The role of moderate and high intensity supervised aerobic training in reducing steatosis and hepatic fibrosis in patients with non-alcoholic fatty liver disease; A randomized clinical trial
Gastroenterology and Hepatology from Bed to Bench,
Introduction: Exercise is probably regarded as an appropriate way to prevent and treat Non-Alcoholic Fatty Liver Disease (NAFLD) - the most common chronic liver disease. This study aimed to evaluate the effect of the same volume of moderate and high intensity aerobic exercise on patients' liver status.
Methods: This study was performed as a parallel RCT on 60 patients with NAFLD in 3 groups of 20 people. 40 patients remained in the study after 6 months of follow up. Fibrosis and steatosis of liver including Control Attenuated Parameter (CAP) determined by fibroscan device.
The control group, as a routine management, was advised to adjust their lifestyle and received nutritional recommendations. The intervention groups additionally, participated on supervised exercise programs with two different intestines but the same volume of 1000 KCal per week. The intensities of 50 and 70 percent of V02 reserve were considered for moderate and vigorous programs respectively.
Results: On 6 months’ follow-ups, the mean of CAP scores changes were -20 (P=0.04), -10 (P=0.001), and -15 (P=0.002) within control, moderate, and high intensity groups, respectively. In the intervention groups, in addition to steatosis, this difference was also observed in the rate of fibrosis. The means of fibrosis changes were 0 (P=0.85), -0.5 (P=0.05), and -0.7 (<0.0001) within control, moderate, and high intensity groups, respectively. No significant differences between groups could be detected in steatosis, fibrosis, anthropometric, and laboratory findings were found.
The data yielded by the present study appear to suggest that independent of intensity, aerobic exercise can improve the course of fibrosis and steatosis in NAFLD patients.
- aerobic training
- hepatic fibrosis
- non-alcoholic fatty liver disease
How to Cite
2. Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nature reviews Gastroenterology & hepatology. 2018;15(1):11-20.
3. De Minicis S, Day C, Svegliati-Baroni G. From NAFLD to NASH and HCC: pathogenetic mechanisms and therapeutic insights. Current pharmaceutical design. 2013;19(29):5239-49.
4. Leoni S, Tovoli F, Napoli L, Serio I, Ferri S, Bolondi L. Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis. World journal of gastroenterology. 2018;24(30):3361.
5. Westfall E, Jeske R, Bader AR. Nonalcoholic Fatty Liver Disease: Common Questions and Answers on Diagnosis and Management. American family physician. 2020;102(10):603-12.
6. Dong F, Zhang Y, Huang Y, Wang Y, Zhang G, Hu X, et al. Long-term lifestyle interventions in middle-aged and elderly men with nonalcoholic fatty liver disease: a randomized controlled trial. Scientific reports. 2016;6(1):1-8.
7. van der Windt DJ, Sud V, Zhang H, Tsung A, Huang H. The effects of physical exercise on fatty liver disease. Gene expression. 2018;18(2):89.
8. Schwenzer NF, Springer F, Schraml C, Stefan N, Machann J, Schick F. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. Journal of hepatology. 2009;51(3):433-45.
9. Talwalkar JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM. Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis. Clinical gastroenterology and hepatology. 2007;5(10):1214-20.
10. Malekzadeh R, Poustchi H. Fibroscan for assessing liver fibrosis: an acceptable alternative for liver biopsy: Fibroscan: an acceptable alternative for liver biopsy. Hepatitis monthly. 2011;11(3):157.
11. Ferraioli G, Tinelli C, De Silvestri A, Lissandrin R, Above E, Dellafiore C, et al. The clinical value of controlled attenuation parameter for the noninvasive assessment of liver steatosis. Liver International. 2016;36(12):1860-6.
12. Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clinical gastroenterology and hepatology. 2009;7(10):1104-12.
13. Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317-25.
14. Medicine ACoS. ACSM's guidelines for exercise testing and prescription: Lippincott Williams & Wilkins; 2013.
15. Abdelbasset WK, Tantawy SA, Kamel DM, Alqahtani BA, Elnegamy TE, Soliman GS, et al. Effects of high-intensity interval and moderate-intensity continuous aerobic exercise on diabetic obese patients with nonalcoholic fatty liver disease: A comparative randomized controlled trial. Medicine. 2020;99(10):e19471.
16. Hallsworth K, Fattakhova G, Hollingsworth KG, Thoma C, Moore S, Taylor R, et al. Resistance exercise reduces liver fat and its mediators in non-alcoholic fatty liver disease independent of weight loss. Gut. 2011;60(9):1278-83.
17. Golabi P, Locklear CT, Austin P, Afdhal S, Byrns M, Gerber L, et al. Effectiveness of exercise in hepatic fat mobilization in non-alcoholic fatty liver disease: Systematic review. World journal of gastroenterology. 2016;22(27):6318.
18. Eckard C, Cole R, Lockwood J, Torres DM, Williams CD, Shaw JC, et al. Prospective histopathologic evaluation of lifestyle modification in nonalcoholic fatty liver disease: a randomized trial. Therapeutic advances in gastroenterology. 2013;6(4):249-59.
19. Bacchi E, Negri C, Targher G, Faccioli N, Lanza M, Zoppini G, et al. Both resistance training and aerobic training reduce hepatic fat content in type 2 diabetic subjects with nonalcoholic fatty liver disease (the RAED2 Randomized Trial). Hepatology. 2013;58(4):1287-95.
20. Sumida Y, Nakajima A, Itoh Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World journal of gastroenterology: WJG. 2014;20(2):475.
21. Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR, et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51(1):121-9.
22. Keating SE, Hackett DA, Parker HM, Way KL, O'Connor HT, Sainsbury A, et al. Effect of resistance training on liver fat and visceral adiposity in adults with obesity: A randomized controlled trial. Hepatology Research. 2017;47(7):622-31.
23. Keating SE, Hackett DA, Parker HM, O’Connor HT, Gerofi JA, Sainsbury A, et al. Effect of aerobic exercise training dose on liver fat and visceral adiposity. Journal of hepatology. 2015;63(1):174-82.
24. Jin YJ, Kim KM, Hwang S, Lee SG, Ha TY, Song GW, et al. Exercise and diet modification in non‐obese non‐alcoholic fatty liver disease: analysis of biopsies of living liver donors. Journal of gastroenterology and hepatology. 2012;27(8):1341-7.
25. Saldiran TÇ, Mutluay FK, Yağci İ, Yilmaz Y, editors. Impact of aerobic training with and without whole-body vibration training on metabolic features and quality of life in non-alcoholic fatty liver disease patients. Annales d'Endocrinologie; 2020: Elsevier.
26. Slentz CA, Tanner CJ, Bateman LA, Durheim MT, Huffman KM, Houmard JA, et al. Effects of exercise training intensity on pancreatic β-cell function. Diabetes care. 2009;32(10):1807-11.
27. Houmard JA, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Kraus WE. Effect of the volume and intensity of exercise training on insulin sensitivity. Journal of applied physiology. 2004;96(1):101-6.
- Abstract Viewed: 0 times