Table 3.
Protocols and results of interventional studies measuring non-invasive test outcomes
| Study number | Exercise and control group interventions | Mean change in weight or BMI | Exercise Protocol |
Non-invasive test outcomes |
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|---|---|---|---|---|---|---|---|---|
| Intervention duration (weeks) | Frequency (sessions per week) | Session duration | Intensity | Imaging-based | Serum-based | |||
| 3 | EG: aerobic exercise (n=16) | Weight: | 12 | 3–5 | Initially 21 min, gradually increased to 42 min over 12 weeks + 5–7 min warm-up and cooldown | “Individualized” (40–75% HR reserve) | Transient elastography: | EG: |
| DG: hypocaloric Mediterranean diet (n=15) | EG: –2 kg (P=0.0005) | EG: | FAST: not improved (P=0.08) | |||||
| CG: No intervention (n=14) | DG: –7 kg (P<0.0001) | Steatosis: improved (P=0.003) | FIB-4: not improved (P=0.14) | |||||
| CG: 0 kg (P=0.99) | Fibrosis: improved (P=0.004) | DG: | ||||||
| BMI: | DG: | FAST: improved (P=0.004) | ||||||
| EG: –1.1 kg/m2 (P<0.0001) | Steatosis: improved (P=0.004) | FIB-4: not improved (P=0.23) | ||||||
| DG: –1.9 kg/m2 (P=0.0002) | Fibrosis: improved (P=0.02) | CG: | ||||||
| CG: +0.5 kg/m2 (P=0.14) | CG: | FAST: improved (P=0.04) | ||||||
| Steatosis: not improved (P=0.21) | FIB-4: improved (P=0.03) | |||||||
| Fibrosis: not improved (P=0.22) | ||||||||
| 4 | EG: aerobic exercise (n=16) | EG: –2.1 kg/m2 (P<0.001 within EG, P=0.04 compared to CG) | 12 | 3–5 | Initially 21 min, gradually increased to 42 min over 12 weeks + 5–7 min warm-up and cooldown | “Moderate to vigorous” (40–75% HR reserve) | Transient elastography: | n.r. |
| EG: | ||||||||
| CG: no intervention (n=8) | Steatosis: improved (P=0.006) | |||||||
| CG: exact change n.r. | Fibrosis: improved (P=0.03) | |||||||
| CG: | ||||||||
| Steatosis: not improved (P=0.75) | ||||||||
| Fibrosis: not improved (P=0.08) | ||||||||
| 5 | EG: aerobic exercise (n=19) | EG: –0.55 kg/m2 (P=0.06) | 24 | 2 | Initially 30 min, increased every 8 weeks until maximum of 50 min + 5 min warmup and cooldown | Ranged from ventilatory anaerobic threshold up to 10% below respiratory compensation point | Transient elastography: no significant difference in change in steatosis and fibrosis between EG and CG (P-value n.r.) | n.r. |
| CG: no intervention (n=21) | CG: –0.25 kg/m2 (P=0.34) | |||||||
| 6 | EG: aerobic exercise (n=18) | Weight: | 20 | 5 | 30 min | “Moderate” (HR corresponding to 45–55% VO2 peak) | MRI-PDFF | No difference between EG and CG in change in NFS, FIB-4, APRI, AST/ALT, ADN, or CK-18 |
| EG: –2.5kg | EG: | |||||||
| CG: no intervention (n=10) | CG: +1.5kg (p<0.01 between EG and CG) | Steatosis: improved (P=0.02) | ||||||
| CG: | ||||||||
| BMI: No difference between 2 groups (exact change n.r.) | Steatosis: not improved (P=0.94) | |||||||
| EG vs. CG: | ||||||||
| Difference in change in steatosis: P=0.01 | ||||||||
| 7 | EG: aerobic and resistance exercise (n=12) | Weight: | 12 | 3 | 45–60 min | Aerobic exercise: 16–18 on Borg RPE (very hard) | MRS: | No difference between EG and CG in change in AST/ALT, NFS, ELF, or CK-18 |
| EG: +1 kg (P=0.12) | EG: | |||||||
| CG: no intervention (n=12) | CG: +1 kg (P=0.15) | Resistance exercise: 14–16 on Borg RPE (hard) | Steatosis: improved (P=0.04) | |||||
| BMI: | CG: | |||||||
| EG: 0 kg/m2 (P=0.12) | Steatosis: not improved (P=0.08) | |||||||
| CG: +1 kg/m2 (P=0.18) | EG vs. CG: | |||||||
| Difference in change in steatosis: P=0.02 | ||||||||
BMI, body mass index; EG, exercise group; DG, diet group; CG, control group; kg, kilogram; m, meter; min, minute; HR, heart rate; FAST, Fibroscan-AST score; FIB-4, Fibrosis-4 index; n.r., not reported; MRI-PDFF, magnetic resonance imaging-proton density fat fraction; NFS, NAFLD fibrosis score, APRI, AST-to-platelet ratio; ADN, adiponectin; CK-18, cytokeratin 18; RPE, rating of perceived exertion; MRS, magnetic resonance spectroscopy; ELF, enhanced liver fibrosis test.