Modified high-intensity interval training reduces liver fat and improves cardiac function in non-alcoholic fatty liver disease: a randomized controlled trial

Abstract

Although lifestyle changes encompassing weight loss and exercise remain the cornerstone of non-alcoholic fatty liver disease (NAFLD) management, the effect of different types of exercise on NAFLD is unknown. This study defines the effect of modified high-intensity interval training (HIIT) on liver fat, cardiac function and metabolic control in adults with NAFLD. Twenty-three patients with NAFLD [age 54±10 years, body mass index (BMI) 31±4 kg/m(2), intra-hepatic lipid >5%) were assigned to either 12 weeks HIIT or standard care (controls). HIIT involved thrice weekly cycle ergometry for 30-40 min. MRI and spectroscopy were used to assess liver fat, abdominal fat and cardiac structure/function/energetics. Glucose control was assessed by oral glucose tolerance test and body composition by air displacement plethysmography. Relative to control, HIIT decreased liver fat (11±5% to 8±2% compared with 10±4% to 10±4% P=0.019), whole-body fat mass (35±7 kg to 33±8 kg compared with 31±9 kg to 32±9 kg, P=0.013), alanine (52±29 units/l to 42±20 units/l compared with 47±22 units/l to 51±24 units/l, P=0.016) and aspartate aminotransferase (AST; 36±18 units/l to 33±15 units/l compared with 31±8 units/l to 35±8 units/l, P=0.017) and increased early diastolic filling rate (244±84 ml/s to 302±107 ml/s compared with 255±82 ml/s to 251±82 ml/s, P=0.018). There were no between groups differences in glucose control. Modified HIIT reduces liver fat and improves body composition alongside benefits to cardiac function in patients with NAFLD and should be considered as part of the broader treatment regimen by clinical care teams. ISRCTN trial ID: ISRCTN78698481.

Web-Based Exercise as an Effective Complementary Treatment for Patients With Nonalcoholic Fatty Liver Disease: Intervention Study (Preprint)

“…In the short intervention period of eight weeks, the results of this study are comparable to those of face to face interventions [34,60,61,64,67,68], with respect to changes in body composition and VO 2peak . Takahashi (2015) already assessed the efficiency and safety of two simple resistance exercises in 53 patients with NAFLD [64].…”

“…Nevertheless, exercise studies show, irrespective of nutrition, promising results in terms of decreased insulin and homeostasis model assessment index (HOMA-IR) [60,64], improved cardiorespiratory fitness, [59,65] reduced hepatic and visceral lipids [60,66], reduced liver enzymes and modulated liver fat [34]. Exercise combined with an adjusted diet shows strong interaction effects in relation to weight change, but exercise has also independent modes of action.…”

“…Selfchosen sitting times should be reduced and barriers for regular exercise should be identified and eliminated [78]. Intensive exercise interventions, carried out under supervision in hospitals or fitness centers, [32,34,65,67] impose an unnatural lifestyle on the patients for a short period of time. After the intervention, patients very quickly lose motivation and fall back into their old habits [45].…”

“…In our study a combination of the heart rate, as objective measure and the Borg 383 value [69] as subjective measure were used for the determination of the intensity. Borg values are considered as an appropriate measure for monitoring and regulating exercise intensity [34,70,71]. To clarify whether the intensity or the volume is more effective, Keating (2015) aimed to determine the more important training parameter in inactive overweight adults [61].…”

Amelioration of liver function and glucose control with pioglitazone in a patient with diabetes mellitus type 2 and nonalcoholic fatty liver disease

“…There are no registered medications for causal treatment of NAFLD at the moment. The most important therapeutic recommendation is behavioral intervention, which involves the proper diet and regular physical activity, both of which are beneficial for people with NAFLD and have a positive impact on cardiovascular risk factors [15,16]. Furthermore, it should be remembered that patients with NAFLD, diabetes and dyslipidaemia are high cardiovascular risk patients and statin treatment should be considered for them.…”