Physical activity and liver diseases

Abstract

Regular physical activity beneficially impacts the risk of onset and progression of several chronic diseases. However, research regarding the effects of exercising on chronic liver diseases is relatively recent. Most researchers focused on nonalcoholic fatty liver disease (NAFLD), in which increasing clinical and experimental data indicate that skeletal muscle crosstalking to the adipose tissue and the liver regulates intrahepatic fat storage. In this setting, physical activity is considered to be required in combination with calories restriction to allow an effective decrease of intrahepatic lipid component, and despite that evidence is not conclusive, some studies suggest that vigorous activity might be more beneficial than moderate activity to improve NAFLD/nonalcoholic steatohepatitis. Evidence regarding the effects of exercise on the risk of hepatocellular carcinoma is scarce; some epidemiological studies indicate a lower risk in patients regularly and vigorously exercising. In compensated cirrhosis, exercise acutely increases portal pressure, but in the longer term it has been proved safe and probably beneficial. Decreased aerobic capacity (VO2) correlates with mortality in patients with decompensated cirrhosis, who are almost invariably sarcopenic. In these patients, VO2 is improved by physical activity, which might also reduce the risk of hepatic encephalopathy through an increase in skeletal muscle mass. In solid organ transplantation recipients, exercise is able to improve lean mass, muscle strength, and, as a consequence, aerobic capacity. Few data exist in liver transplant recipients, in whom exercise should be an object of future studies given its high potential of providing long‐term beneficial effects. Conclusions: Despite that evidence is far from complete, physical activity should be seen as an important part of the management of patients with liver disease in order to improve their clinical outcome. (Hepatology 2016;63:1026–1040)

Web-Based Exercise as an Effective Complementary Treatment for Patients With Nonalcoholic Fatty Liver Disease: Intervention Study (Preprint)

“…In contrast to the findings of Perri, [72] many study participants in this trial reported at the end of the study, that they struggled with the integration of the demanding volume in the second half of the intervention. Berzagotti (2016) summarized the beneficial effects of exercise on the health of NAFLD patients, but also discuss high dropout rates in physical activity trials in these patients [3]. There is an urgent need to counteract with the sedentary habits of NAFLD patients.…”

Effect of exercise on the development of new fatty liver and the resolution of existing fatty liver

“…The available evidence to date suggests a benefit of exercise to decrease fatty liver in NAFLD [13][14][15][16]23], and the question of the optimum prescribed 'dose' of exercise for all liver diseases [14] and the effect of aerobic exercise on liver fat [24] have recently been examined. These analyses show that it remains uncertain as to what exercise should be advised and how intense (and for how long), that exercise needs to be, in order to influence liver fat.…”

“…In short duration studies, lifestyle changes that have focussed on diet and exercise modification have shown promise in decreasing liver fat as a manifestation of early disease in NAFLD [13][14][15][16]. However, guidelines from Specialist societies regarding recommendations for amounts and intensity of exercise/physical activity in NAFLD are variable.…”

Importance of sarcopenia parameter changes after living donor liver transplantation

“…The systemic role of muscle tissue is strengthened by the large system of hormones, chemokines and other mediators that constitute a dense network of communication between the skeletal muscle and the liver (1,2). This, associated with the evidence of a progressive malnutrition and depletion of muscle mass in end-stage liver disease (ESLD) patients, has led many to study the role of sarcopenia and its systemic effects in this setting, and to identify it as critical risk factor for post-liver transplantation (LT) mortality (3)(4)(5).…”

“…Post-LT physical activity should be aimed at restoring muscle tone, increased aerobic capacity, reducing obesity and insulin resistance and, ultimately, counteracting the effects of the accumulation of visceral adipose tissue and intrahepatic fat (1). The effect of sarcopenia pre-and post-LT in defining the outcomes of transplantation has been established, as has the need to correct it with nutritional and rehabilitative interventions.…”