Given the lack of pharmacological interventions, exercise remains a critical strategy for managing non-alcoholic fatty liver disease (NAFLD), with its efficacy well-established. Different exercise modalities induce distinct physiological stress profiles, potentially exerting differential effects on NAFLD. As NAFLD is considered a hepatic manifestation of systemic metabolic dysregulation, this study comprehensively compared the therapeutic effects of moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), and resistance training (RT) on NAFLD across multiple metabolic dimensions: liver fat, glucose metabolism, lipid metabolism, and central obesity. Thirty-six adults with NAFLD (age: 51±8 years) were randomized to three 8-week supervised exercise regimens: MICT (3 sessions/week, 60 minutes/session at 60-70% HRmax), HIIT (3 sessions/week, 3 sets/session alternating 4-minute intervals at 85% HRmax and 4-minute recovery at 60% HRmax), or RT (3 sessions/week, 8 exercises at 60% 1RM, 3 sets × 12 repetitions). Liver fat content was measured using MRI-PDFF, insulin resistance was assessed using HOMA-IR, insulin sensitivity was assessed using the QUICKI index, and the degree of central obesity was assessed using waist circumference. After 8 weeks, both MICT (−2.13%; 95% CI, −3.23 to −1.02; p < 0.01) and HIIT (−1.74%; 95% CI, −3.00 to −0.48; p < 0.01) significantly reduced liver fat, with no difference between the two (P = 0.64). MICT also lowered fasting insulin levels (−3.47 μU/mL; 95% CI, −6.22 to −0.72; p = 0.02) and improved insulin sensitivity (QUICKI: +0.01; 95% CI, 0.002–0.02; p = 0.02). Waist circumference decreased in both MICT (−5.46 cm; 95% CI, −8.18 to −2.74; p < 0.01) and RT (−3.25 cm; 95% CI, −6.07 to −0.43; p = 0.02), with MICT showing a greater reduction than HIIT (p = 0.02). HIIT increased HDL cholesterol (+0.118 mmol/L; 95% CI, 0.02–0.22; p = 0.03). MICT was the most effective exercise modality for NAFLD management, achieving simultaneous improvements in hepatic steatosis, insulin resistance, and central obesity. While HIIT reduced liver fat, it exhibited limitations in addressing glucose metabolism and central obesity. RT showed no direct therapeutic effect on NAFLD pathology.
He et al. (Thu,) studied this question.