Improvement in histological endpoints of MAFLD following a 12‐week aerobic exercise intervention

Abstract

Summary Background Lifestyle interventions are the primary treatment for metabolic (dysfunction) associated fatty liver disease (MAFLD). However, the histological and cardiometabolic effects of aerobic exercise in MAFLD remain unclear. Aims To assess the effects of a 12‐week aerobic exercise intervention on histological and cardiometabolic endpoints in MAFLD. Methods Patients with biopsy‐confirmed MAFLD participated in a 12‐week aerobic exercise intervention. Liver histology, cardiorespiratory fitness (estimated V̇O2max), physical activity, anthropometry and biochemical markers were assessed at baseline, intervention completion, and 12 and 52 weeks after intervention completion. Results Twenty‐four patients completed the exercise intervention (exercise group n = 16, control group n = 8). In the exercise group, 12 weeks of aerobic exercise reduced fibrosis and hepatocyte ballooning by one stage in 58% (P = 0.034) and 67% (P = 0.020) of patients, with no changes in steatosis (P = 1.000), lobular inflammation (P = 0.739) or NAFLD activity score (P = 0.172). Estimated V̇O2max increased by 17% compared to the control group (P = 0.027) but this level of improvement was not maintained at 12 or 52 weeks after the intervention. Patients with fibrosis and ballooning improvement increased estimated V̇O2max by 25% (P = 0.020) and 26% (P = 0.010), respectively. Anthropometric reductions including body mass (P = 0.038), waist circumference (P = 0.015) and fat mass (P = 0.007) were also observed, but no patient achieved 7%‐10% weight loss. Conclusion This study highlights the potential benefits of a 12‐week aerobic exercise intervention in improving histological endpoints of MAFLD. The development of strategies to ensure continued engagement in aerobic exercise in MAFLD are needed.

Improvement in cognitive impairment following a 12‐week aerobic exercise intervention in individuals with non‐cirrhotic chronic hepatitis C

“…The failure to sustain the benefits of the exercise intervention at T2 is in keeping with previous exercise interventions in HCV, 47 non‐alcoholic fatty liver disease (NAFLD) 56 and T2DM 57 cohorts, and emphasizes the unmet need for exercise maintenance in the unsupervised setting in these cohorts. Following a six‐week exercise intervention, McKenna et al reported that improvements in cardiometabolic outcomes were not maintained upon a one‐year follow‐up, 47 stressing that effective strategies to promote long‐term exercise are needed.…”

Exercising in the COVID-19 era: implications in non-alcoholic fatty liver disease (NAFLD)

“… 36 A better understanding of how physical exercise affects liver mitochondrial function will be a key factor in the design of beneficial exercise programmes in the future. A recent paired-biopsy study reported a significant regression in histological endpoints following a 12-week aerobic exercise intervention in patients with NAFLD, 37 and suggested that exercise-induced immune responses may be responsible for the observed histological benefits. This study additionally reported a potential link between histological benefit and cardiorespiratory fitness improvements.…”

“…This study additionally reported a potential link between histological benefit and cardiorespiratory fitness improvements. 37 A recent report has suggested that higher cardiorespiratory fitness may protect against the pro-inflammatory response observed in severe COVID-19 and reduce the risk of hospitalisation, 38 suggesting that exercise-induced improvements in cardiorespiratory fitness may be protective for patients with NAFLD in the COVID-19 era. However, in the absence of primary data on the beneficial effects of exercise training programmes demonstrating a definitive protective effect against COVID-19, this remains speculative.…”

Association Between the Triglyceride–Glucose Index and Outcomes of Nonalcoholic Fatty Liver Disease: A Large-Scale Health Management Cohort Study

“… 28 A healthy lifestyle may reduce NASH and hepatic fibrosis. 29 , 30 NAFLD is increasingly emerging as a major health burden, and there are still few data on its natural history. One major reason for this is likely the difficulty of performing long-term follow-up on subjects.…”