Breaking Down Barriers to Physical Activity in Patients with Nonalcoholic Fatty Liver Disease

Abstract

Background: Lifestyle changes, including physical activity, are the cornerstones of the treatment of nonalcoholic fatty liver disease (NAFLD). For unclear reasons, most NAFLD patients do not achieve the recommended amount of weekly activity.

Aims: Our aim was to measure perceived barriers to physical activity and enablers to exercise intervention.

Methods: Consecutive subjects aged 18-70 with NAFLD were prospectively enrolled. An exercise motivation questionnaire was administered to assess current behaviors and perceived barriers.

Results: Eighty-seven subjects (60% female) were enrolled with mean age 52 years and mean body mass index (BMI) 34.5 kg/m². Metabolic comorbidities were common: 49% had hyperlipidemia, 42% hypertension, and 40% diabetes. The majority (75%) did not achieve ≥ 150 min/week of physical activity. Ninety-one percent agreed that activity was important in improving NAFLD; 88% desired to be more active. Lack of exercise resources and education from treating provider (47%), physical discomfort during exercise (44%), and time constraints (32%) were the most common barriers. Rates of fitness tracker (34%), gym (33%), exercise program (33%), and personal trainer (17%) use were low.

Conclusions: While nearly all subjects with NAFLD identify physical activity to be important and desire to be more active, only a few meet activity recommendations. This discordance is due to a perceived lack of resources and education, physical discomfort, and time constraints. Better understanding of these barriers and behaviors are important to improve morbidity and mortality in NAFLD. Future behavioral research removing the identified barriers is of great importance to global public health and should be prioritized.

Keywords: Cirrhosis; Exercise; Lifestyle; Steatohepatitis; Steatosis.

Fig. 1

Fitness resources and tools are underutilized by most NAFLD patients

Fig. 2

Baseline physical activity, diabetes, and liver fibrosis influence barriers to exercise. a Subjects who reported a lack of medical provider resources and education were less likely to complete recommended 150 min per week of exercise (10% vs. 38%, p = 0.002). b Subjects who reported physical discomfort were more likely to have advanced fibrosis based on clinical decision aids (16% vs. 0%, p = 0.040). c Subjects who reported time as a barrier were less likely to be diabetics, trending toward statistical significance (20% vs. 44%, p = 0.088)