1Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
2Department of Public Health Sciences, The Pennsylvania State University-College of Medicine, Hershey, Pennsylvania, USA.
3Section of Gastroenterology, Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
4Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
5Department of Family Medicine and Sports Medicine, Kaiser Permanente Medical Center, Fontana, California, USA.
6Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
7Liver Transplant Unit, Queen Elizabeth University Hospitals Birmingham and NIHR Birmingham BRC, Birmingham, UK.
8Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA.
9Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
10Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA.
11Newcastle NIHR Biomedical Research Centre and the Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
12Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
13Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina, USA.
14School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.
15Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
16Liver & Energy Metabolism Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
17Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
18Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Background and aims: We present findings from the inaugural American College of Sports Medicine (ACSM) International Multidisciplinary Roundtable, which was convened to evaluate the evidence for physical activity as a means of preventing or modifying the course of NAFLD.
Approach and results: A scoping review was conducted to map the scientific literature and identify key concepts, research gaps, and evidence available to inform clinical practice, policymaking, and research. The scientific evidence demonstrated regular physical activity is associated with decreased risk of NAFLD development. Low physical activity is associated with a greater risk for disease progression and extrahepatic cancer. During routine health care visits, all patients with NAFLD should be screened for and counseled about physical activity benefits, including reduction in liver fat and improvement in body composition, fitness, and quality of life. While most physical activity benefits occur without clinically significant weight loss, evidence remains limited regarding the association between physical activity and liver fibrosis. At least 150 min/wk of moderate or 75 min/wk of vigorous-intensity physical activity are recommended for all patients with NAFLD. If a formal exercise training program is prescribed, aerobic exercise with the addition of resistance training is preferred.
Conclusions: The panel found consistent and compelling evidence that regular physical activity plays an important role in preventing NAFLD and improving intermediate clinical outcomes. Health care, fitness, and public health professionals are strongly encouraged to disseminate the information in this report. Future research should prioritize determining optimal strategies for promoting physical activity among individuals at risk and in those already diagnosed with NAFLD.