therapy,” O’Gorman concluded. “Future studies should aim to evaluate the feasibility of transitioning exercise therapy into a community setting to promote lifelong adherence to exercise therapy.” – by Talitha Bennett

Reference:

O’Gorman P. Abstract PS-105. Presented at: International Liver Congress; April 10-14, 2019; Vienna, Austria.

Disclosures: Healio Gastroenterology and Liver Disease was unable to confirm relevant financial disclosures at the time of publication.