Experts Say Exercise, Regardless Of Intensity, Can Improve Non-Alcoholic Fatty Liver Disease

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IN PHOTO: People participate in an aerobics class at the gymnasium Reuters/ Juan Carlos Ulate

A new study published by the Journal of Hepatology suggests that low, moderate and high intensity exercises can benefit overweight patients with Non-alcoholic fatty liver disease (NAFLD). NAFLD is part of a metabolic syndrome linked to health diseases, such as obesity and diabetes.

Many lifestyle changes are linked to the improvement of patients with NAFLD, all of which lead to weight loss, which is also said to prevent non-alcoholic steatohepatitis (NASH), the progressive form of NAFLD. Although weight loss has been highly recommended to patients with NAFLD, the exact degree of intensity and level of exercise programs needed have not been determined prior to the study. Literature merely indicates that both aerobic and resistance training exercises can decrease liver and visceral fat and subsequently benefit patients with NAFLD.

In the recent research, the team investigated the effects of several aerobic workouts to obese and overweight patients with sedentary lifestyles, particularly delving into the improvement of liver and visceral fat. The 48 participants were randomly divided into four equal groups, following a placebo-controlled clinical trial (RCT) approach. For eight weeks, the first group was asked to perform low-to-moderate intensity high-volume aerobic exercise (LO:HI); the second, high-intensity, low-volume aerobic exercise (HI:LO); the third, low-to-moderate intensity, low-volume aerobic exercise (LO:LO) and the last group was the placebo (PLA) group. The amount of liver fat of these participants were then assessed using magnetic resonance spectroscopy (MRS).

The findings of the study show that regardless of the intensity of the exercise regimen, all three groups exhibited an average of 18-29 percent improvement in liver fat from an average baseline of 7.5 percent. Conversely, the placebo group showed an average of 14 percent increase in liver fat after the study. Although there were slightly higher liver and visceral fat reduction in the groups that underwent either the high intensity with low volume (HI:LO) or low intensity with high volume (LO:HI) aerobic exercise, the researchers said that there were no significant differences across the study groups.

"The results from our study show that all exercise doses, irrespective of volume or intensity, were efficacious in reducing liver fat and visceral fat by an amount that was clinically significant, in previously inactive, overweight, or obese adults compared with placebo. These changes were observed without clinically significant weight loss," explained lead investigator Dr. Nathan Johnson, PhD, Senior Lecturer at the University of Sydney, Australia. Jacob George, PhD, MBBS, Professor of Hepatic Medicine at the University of Sydney, Australia and Head of the Department of Gastroenterology and Hepatology at Westmead Hospital and University of Sydney also adds that they have not found a difference between the exercise regimens in relation to the benefits in question.

Dr Rohit Loomba, MD, MHSc, of the Division of Gastroenterology and Epidemiology at the University of California, San Diego and Helena Cortez-Pinto, MD, PhD, of the Gastroenterology Service, Hospital de Santa Maria, Lisbon, Portugal further noted in the editorial that she inspected exercise is beneficial to patients and that both types of exercises can produce satisfactory effects, even without weight loss. The researchers then suggest that it is now up to patient on what exercise regimen he/ she wants to perform, as all types produce the same results.

Both Loomba and Cortez-Pinto iterate however that there are no evidence stating that exercise without weight loss can improve NASH. "The individual and joint effect of dose and intensity of exercise and their association with improvement in liver fat and other histologic features that are associated with NASH are key research priorities. In our expert opinion, a more stringent exercise-regimen than the U.S. Department of Health and Human Services recommends, coupled with dietary interventions, may be needed to induce improvement in liver histologic features associated with NASH," they closed.

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