For non-alcoholic patients, exercise training is 3.5 times more likely to produce a clinically meaningful response to liver fat compared to standard clinical care fatty liver disease (NAFLD), according to a new systematic review and meta-analysis.
Independent of weight loss, therapeutic benefit required 750 metabolic equivalent (MET) minutes per week or 150 minutes of brisk walking per week.
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“In the absence of regulatory-approved pharmacological treatments or treatments, lifestyle modification through dietary changes and increased exercise is recommended for all patients with NAFLD,” said first author and expert in Medical and Public Health Sciences. Associate Professor and Director of the Fatty Liver Program at the Pennsylvania State Health Milton S. Hershey Medical Center in Hershey, PA. Medscape Medical News.
“That said, there are many important open questions about how best to prescribe exercise as a drug to patients with NAFLD, including whether we see liver-specific benefits of exercise without weight loss. “If so, how much exercise would you need to do to get a clinically meaningful benefit?” rice field.
A study by Stein and his colleagues found that publish online of American Journal of Gastroenterology.
Research analysis
Exercise training, including planned and structured physical activity aimed at improving physical fitness, has been shown to have multiple benefits for patients with NAFLD, write the study authors. Benefits include improvements in liver fat, strength, body composition, vascular biology, and health-related quality of life.
However, it is unclear whether exercise training achieves a relative reduction in liver fat of more than 30%, which is considered the minimal clinically important difference and is associated with histological response or liver fibrosis. on behalf of the improvement of
In a systematic review and meta-analysis, Stine and colleagues analyzed the evidence for MRI-measured liver reduction in response to varying doses of exercise training. They included randomized controlled trials involving adults with NAFLD who participated in an exercise training program.
The 14 studies included a total of 551 participants. The average age of the participants he was 53 years old and the average body mass index was 31 kg/mg.2The duration of the interventions ranged from 4 to 52 weeks and included different types of exercise, including aerobic exercise, high-intensity interval training, resistance training, and aerobic and resistance training.
None of the studies resulted in clinically significant weight loss (7% to 10%) required for histological response. The average weight loss of those who participated in exercise training was approximately 2.8%.
Overall, seven studies of 152 participants provided data showing a 30% or greater reduction in MRI-measured liver fat. The pooled proportion was 34% in the exercise training and 13% in the control condition.
In general, those who participated in exercise training were 3.5 times more likely to achieve a relative reduction of 30% or more in MRI-measured liver fat than those in the control condition.
Among all participants, the mean change in absolute liver fat was -6.7% in 338 participants enrolled in exercise training compared to -0.8% in 213 participants under control conditions. was. The pooled mean difference in absolute change in liver fat measured by MRI between exercise training and controls was -5.8%.
For relative changes in liver fat measured by MRI, researchers analyzed nine studies involving 195 participants (118 exercise-trained participants and 77 control participants). The mean relative change was -24.1% in the exercise-trained group and +7.3% in the control group. The pooled mean difference in relative change between exercise training and controls was -26.4%.
All 14 studies found significant treatment effects at 750 MET minutes or more of physical activity per week. This equates to 150 minutes of moderate-intensity exercise per week, such as brisk walking, or 75 minutes of vigorous activity, such as jogging or biking.
Participants who consumed 750 MET minutes per week had an absolute mean difference of -8% and a relative mean difference of -28.9% in liver fat as measured by MRI, compared to -4.1 for those who consumed less, respectively. % and -22.8%. 750 MET minutes per week.
At least 750 MET minutes of exercise per week reduced MRI-measured liver fat by 30% or more in 39.3% of participants.
Treatment response was independent of clinically significant weight loss greater than 5%.
“Prior to our study, it was thought that a weight loss of at least 5% was required to significantly improve liver histology.” We challenge this notion in that we achieved significant liver fat reduction rates in
ongoing research
Stine and colleagues continue their study, directly comparing biopsy-proven adult standard clinical care with 750 MET minutes and 1000 MET minutes per week of physical activity. non-alcoholic steatohepatitisor advanced form of NAFLD.
“Importantly, this new study we’re doing is designed to mimic real-world settings where people’s daily schedules are highly variable,” he said. “Our team of experienced exercise professionals can vary the frequency and duration of exercise during the week, as long as study participants achieve the prescribed amount of exercise.
Currently, major professional societies have not reached consensus on the optimal physical activity program for patients with NAFLD, write the study authors. However, most clinical guidelines support at least 150 minutes of moderate-intensity aerobic exercise per week.
Although more direct clinical trials are needed, exercise training appears to reduce liver fat and provide other benefits such as cardiopulmonary health, altered body composition, and improved vascular biology.
“Important here is that this review shows that weight loss is not necessary to improve fatty liver disease,” says nutrition professor Jill Canary, Ph.D. exercise physiology at the University of Missouri, Columbia, Medscape Medical News.
Dr. Canary, who was not involved in the study, is studying exercise training for people with NAFLD. She and her colleagues found that moderate- and high-intensity exercise may reduce liver lipid content and her NAFLD risk factors, independent of reduction in abdominal fat or body weight. .
“People often get frustrated with exercise if they don’t see any weight loss,” she said.
This study was supported by the National Institute of Diabetes and Gastrointestinal and Kidney Disease. The authors have received research funding and have acted as consultants with numerous pharmaceutical companies. Canary has not reported any related financial relationships.
J digestive system. Published January 30, 2023. overview
Carolyn Crist is a health and medical journalist reporting on the latest research for Medscape, MDedge and WebMD.
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