EXPERIENCES AND PERCEPTIONS OF PHYSICAL ACTIVITY AND EXERCISE IN PEOPLE WITH METABOLIC-ASSOCIATED FATTY LIVER DISEASE: A META-ETHNOGRAPHIC REVIEW

Metabolic-associated fatty liver disease (MAFLD) affects one third of adults worldwide (>5 million Australians) with significant health and socioeconomic burden. Physical activity (PA) is an effective component of MAFLD management, with Australian exercise guidelines recently developed. However, <20% of people with MAFLD meet recommended PA targets. We aimed to review published data on the lived experiences and perceptions of PA and exercise in people with MAFLD. A meta-ethnographic synthesis was utilised to systematically review articles published in English relating to the experiences and perceptions of PA/exercise in people with MAFLD. Databases (PubMed, Embase, Web of Science) were searched from inception to November 2023. Two researchers (CD, SK) independently screened titles and extracted data. Data (study-level themes and subthemes) were coded and themed using the validated Noblit and Hare model. Study quality was assessed using the Critical Appraisal Skills Programme checklist. A total of 1538 articles were screened, with seven studies included (n=161 participants across six countries; overall study quality rated ‘high’). Semi-structured interviews and focus groups were the predominant methods. Key findings encompassed barriers to PA/exercise uptake and maintenance including: lack of awareness of MAFLD, which lowered risk perception; lack of information provision regarding the role and importance of PA/exercise for MAFLD management; lack of resources, tailored exercise plans or referrals; multiple comorbidities and symptoms including obesity, musculoskeletal conditions, pain and fatigue; ambivalence of perceived exercise capabilities and low exercise-related self-efficacy; lack of time and competing priorities. Reported enablers of PA/exercise included: accountability to themselves (e.g., habit forming) and to the healthcare professional; social support from family, friends, and healthcare providers; the experience of symptom relief and holistic benefits. This study translated first-hand experiences and perceptions of physical activity and exercise for people with MAFLD, identifying priorities to target for improved uptake and maintenance.