Oral Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2023

Exercise in the management of metabolic-associated fatty liver disease (MAFLD) in adults: A position statement from Exercise and Sport Science Australia (97811)

Shelley E Keating 1 , Angelo Sabag 2 3 4 , Kate Hallsworth 5 6 7 , Ingrid J Hickman 8 9 , Graeme A Macdonald 9 10 , Jonathan G Stine 11 12 13 14 , Jacob George 15 , Nathan A Johnson 2 3
  1. School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
  2. Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, NSW, Australia
  3. Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
  4. NICM Health Research Institute, Western Sydney University, Westmead, NSW, AUSTRALIA
  5. NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UNITED KINGDOM
  6. Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UNITED KINGDOM
  7. Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UNITED KINGDOM
  8. Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
  9. Faculty of Medicine, PA-Southside Clinical Unit, The University of Queensland, Brisbane, QLD, AUSTRALIA
  10. Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, AUSTRALIA
  11. Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
  12. Department of Public Health Sciences, The Pennsylvania State University- College of Medicine, Hershey, PA, USA
  13. Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
  14. Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
  15. Storr Liver Centre, The Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, AUSTRALIA

Introduction: Metabolic-associated fatty liver disease (MAFLD) is the most prevalent liver disease, affecting ~25% of people globally and ~80% of individuals with obesity. This position statement aimed to i) examine evidence for exercise in the management of MAFLD, and based on this, ii) provide evidence- and consensus-based recommendations for exercise therapy in MAFLD management.

Method: A systematic search for systematic reviews with meta-analyses was conducted from database inception to June 2023 across seven electronic databases. The evidence generated by extraction and collation of literature was reviewed and graded. Consensus on the content and recommendations of the position statement was reached through an iterative process involving the multidisciplinary authorship team.

Results: Five overarching evidence statements were defined. Grade A evidence was conferred for aerobic exercise for: 1) moderate reduction in hepatic steatosis (2-4%); 2) small reductions in body mass index (~0.85-0.97 kg/m2) and; 3) clinically meaningful improvement in cardiorespiratory fitness (~3.5-8.0 mL/kg/min), with high-certainty of evidence. Emerging evidence suggested that high-intensity interval training (HIIT) may be comparable to moderate-intensity continuous training for reducing hepatic steatosis. Evidence for the efficacy of resistance training on reducing hepatic steatosis was uncertain. There was minimal data to inform the effect of exercise on histological features of MAFLD. Exercise prescription recommendations were developed for four management goals: 1) reduction in hepatic steatosis; 2) reduction in central adiposity; 3) improvement in body mass and 4) improvement in cardiorespiratory fitness.

Conclusion: Evidence indicated that 150-240 min/week of at least moderate-intensity aerobic exercise can reduce hepatic steatosis by ~2-4%; but as little as 135 min/week has been shown to be effective. There does not appear to be an intensity-dependent benefit as long as the recommended exercise amount is achieved. This dose of exercise is likely to improve central adiposity, cardiorespiratory fitness and cardiometabolic health, irrespective of weight loss.