Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: a systematic review
Abstract
Background & aims Exercise is a first-line therapy for patients with non-alcoholic fatty liver disease (NAFLD). We sought to: 1) summarize effective aerobic and resistance exercise protocols for NAFLD; and 2) compare the effects and energy consumption of aerobic and resistance exercises.Methods A literature search was performed using PubMed, Web of Science, and Scopas to January 28, 2016. From a total of 95 articles, 23 studies including 24 aerobic and 7 resistance exercise protocols were selected for the summary of exercise protocols. Twelve articles including 13 aerobic and 4 resistance exercise protocols were selected for the comparative analysis.Results For aerobic exercise, the median effective protocol was 4.8 metabolic equivalents (METs) for 40min/session, 3times/week for 12weeks. For resistance exercise, the median effective protocol was 3.5 METs for 45min/session, 3times/week for 12weeks. Aerobic and resistance exercise improved hepatic steatosis. No significant difference was seen in the duration, frequency, or period of exercise between the two exercise groups; however, %VO 2 max and energy consumption were significantly lower in the resistance than in the aerobic group (50% [45-98] vs. 28% [28-28], p=0.0034; 11,064 [6394-21,087] vs. 6470 [4104-12,310] kcal/total period, p=0.0475).Conclusions Resistance exercise improves NAFLD with less energy consumption. Thus, resistance exercise may be more feasible than aerobic exercise for NAFLD patients with poor cardiorespiratory fitness or for those who cannot tolerate or participate in aerobic exercise. These data may indicate a possible link between resistance exercise and lipid metabolism in the liver.Lay summary Both aerobic and resistance exercise reduce hepatic steatosis in non-alcoholic fatty liver disease (NAFLD) with similar frequency, duration, and period of exercise (40-45min/session 3times/week for 12weeks); however, the two forms of exercise have different characteristics. Intensity and energy consumption were significantly lower for resistance than for aerobic exercise. Resistance exercise may be more feasible than aerobic exercise for NAFLD patients with poor cardiorespiratory fitness or for those who cannot tolerate or participate in aerobic exercise.
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Most RCTs of different types of exercise training programmes were effective for steatosis reduction, without a single optimal exercise prescription being identified for individuals with fibrosis.
“Most were effective for steatosis reduction, without a single optimal exercise prescription being identi fi ed for individuals with fi brosis. 315,316”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [316]
Resistance exercise resulted in modest changes in BMI and serum ALT levels.
“Resistance exercise resulted in modest changes in BMI and serum alanine aminotransferase (ALT) levels.”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [64]
In a comprehensive review of clinical trials, Hashida et al. included twenty-four exercise protocols from 18 articles, demonstrating a decrease in hepatic steatosis in 91.7% of the protocols.
“In a comprehensive review of clinical trials, Hashida et al. included twenty-four exercise protocols from 18 articles, demonstrating a decrease in hepatic steatosis in 91.7% of the protocols (64).”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [64]
The optimal duration for resistance exercise to improve hepatic steatosis appears to be 12 weeks.
“The optimal duration for resistance exercise to improve hepatic steatosis appears to be 12 weeks.”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [64]
Resistance exercise may have distinct therapeutic characteristics compared to aerobic exercise in MASLD patients, as it showed modest changes in BMI and demonstrated steatosis improvement independent of body weight reduction.
“Resistance exercise may have distinct therapeutic characteristics compared to aerobic exercise in MASLD patients, as it showed modest changes in BMI and demonstrated steatosis improvement independent of body weight reduction.”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [64]
In Hashida et al., resistance exercise resulted overall beneficial in MASLD.
“In the same work from Hashida et al. (64) resistance exercise resulted overall beneficial in MASLD.”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [64]
Based on seven protocols from seven studies, a reduction in hepatic steatosis was observed in 85.7% of resistance exercise protocols, including five randomized controlled trials.
“Based on seven protocols from seven studies, a reduction in hepatic steatosis was observed in 85.7% of the protocols, including five randomized controlled trials (76–82).”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [64]
Moderate-intensity aerobic exercise for 40 min over 12 weeks was the typical protocol and led to improvements in BMI and serum alanine aminotransferase levels.
“Moderate-intensity aerobic exercise for a duration of 40 min over a 12-week period was the typical protocol. Aerobic exercise led to improvements in BMI and serum alanine aminotransferase levels.”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [64]
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- Authors
- Hashida, R., Kawaguchi, T., Bekki, M., Omoto, M., Matsuse, H., Nago, T., Takano, Y., Ueno, T., Koga, H., George, J., Shiba, N., & Torimura, T.
- Affiliations
- Kurume University (JP)
- Fukuoka International University (JP)
- The University of Sydney (AU)
- Corresponding author
- Kawaguchi, Takumi
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 66
- Issue
- 1
- Pages
- 142-152
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2520428730
- Cited by
- 509
- References
- 65
- Citations by year
- 2026: 50 · 2025: 64 · 2024: 69 · 2023: 72 · 2022: 62 · 2021: 69 · 2020: 53 · 2019: 27 · 2018: 22 · 2017: 18 · 2016: 2
- FWCI
- 3.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- non-alcoholic fatty liver disease, aerobic exercise, resistance training, hepatic steatosis, exercise protocols, energy expenditure, VO2max, exercise intensity, cardiorespiratory fitness, lipid metabolism, exercise feasibility, exercise therapy
- MeSH terms
- Humans, Exercise, Patient Selection, Resistance Training, Non-alcoholic Fatty Liver Disease
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