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International Journal of
DEVELOPMENT RESEARCH
ISSN: 2230-9926
International Journal of Development Research Vol. 07, Issue, 05, pp.12676-12678, May, 2017
Full Length Research Article AEROBIC EXERCISE: BENEFITS IN NONALCOHOLIC FATTY LIVER DISEASE: MINI REVIEW 1Matheus
Santos de Sousa Fernandes, 1Lucas de Lucena Simões e Silva, 4Gabriela Carvalho Jurema Santos, ²Camilla Araújo de Brito, 2,3Érika Rabelo Forte de Siqueira ¹School of Physical Education, University of Pernambuco, Recife, Pernambuco, Brazil ²Pernambuco Liver Institute, Recife, Pernambuco, Brazil ³Department of Gastroenterology, University of Pernambuco, Pernambuco, Brazil 4Department of Nutrition, University Federal of Pernambuco-UFPE
ARTICLE INFO
ABSTRACT
Article History:
The non-alcoholic fatty liver disease (NAFLD), comprises a wide spectrum of factors that contribute to the development of chronic liver disease.In this spectrum is present to nonalcoholic steatohepatitis (NASH), which includes significant variables in this liver disease chronicity process. So far there is no specific drug therapy for NAFLD .However nonpharmacological tools such as regular physical exercise and dietary changes emerge as the only way feasible to improve NAFLD patient. Some investigations have been made with physical exercise (PE) in different ways, it is still not clear some mechanisms and variables related to the PE, such as intensity, duration, type of exercise and weekly frequency of the practice of PE and how they interact with NAFLD. Therefore this review aims to understand the role of aerobic exercise within the NAFLD.
Received 19th February, 2017 Received in revised form 27th March, 2017 Accepted 04th April, 2017 Published online 18th May, 2017
Key Words: Liver, Exercise and Hepatology.
Copyright©2017, Matheus Santos de Sousa Fernandes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
INTRODUCTION The non-alcoholic fatty liver disease (NAFLD), comprises a wide spectrum of etiological factors that contribute to the development of chronic liver disease (Pellicoro, 2014). In this spectrum is present to nonalcoholic steatohepatitis (NASH), which includes significant variables in this liver disease chronicity process such as lobular inflammation, micro and macro vesicular steatosis, inflammatory response, production of Mallory bodies, disbalance the redox balance with excessive production reactive oxygen species (ROS) and nitrogen (RNS), as well as cirrhosis, liver fibrosis and in some cases hepatocellular carcinoma cell (HCC) (Bataller and Brenner, 2005; Holt et al., 2008). So far there is no specific drug therapy for NAFLD (Duffield, 2005). However nonpharmacological tools such as regular physical exercise and dietary changes emerge as the only way feasible to prevention, treatment and rehabilitation of this disease, can restructure and rebalance the pathophysiological factors affecting these patients with NAFLD (Jarvisen, 2015). Although some investigations have been made with physical exercise (PE) in different ways, it is still not clear some *Corresponding author: Matheus Santos de Sousa Fernandes School of Physical Education, University of Pernambuco, Recife, Pernambuco, Brazil
mechanisms and variables related to the PE, such as intensity, duration, type of exercise and weekly frequency of the practice of PE and how they interact with NAFLD. Therefore this review aims to understand the role of aerobic within the NAFLD. Development of nafld The NAFLD development process is multifactorial, involving genetic, immunologic, metabolic, and connected to the individual's lifestyle, and these have important associations that lead to a decrease in the health condition of the patient (Oliveira et al., 2016). Among the major mediators this insulin resistance, it indicates an inhibition of transporters GLUT-2 e GLUT-4 (glucose transporter 2 and 4) and insulin receptor substrate 1 and 2 (IRS-1 e IRS-2). The metabolic deregulation lipogenic causes excessive production by addition to an imbalance in the rate of storage and lipid oxidation with intrahepatic triglyceride installation (Farell, 2007). This metabolic dysregulation causes excessive lipogenic production, through this, to a decompensation in the storage rate and oxidation of lipid, with installation of intrahepatic triglycerides. This accumulation is accompanied by an oxidative energy deficit, gradually cause the NAFLD (Mehal, 2011 and Gonçalves, 2013). With this way of lipogenic
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signaling free to transcribe and express their factors, there is an immediate immune response through a macrophage signaling pathway and subsequent expression of inflammatory pro cytokines such as interleukin 6, 2 (IL-6 and IL-2) and tumor necrosis factor alfa (TNF-a). This inflammatory process tends to activate major signaling pathways in the production of oxidative stress with ROS production (Brunt em, 1999). Additionally, this process immunomodulatory causes activation of signaling cascades fibrogenesis via deposition of collagen in the extracellular matrix (Oliveira, 2006 and Brunt, 2011). Such elements directly impact the health of patients with NAFLD, leading to more chronic disease conditions, directly impact the health of the patient with NAFLD, causing more chronic conditions of this disease. In addition, lifestyle variables with levels of physical activity and diet also contribute to such phenomena. Physical inactivity causes an increased inflammatory state, and reduces the oxidative capacity of acids free fatty (FFA) and when it is associated with high intake of simple carbohydrates (CHO), high dietary levels of saturated fats and decrease the consumption of acids mono unsaturated fatty and polyunsaturated fats, which contribute to systemic deregulation and installation of pathogenic process of NAFLD (Berzigotti, 2000 and Matsudo, 2000). Aerobic exercise: General features and benefits in the nafld The regular practice of aerobic exercise (AE) is critical to occur a series of morphological and functional benefits in the body, including the improvement in cardiopulmonary fitness, increased activation of mitochondrial activity, improved oxidative rate of lipids, decreased proinflammatory response and ROS production (Benjamin Rodriguez, 2012) Thus benefits occur by promoting capacity multiplication and mitochondrial hypertrophy, which is held by transcription and signaling pathway expression activated by peroxisome proliferator-activated receptor c coactivator 1 (PGC-1a) mainly it affects the increase in adenosine production triphosphate (ATP), generating more energy to fight comorbidities installed by NAFLD (Johnson, 2012). Furthermore, in moderate aerobic exercise is capable of promoting immunomodulatory effects in reducing the production of pro-inflammatory cytokines, acting directly in the cascade mediated by the M1 generation of macrophages (Fallowfield, 2007). These benefits occur through the ability to promote mitochondrial multiplication and hypertrophy, which is carried out by transcription and expression of the peroxisome proliferator-activated receptor-coactivator 1 (PGC-1A) activated signaling pathway, which has an effect on the increase in adenosine production tri phosphate (ATP), generating more energy to combat the comorbidities installed by NAFLD. In addition, at moderate intensity the aerobic exercise is able to promote immunomodulatory effects in the decrease in the production of proinflammatory cytokines, acting directly in the cascade mediated by macrophages of generation M1(Kistler, 2011). In addition, several studies have demonstrated the ability of the aerobic exercise to positively modify body composition patterns, which are represented by the biochemical profile (HDL, LDL), triglycerides, central and peripheral adiposity and body weight, it is believed that the association of these modifications should The magnitude of the lipid metabolism response to the stimuli caused by the
improvement of the lipid oxidation rate generated by the practice of AE (American College Sports Medicine, 2014 and Neuschwander-tetri, 2013). Evangelista et al. (Song, 2012). developed a protocol in ob / ob mice, using training with aerobic exercise with intensity of 60% of the maximum speed achieved with 60 minutes duration and weekly frequency of five days a week, we found in the results positive changes in caloric expenditure and weight loss, demonstrating the ability of exercise to modulate positively lipogenesis through increased mitochondrial activity. Besides, this results in improved ROS production and decreased inflammatory response involved in the development NAFLD. In this case, it is believed that the AE can increase the maximum oxygen volume of these animals, affecting the increase in the oxidative rate, which is beneficial within the metabolic and immunological conditions that the patient has, since there is a decrease in these variables (Evangelista, 2015). This can be attributed to increased gene expression adenosine monophosphate-activated protein kinase (AMPK), which is accomplished by physical exercise in general, this molecular generates a cascade of reactions, resulting in the inhibition of a key complex in intra hepatic lipogenesis. This complex is mainly composed of three proteins: Sterol regulatory elementbinding protein (SREBP), which in turn can modulate other two protein components of lipogenesis intrahepatic the fatty acid synthesis (FAS) and its receptor (FASL) with these elements inhibited the lipolysis system increases, cumulating in the increase in reactions of beta-oxidation and better mitochondrial activity (Rector and thyfault, 2011). Conclusion Regular AE practice associated with diet modifications appears as a fundamental tool in the clinical management of patients with NAFLD in need of an effective treatment, as it still does not have medication that is used to contain the path physiological processes.
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