S2373 Barriers and Facilitators of Increased Physical Activity Levels Among Hispanic Patients With MASLD: An Explanatory Sequential Mixed-Methods Study

Introduction: Engaging in sufficient physical activity (PA) – defined as ≥150 minutes of moderate to vigorous PA every week – is vital for managing metabolic-dysfunction associated steatotic liver disease (MASLD). Yet 75% of patients with MASLD have insufficient PA levels, and only 30%-50% follow physicians’ advice to increase PA. This explanatory sequential mixed-method study assessed rates and determinants of increased PA among Hispanic patients receiving standard MASLD care to identify potential behavioral strategies to help patients increase their PA levels. We focused on this population due to their highest MASLD prevalence in the U.S. and limited research addressing their unique needs. Methods: We used descriptive statistics and logistic regression to determine rates and predictors of increased PA levels among a convenience sample of 94 participants with MASLD receiving standard care in Houston, TX who completed baseline and follow-up PA surveys. Among a subset of 27 participants (14 with sufficient and 13 with insufficient PA at follow), we conducted in-depth qualitative interviews and used thematic analysis to assess barriers and facilitators influencing adherence to sufficient PA levels. Results: Over an average follow-up of 24 months, 54% of participants (80% woman, average age 47 years, body mass index 33 kg/m2) increased or maintained sufficient PA levels. Age, gender, body mass index, and baseline medical conditions were not associated with PA changes over time. Analysis of interviews among those who were and were not sufficiently active at follow-up revealed 2 main themes. First, both groups reported multiple PA barriers (e.g., time, pain, stress). However, participants who had sufficient PA levels at follow up described strategies for sustaining intrinsic motivation and problem-solving barriers, whereas motivation and pain persistently hindered those who did not. Second, while both groups experienced emotional social support for PA, those who achieved sufficient PA levels more frequently received tangible and appraisal support. Conclusion: This mixed methods study highlights that intrinsic motivation and effective problem solving are pivotal in achieving and maintaining sufficient PA levels. Notably, tangible social support (e.g. assistance with childcare or accessing exercise equipment) and appraisal support (e.g. PA advice) also facilitate behavior change. Potential clinical strategies to enhance PA levels include motivational interviewing, problem solving training, and addressing social support mechanisms.