Perceptions of Exercise and Its Challenges in Patients With Nonalcoholic Fatty Liver Disease: A Survey-Based Study

Abstract

Exercise is a foundational treatment for nonalcoholic fatty liver disease (NAFLD); however, the majority of patients are unable to initiate and maintain effective exercise habits and remain at increased risk for progressive liver disease. Barriers and limitations to exercise in patients with NAFLD have not been fully identified. We performed a single survey of 94 patients with biopsy-proven NAFLD to understand baseline physical activity and sedentary behavior, self-perceived fitness, limitations to exercise, potential solutions to increase physical activity behavior, and perception of exercise as a foundational treatment for NAFLD. For exploratory analyses, we evaluated differences in responses to the survey by grouping severity of hepatic fibrosis as follows: nonalcoholic fatty liver (NAFL); early stage (nonalcoholic steatohepatitis [NASH] F0, NASH F1, NASH F2); and late stage (NASH F3, NASH F4). Zero weekly total physical activity was reported by 29% of patients with NAFLD. Late-stage NASH had significantly lower vigorous (P = 0.024), walking (P = 0.029), total weekly activity (P = 0.043), and current fitness level (P = 0.022) compared to early stage NASH. Overall, 72% of patients with NAFLD reported limitations to exercise, with the greatest proportion citing lack of energy (62%), fatigue (61%), prior/current Injury (50%), and shortness of breath (49%). A preference for personal training to increase their physical activity was indicated by 66% of patients with NAFLD, and 63% preferred exercise over medication to treat NAFLD. Conclusion: The majority of patients with NAFLD have limitations to exercise but prefer exercise as a treatment option for NAFLD in the form of personal training. Patients with NAFLD may have unique physiologic limitations to exercise that worsen with fibrosis severity. Exercise interventions or services that are personalized and scalable may improve sustainability of exercise habits in the long term.

© 2021 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.

Figures

FIG. 1

Weekly physical activity by METs and sedentary behavior in patients with NAFLD. (A) Weekly vigorous, moderate, and walking METs in patients with NAFLD (n = 94). (B) Total weekly METs in patients with NAFLD. (C) Total weekly METs by NAFL, early stage NASH, and late‐stage NASH. (D) Weekly vigorous METs by NAFL, early stage NASH, and late‐stage NASH. (E) Weekly moderate METs by NAFL, early stage NASH, and late‐stage NASH. (F) Weekly walking METs by NAFL, early stage NASH, and late‐stage NASH. (G) Total daily hours spent sitting in patients with NAFLD. (H) Total daily hours spent sitting by NAFL, early stage NASH, and late‐stage NASH. Box plots show median (bold horizontal line), interquartile range (box), third quartile (upper limit of box), and first quartile (lower limit of box). Dashed lines indicate data range; horizontal lines show minimum (bottom) and maximum (top) values.

FIG. 2

Fitness levels and fitness‐related services that would increase the desire and/or ability for patients with NAFLD to be more physically active. (A) Current, best, and importance of fitness in NAFL, early stage NASH, and late‐stage NASH, using a 1‐10 scale. Means are presented with SD; *P < 0.05. (B) Proportion of responses to fitness‐related services from patients with NAFLD.