Week 8 - Metabolic

What are the stages to liver disease

1. Healthy Liver

2. Fatty Liver

3. Fibrosis

4. Cirrhosis  

5. End Stage Liver Disease

What occurs to the liver in the healthy liver stage

hepatocytes capable of maintaining liver homeostasis

What occurs to the liver in the fatty liver stage 

excess fat builds up in the liver

What occurs to the liver in the fibrosis stage 

 connective tissue replaces normal tissue

What occurs to the liver in the Cirrhosis stage 

formation of nodular texture surrounded by fibrosis

What occurs in the end stage liver disease

1. inability to function adequately

What does (MASLD) stand for

Metabolic dysfunction-Associated Steatotic Liver Disease

How is MASLD defiend

Excess alcohol intake (>2-3 standard drinks per day)
Hepatitis B or C
Autoimmune hepatitis 
Iron overload 
Drugs or toxins 
>5.5% of fat relative to water within the liver

What NAFLD represent

a spectrum of liver conditions and a excess build up of fat within the liver

What is the key clinical feature of NAFLD

imaging >5.5% of fat relative to water

What can NAFLD lead to

 non-alcoholic steatohepatitis (NASH)
Cirrhosis (permanent scarring)

What are liver fat removal pathways

Beta oxidation (breakdown of fatty acids)

Assembly of VLDL’s that are secreted

What conditions is liver fat linked to

Insulin resistance

Dyslipidaemia

Impaired vascular function

What are some of the established risk factors for NAFLD

Obesity
Insulin Resistance
Dyslipidaemia 
Metabolic Syndrome 

What are some of the emerging risk factors for NAFLD

PCOS
Hypothyroidism 
Obstructive Sleep apnoea
Hypopituitarism 
Hypogonadism 
Pancreatic duodenal resection

What do patients usually present with

• Fatigue

• Pain in upper right quadrant (some)

• Enlarged liver referred to as hepatomegaly (common)

How is NAFLD confirmed

• Ultrasound

• Biopsy – gold standard

• Magnetic resonance imaging/spectroscopy (MRI/MRS)

• Serum biomarkers

What baseline measures should be obtained

• Cardiorespiratory fitness

• Functional capacity 

• Exercise Capacity

What are some special considerations for those with NAFLD

• Low work capacity – due to excess body weight

• Orthopaedic limitations – OA, previous injuries

• Risk for CV disease-related events – myocardial ischemia

• Medications – understanding effects on exercise

How does exercise affect fatty liver disease

• Improved peripheral insulin resistance

• Reduces glucose lipogenesis 

• Increases fatty acid oxidation
  reduces fatty acid synthesis

What is the goal of exercise management

Prevention of cardiometabolic related morbidity and mortality

Resolution of NAFLD/prevention of NAFLD progression

What is the recommended amount of physical activity

recommend at least 150 minutes per week of moderate OR 75 minutes per week of vigorous-intensity PA with the addition of resistance training 

What is the recommended prescription for reduction of hepatic steatosis: aerobic

F: 3-5 days per week
I: Moderate to vigorous
T: 135, progress to 150-240 per week
T: Walking, jogging, cycling 
or 
F: 3-5 days per week 
I: moderate to vigorous
T: 1-5 intervals for 2-4 minutes, with 2-3 min of recovery 
T: HIIT

What is the recommended prescription for reduction of central adiposity: aerobic

F: 3-5 days per week
I: Moderate to vigorous
T: 150-240 minutes per week
T: brisk walking, cycling, jogging

What is the recommended prescription for improvement in cardiorespiratory fitness: aerobic

F: 3-5 days per week
I: Moderate to vigorous
T: 135 minutes per week
T: brisk walking, cycling, jogging

What is the recommended prescription for weight loss: aerobic

F: 3-5 days per week
I: Moderate to vigorous
T: 150 - 240 minutes per week
T: brisk walking, cycling, jogging

What are the benefits of resistance training for liver disease

Shown to modestly decrease liver fat in NAFLD
Increase whole body fat burning capacity
Greater post-exercise fat oxidation.
Energy expenditure has been found to be elevated for up to 48 hours after

What are the recommended guidelines for resistance training

F: 2-3 non consecutive days per week
I: 70-84%1RM
T: 8-12 exercise, 2-4 sets, 8-10 reps
T: Machine, circuit, resistance bands, body weight exercises

What are the benefits of PA for those with end stage liver disease

VO2 is improved by PA 
Reduce the risk of hepatic encephalopathy through increase in skeletal muscle mass
Low-intensity activity safe

What is the key treatment goal for those with end stage liver disease

maintaining functional status and improving QOL

How are you able to support behviour change in those with NAFLD

Goal setting 

Self-monitoring of outcomes and/or behaviours 

Repeated contact with healthcare professionals