Physical activity, exercise and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver conditions ranging from hepatic steatosis through steatohepatitis to cirrhosis. Its prevalence has been estimated at between one-in-five and one-in-three of the adult population depending on country and diagnostic criteria used. Prevalence increases with degree of obesity, and is very common in those with Type 2 diabetes (T2DM). Rising prevalence of obesity and T2DM, particularly in younger people, will ensure that NAFLD remains a growing clinical concern for the future. Lifestyle modification, which encompasses diet, weight loss, physical activity, and/or exercise related behaviours, is the primary recommended therapy for NAFLD, especially in the absence of approved pharmaceutical agents. Despite lifestyle modifications being central to the management of NAFLD, the evidence base upon which these guidelines are based is lacking, and this is particularly true for physical activity and exercise. The focus of this thesis is on defining, exploring and developing the evidence for physical activity and exercise in NAFLD with a view to improving clinical care. The work contained within this thesis demonstrates that low levels of physical activity are prominent in people with NAFLD and that targeting this with resistance exercise therapy confers benefits to both liver lipid and the factors promoting its accumulation. It also highlights alterations in cardiac structure and function in people with NAFLD in the absence of overt cardiac disease, which may provide a therapeutic avenue in which to decrease cardiac disease risk in people with fatty liver. Over the duration of the work described in this thesis, the number of studies reporting on exercise and liver fat in people with NAFLD has increased markedly. The new information contained within this thesis contributes to this body of knowledge and, over time, will improve the management of a condition that is an increasing burden to the people of the Western world.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Lifestyle Behavior Change in Patients With Nonalcoholic Fatty Liver Disease:A Qualitative Study of Clinical Practice

Nonalcoholic fatty liver disease (NAFLD) is the most common liver condition worldwide and is linked largely to obesity and inactivity. Lifestyle modification is the primary treatment for NAFLD targeting dietary change, physical activity, and exercise to facilitate weight loss and weight loss maintenance. This has been shown to reduce steatosis and ameliorate steatohepatitis. European Clinical Practice Guidelines for the management of NAFLD highlight the importance of targeting lifestyle behavior change in all patients with NAFLD regardless of disease severity. These guidelines recommend combining dietary restriction and a progressive increase in aerobic exercise and resistance training with a focus on tailoring interventions to the individual patient. Practice guidelines published by the American Association for the Study of Liver Diseases recommend weight loss of at least 3% to 5% of body weight via hypocaloric diet or diet combined with increased physical activity but state that these lifestyle interventions should target patients with nonalcoholic steatohepatitis. Given the benefits of lifestyle behavior change, this study explored the perceptions surrounding clinical care as currently offered to patients with NAFLD. The aim of this study was to establish whether current provision of lifestyle behavior change support is sufficient, whether health care professionals believe they have the tools to target lifestyle behavior changes effectively, and how targeting diet and physical activity/exercise to facilitate weight loss and weight loss maintenance in practice can be improved from the perspective of health care professionals and patients

Effects of Community Exercise Therapy on Metabolic, Brain, Physical, and Cognitive Function Following Stroke : A Randomized Controlled Pilot Trial

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Digital Intervention With Lifestyle Coach Support to Target Dietary and Physical Activity Behaviors of Adults With Nonalcoholic Fatty Liver Disease: Systematic Development Process of VITALISE Using Intervention Mapping

Background: Non-alcoholic fatty liver disease (NAFLD) is linked to excess calorie consumption, physical inactivity and being overweight. Patients with NAFLD can halt or decelerate progression, and potentially reverse their condition by changing their lifestyle behaviour. National and international guidelines recommend the use of lifestyle interventions, however there remains a discordance between published guidelines and clinical practice. This is primarily due to a lack of NAFLD-specific lifestyle interventions to support weight loss and improve liver function. Objective: To use Intervention Mapping to systematically develop a digital intervention to support patients with NAFLD to initiate and maintain changes to their dietary and physical activity behaviour to promote weight loss. Methods: Intervention Mapping consisted of 6 steps. A needs assessment with primary and secondary healthcare professionals and patients with NAFLD (step 1). Identification of the social cognitive determinants of change and behavioural outcomes of the intervention (step 2). Linking social cognitive determinants of behavioural outcomes with behaviour change techniques to effectively target dietary and physical activity behaviour (step 3). Step 4 involved the development of a prototype digital intervention that integrated the strategies from step 3, and the information content identified as important for improving knowledge and skills from steps 1 and 2. Step 5 involved development of an implementation plan with a digital provider of lifestyle behaviour change programmes to NHS patients using their delivery platform and lifestyle coaches. Finally, step 6 involved piloting the digital intervention with patients to obtain data on access, usability and content. Results: A digital intervention was developed consisting of eight modules, self-regulatory tools and provision of telephone support by trained lifestyle coaches to help facilitate behavioural intention, enactment and maintenance. A commercial provider of digital lifestyle behaviour change programmes enrolled 16 patients with NAFLD to the prototype intervention for 12 consecutive weeks. Eleven of the 16 participants successfully accessed the intervention and continued to engage with the content following initial log-in (on average four times over the piloting period). Most frequently accessed modules were “welcome to the programme”, “understanding NAFLD”, and “food and NAFLD”. Goal setting and self-monitoring tools were accessed on 22 occasions (four times per tool on average). Three out of eleven participants requested access to a lifestyle coach. Conclusions: Intervention Mapping provided a systematic methodological framework to guide a theory- and evidence-informed co-design intervention development process with patients and HCPs. The digital intervention with remote support by a lifestyle coach was acceptable to patients with NAFLD and feasible to deliver. Issues with initial access, optimisation of information content and promoting the value of remote lifestyle coach support require further development ahead of future research to establish intervention effectiveness