Date of Award
2025
Document Type
Thesis
Publisher
Edith Cowan University
Degree Name
Doctor of Philosophy (Integrated)
School
School of Medical and Health Sciences
First Supervisor
Ken Nosaka
Second Supervisor
John Olynyk
Third Supervisor
Oyekoya Ayonrinde
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease globally. Exercise is essential for MASLD management; however, many MASLD patients lack opportunities to exercise and lead active lives. This thesis project: i) evaluated exercise-related barriers and determined patient awareness of exercise's necessity for MASLD management (Study 1); ii) assessed patient attitudes toward exercise and awareness of MASLD through a qualitative analysis of interviews with MASLD patients (Study 2); iii) presented a case study of a 65-year-old female who improved her metabolic health through lifestyle changes, emphasizing exercise and diet (Study 3); and iv) evaluated liver function, metabolic indicators, and health-related quality of life in people with MASLD following an 8-week online, body-weight eccentric exercise intervention.
Study 1: A survey on exercise habits, barriers to adherence, and awareness of exercise's effect on MASLD was sent to eighty-one patients at a hepatology outpatient clinic. Results indicated that 73% did not meet the exercise recommendation of 150 minutes of moderate exercise per week, and 54% were unaware that exercise could help with MASLD. Reported barriers included poor physical and mental well-being (57%), limited time (43%), apathy (31%), and fatigue from exercising (24%). These results point to specific barriers requiring intervention and education and suggest future exercise program settings that account for time limitations, fatigue, and attitudes toward exercise.
Study 2: A thematic analysis of interviews with 18 MASLD patients revealed high awareness of the condition but low awareness of treatment via exercise. Patients expressed a preference for low-intensity, low-accessibility activities like walking, bodyweight, and resistance training. This study highlights the necessity of matching exercise options to patient preferences, ensuring feasibility for long-term adherence.
Study 3: A qualitative single-patient case study assessed obstacles and facilitators to sustained lifestyle changes, demonstrating how holistic, inclusive lifestyle adjustments can impact MASLD. This intervention showed that with adequate instruction and support, the patient could make meaningful changes, reflecting how a customized approach can empower patients to manage symptoms effectively.
Study 4: Sixteen participants were divided into an exercise group (n=9) and a non-exercise control group (n=7). The exercise group completed a supervised, progressive web-based body-weight eccentric exercise program for eight weeks. Participants in the exercise group showed significant improvements in hepatic steatosis severity (13.2±13.8%), waist circumference (4.4±13.5%), hip circumference (2.6±11.1%), and gamma-glutamyl transferase levels (23.9±30.0%). They also demonstrated enhanced (p < 0.05) physical fitness, including improvements in the sit-to-stand test (24.3±33.2%), 3-metre timed up and go test (-15.6±16.4%), 2-minute step test (37.5±20.5%), and single-leg balance test (25.1±37.6%). These findings suggest that home-based, web-delivered eccentric resistance exercises are an effective intervention for improving liver and metabolic health in patients with MASLD.
Overall, the findings from these four studies contribute to a deeper understanding of the barriers, perspectives, and effective interventions for exercise in MASLD patients. The research underscores the need for greater awareness of exercise's role in MASLD management and the importance of addressing patient-specific barriers through tailored interventions. The novel web-based bodyweight eccentric exercise program shows significant potential for improving liver health and physical fitness in this population, addressing key obstacles like time constraints, fatigue, and accessibility. Future interventions should focus on increasing patient education and providing flexible, personalized exercise options to promote long-term adherence and better health outcomes in MASLD management.
DOI
10.25958/cyxn-7226
Access Note
Access to this thesis is embargoed until 24th May 2026
Recommended Citation
Deshpande, K. S. (2025). Barriers, perspectives, and interventions of exercise for patients with metabolic dysfunction-associated steatotic liver disease. Edith Cowan University. https://doi.org/10.25958/cyxn-7226