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Review
. 2021 Apr 13;10(8):1659.
doi: 10.3390/jcm10081659.

Evidence-Based Aerobic Exercise Training in Metabolic-Associated Fatty Liver Disease: Systematic Review with Meta-Analysis

Joanna Słomko  1 , Marta Zalewska  2 , Wojciech Niemiro  3   4 , Sławomir Kujawski  1 , Maciej Słupski  5 , Beata Januszko-Giergielewicz  5 , Monika Zawadka-Kunikowska  1 , Julia Newton  6 , Lynette Hodges  7 , Jacek Kubica  8 , Paweł Zalewski  1
Affiliations
Review

Evidence-Based Aerobic Exercise Training in Metabolic-Associated Fatty Liver Disease: Systematic Review with Meta-Analysis

Joanna Słomko et al. J Clin Med. .

Abstract

Background: This meta-analysis evaluates the overall effect of the non-pharmacological intervention, aerobic exercise, upon serum liver enzymes levels, glucose metabolism and anthropometric measures amongst patients with metabolic associated fatty liver disease (MAFLD). It also examines whether the effects on these outcomes are moderated by the aerobic training protocol when considered according to the American College of Sports Medicine (ACSM) recommended FITT (frequency, intensity, time, type) principles. Approach and Results: Fifteen randomized control trials were included in the meta-analysis. Compared with usual care, continuous and interval training showed significant efficacy in alanine aminotransferase (ALT) level improvement (MD = -2.4, 95% CI: -4.34 to -0.46 p = 0.015, I2 = 9.1%). Interventions based on all types of aerobic exercise protocols showed significant improvement of intrahepatic triglycerides (MD = -4.0557, 95% CI: -5.3711 to -2.7403, p < 0.0001, I2 = 0%) and BMI (MD = -0.9774, 95% CI: -1.4086 to -0.5462, p < 0.0001, I2 = 0). Meta-regression analysis demonstrated a significant correlation between total intervention time and ALT level (for all aerobic protocols: 6.0056, se = 2.6896, z = 2.2329, p = 0.02; as well as for continuous and interval aerobic protocols: 5.5069, se = 2.7315, z = 2.016, p = 0.04).

Conclusions: All types of aerobic exercise protocols are effective at improving intrahepatic triglycerides and lead to a reduction in body mass index. In addition, continuous and interval aerobic exercise may be more effective at improving ALT ≤12 weeks intervention time benefits the management of MAFLD.

Keywords: aerobic activity; exercise; fatty liver; metabolic fatty liver; treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of studies and critical appraisal. (A). Flow chart of the inclusion/exclusion process, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [23]. (B). Quality of the trials and Cochrane risk bias [24].
Figure 2
Figure 2
Details of included aerobic protocols according to FITT principle recommended by ACSM. (a) Frequency: eight protocols 3 d per week, three protocols 3–5 d per week, three protocols 5 d per week and one from each of the following: 4–7 d per week, 4–5 d per week, 2 d per week; (b) Intensity: five protocols light to moderate, 4 protocols interval training, two protocols moderate, two protocols moderate to vigorous, one from each of the following: light to vigorous, very light, vigorous; (c) Time: six protocols 16 weeks, four protocols 24 weeks, two protocols 12 weeks, two protocols 8 weeks, one from each of the following: 6 and 4 weeks; (d) Type: eight protocols treadmill, six protocols cycle ergometer, two protocols treadmill with cycle ergometer and one outdoor training.
Figure 3
Figure 3
(A). Effect of continuous and interval aerobic exercise (left) vs. usual care (right) on ALT levels in patients with MAFLD; ALT, alanine aminotransferase. (B). Effect of exercise (left) vs. control (right) on IHTG levels; IHTG, intrahepatic triglycerides. (C). Effect of exercise (left) vs. control (right) on BMI levels; BMI, body mass index.
Figure 3
Figure 3
(A). Effect of continuous and interval aerobic exercise (left) vs. usual care (right) on ALT levels in patients with MAFLD; ALT, alanine aminotransferase. (B). Effect of exercise (left) vs. control (right) on IHTG levels; IHTG, intrahepatic triglycerides. (C). Effect of exercise (left) vs. control (right) on BMI levels; BMI, body mass index.
See this image and copyright information in PMC

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