The growing prevalence of nonalcoholic fatty liver disease, or NAFLD, is quite astounding. With one in three people affected worldwide, NAFLD is a substantial public health issue that demands attention. Characterized by excessive fat deposition in the liver, NAFLD is typically found in the setting of metabolic dysfunction. If uncorrected, NAFLD can progress to advanced liver disease and may require life-saving liver transplantation.
The urgency to tackle NAFLD at an early stage cannot be emphasized enough — early intervention could spare patients from the dire consequences of advanced liver disease.
Physical activity is a formidable tool in the fight against NAFLD. In recognition of this, in July 2022, the American College of Sports Medicine® (ACSM) assembled experts from across the globe for the inaugural International Multidisciplinary Roundtable on Physical Activity and NAFLD. This initiative yielded a wealth of insight, encapsulated in 30 consensus statements that are backed by high-quality scientific evidence. The summative ACSM roundtable statement in Medicine & Science in Sports & Exercise® provides the busy clinician with a comprehensive framework for incorporating physical activity as a therapeutic strategy for all with NAFLD.
Within the roundtable statement can be found a compelling portrait of the substantial evidence supporting the undeniable benefits of regular physical activity. From reducing liver fat to enhancing cardiorespiratory fitness to decreasing cardiovascular risk and even contributing to an improved quality of life, the breadth of positive outcomes is impressive. What’s striking is that these advantages are attainable without a significant emphasis on the loss of body weight — physical activity seems to exert a distinct influence on NAFLD beyond the simple shedding of pounds. Furthermore, the statement underscores the potential of regular physical activity to mitigate the risk of primary liver and extrahepatic cancers. Given the heightened risk faced by individuals with NAFLD, this is a crucial point to consider. It’s not just about liver health, but the overall well-being of the individual.
Additionally, it’s important to discuss how we translate the roundtable guidance into day-to-day clinical practice. Really, it all begins with the routine interactions between clinicians and individuals with NAFLD. It is crucial to use these moments for screening and initiating discussions about physical activity to plant the seeds of change. Moreover, when patient-centered language and techniques like motivational interviewing are used during these conversations, we demonstrate our understanding of the individual’s perspective and needs and acknowledge the complexities of human behavior. When an individual feels understood and supported, they’re more likely to engage in the necessary steps for their well-being. It’s not just about relaying information; it’s about building a rapport and instilling a sense of empowerment.
When we discuss physical activity with our patients with NAFLD, there are complexities we need to consider. It’s quite clear that a personalized approach is essential. The heterogeneity of disease stage, physical limitations, and prior experience with being physically active necessitates a tailored approach, and there’s certainly a no one-size-fits-all regimen. That’s where the concept of the cumulative dose of activity comes into play, where variation in time under tension may improve adherence and allow clinicians to craft programs that align with their patients’ circumstances and preferences. What if a clinician is too pressed for time or lacks the necessary expertise? This is where a referral to an ACSM Certified Clinical Exercise Physiologist® can play a crucial role in bridging the gap to ensure each patient receives the right guidance. However, when direct access to exercise professionals isn’t feasible, another option could be using telehealth and mobile health applications. These have shown promise in delivering lifestyle intervention programs remotely and have the potential to enhance the reach and impact of the physical activity recommendations to more individuals with NAFLD.
In conclusion, the ACSM roundtable report shines light on the transformative potential of physical activity to impact individuals with NAFLD. It also serves as a rallying cry for health care providers, exercise professionals, and public health officials to embrace regular physical activity as a cornerstone of NAFLD patient care. While the fight against NAFLD appears quite complex, one solution is readily available and surprisingly simple — get moving.
Dr. Jonathan Stine is an associate professor of medicine and public health science at Penn State, where he serves as the Fatty Liver Program director and Liver Center director of research. He is an internationally recognized expert on NAFLD and exercise and has authored >100 peer-reviewed papers. Stine is the recipient of multiple research grants from the American Association for the Study of Liver Diseases, American Cancer Society and has maintained continuous NIH funding since 2018. He served as co-chair for the ACSM Roundtable on Physical Activity and NAFLD and is the NAFLD consultant for Exercise is Medicine®. You can connect with Dr. Stine at TW: @JonathanStineMD
Viewpoints presented in ACSM Bulletin commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. Dr. Stine receives research funding from Astra Zeneca; Galectin; Noom, Inc.; Novo Nordisk; and Zydus. He also consults for Novo Nordisk.
