Regular exercise is fundamental for people with metabolic dysfunction-associated steatotic liver disease (MASLD), yet exercise maintenance is generally poor. This generative co-design process aimed to embed the voices and opinions of people with lived experience of MASLD and their care stakeholders to (i) frame barriers and enablers to exercise maintenance and (ii) highlight priorities for exercise-focused research agendas in MASLD.
Methods
A generative co-design framework was applied. Two virtual co-design sessions were undertaken: Session 1 – Framing the issue, where initial discovery was conducted with people with lived experience of MASLD; and Session 2 – Generative design and sharing ideas with lived experience partners and healthcare stakeholders. Sessions were audio-recorded and transcribed, and key determinants and considerations were discerned by two independent researchers.
Results
Lived experience partners (n = 5, 53 ± 16 years, 40% male) ranked five equally important barriers to exercise maintenance: musculoskeletal and pain issues, lack of access to exercise equipment/facilities, cost, competing priorities, and low energy levels, which influenced core positive and negative determinants. Alongside lived experience partners, healthcare stakeholders (hepatologists [n = 3], exercise professionals [n = 3], 67% male) identified three core needs with eight considerations. Some disconnects in priorities were observed. Lived experience partners emphasized affordability, accessibility, and considerations for comorbidities, while healthcare partners advocated for research on natural history, prevention, behavior change, cost-effectiveness, and health system change.
Conclusions
The disconnect between research priorities of hepatologists, exercise professionals, and people with MASLD highlights the critical importance of community and consumer involvement throughout all phases of research design and delivery. Key clinical recommendations include: (i) Patient-important outcomes should be assessed and prioritized in research concerning exercise and MASLD management. (ii) The benefits of exercise on patient-important outcomes should be highlighted in exercise conversations. (iii) Exercise research should include standardized non-invasive outcomes of liver histology and appropriately assess and report exercise adherence data to better inform dose-response relationships of exercise on histological outcomes. (iv) Research concerning exercise adherence-building strategies, which may include digital technologies, should be co-designed with lived experience partners. (v) Culturally responsive models of exercise care and point-of-care patient resources need to be defined, evaluated, and implemented across local, national, and global settings. (vi) Training in exercise-related care should be embedded in the curricula and professional development of medical practitioners and clinicians involved in MASLD care.
There is a need to address the priorities of people with MASLD in ongoing research. Exercise and diet intervention studies are well placed for hybrid implementation-effectiveness trials, which have co-primary aims to investigate the effectiveness of type and dose of exercise along with implementation strategies to overcome non-liver barriers such as access, cost, and complex lives with competing priorities. Co-design at each stage of the research lifecycle is vital to advance the awareness and management of MASLD.
Full text
https://www.xiahepublishing.com/2310-8819/JCTH-2025-00155
The study was recently published in the Journal of Clinical and Translational Hepatology .
The Journal of Clinical and Translational Hepatology (JCTH) is owned by the Second Affiliated Hospital of Chongqing Medical University and published by XIA & HE Publishing Inc. JCTH publishes high quality, peer reviewed studies in the translational and clinical human health sciences of liver diseases. JCTH has established high standards for publication of original research, which are characterized by a study's novelty, quality, and ethical conduct in the scientific process as well as in the communication of the research findings. Each issue includes articles by leading authorities on topics in hepatology that are germane to the most current challenges in the field. Special features include reports on the latest advances in drug development and technology that are relevant to liver diseases. Regular features of JCTH also include editorials, correspondences and invited commentaries on rapidly progressing areas in hepatology. All articles published by JCTH, both solicited and unsolicited, must pass our rigorous peer review process.
