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Original Investigation |

Effects of Moderate and Vigorous Exercise on Nonalcoholic Fatty Liver Disease A Randomized Clinical Trial

Hui-Jie Zhang, MD, PhD1,2; Jiang He, MD, PhD2,3; Ling-Ling Pan, MD, PhD3; Zhi-Min Ma, MD, PhD4; Cheng-Kun Han, MD1; Chung-Shiuan Chen, MS2; Zheng Chen, MD1; Hai-Wei Han, MD1; Shi Chen, MD1; Qian Sun, MD1; Jun-Feng Zhang, MD1; Zhi-Bin Li, MD1; Shu-Yu Yang, MD, PhD1; Xue-Jun Li, MD, PhD1; Xiao-Ying Li, MD, PhD1,3,5
[+] Author Affiliations
1Xiamen Diabetes Institute, Department of Endocrinology and Metabolism, First Affiliated Hospital of Xiamen University, Xiamen, China
2Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
3Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrinology and Metabolism, Rui-Jin Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
4Department of Endocrinology, Second Affiliated Hospital of Soochow University, Suzhou, China
5Department of Endocrinology and Metabolism, Zhongshan Hospital of Fudan University, Shanghai, China
JAMA Intern Med. 2016;176(8):1074-1082. doi:10.1001/jamainternmed.2016.3202.
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Importance  Nonalcoholic fatty liver disease (NAFLD) is a prevalent risk factor for chronic liver disease and cardiovascular disease.

Objective  To compare the effects of moderate and vigorous exercise on intrahepatic triglyceride content and metabolic risk factors among patients with NAFLD.

Design, Setting, and Participants  In this randomized clinical trial, participants with central obesity and NAFLD were recruited from community-based screening in Xiamen, China, from December 1, 2011, through December 25, 2013. Data analysis was performed from August 28, 2015, through December 15, 2015.

Interventions  Participants were randomly assigned to vigorous-moderate exercise (jogging 150 minutes per week at 65%-80% of maximum heart rate for 6 months and brisk walking 150 minutes per week at 45%-55% of maximum heart rate for another 6 months), moderate exercise (brisk walking 150 minutes per week for 12 months), or no exercise.

Main Outcomes and Measures  Primary outcome, change in intrahepatic triglyceride content measured by proton magnetic resonance spectroscopy at 6 and 12 months; secondary outcomes, changes in body weight, waist circumference, body fat, and metabolic risk factors.

Results  A total of 220 individuals (mean [SD] age, 53.9 [7.1] years; 149 woman [67.7%]) were randomly assigned to control (n = 74), moderate exercise (n = 73), and vigorous-moderate exercise (n = 73) groups. Of them, 211 (95.9%) completed the 6-month follow-up visit; 208 (94.5%) completed the 12-month follow-up visit. Intrahepatic triglyceride content was reduced by 5.0% (95% CI, −7.2% to 2.8%; P < .001) in the vigorous-moderate exercise group and 4.2% (95% CI, −6.3% to −2.0%; P < .001) in the moderate exercise group compared with the control group at the 6-month assessment. It was reduced by 3.9% (95% CI, −6.0% to −1.7%; P < .001) in the vigorous-moderate exercise group and 3.5% (95% CI, −5.6% to −1.3%; P = .002) in the moderate exercise group compared with the control group at the 12-month assessment. Changes in intrahepatic triglyceride content were not significantly different between vigorous-moderate and moderate exercise at the 6- or 12-month assessment. Body weight, waist circumference, and blood pressure were significantly reduced in the vigorous-moderate exercise group compared with the moderate exercise and control groups at the 6-month assessment and in the vigorous-moderate and moderate exercise groups compared with the control group at the 12-month assessment. In addition, body fat was significantly reduced in the vigorous-moderate exercise group compared with the moderate exercise and control groups at the 12-month assessment. After adjusting for weight loss, the net changes in intrahepatic triglyceride content were diminished and became nonsignificant between the exercise and control groups (except for the moderate exercise group at the 6-month assessment).

Conclusions and Relevance  Vigorous and moderate exercise were equally effective in reducing intrahepatic triglyceride content; the effect appeared to be largely mediated by weight loss.

Trial Registration  clinicaltrials.gov Identifier: NCT01418027

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Figure 1.
Flowchart of Trial Participants

NAFLD indicates nonalcoholic fatty liver disease.

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Figure 2.
Effects of Moderate and Vigorous Exercise on Intrahepatic Triglyceride Content (IHTG)

Numbers in parentheses are 95% CIs.

aP < .005.

bP < .001.

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