Skip to main content
Erschienen in: Digestive Diseases and Sciences 10/2021

23.10.2020 | Original Article

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

verfasst von: Jonathan G. Stine, Christopher Soriano, Ian Schreibman, Gloriany Rivas, Breianna Hummer, Esther Yoo, Kathryn Schmitz, Christopher Sciamanna

Erschienen in: Digestive Diseases and Sciences | Ausgabe 10/2021

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Lonardo A, Nascimbeni F, Maurantonio M, Marrazzo A, Rinaldi L, Adinolfi LE. Nonalcoholic fatty liver disease: Evolving paradigms. World J Gastroenterol. 2017;23:6571–6592.CrossRef Lonardo A, Nascimbeni F, Maurantonio M, Marrazzo A, Rinaldi L, Adinolfi LE. Nonalcoholic fatty liver disease: Evolving paradigms. World J Gastroenterol. 2017;23:6571–6592.CrossRef
2.
Zurück zum Zitat Diehl AM, Day C. Cause, pathogenesis, and treatment of nonalcoholic steatohepatitis. N Engl J Med. 2017;377:2063–2072.CrossRef Diehl AM, Day C. Cause, pathogenesis, and treatment of nonalcoholic steatohepatitis. N Engl J Med. 2017;377:2063–2072.CrossRef
3.
Zurück zum Zitat Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(389–397):e310. Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(389–397):e310.
4.
Zurück zum Zitat Stine JG, Rinella ME. Editorial: age and non-invasive markers of fibrosis in patients with nonalcoholic fatty liver disease: Time to adjust the clock? Am J Gastroenterol. 2017;112:752–754.CrossRef Stine JG, Rinella ME. Editorial: age and non-invasive markers of fibrosis in patients with nonalcoholic fatty liver disease: Time to adjust the clock? Am J Gastroenterol. 2017;112:752–754.CrossRef
5.
Zurück zum Zitat Bhala N, Angulo P, van der Poorten D, et al. The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: An international collaborative study. Hepatology. 2011;54:1208–1216.CrossRef Bhala N, Angulo P, van der Poorten D, et al. The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: An international collaborative study. Hepatology. 2011;54:1208–1216.CrossRef
6.
Zurück zum Zitat Younossi ZM, Stepanova M, Rafiq N, et al. Pathologic criteria for nonalcoholic steatohepatitis: Interprotocol agreement and ability to predict liver-related mortality. Hepatology. 2011;53:1874–1882.CrossRef Younossi ZM, Stepanova M, Rafiq N, et al. Pathologic criteria for nonalcoholic steatohepatitis: Interprotocol agreement and ability to predict liver-related mortality. Hepatology. 2011;53:1874–1882.CrossRef
7.
Zurück zum Zitat Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61:1547–1554.CrossRef Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61:1547–1554.CrossRef
8.
Zurück zum Zitat Pollock ML, Franklin BA, Balady GJ, et al. AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: Benefits, rationale, safety, and prescription: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position paper endorsed by the American College of Sports Medicine. Circulation. 2000;101:828–833.CrossRef Pollock ML, Franklin BA, Balady GJ, et al. AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: Benefits, rationale, safety, and prescription: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position paper endorsed by the American College of Sports Medicine. Circulation. 2000;101:828–833.CrossRef
9.
Zurück zum Zitat Centers for Disease Control and Prevention-Physical Activity Guidelines for Americans, 2nd ed. 2018. Centers for Disease Control and Prevention-Physical Activity Guidelines for Americans, 2nd ed. 2018.
11.
Zurück zum Zitat Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2017. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2017.
12.
Zurück zum Zitat Shen J, Wong GL, Chan HL, et al. PNPLA3 gene polymorphism and response to lifestyle modification in patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2015;30:139–146.CrossRef Shen J, Wong GL, Chan HL, et al. PNPLA3 gene polymorphism and response to lifestyle modification in patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2015;30:139–146.CrossRef
13.
Zurück zum Zitat Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149:367–378.e365; quiz e314–365. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149:367–378.e365; quiz e314–365.
14.
Zurück zum Zitat Lazo M, Solga SF, Horska A, et al. Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes. Diabetes Care. 2010;33:2156–2163.CrossRef Lazo M, Solga SF, Horska A, et al. Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes. Diabetes Care. 2010;33:2156–2163.CrossRef
15.
Zurück zum Zitat Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–131.PubMedPubMedCentral Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–131.PubMedPubMedCentral
16.
Zurück zum Zitat Katsagoni CN, Georgoulis M, Papatheodoridis GV, Panagiotakos DB, Kontogianni MD. Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: A meta-analysis. Metabolism. 2017;68:119–132.CrossRef Katsagoni CN, Georgoulis M, Papatheodoridis GV, Panagiotakos DB, Kontogianni MD. Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: A meta-analysis. Metabolism. 2017;68:119–132.CrossRef
17.
Zurück zum Zitat Hallsworth K, Adams LA. Lifestyle modification in NAFLD/NASH: Facts and figures. JHEP Rep. 2019;1:468–479.CrossRef Hallsworth K, Adams LA. Lifestyle modification in NAFLD/NASH: Facts and figures. JHEP Rep. 2019;1:468–479.CrossRef
18.
Zurück zum Zitat Zhang HJ, He J, Pan LL, et al. Effects of moderate and vigorous exercise on nonalcoholic fatty liver disease: A randomized clinical trial. JAMA Intern Med. 2016;176:1074–1082.CrossRef Zhang HJ, He J, Pan LL, et al. Effects of moderate and vigorous exercise on nonalcoholic fatty liver disease: A randomized clinical trial. JAMA Intern Med. 2016;176:1074–1082.CrossRef
19.
Zurück zum Zitat Gerber L, Otgonsuren M, Mishra A, et al. Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population-based study. Aliment Pharmacol Ther. 2012;36:772–781.CrossRef Gerber L, Otgonsuren M, Mishra A, et al. Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population-based study. Aliment Pharmacol Ther. 2012;36:772–781.CrossRef
20.
Zurück zum Zitat Krasnoff JB, Painter PL, Wallace JP, Bass NM, Merriman RB. Health-related fitness and physical activity in patients with nonalcoholic fatty liver disease. Hepatology. 2008;47:1158–1166.CrossRef Krasnoff JB, Painter PL, Wallace JP, Bass NM, Merriman RB. Health-related fitness and physical activity in patients with nonalcoholic fatty liver disease. Hepatology. 2008;47:1158–1166.CrossRef
21.
Zurück zum Zitat Weinstein AA, Escheik C, Oe B, Price JK, Gerber LH, Younossi ZM. Perception of effort during activity in patients with chronic hepatitis C and nonalcoholic fatty liver disease. PM R. 2016;8:28–34.CrossRef Weinstein AA, Escheik C, Oe B, Price JK, Gerber LH, Younossi ZM. Perception of effort during activity in patients with chronic hepatitis C and nonalcoholic fatty liver disease. PM R. 2016;8:28–34.CrossRef
22.
Zurück zum Zitat Sayiner M, Stepanova M, Pham H, Noor B, Walters M, Younossi ZM. Assessment of health utilities and quality of life in patients with non-alcoholic fatty liver disease. BMJ Open Gastroenterol. 2016;3:e000106.CrossRef Sayiner M, Stepanova M, Pham H, Noor B, Walters M, Younossi ZM. Assessment of health utilities and quality of life in patients with non-alcoholic fatty liver disease. BMJ Open Gastroenterol. 2016;3:e000106.CrossRef
23.
Zurück zum Zitat Avery L, Exley C, McPherson S, Trenell MI, Anstee QM, Hallsworth K. Lifestyle behavior change in patients with nonalcoholic fatty liver disease: A qualitative study of clinical practice. Clin Gastroenterol Hepatol. 2017;15:1968–1971.CrossRef Avery L, Exley C, McPherson S, Trenell MI, Anstee QM, Hallsworth K. Lifestyle behavior change in patients with nonalcoholic fatty liver disease: A qualitative study of clinical practice. Clin Gastroenterol Hepatol. 2017;15:1968–1971.CrossRef
24.
Zurück zum Zitat Haigh L, Bremner S, Houghton D, et al. Barriers and facilitators to mediterranean diet adoption by patients with nonalcoholic fatty liver disease in northern Europe. Clin Gastroenterol Hepatol. 2019;17(1364–1371):e1363. Haigh L, Bremner S, Houghton D, et al. Barriers and facilitators to mediterranean diet adoption by patients with nonalcoholic fatty liver disease in northern Europe. Clin Gastroenterol Hepatol. 2019;17(1364–1371):e1363.
25.
Zurück zum Zitat Hallsworth K, Dombrowski SU, McPherson S, Anstee QM, Avery L. Using the theoretical domains framework to identify barriers and enabling factors to implementation of guidance for the diagnosis and management of nonalcoholic fatty liver disease: A qualitative study. Transl Behav Med. 2019. Hallsworth K, Dombrowski SU, McPherson S, Anstee QM, Avery L. Using the theoretical domains framework to identify barriers and enabling factors to implementation of guidance for the diagnosis and management of nonalcoholic fatty liver disease: A qualitative study. Transl Behav Med. 2019.
26.
Zurück zum Zitat Sechrist KR, Walker SN, Pender NJ. Development and psychometric evaluation of the exercise benefits/barriers scale. Res Nurs Health. 1987;10:357–365.CrossRef Sechrist KR, Walker SN, Pender NJ. Development and psychometric evaluation of the exercise benefits/barriers scale. Res Nurs Health. 1987;10:357–365.CrossRef
27.
Zurück zum Zitat Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.CrossRef Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.CrossRef
28.
Zurück zum Zitat Stukenborg GJ, Blackhall L, Harrison J, et al. Cancer patient-reported outcomes assessment using wireless touch screen tablet computers. Qual Life Res. 2014;23:1603–1607.CrossRef Stukenborg GJ, Blackhall L, Harrison J, et al. Cancer patient-reported outcomes assessment using wireless touch screen tablet computers. Qual Life Res. 2014;23:1603–1607.CrossRef
29.
Zurück zum Zitat Stine JG, Stukenborg GJ, Wang J, et al. Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing. Ann Hepatol. 2020;19:62–68.CrossRef Stine JG, Stukenborg GJ, Wang J, et al. Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing. Ann Hepatol. 2020;19:62–68.CrossRef
30.
Zurück zum Zitat Addo SF, Maiden K, Ehrenthal DB. Awareness of the 5 A’s and motivational interviewing among community primary care providers. Del Med J. 2011;83:17–21.PubMed Addo SF, Maiden K, Ehrenthal DB. Awareness of the 5 A’s and motivational interviewing among community primary care providers. Del Med J. 2011;83:17–21.PubMed
31.
Zurück zum Zitat Vallabhan MK, Kong AS, Jimenez EY, Summers LC, DeBlieck CJ, Feldstein Ewing SW. Training primary care providers in the use of motivational interviewing for youth behavior change. Res Theory Nurs Pract. 2017;31:219–232.CrossRef Vallabhan MK, Kong AS, Jimenez EY, Summers LC, DeBlieck CJ, Feldstein Ewing SW. Training primary care providers in the use of motivational interviewing for youth behavior change. Res Theory Nurs Pract. 2017;31:219–232.CrossRef
32.
Zurück zum Zitat Nascimbeni F, Pais R, Bellentani S, et al. From NAFLD in clinical practice to answers from guidelines. J Hepatol. 2013;59:859–871.CrossRef Nascimbeni F, Pais R, Bellentani S, et al. From NAFLD in clinical practice to answers from guidelines. J Hepatol. 2013;59:859–871.CrossRef
33.
Zurück zum Zitat Mazzotti A, Caletti MT, Brodosi L, et al. An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers. J Hepatol. 2018;69:1155–1163.CrossRef Mazzotti A, Caletti MT, Brodosi L, et al. An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers. J Hepatol. 2018;69:1155–1163.CrossRef
34.
Zurück zum Zitat Moolla A, Motohashi K, Marjot T, et al. A multidisciplinary approach to the management of NAFLD is associated with improvement in markers of liver and cardio-metabolic health. Frontline Gastroenterol. 2019;10:337–346.CrossRef Moolla A, Motohashi K, Marjot T, et al. A multidisciplinary approach to the management of NAFLD is associated with improvement in markers of liver and cardio-metabolic health. Frontline Gastroenterol. 2019;10:337–346.CrossRef
35.
Zurück zum Zitat Matsuda M, Huh Y, Ji RR. Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain. J Anesth. 2019;33:131–139.CrossRef Matsuda M, Huh Y, Ji RR. Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain. J Anesth. 2019;33:131–139.CrossRef
36.
Zurück zum Zitat Brandao AF, Bonet IJM, Pagliusi M Jr, et al. Physical activity induces nucleus accumbens genes expression changes preventing chronic pain susceptibility promoted by high-fat diet and sedentary behavior in mice. Front Neurosci. 2019;13:1453.CrossRef Brandao AF, Bonet IJM, Pagliusi M Jr, et al. Physical activity induces nucleus accumbens genes expression changes preventing chronic pain susceptibility promoted by high-fat diet and sedentary behavior in mice. Front Neurosci. 2019;13:1453.CrossRef
37.
Zurück zum Zitat Lima LV, Abner TSS, Sluka KA. Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. J Physiol. 2017;595:4141–4150.CrossRef Lima LV, Abner TSS, Sluka KA. Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. J Physiol. 2017;595:4141–4150.CrossRef
38.
Zurück zum Zitat Ruseski JE, Humphreys BR, Hallmann K, Breuer C. Family structure, time constraints, and sport participation. Eur Rev Aging Phys Act. 2011;8:57–66.CrossRef Ruseski JE, Humphreys BR, Hallmann K, Breuer C. Family structure, time constraints, and sport participation. Eur Rev Aging Phys Act. 2011;8:57–66.CrossRef
39.
Zurück zum Zitat Thomas AM, Beaudry KM, Gammage KL, Klentrou P, Josse AR. Physical activity, sport participation, and perceived barriers to engagement in first-year Canadian university students. J Phys Act Health. 2019;16:437–446.CrossRef Thomas AM, Beaudry KM, Gammage KL, Klentrou P, Josse AR. Physical activity, sport participation, and perceived barriers to engagement in first-year Canadian university students. J Phys Act Health. 2019;16:437–446.CrossRef
40.
Zurück zum Zitat Williams FR, Vallance A, Faulkner T, et al. Home-based exercise in patients awaiting liver transplantation: A feasibility study. Liver Transpl. 2019;25:995–1006.CrossRef Williams FR, Vallance A, Faulkner T, et al. Home-based exercise in patients awaiting liver transplantation: A feasibility study. Liver Transpl. 2019;25:995–1006.CrossRef
41.
Zurück zum Zitat Chen HW, Ferrando AA, Dunn MA, Kim WR, Duarte-Rojo A. Cadence from physical activity trackers for monitoring of home-based exercise intensity in advanced liver disease. Liver Transpl. 2020. Chen HW, Ferrando AA, Dunn MA, Kim WR, Duarte-Rojo A. Cadence from physical activity trackers for monitoring of home-based exercise intensity in advanced liver disease. Liver Transpl. 2020.
Metadaten
Titel
Breaking Down Barriers to Physical Activity in Patients with Nonalcoholic Fatty Liver Disease
verfasst von
Jonathan G. Stine
Christopher Soriano
Ian Schreibman
Gloriany Rivas
Breianna Hummer
Esther Yoo
Kathryn Schmitz
Christopher Sciamanna
Publikationsdatum
23.10.2020
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 10/2021
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-020-06673-w

Weitere Artikel der Ausgabe 10/2021

Digestive Diseases and Sciences 10/2021 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.