title: Exercise-induced improvements in liver fat and endothelial function are not sustained 12 months following cessation of exercise supervision in nonalcoholic fatty liver disease.
abstract: Supervised exercise reduces liver fat and improves endothelial function, a surrogate of cardiovascular disease (CVD) risk, in nonalcoholic fatty liver disease (NAFLD). We hypothesised that after a 16-week supervised exercise program, patients would maintain longer-term improvements in cardiorespiratory fitness, liver fat and endothelial function. Ten NAFLD patients (5/5 males/females, age 51±13 years, body mass index 31±3 kg m-2(mean±s.d.)) underwent a 16-week supervised moderate-intensity exercise intervention. Biochemical markers, cardiorespiratory fitness (VO2peak), subcutaneous, visceral and liver fat (measured by magnetic resonance imaging and spectroscopy respectively) and brachial artery flow-mediated dilation (FMD) were assessed at baseline, after 16 weeks of supervised training and 12 months after ending supervision. Despite no significant change in body weight, there were significant improvements in VO2peak(6.5 ml kg-1min-1(95% confidence interval 2.8, 10.1); P=0.003), FMD (2.9% (1.5, 4.2); P=0.001), liver transaminases (P<0.05) and liver fat (-10.1% (-20.6, 0.5); P=0.048) immediately after the 16-week supervised training. Nevertheless, 12 months after ending supervision, VO2peak(0.9 ml kg-1min-1(-3.3, 5.1); P=0.65), FMD (-0.07% (-2.3, 2.2); P=0.95), liver transaminases (P>0.05) and liver fat (1.4% (-13.0, 15.9); P=0.83) were not significantly different from baseline. At 12 months following cessation of supervision, exercise-mediated improvements in liver fat and other cardiometabolic variables had reversed with cardiorespiratory fitness at baseline levels. Maintenance of high cardiorespiratory fitness and stability of body weight are critical public health considerations for the treatment of NAFLD (Clinicaltrials.gov identifier: NCT01834300).
authors.affiliation: Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: C J A
authors.initials: CJ
authors.lastname: Pugh
authors.affiliation: Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.|Obesity and Endocrinology Research Group, University Hospital Aintree, Liverpool, UK.
authors.forename: V S
authors.initials: VS
authors.lastname: Sprung
authors.affiliation: Research Institute for Sport & Exercise Science, Liverpool John Moores University, Liverpool, UK.
authors.forename: H
authors.initials: H
authors.lastname: Jones
authors.affiliation: Department of Hepatology, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: P
authors.initials: P
authors.lastname: Richardson
authors.affiliation: Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
authors.forename: F
authors.initials: F
authors.lastname: Shojaee-Moradie
authors.affiliation: Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Umpleby
authors.affiliation: Research Institute for Sport & Exercise Science, Liverpool John Moores University, Liverpool, UK.|School of Sport Science, Exercise & Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Green
authors.affiliation: Research Institute for Sport & Exercise Science, Liverpool John Moores University, Liverpool, UK.|Department of Sports Science, Aspire Academy, Doha, Qatar.
authors.forename: N T
authors.initials: NT
authors.lastname: Cable
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
authors.forename: M I
authors.initials: MI
authors.lastname: Trenell
authors.affiliation: Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.|Magnetic Resonance and Image Analysis Research Centre (MARIARC), University of Liverpool, Liverpool, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Kemp
authors.affiliation: Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.|Obesity and Endocrinology Research Group, University Hospital Aintree, Liverpool, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Cuthbertson
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D001916:Brachial Artery / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D009765:Obesity / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D010349:Patient Compliance; D010865:Pilot Projects; D012008:Recurrence; D016896:Treatment Outcome