THE TREATMENT OF NON-ALCOHOLIC FATTY LIVER DISEASE THROUGH PHYSIOTHERAPY REHABILITATION

Background

One focus of non-alcoholic fatty liver disease (NAFLD) treatment is physical exercise. Resistance training (ET) has become a viable option for initial physical activity for patients with NAFLD, due to the low cardiorespiratory fitness and sedentary lifestyle found in most of these patients. The physiotherapist, on the other hand, has the competence to rehabilitate individuals who have intercurrent functional kinetic disorders in organs and systems of the human body, generated by genetic alterations, trauma and acquired diseases. Considering that the association between NAFLD and physiotherapeutic rehabilitation is in constant development, clear definitions and more research are needed to help improve the understanding of the subject. Therefore, considering the growing number of individuals affected by NAFLD and the need to provide practical data to help prevent and control this pathology, it was important to carry out a systematic review on the subject, since this could lead to interventions additional and potential therapies in the management of individuals diagnosed with NAFLD.

Objective

To analyze the effect of physiotherapeutic rehabilitation, through resistance training on the clinical markers of individuals diagnosed with NAFLD.

Methods

It is a Systematic Review study with Randomized Clinical Trials (RCTs), formatted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA Statement) and registered in PROSPERO27 Nº CRD4202236638. Searches were carried out in Medline (accessed by PubMed), Lilacs, Embase, Cochrane, and Scielo databases, in addition to manual searches, from January/2011 to December/2022. Studies with individuals who were not diagnosed with NAFLD through imaging or biopsy were excluded. The ROB 2.0(30) tool was used to assess the risk of bias in the eligible studies. A summary guide without meta-analysis (SWiM) was applied for data analysis and outcomes.

Results

A total of six studies were included, totaling 232 adult participants diagnosed with NAFLD. Hepatic fat (GH) showed a significant reduction (p ≤ 0.05) when comparing the beginning and end of the intervention, in the groups that were only submitted to resistance training. Already, the resistance training groups associated with dietary intervention, showed a reduction in GH (11.8%) between the beginning and end of the intervention, as well as a relative reduction of 212.6% (95% CI) of GH, in the same period. The groups that used the resistance training protocol showed improvement in insulin sensitivity and insulin resistance (IR) in the comparison between the initial and final period of the intervention.

Conclusion

The resistance training protocol can play an important role in physical therapy rehabilitation in individuals with NAFLD, as it reduces liver fat and improves insulin sensitivity and resistance in these individuals. Furthermore, it is possible to consider that the practice of resistance training is an easily accepted and consistent option for individuals with NAFLD, even when there is dietary intervention.

Implications

The articles in this systematic review showed heterogeneity in the intervention protocols and in the diagnostic criteria and outcomes of NAFLD, therefore, these points were observed as limiting aspects for this study.