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The role of physical exercise in treating people with non-alcoholic fatty liver disease

 

Ahmed A. Ibrahim1, 2, Walid Kamal Abdelbasset 2, 3*

1 Department of Physical Therapy, College of Applied Medical Sciences, Hail University, Hail, Saudi Arabia. 2 Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia.3 Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt.

Correspondence: Walid Kamal Abdelbasset, Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia. Email: walidkamal.wr @ gmail.com

ABSTRACT

Objectives: This study aimed to investigate the role of exercise training programs in the prevention and management of non-alcoholic fatty liver disease (NAFLD).Method: the literature review was conducted from January 1, 2020, using the web of science, SCOPUS, and PubMed. Comprehensive exploration was performed with keywords (exercise, NAFLD, liver, and hepatic diseases). Published researches and studies which collected from the exploration were reviewed. Unclear studies were ignored. Results: Many exercise programs were recognized. Most documents confirm a decrease in the fatty liver index, alanine transaminase (ALT), hepatic lipid content, intrahepatic triglyceride (IHTG), improving insulin sensitivity and improving cardiorespiratory fitness. Conclusions: Despite the variations of exercise programs may be adjusted to manage NAFLD, the present review on this issue is restricted in extent. Future studies have to be carried out to strictly clarify which of these changes in daily living may improve obesity-related to NAFLD‎.

Keywords: NAFLD, physical exercise, resistance exercise, aerobic exercise

 

Introduction

 Like all the organs of the body liver can be affected by many sources.[1-3] NAFLD is a group of liver disorders ranging from isolated hepatic steatosis (fatty liver) to progressive nonalcoholic steatohepatitis (NASH), characterized by the occurrence of swollen hepatocytes, and hepatic fibrosis. NAFLD now affects about15–30% of the community, with a high prevalence ofNAFLD in diabetic and obese individuals, 25% contribute to the creation of NASH, in this manner presenting an expanded hazard for dynamic hepatic fibrosis, the essential determinant of liver-related mortality and morbidity for patients with NASH.[4, 5] Diet-and exercise-prompted  weight loss >5% body weight improves NAFLD and reverses hepatic fibrosis and inflammation.[6]

NAFLD practical management guidelines recommended exercise; no specific approach or duration of exercise is otherwise detailed for specialists.[7] The physical activity guidelines for healthy adults recommended the majority of exercise interventions in NAFLD at least 150 min per week of moderate-intensity exercise or 75 min weekly of high-intensity exercise, with resistance training two times per week on non-consecutive days.[8] Therefore, this study aimed to evaluate the evidence of the exercise efficacy in patients with NAFLD and provide guidelines for appropriate physical exercise training to control NAFLD.

Physical Exercise Training for NAFLD Patients

      1. Aerobic Training (see Tables 1 and 2)

Aerobic exercise for NAFLD patients largely depends on the utilization of skeletal muscles for oxygen during aerobic training to produce the energy needed.[9] The primary method for determining the intensity of prescribed exercise is maximum heart rate (Max HR), metabolic equivalent (MET), heart rate reserve (HRR), or maximum oxygen uptake (VO2max). Exercise intensity varies from low to moderate (30–39% of HRR, 57–63% of HRR, 2.0–3.9 METs, and 37–45% of VO2max) moderate (40–59% of HRR, 64–76% of HRR, 4.0–5.9 METs, and 46–63% of VO2max), and vigorous (60–89% of HRR, 77–95% of HRR, 6.0–8.4 METs, and 64–90% of VO2max), exercise modalities include recreational walking, treadmill running, cycle ergometer, cross-training, rowing, and rhythmic exercise.[10]

Aerobic exercises reduce hepatic fat by 3–43% significantly, with various studies showing that weight loss is significantly reduced, however, the frequency, volume, and intensity are still unclear to achieve intrahepatic fat loss. A study by Kistler et al. [11] suggested that high-intensity aerobics, despite its capacity, reduced the level of threat in NAFLD. Whereas, Keating et al. [12] evaluated the effects of exercise intensity and volume on intrahepatic fat, including forty-eight obese participants, different intensities of exercise training did not show significant differences in fatty liver.[13]

Haus et al. evaluated the impact of short-term aerobic exercise, that did not make a significant difference in liver fat levels in NAFLD patients after seven days of high-intensity exercise (treadmill exercise).[14] Thus, a median of 12-week aerobic exercise at high-intensity, 3 sessions per week could be the minimum needed to reduce intrahepatic fat in NAFLD. Additional studies are needed to evaluate the various exercise parameters (mood, frequency, and intensity) present in this plan for liver fat, to identify appropriate NAFLD therapies.

      1. Resistance Training (see Tables 1 and

According to the stated guidelines by the American College of Sports Medicine, this paper is about advanced techniques of resisted exercise for good adults. Exercises include shoulder press, latissimus pulling down, chest press, biceps curling, seated rowing, leg curling, leg extending and leg press, three sets, eighteen to twelve repetitions/set, resting between 1-2 min, for 40-minutes. Exercises performed in a public location in the gyms closest to their house or workplace. Given the patient's ability to achieve ten to twelve repetitions, the load gradually increased by two to ten percent in subsequent exercise.[8]

Hashida et al. [15] showed that twelve weeks of resistance training with the medium efficient program, 3 sets per week, 45 min/set with 3.5 METs improved NAFLD with lower energy consumption. Many randomized and non-randomized control studies explored the impacts of resisted exercise on NAFLD, they used device-based resisted exercise; one resisted device with a weight of the body; one utilized solely the participant’s body weight; and one weighted-belts, the other one identify 1RM; two individuals did not identify the number of prescribed replications, and oneform of prescribed resistance exercise did not identify the prescribed resistance.[10, 16-22]

Also, in a study by Shamsoddini et al.[16], results in patients with NAFLD showed improvement in cardiac metabolic risk factors; they had used resistance training in circuit training but this dose of circuit training, without concomitant weight loss, it was not enough to improve histology in the NAFLD. The exercise protocol was resisted exercise with fixed intensity with 50% of 1RM, 1-5 circuits for 60 minutes per session, 3 sessions per week.

Moreover, Jakovljevic et al. [23] using resistance exercise, 3 per week, 2 to 3 circuits, 45–60 minutes with intensity: 50% up to 70% 1RM, resistance training can improve hemodynamic regulation and autonomic regulation in NAFLD. A study done by Hallsworth et al. [20] applied resistance exercise: circuit training with the frequency of 3 per week, 2 to 3 circuits, 45–60 minutes, intensity of 50% to  70%, 1RM. Resistance training may improve liver lipid and Lipid oxidationwith no effect on body weight, visceral adipose tissue volume, or whole-body fat mass.

      1. Aerobic and Resistance Combination Training (see Tables 1 and 2)

The study by Houghton et al. [24] was conducted in a randomized study in NASH patients, which included twelve weeks of arm cycling for 2 minutes with 1-min rest in between; then tracked by resisted exercise for knee, hip muscles, and chest press, significantly reduced levels of plasma triglyceride and visceral fats in NASH patients, while non-significant changes in inflammatory and circulatory indicators or fibrosis. Exercise training alone without weight control interventions may affect some of the variables, not all factors related to NASH.

Shojaee-Moradie et al. [25] performed a randomized study of twenty-seven NAFLD patients for 16 weeks. This exercise was arm fulfilled whether outdoor or gym-based exercise, tracked by resisted exercise.The intensity was 40–60% of HRR for 20 min; the time was increased to an hour, 4 to 5 times per week for 16 weeks. The results showed an efficient reduction in intrahepatic fat. Combined interventions can provide a new perspective that will create a preceptor training program to target NAFLD patients to gain better outcomes in aerobic or resisted exercises.

      1. Novel Training Regimens (see Tables 1 and 2)

Novel training is an exercise that is neither resistance nor aerobic. Accelerated training and hybrid training are an example of novel training. The common form of acceleration training is whole-body vibration: external equipment generates energy and transmits it to the patient’s body at various frequencies, enhancing the gravitational speeding up of the skeletal muscle through vibration. Oh et al. [26] conducted a twelve-week accelerated exercise program on eighteen NAFLD patients, with significant improvement in hepatic fat and ALT. The program of accelerating exercise consisted of 3 exercises: first a moving session with 4 stretches, with frequency 30 Hz, low amplitude, for 30 seconds and two sets for per exercise; the second power session is applied to the larger muscle group with thirty to thirty-five Hz, low amplitude, for 30 seconds and 2 sets training for per group; and third a massage session with the frequency of 40 Hz, high amplitude, for 60 seconds and two training sessions each. Acceleration training was conducted twice a week. The outcomes showed a reduction in hepatic fat, ALT, and improvement of the quadriceps cross-section area.[26] Established that though existence therapy using physical activity and diet have to be emphasized, exercise therapy could have other beneficial effects for NAFLD patients who are unable to modify their lifestyle.

Kawaguchi et al. [27] studied the effect of twelve weeks on thirty-five NAFLD patients. Participants were divided into hybrid training, performed 10 repetitions 3 seconds extension and flexion of the knee joint, twice a week. The findings showed that hybrid training significantly reduced the grade of hepatic steatosis and ALT level. Cross and speeding up exercise may provide new exercise intervention for patients with NAFLD, who cannot contribute to resisted or aerobic exercise, particularly experiencing physical limitations that could otherwise exclude them from such training.[28-32]

Conclusions and Recommendations

From the available literature, it is evident that exercise intervention has a useful influence on NAFLD. Various regimens of resistance training and novel have been shown to reduce hepatic fat content, liver fat and improve liver function, functional capacity, muscle power, and lifestyle, these data justify current guidelines that recommend an exercise regimen that fits with the patient’s abilities and preferences, to facilitate long-term compliance with a more active lifestyle.[33-38]

The benefits of exercise in NAFLDare well-recognized. Aerobic, resistance, combination, and narrative exercise programs may enhance systemic indicators of hepatic functions and intrahepatic fats in NAFLD patients either mild or advanced cases. Although the favorable type of exercise training is imprecise, no particular exercise training is likely favorable. Eventually, adherence to exercise training for the long-term has to be highlighted, which could be stated by individual preferences for exercise specifications (mood, frequency, duration, and intensity). When considering exercise training, particular thought must be given to be improving cardiorespiratory fitness and improving musculoskeletal strength through progressive resistance training. Therefore, resisted exercise training in NAFLD patients may be more effective than aerobic exercise, but it has a poor effect on cardiorespiratory capacity in those patients, particularly those who cannot endure or contribute to aerobic training.

Funding

None.

Conflict of Interest

The authors declared no competing interests to disclose.

Acknowledgment

This publication was supported by the Deanship of Scientific Research at Prince Sattam bin Abdulaziz University.

Abbreviations

AASLD: American Association for the Study of Liver Diseases

ACSM: According to the American College of Sports Medicine

ALT: Alanine Transaminases

AT: Aerobic Training

CVD: Cardiovascular Diseases

HRR: Heart Rate Reserve

HTG: Hepatic Triglyceride Content

IHCL: Intrahepatocellular Lipid

IHL: Intrahepatic Lipid

IHTG: Intrahepatic Triglyceride

METs: Metabolic Equivalents

MHR: Maximum Heart Rate

NAFLD: Nonalcoholic Fatty Liver Disease

NASH: Nonalcoholic Steatohepatitis

Non-RCT: Non-Randomized Control Trial

RCT: Randomized Control Trial

RM: Repetition Maximum

RPE: Rate of Perceived Exertion

RT: Resisted Training 

TG: Triglycerides

VLDL: Very Low-Density Lipoprotein

VO2 peak/max: Maximal oxygen consumption

WBV: Whole-Body Vibration

 

 

Table 1. Published Exercise Interventions in Nonalcoholic Fatty Liver Disease  RCT randomized control study / NAFLD.

Reference

No of Patients

Exercise Protocol

Main Results

[25]

39

8-week aerobic training (three sessions of 45 minutes per week at 55-75% HRR (heart rate reserve).

Aerobic training was more effective than resistance training in improving blood lipids profile in the elderly with NAFLD and can play a role in the management of this condition.

 

[21]

24

Combination Ex: Exercise at high distances (cycling) and resistance training. ExerciseFrequency: 3 per week. 45–60 minutes /session. Intensity: Cycling at RPE between 16 to 18, RPE resistance exercise at 14 to 16.

The decrease in HTGC, visceral fat and plasma triglyceride levels. No effect of exercise on liver enzyme levels, metabolic parameters, inflammatory markers of circulation (levels of interleukin 6, tumor necrosis factor-α, or C-reactive protein) and fibrosis.

 

[7]

61

High-intensity Aerobic: Exercise frequency: 3 weekly, 3 sets of 3-minute cycling sessions, 2-minute rest(at a lower VO2 Max)Exercise intensity: 80–85% VO2 Max (50% VO2 Max at rest).

Medium-intensity continuous exercise: Exercise frequency: 3 per week, 40 minutes per session. The intensity of exercise: 60–65% VO2 maximum resistance.

 

Improved hepatic fat accumulation. Weight loss or visceral fat. HIAT also appeared to improve hepatic stiffness.

[26]

69

Aerobic Ex: Treadmill, cross-trainer, bike ergometer, Exercise frequency: 3 to eventually 5 per week, 30 to eventually 45 minutes /session. Exercise intensity: 30% to eventually 60% HRR.

Peripheral insulin sensitivity was significantly increased, decreased liver fat, improved peripheral IR, no significant change in hepatic glucose production, and no changein the control group.

 

[22]

27

Combination Ex: Gym or outdoor-based aerobic training and resistance training. Exercise frequency: 4–5 per week, 20 to finally 60 minutes practice intensity: 40–60% HRR.

Increased VLDL clearance may contribute to a significant decrease in liver fat after 16 weeks of exercise. longer duration or higher-intensity exercise interventions may be needed to reduce plasma TG and VLDL production rates.

 

[27]

220

Vigorous-moderate aerobic Ex: Treadmill, exercise frequency: 5 per week, 30 minutes per session. Practice intensity: 65–80% of MHR for 6-months (8–10 METs), 45–55% of MHR for last 6 months (3–6 METs).

Moderate intensity: Exercise modality: Treadmill, exercise frequency: 5 per week, 30 minutes per session. Exercise intensity: 45–55% of MHR for 12 months (3–6 METs).

 

The intense and moderate exercise was equally effective in reducing intrahepatic triglyceride content; this effect appears to be largely mediated by weight loss.

[13]

30

Aerobic Ex: Exercise frequency: 3 per week, 45 minutes per session. Exercise intensity: 60–75% MHR.

Resistance Ex: Circuit training. Exercise frequency: 3 per week, 2 to finally 3 circuits per session, 90 s rest between circuits. Exercise intensity: 50% to eventually 70% of 1RM.

 

RT and AT are equally effective in reducing hepatic fat content and liver enzyme levels in patients with NAFLD. However, aerobic exercise specifically improves NAFLD independent of any change in body weight.

 

[28]

31

Aerobic Ex: Exercise frequency: 3 to finally 5 per week, 30 to finally 45 minutes per session. Exercise intensity: 30% to eventually 60% HRR.

Exercise training, but not conventional care, significantly improved the V̇O2peak. Endothelial dysfunction in the NAFLD cannot be fully explained by excess VAT, but can be reversed by exercise training; this has potential implications for primary prevention of CVD in NAFLD.

 

[15]

82

Resistance Ex: Exercise frequency: 3 per week, 3 sets per 8–12 reps with 1–2 min rest between sets, for a total duration of about 40 min. Exercise intensity: 1% RM unspecified, load gradually increased 2–10% per week.

Three months of RT improved hepatic fat content accompanied byfavorable changes in body composition and ferritin. RT may serve as a complement to NAFLD treatment.

 

[14]

40

Aerobic Ex: Exercise Frequency: 3 per week, 60 minutes per session. Exercise intensity: 60–65% HRR.

Resistance Ex: 3 per week. 3sets per 10reps per exercise with 1 min recovery between sets. Exercise intensity: 70–80% of 1RM.

 

Resistance training and aerobic training were equally effective in reducing hepatic fat content in type 2 diabetic patients with NAFLD in both intervention groups.

[18]

21

Resistance Ex: Exercise Frequency: 3 per week, 1 circuit to finally 5 circuits, 12 to finally 60 minutes session. Exercise intensity: Fixed at 50% of 1RM.

Circuit training is safe and effective for improving cardiac metabolic risk factors in patients with NAFLD, however this dose of circuit training, without concomitant weight loss, was not sufficient to improve histology in NAFLD.

 

[29]

17

Resistance Ex: 3 per week, 2 to finally  3 circuits, 45–60 minutes Exercise intensity: 50% to finally 70% 1RM.

The hemodynamic measures of rest were similar between groups. Resistance exercise therapy seems to improve the autonomic and submaximal exercise hemodynamic regulation in NAFLD.

 

[30]

13

Aerobic Ex: Exercise frequency: 3 to finally 5 per week, 30 to finally, 45 minutes per session. Exercise intensity: 30% to finally 60% of HRR.

Exercise training improves cutaneous microvascular. NO function compared to conventional care strongly supports the role of exercise in preventing CVD in NAFLD.

[31]

33

Aerobic Ex: Exercise frequency: 5 per week, gradual increase to 30–60 minutes per session. Exercise intensity: 45–55% of VO2peak.

Decreased IHTG content (P < 0.05), no change in total body weight or body fat percentage hepatic VLDL-TG secretion rate.

 

[17]

19

Resistance Ex: Exercise Frequency: 3 per week, 2 to finally 3 circuits, 45–60 minutes. Exercise intensity: 50% to finally 70% 1RM.

The relative decrease in liver lipid and Lipid oxidationdoes not effect body weight, visceral adipose tissue volume, or whole-body fat mass.

 

[34]

32

Aerobic Ex: Exercise frequency: 3 per week, 40 minutes per session. Exercise intensity: 80% to 85% of the VO2max with an interval at 50% of the VO2max.

Significant decrease in BMI, IHTG, visceral adipose fat, plasma lipids, HbA1c, HOMA-IR, and improvement in HRQoL.

 

Table 2. Distribution of Exercise Interventions in Nonalcoholic Fatty Liver Disease (non-randomized control study) NAFLD.

Reference

No of Patients

Exercise Protocol

Main Results

[19]

53

Exercise frequency: 3 times a week, 3 sets per 10 push-ups and 3 sets per 10 squats at 1 minute intervals per set over 20–30 minutes. Exercise intensity: N/A.

 

Fat-free mass and muscle mass were significantly increased, whereas hepatic steatosis grade, mean insulin and ferritin levels, and the homeostasis model assessment-estimated insulin resistance index was significantly reduced.

 

[23]

18

Exercise frequency: 2 times a week, 40 minutes per session. Exercise intensity: Movement session with four stretches, at a 30 Hz frequency, amplitude low, for 30 s and two sets per exercise; Strength and power session that uses larger muscle group contraction, at a  30–35 Hz frequency, low amplitude, for 30 s and two sets for each exercise; Massage session at a 40 Hz frequency, high amplitude, for 60 s and two sets for each exercise.

 

Total cholesterol and ALT are reduced. TG and AST have not changed. Improved health-related quality of life.

[32]

     32

Exercise frequency: 3 per week, 2 sets per 10 reps. Exercise intensity: Starting at 1kg less than 3RM, .5kg was added after each week.

 

Significant improvement in hepatic fat, truncal subcutaneous fat, and insulin sensitivity.

[11]

17

Exercise frequency: 60 minutes per day for 7 days in a row. Exercise intensity: 80–85% MHR.

 

HTG reduction.

[10]

90

No specified exercise prescription.

Decreased TG, ALT,   and AST.

 

[33]

13

Exercise frequency: 60 minutes per day for 7 days in a row. Exercise intensity: 80–85% MHR.

Decreased ALT and plasma glucose. AST has not changed. IHL has not changed.

 

[24]

35

Exercise frequency: 2 per week, 10 sets per 10 reciprocal 3-s knee flexion and extension contractions, 1 min rest between sets, 19 min per day. Exercise intensity: Electrical stimulation intensity was set at a level of 20–25 consecutive knee flexions and extensions.

Decreased liver fat and ALT.

Non-RCT: Non-randomized control trial; TG: Triglycerides; HTG: Hepatic triglyceride content; IHTG: Intrahepatic triglyceride content; IHCL: Intrahepatocellular lipid; IHL: Intrahepatic lipid; IHTG: Intrahepatic triglyceride content; HRR: Heart rate reserve; MHR: Maximum Heart Rate; VO2 peak/max: Maximal oxygen consumption; RM: Repetition maximum; RPE: Rate of perceived exertion.

 

 

References

  1. Shams GE, Fouad AE, Naiem N. Nitazoxanide Adverse Effects on Biochemical Markers of Liver & Kidney Injury and Antioxidant Enzymes on Rats. International Journal of Pharmaceutical Research & Allied Sciences. 2018 Oct 1;7(4).
  2. Linawati N.M, Sriwidyani N.P, Nyoman Wande I, Kamasan A, Wiryawan S, Ratnayanti D, Sugiritama W, Wahyuniari I. The combination extract of pare and apples (APa) reduces risk of atherosclerosis through reduction of interleukin 17 and aggregate focus of liver inflammation in high-fat diet mice. Int. J. Pharm. Phytopharm. Res. 2018;8(4):63-69.
  3. Bentayeb Y, Moumen Y, Boulahbal S, Chentouh S. The Protective Role of the Date Palm Pollen (Phoenix Dactilyfera) on Liver and Haematological Changes Induced by the Diethyl Phthalate. World Journal of Environmental Biosciences. 2018;7(4):90-4.
  4. Bellentani S, Scaglioni F, Marino M, Bedogni G. Epidemiology of non-alcoholic fatty liver disease. Digestive diseases. 2010;28(1):155-61.
  5. Heidari Z, Gharebaghi A. Prevalence of non alcoholic fatty liver disease and its association with diabetic nephropathy in patients with type 2 diabetes mellitus. Journal of clinical and diagnostic research: JCDR. 2017 May;11(5):OC04.
  6. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, Friedman SL, Diago M, Romero-Gomez M. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015 Aug 1;149(2):367-78.
  7. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ. The diagnosis and management of nonalcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012 Jun;55(6):2005-23.
  8. Medicine, A.C.o.S., American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and science in sports and exercise, 2009. 41(3): p. 687.
  9. Patel H, Alkhawam H, Madanieh R, Shah N, Kosmas CE, Vittorio TJ. Aerobic vs anaerobic exercise training effects on the cardiovascular system. World journal of cardiology. 2017 Feb 26;9(2):134.
  10. Oh S, So R, Shida T, Matsuo T, Kim B, Akiyama K, Isobe T, Okamoto Y, Tanaka K, Shoda J. High-intensity aerobic exercise improves both hepatic fat content and stiffness in sedentary obese men with nonalcoholic fatty liver disease. Scientific reports. 2017 Feb 22;7:43029.
  11. Kistler KD, Brunt EM, Clark JM, Diehl AM, Sallis JF, Schwimmer JB, NASH CRN Research Group. Physical activity recommendations, exercise intensity, and histological severity of nonalcoholic fatty liver disease. The American journal of gastroenterology. 2011 Mar;106(3):460.
  12. Keating SE, Hackett DA, Parker HM, O’Connor HT, Gerofi JA, Sainsbury A, Baker MK, Chuter VH, Caterson ID, George J, Johnson NA. Effect of aerobic exercise training dose on liver fat and visceral adiposity. Journal of hepatology. 2015 Jul 1;63(1):174-82.
  13. Khaoshbaten M, Gholami N, Sokhtehzari S, Monazami AH, Nejad MR. The effect of an aerobic exercise on serum level of liver enzymes and liver echogenicity in patients with non alcoholic fatty liver disease. Gastroenterology and hepatology from bed to bench. 2013;6(Suppl 1):S112.
  14. Haus JM, Solomon TP, Kelly KR, Fealy CE, Kullman EL, Scelsi AR, Lu L, Pagadala MR, McCullough AJ, Flask CA, Kirwan JP. Improved hepatic lipid composition following short-term exercise in nonalcoholic fatty liver disease. The Journal of Clinical Endocrinology & Metabolism. 2013 Jul 1;98(7):E1181-8.
  15. Hashida R, Kawaguchi T, Bekki M, Omoto M, Matsuse H, Nago T, Takano Y, Ueno T, Koga H, George J, Shiba N. Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: A systematic review. Journal of hepatology. 2017 Jan 1;66(1):142-52.
  16. Shamsoddini A, Sobhani V, Chehreh ME, Alavian SM, Zaree A. Effect of aerobic and resistance exercise training on liver enzymes and hepatic fat in Iranian men with nonalcoholic fatty liver disease. Hepatitis monthly. 2015 Oct;15(10).
  17. Bacchi E, Negri C, Targher G, Faccioli N, Lanza M, Zoppini G, Zanolin E, Schena F, Bonora E, Moghetti P. 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 Oct 1;58(4):1287-95.
  18. Zelber-Sagi S, Buch A, Yeshua H, Vaisman N, Webb M, Harari G, Kis O, Fliss-Isakov N, Izkhakov E, Halpern Z, Santo E. Effect of resistance training on non-alcoholic fatty-liver disease a randomized-clinical trial. World journal of gastroenterology: WJG. 2014 Apr 21;20(15):4382.
  19. Jakovljevic DG, Hallsworth K, Zalewski P, Thoma C, Klawe JJ, Day CP, Newton J, Trenell MI. Resistance exercise improves autonomic regulation at rest and haemodynamic response to exercise in non-alcoholic fatty liver disease. Clinical Science. 2013 Aug 1;125(3):143-9.
  20. Hallsworth K, Fattakhova G, Hollingsworth KG, Thoma C, Moore S, Taylor R, Day CP, Trenell MI. Resistance exercise reduces liver fat and its mediators in non-alcoholic fatty liver disease independent of weight loss. Gut. 2011 Sep 1;60(9):1278-83.
  21. Hickman IJ, Byrne NM, Croci I, Chachay VS, Clouston AD, Hills AP, Bugianesi E, Whitehead JP, Gastaldelli A, O'Moore-Sullivan TM, Prins JB. A pilot randomised study of the metabolic and histological effects of exercise in non-alcoholic steatohepatitis. Journal of diabetes and Metabolism. 2013 Oct 17;4(8).
  22. Takahashi A, Abe K, Usami K, Imaizumi H, Hayashi M, Okai K, Kanno Y, Tanji N, Watanabe H, Ohira H. Simple resistance exercise helps patients with non-alcoholic fatty liver disease. International journal of sports medicine. 2015 Oct;94(10):848-52.
  23. Jakovljevic DG, Hallsworth K, Zalewski P, Thoma C, Klawe JJ, Day CP, Newton J, Trenell MI. Resistance exercise improves autonomic regulation at rest and haemodynamic response to exercise in non-alcoholic fatty liver disease. Clinical Science. 2013 Aug 1;125(3):143-9.
  24. Houghton D, Thoma C, Hallsworth K, Cassidy S, Hardy T, Burt AD, Tiniakos D, Hollingsworth KG, Taylor R, Day CP, McPherson S. Exercise reduces liver lipids and visceral adiposity in patients with nonalcoholic steatohepatitis in a randomized controlled trial. Clinical Gastroenterology and Hepatology. 2017 Jan 1;15(1):96-102.
  25. Shojaee-Moradie F, Cuthbertson DJ, Barrett M, Jackson NC, Herring R, Thomas EL, Bell J, Kemp GJ, Wright J, Umpleby AM. Exercise training reduces liver fat and increases rates of VLDL clearance but not VLDL production in NAFLD. The Journal of Clinical Endocrinology & Metabolism. 2016 Nov 1;101(11):4219-28.
  26. Oh S, Shida T, Sawai A, Maruyama T, Eguchi K, Isobe T, Okamoto Y, Someya N, Tanaka K, Arai E, Tozawa A. Acceleration training for managing nonalcoholic fatty liver disease: a pilot study. Therapeutics and clinical risk management. 2014;10:925.
  27. Kawaguchi T, Shiba N, Maeda T, Matsugaki T, Takano Y, Itou M, Sakata M, Taniguchi E, Nagata K, Sata M. Hybrid training of voluntary and electrical muscle contractions reduces steatosis, insulin resistance, and IL-6 levels in patients with NAFLD: a pilot study. Journal of gastroenterology. 2011 Jun 1;46(6):746-57.
  28. Ghamarchehreh ME, Shamsoddini A, Alavian SM. Investigating the impact of eight weeks of aerobic and resistance training on blood lipid profile in elderly with non-alcoholic fatty liver disease: a randomized clinical trial. Gastroenterology and hepatology from bed to bench. 2019;12(3):190.
  29. Cuthbertson DJ, Shojaee-Moradie F, Sprung VS, Jones H, Pugh CJ, Richardson P, Kemp GJ, Barrett M, Jackson NC, Thomas EL, Bell JD. Dissociation between exercise-induced reduction in liver fat and changes in hepatic and peripheral glucose homoeostasis in obese patients with non-alcoholic fatty liver disease. Clinical science. 2016 Jan 1;130(2):93-104.
  30. Zhang HJ, He J, Pan LL, Ma ZM, Han CK, Chen CS, Chen Z, Han HW, Chen S, Sun Q, Zhang JF. Effects of moderate and vigorous exercise on nonalcoholic fatty liver disease: a randomized clinical trial. JAMA internal medicine. 2016 Aug 1;176(8):1074-82.
  31. Pugh CJ, Sprung VS, Kemp GJ, Richardson P, Shojaee-Moradie F, Umpleby AM, Green DJ, Cable NT, Jones H, Cuthbertson DJ. Exercise training reverses endothelial dysfunction in nonalcoholic fatty liver disease. American Journal of Physiology-Heart and Circulatory Physiology. 2014 Nov 1;307(9):H1298-306.
  32. Jakovljevic DG, Hallsworth K, Zalewski P, Thoma C, Klawe JJ, Day CP, Newton J, Trenell MI. Resistance exercise improves autonomic regulation at rest and haemodynamic response to exercise in non-alcoholic fatty liver disease. Clinical Science. 2013 Aug 1;125(3):143-9.
  33. Pugh CJ, Cuthbertson DJ, Sprung VS, Kemp GJ, Richardson P, Margot Umpleby A, Green DJ, Timothy Cable N, Jones H. Exercise training improves cutaneous microvascular function in nonalcoholic fatty liver disease. American Journal of Physiology-Endocrinology and Metabolism. 2013 Jul 1;305(1):E50-8.
  34. Sullivan S, Kirk EP, Mittendorfer B, Patterson BW, Klein S. Randomized trial of exercise effect on intrahepatic triglyceride content and lipid kinetics in nonalcoholic fatty liver disease. Hepatology. 2012 Jun;55(6):1738-45.
  35. Damor K, Mittal K, Bhalla AS, Sood R, Pandey RM, Guleria R, Luthra K, Vikram NK. Effect of progressive resistance exercise training on hepatic fat in Asian Indians with non-alcoholic fatty liver disease. Journal of Advances in Medicine and Medical Research. 2014:114-24.
  36. Fealy CE, Haus JM, Solomon TP, Pagadala M, Flask CA, McCullough AJ, Kirwan JP. Short-term exercise reduces markers of hepatocyte apoptosis in nonalcoholic fatty liver disease. Journal of Applied Physiology. 2012 Jul 1;113(1):1-6.
  37. Abdelbasset WK, Tantawy SA, Kamel DM, Alqahtani BA, Soliman GS. A randomized controlled trial on the effectiveness of 8-week high-intensity interval exercise on intrahepatic triglycerides, visceral lipids, and health-related quality of life in diabetic obese patients with nonalcoholic fatty liver disease. Medicine. 2019 Mar;98(12):e14918.
  38. Abdelbasset WK, Tantawy SA, Kamel DM, Alqahtani BA, Elnegamy TE, Soliman GS, Ibrahim AA. 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 Mar;99(10):e19471.


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