title: Effectiveness of exercise in hepatic fat mobilization in non-alcoholic fatty liver disease: Systematic review.
abstract: OBJECTIVE
  To investigate the efficacy of exercise interventions on hepatic fat mobilization in non-alcoholic fatty liver disease (NAFLD) patients.
  
  
  METHODS
  Ovid-Medline, PubMed, EMBASE and Cochrane database were searched for randomized trials and prospective cohort studies in adults aged ≥ 18 which investigated the effects of at least 8 wk of exercise only or combination with diet on NAFLD from 2010 to 2016. The search terms used to identify articles, in which exercise was clearly described by type, duration, intensity and frequency were: "NASH", "NAFLD", "non-alcoholic steatohepatitis", "non-alcoholic fatty liver disease", "fat", "steatosis", "diet", "exercise", "MR spectroscopy" and "liver biopsy". NAFLD diagnosis, as well as the outcome measures, was confirmed by either hydrogen-magnetic resonance spectroscopy (H-MRS) or biopsy. Trials that included dietary interventions along with exercise were accepted if they met all criteria.
  
  
  RESULTS
  Eight studies met selection criteria (6 with exercise only, 2 with diet and exercise with a total of 433 adult participants). Training interventions ranged between 8 and 48 wk in duration with a prescribed exercise frequency of 3 to 7 d per week, at intensities between 45% and 75% of VO2 peak. The most commonly used imaging modality was H-MRS and one study utilized biopsy. The effect of intervention on fat mobilization was 30.2% in the exercise only group and 49.8% in diet and exercise group. There was no difference between aerobic and resistance exercise intervention, although only one study compared the two interventions. The beneficial effects of exercise on intrahepatic triglyceride (IHTG) were seen even in the absence of significant weight loss. Although combining an exercise program with dietary interventions augmented the reduction in IHTG, as well as improved measures of glucose control and/or insulin sensitivity, exercise only significantly decreased hepatic lipid contents.
  
  
  CONCLUSIONS
  Prescribed exercise in subjects with NAFLD reduces IHTG independent of dietary intervention. Diet and exercise was more effective than exercise alone in reducing IHTG.
authors.affiliation: Pegah Golabi, Patrick Austin, Sophie Afdhal, Lynn Gerber, Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States.
authors.forename: Pegah
authors.initials: P
authors.lastname: Golabi
authors.affiliation: Pegah Golabi, Patrick Austin, Sophie Afdhal, Lynn Gerber, Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States.
authors.forename: Cameron T
authors.initials: CT
authors.lastname: Locklear
authors.affiliation: Pegah Golabi, Patrick Austin, Sophie Afdhal, Lynn Gerber, Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States.
authors.forename: Patrick
authors.initials: P
authors.lastname: Austin
authors.affiliation: Pegah Golabi, Patrick Austin, Sophie Afdhal, Lynn Gerber, Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States.
authors.forename: Sophie
authors.initials: S
authors.lastname: Afdhal
authors.affiliation: Pegah Golabi, Patrick Austin, Sophie Afdhal, Lynn Gerber, Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States.
authors.forename: Melinda
authors.initials: M
authors.lastname: Byrns
authors.affiliation: Pegah Golabi, Patrick Austin, Sophie Afdhal, Lynn Gerber, Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States.
authors.forename: Lynn
authors.initials: L
authors.lastname: Gerber
authors.affiliation: Pegah Golabi, Patrick Austin, Sophie Afdhal, Lynn Gerber, Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D001706:Biopsy; D004035:Diet Therapy; D005081:Exercise Therapy; D006801:Humans; D007333:Insulin Resistance; D050356:Lipid Metabolism; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D009682:Magnetic Resonance Spectroscopy; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D014280:Triglycerides / Q000378:metabolism
chemical_list: D014280:Triglycerides
keywords: Diet; Exercise; Fat mobilization; Lifestyle modification; Non-alcoholic fatty liver disease