Resistance exercise reduces liver fat and its mediators in non-alcoholic fatty liver disease independent of weight loss
Open accessAbstract
BACKGROUND: Lifestyle interventions focusing on weight loss remain the cornerstone of non-alcoholic fatty liver disease (NAFLD) management. Despite this, the weight losses achieved in research trials are not easily replicated in the clinic and there is an urgent need for therapies independent of weight loss. Aerobic exercise is not well sustained and the effectiveness of the better tolerated resistance exercise upon liver lipid and mediators of liver lipid has not been assessed. METHODS: Sedentary adults with clinically defined NAFLD were assigned to 8 weeks of resistance exercise (n=11) or continued normal treatment (n=8). RESULTS: 8 weeks of resistance exercise elicited a 13% relative reduction in liver lipid (14.0 ± 9.1 vs. 12.2 ± 9.0; p<0.05). Lipid oxidation (submaximal RQ -0.020 ± 0.010 vs. -0.004 ± 0.003; p<0.05), glucose control (-12% vs. +12% change AUC; p<0.01) and homeostasis model assessment insulin resistance (5.9 ± 5.9 to 4.6 ± 4.6 vs. 4.7 ± 2.1 to 5.1 ± 2.5; p<0.05) were all improved. Resistance exercise had no effect on body weight, visceral adipose tissue volume, or whole body fat mass (p>0.05). CONCLUSION: This is the first study to demonstrate that resistance exercise specifically improves NAFLD independent of any change in body weight. These data demonstrate that resistance exercise may provide benefit for the management for non-alcoholic fatty liver, and the long-term impact of this now requires evaluation.
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Resistance exercise significantly reduced ALT levels compared with control groups (WMD = -15.40 IU/L, 95% CI -28.60 to -2.20, P < 0.001).
“Resistance exercise showed significant reduction in ALT levels compared with control groups (WMD = − 15.40 IU/L, 95%CI − 28.60 to − 2.20, P < 0.001)”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [80]
The Results section (‘Blood lipids and liver enzymes’) explicitly reports no significant change in ALT in either group. Table 1 shows ALT unchanged in the exercise group (59.6 to 59.6 U/l), with no significant time-by-treatment interaction (p=0.98), contrary to the claimed significant reduction versus control. The stated WMD and confidence interval are not reported in this paper. (LLM, conf=0.93)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredHallsworth et al. showed no differences in liver steatosis between resistance exercise and control in participants with NAFLD.
“Hallsworth et al. [80] assessed the effects of only resistance exercise on liver steatosis in participants with NAFLD, showing no differences between the intervention group and control.”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [80]
The Results (Intrahepatic lipid) say there was no significant difference between groups at the end of the intervention, which supports a narrow reading of the claim. But they also report a 13% reduction in liver fat with resistance exercise, no change in controls, and a significant time-by-treatment interaction; the unqualified statement that there were 'no differences' omits these findings. (LLM, conf=0.89)
Experimental — accuracy not yet measuredMost 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 [315]
The Results > Intrahepatic lipid section reports reduced liver fat after resistance exercise, supporting one example of steatosis reduction. The study tested only one exercise programme, not most RCTs or different types of training. The Discussion says patients with fibrosis were excluded, so it cannot establish an optimal prescription for them. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBased 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 [76]
Three resistance exercise protocols demonstrated improvements in hepatic steatosis without significant weight loss.
“Three protocols demonstrated improvements in hepatic steatosis without significant weight loss (76, 80, 83).”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [76]
MR spectroscopy showed a decrease in intrahepatic lipid levels in three studies (13%; 3%; and 25% reduction from baseline).
“MR spectroscopy showed a decrease in intrahepatic lipid levels in three studies (13%; 3%; and 25% reduction from baseline (76–78)).”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [76]
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- Authors
- Hallsworth, K., Fattakhova, G., Hollingsworth, K. G., Thoma, C., Moore, S., Taylor, R., Day, C. P., & Trenell, M. I.
- Affiliations
- Newcastle University (GB)
- Corresponding author
- Trenell, Michael I
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2011-06-27
- Volume
- 60
- Issue
- 9
- Pages
- 1278-1283
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC3152868
- OpenAlex
- W2131294862
- Cited by
- 529
- References
- 58
- Citations by year
- 2026: 36 · 2025: 30 · 2024: 37 · 2023: 34 · 2022: 35 · 2021: 38 · 2020: 40 · 2019: 31 · 2018: 28 · 2017: 38 · 2016: 49 · 2015: 40 · 2014: 36 · 2013: 32 · 2012: 21
- FWCI
- 22.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Gut (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- National Institute for Health and Care Research (FP7/2007–2013)
- Diabetes UK
- European Commission (2007–2013, FP7 2007-2013, FP7/2007, 241762)
- Medical Research Council (MC_G0802536)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- resistance training, non-alcoholic fatty liver disease, liver fat, hepatic lipid oxidation, insulin resistance, glycemic control, visceral adipose tissue, sedentary adults
- MeSH terms
- Adult, Aged, Anthropometry, Blood Glucose, Body Composition, Exercise Test, Fatty Acids, Nonesterified, Fatty Liver, Female, Humans, Lipids, Liver, Male, Middle Aged, Motor Activity, Oxidation-Reduction, Weight Loss, Treatment Outcome, Lipid Metabolism, Resistance Training, Non-alcoholic Fatty Liver Disease
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