Science-Backed Health Benefits of Exercise for Non-Alcoholic Fatty Liver Disease (NAFLD)

April 24, 2022

by Cathe Friedrich

Non-alcoholic fatty liver disease (NAFLD) is a condition in which fat builds up in the liver. Non-alcoholic fatty liver disease (NAFLD) has been compared to a tsunami by some experts. In fact, it’s the most common cause of chronic liver illness in Western countries and is a growing issue globally, especially in developed countries.

As per the American Liver Foundation, NAFLD affects around 25% of people living in the United States, and the number is growing every year. Even if someone with non-alcoholic fatty liver disease does not experience any symptoms, that does not mean their condition is not harmful to health.

What is NAFLD?

NAFLD can progress to non-alcoholic steatohepatitis (NASH) in around 10% of people with NAFLD. At this stage, the liver becomes inflamed. NAFLD can also progress to cirrhosis of the liver — where healthy tissue is replaced by non-functioning scar tissue. This can lead to liver failure, liver cancer, and death. The disease is widespread because it affects people in so many parts of the world.

It is normal to have some fat in your liver. But if more than 5%-10% of the liver’s weight is fat, and it isn’t due to alcohol consumption, it’s called fatty liver or NAFLD. Risk factors for NAFLD include:

Being overweight or obese
Having high cholesterol or high triglycerides
Having type 2 diabetes
Eating a high-fat diet
Having prediabetes (blood sugars above normal but not yet in the diabetic range)

Non-alcoholic fatty liver disease is a spectrum of conditions ranging from simple fatty liver to non-alcoholic steatohepatitis (NASH), which is marked by inflammation of the liver. NASH is the most severe form of NAFLD and can lead to cirrhosis and end-stage liver disease. Once liver scarring has progressed to cirrhosis, a transplant is the only viable treatment option.

NAFLD is sometimes called metabolic liver disease. This term means that NAFLD is often associated with other metabolic diseases, such as metabolic syndrome and type 2 diabetes. Therefore, lifestyle habits that lower the risk of type 2 diabetes are also beneficial for non-alcoholic fatty liver. Beyond diet and exercise, getting enough sleep and managing stress matters for metabolic health.

Why Exercise Is Good Medicine for NAFLD

Most doctors will tell you, if you have NAFLD, to lose weight and be more physically active. Good advice! If you have non-alcohol fatty liver disease, it’s time to start moving. NAFLD is a health condition that responds to lifestyle, as there are few medications for treating NAFLD that have a significant impact on liver fat build-up. Let’s look at ways exercise is the best non-pharmacologic treatment.

Exercise Reduces Insulin Resistance

Obesity and insulin resistance are two driving forces behind NAFLD, as both increase fat stores in the liver and contribute to the burden of NAFLD. Exercise burns calories and helps with weight loss and weight control, which can benefit NAFLD. Plus, exercise boosts insulin sensitivity and helps counter the insulin resistance problem. So, exercise can lower the liver’s fat burden. How does it do that? Research shows working out increases fatty breakdown in the liver and curbs damage to liver cells and the energy-producing mitochondria inside.

Of course, you should also combine exercise with a healthy diet of whole foods that’s low in sugar and refined carbohydrates. A review of studies found that exercise improves NAFLD even in the absence of weight loss and even when the amount of exercise was below current exercise guidelines. The extra steps you add into your day and the short workouts you do when you have too little time count!

Exercise May Lower the Risk of Blood Clots Associated with NAFLD

A recent study found that exercise may lower the risk of blood clots in people with NAFLD. People with fatty liver are at higher risk of developing blood clots in the legs that can move to the lungs and be fatal. Exercise may reduce that risk. In a study, people with NAFLD who participated in a 20-week aerobic exercise program had lower levels of a protein called PAI-1 that promotes blood clotting. The participants exercised for 30 minutes five days per week. So, exercise does more than lower liver fat through weight loss. It also reduces the risk of dangerous blood clots related to non-alcoholic fatty liver.

The Bottom Line

The best approach to treating NAFLD and liver disease is a long-term one. Unlike other forms of liver disease, there’s no treatment that can turn around NAFLD without the person also making lifestyle changes, including diet, regular exercise, and stress management. But with the right approach, you may be able to prevent further liver problems and even reverse non-alcoholic fatty liver disease.

The bottom line is that NAFLD is a serious problem and won’t just go away on its own but is responsive to lifestyle changes including weight loss and exercise. The best exercise program for NAFLD is a combination of aerobic exercise and strength training. You’ll get multiple benefits for your liver and your overall health if you’re consistent.

References:

Utzschneider KM, Kahn SE. The Role of Insulin Resistance in Nonalcoholic Fatty Liver Disease. The Journal of Clinical Endocrinology & Metabolism. 2006;91(12):4753-4761. doi:10.1210/jc.2006-0587.
van der Windt DJ, Sud V, Zhang H, Tsung A, Huang H. The Effects of Physical Exercise on Fatty Liver Disease. Gene Expr. 2018 May 18;18(2):89-101. doi: 10.3727/105221617X15124844266408. Epub 2017 Dec 6. PMID: 29212576; PMCID: PMC5954622.
MDLinx.com. “Physical activity reduces clotting risk in patients with nonalcoholic fatty liver disease”
Keating SE, Hackett DA, George J, Johnson NA. Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol. 2012 Jul;57(1):157-66. doi: 10.1016/j.jhep.2012.02.023. Epub 2012 Mar 10. PMID: 22414768.
Xiong Y, Peng Q, Cao C, Xu Z, Zhang B. Effect of Different Exercise Methods on Non-Alcoholic Fatty Liver Disease: A Meta-Analysis and Meta-Regression. International Journal of Environmental Research and Public Health. 2021;18(6):3242. doi:10.3390/ijerph18063242.
NASH Definition & Prevalence. American Liver Foundation. Published July 2, 2021. Accessed March 2, 2022. https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/nonalcoholic-steatohepatitis-information-center/nash-definition-prevalence/#:~:text=NAFLD%20is%20the%20most%20common,NAFLD%20have%20simply%20fatty%20liver.
“Exercise and NAFLD – Fatty Liver Foundation.” https://www.fattyliverfoundation.org/exercise_and_nafld.
Keating SE, Hackett DA, George J, Johnson NA. Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol. 2012 Jul;57(1):157-66. doi: 10.1016/j.jhep.2012.02.023. Epub 2012 Mar 10. PMID: 22414768.
Liver Metabolism and Fatty Liver Program – Penn Medicine, https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/gastroenterology/liver-metabolism-and-fatty-liver-program.