Exercise Training Decreases Alcohol Consumption and Tissue Injury by an FGF21-dependent Mechanism

Inclusion Criteria: * • Adults age 18 years or older, of either sex. * Clinical diagnosis of alcohol use disorder (AUD) / alcohol-related liver disease (ALD). * Meets NIAAA hazardous-drinking criteria: at least 7 drinks/week for women or 14 drinks/week for men for more than 6 months, with ongoing alcohol use within 2 months of evaluation. * MELD score less than 21. * Able to safely participate in exercise testing and endurance exercise. * Able to provide informed consent. * No concurrent renal, cardiac, pulmonary, cerebrovascular, or malignant illness that affects skeletal muscle mass; no diabetes mellitus; and no use of medications that affect skeletal muscle mass/protein turnover as described in the protocol, including anabolic steroids, high-dose corticosteroids, or anticoagulants. Exclusion Criteria: * • Pedal edema above the ankle or grade 2 pedal edema. * Liver transplant. * Active malignancy. * Gastrointestinal bleed within the previous 4 weeks. * Hepatic encephalopathy within the previous 6 months. * Grade 2 or greater active esophageal varices. * Active infection. * Large ascites by clinical and/or imaging criteria. * Advanced cardiac disease (NYHA class 3 or 4) or advanced pulmonary disease (GOLD class 3 or 4). * Use of medications affecting muscle protein turnover, including corticosteroids, or medications used to prevent clotting. * Prior orthopedic surgery or chronic joint pain that, in the opinion of the PI, may inhibit participation. * INR greater than 1.7 or platelet count less than 60,000/mL. * Unable to provide informed consent; judged likely to be unable to perform exercise or unlikely to complete the study in the opinion of the investigators. * End-stage kidney disease defined as eGFR less than 15 mL/min/1.73 m² or dialysis. * Considered unsafe for exercise in the opinion of the PI. * Failure to pass the exercise stress test.