Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital Berne, Berne, Switzerland.
Hepatology, Department of Clinical Research, University of Berne, Berne, Switzerland.
Hepatology. 2016 Mar;63(3):1026-40. doi: 10.1002/hep.28132. Epub 2015 Dec 18.
Regular physical activity beneficially impacts the risk of onset and progression of several chronic diseases. However, research regarding the effects of exercising on chronic liver diseases is relatively recent. Most researchers focused on nonalcoholic fatty liver disease (NAFLD), in which increasing clinical and experimental data indicate that skeletal muscle crosstalking to the adipose tissue and the liver regulates intrahepatic fat storage. In this setting, physical activity is considered to be required in combination with calories restriction to allow an effective decrease of intrahepatic lipid component, and despite that evidence is not conclusive, some studies suggest that vigorous activity might be more beneficial than moderate activity to improve NAFLD/nonalcoholic steatohepatitis. Evidence regarding the effects of exercise on the risk of hepatocellular carcinoma is scarce; some epidemiological studies indicate a lower risk in patients regularly and vigorously exercising. In compensated cirrhosis, exercise acutely increases portal pressure, but in the longer term it has been proved safe and probably beneficial. Decreased aerobic capacity (VO2 ) correlates with mortality in patients with decompensated cirrhosis, who are almost invariably sarcopenic. In these patients, VO2 is improved by physical activity, which might also reduce the risk of hepatic encephalopathy through an increase in skeletal muscle mass. In solid organ transplantation recipients, exercise is able to improve lean mass, muscle strength, and, as a consequence, aerobic capacity. Few data exist in liver transplant recipients, in whom exercise should be an object of future studies given its high potential of providing long-term beneficial effects.
Despite that evidence is far from complete, physical activity should be seen as an important part of the management of patients with liver disease in order to improve their clinical outcome.
定期进行身体活动有益于降低多种慢性疾病的发病和进展风险。然而，关于运动对慢性肝病影响的研究相对较新。大多数研究人员专注于非酒精性脂肪性肝病（NAFLD），越来越多的临床和实验数据表明，骨骼肌与脂肪组织和肝脏的串扰调节肝内脂肪储存。在这种情况下，体力活动被认为与热量限制相结合是必需的，以有效地减少肝内脂质成分，尽管证据尚不确凿，但一些研究表明，剧烈运动比适度运动更有益于改善 NAFLD/非酒精性脂肪性肝炎。关于运动对肝细胞癌风险影响的证据很少；一些流行病学研究表明，经常进行剧烈运动的患者风险较低。在代偿性肝硬化中，运动可急性增加门静脉压力，但从长期来看，运动是安全且可能有益的。有氧能力（VO2）降低与失代偿性肝硬化患者的死亡率相关，这些患者几乎总是存在肌肉减少症。在这些患者中，体力活动可改善 VO2，还可通过增加骨骼肌质量来降低肝性脑病的风险。实体器官移植受者进行运动可改善瘦体重、肌肉力量，进而改善有氧能力。在肝移植受者中，运动的相关数据很少，鉴于运动具有提供长期有益效果的巨大潜力，应将其作为未来研究的对象。
尽管证据还远远不够完善，但应将体力活动视为肝病患者管理的重要组成部分，以改善其临床预后。
