title: Potential strategies to improve uptake of exercise interventions in non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  The management of non-alcoholic liver disease (NAFLD) concerns lifestyle modification and exercise; however, adherence is poor. Factors such as lack of confidence to exercise, poor understanding of the benefits of exercise, and a fear of falling all influence engagement in physical activity. To increase exercise in NAFLD it is important to understand the barriers to performing it.
  
  
  METHODS
  Three chronic liver disease cohorts were identified from the Newcastle Liver Database: NAFLD (n=230), alcoholic liver disease (ALD, n=110) and primary biliary cirrhosis (PBC, n=97). Assessment tools were completed by all subjects: Outcome Expectation for Exercise Scale (OEES, understanding the benefits of exercise, lower scores indicate greater understanding), Self-Efficacy for Exercise Scale (SEES, confidence to exercise), Falls Efficacy Scale-International (FES-I, higher scores indicate greater fear of falling). Activity was analysed from a functional perspective using the PROMIS-HAQ.
  
  
  RESULTS
  Understanding the benefits of exercise was similar across each group [median OEES scores: NAFLD 2.38 (range 0.0-5.0), ALD 2.25 (0.0-5.0), PBC 2.28 (1.0-5.0), p=0.6]. In NAFLD confidence to exercise was significantly lower [median SEES score 0.0 (0.0-10.0), PBC 4.5 (0.0-10.0), p<0.001]. Fear of falling was similar in NAFLD and PBC, and greatest in ALD [22 (0-64), 22 (3-64), 30 (0-64), p=0.044]. In NAFLD, fear of falling was independently associated with increasing difficulty performing activity.
  
  
  CONCLUSIONS
  NAFLD patients understand the benefits of exercise but lack confidence to perform it. Fear of falling was independently associated with more difficulty performing activity. Fear of falling and confidence are modifiable and potential targets to improve uptake and adherence for exercise intervention.
authors.affiliation: UK NIHR Biomedical Research Centre in Ageing-Liver Theme, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
authors.forename: James
authors.initials: J
authors.lastname: Frith
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Day
authors.forename: Lisa
authors.initials: L
authors.lastname: Robinson
authors.forename: Chris
authors.initials: C
authors.lastname: Elliott
authors.forename: David E J
authors.initials: DE
authors.lastname: Jones
authors.forename: Julia L
authors.initials: JL
authors.lastname: Newton
mesh_terms: D000058:Accidental Falls; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D015444:Exercise / Q000523:psychology*; D005234:Fatty Liver / Q000628:therapy*; D005235:Fatty Liver, Alcoholic; D005239:Fear; D006801:Humans; D008019:Life Style; D008105:Liver Cirrhosis, Biliary; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D020377:Self Efficacy