Research or Regress
What if you could reverse liver disease?
Liver disease often shows no symptoms until it’s too late. Penn State is using exercise as medicine to stop damage before it becomes deadly.
Erin Boger just wanted to know why her body was breaking out in hives. For more than a year, itchy welts plagued the Cleona, Pennsylvania resident. After multiple tests, her doctor delivered a shocking diagnosis—advanced metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease. It’s a condition where fat builds up in the liver, causing damage over time.
Boger was young—only thirty-six years old—and didn’t have any common symptoms of advanced liver disease. She was devastated but knew she had to do something as her mother had died of the same disease six years earlier. So, when she heard about a clinical trial at the Penn State College of Medicine that could improve liver health, she applied.
The Challenge: Stopping the Progression of Liver Disease
MASLD is the most common chronic liver disease. It affects roughly 40% of residents in Pennsylvania, higher than the national average, according to Jonathan Stine, research director for Penn State Health Liver Center and associate professor at the Penn State College of Medicine. By 2030, an estimated one in two adults are expected to have the condition. MASLD is linked to metabolic conditions like:
Obesity
Type 2 diabetes
High blood pressure
High cholesterol
“This condition is often a ‘silent disease,’ meaning symptoms may not appear until significant liver damage has occurred,” he said. “Most people aren’t aware they have the disease.” Left untreated, the disease can lead to serious complications like liver failure and cancer.
But disease progression isn’t inevitable, especially if you take action early. One of the best things you can do for liver health is exercise. Thanks to years of ongoing research, we know that physical activity can help reduce liver fat, decrease inflammation, and improve cardiovascular health.
How to Improve Liver Health: Exercise
Stine is at the forefront of using therapeutic exercise as a form of “medicine” to improve liver health and prevent chronic liver disease.
“A lot of people don’t want to take medication. Many also say they want to be more active, but only 25% of people meet the minimum recommended guidelines for physical activity,” Stine said. “We need customized programs that fit people’s lifestyles and needs based on frequency, intensity, time, and type of exercise.”
But exactly how much exercise is needed to improve liver health?
That’s the question that Stine set out to answer. He’s trying to see how different levels of exercise influence the build-up of fat in the livers of people like Boger who have advanced MASLD. It’s the first study to compare different doses of therapeutic exercise on liver fat, inflammation, and other markers of liver health.
[Dr. Stine’s work] has given me the tools that I need to change and to get better. I’m very grateful. I want to live, and I don’t want to die young.”
Erin Boger
Penn State is Improving Liver Disease Treatment
Boger enrolled in Stine’s study. She rode a stationary bike for approximately 25 minutes at moderate intensity, four times a week, for just 16 weeks. This consistent exercise conditioning was designed to be effective without being overwhelming. She also met with a nutrition counselor once a month.
“Some days were harder than others, but I didn’t need to push myself and feel pain to see results,” she said. The staff encouraged her every step of the way.
After four months, Boger lost thirty pounds, but more importantly, her liver was healthier. She went from stage three liver fibrosis, or scarring, to stage two. Her liver health has continued to improve with exercise and diet changes. She got a second chance.
“[Dr. Stine’s work] has given me the tools that I need to change and to get better. I’m very grateful,” Boger said. “I want to live, and I don’t want to die young.”
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