Cited by 55Liver Disease Diagnosis and TreatmentExercise and Physiological ResponsesPhysical Activity and Health

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Therapeutic Approaches to Nonalcoholic Fatty Liver Disease: Exercise Intervention and Related Mechanisms

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Takahashi, Hirokazu, Kotani, Kazuhiko, Tanaka, Kenichi, Egucih, Yuichiro, Anzai, Keizo·2018·Frontiers in Endocrinology

DOI 10.3389/fendo.2018.00588PMC PMC6196235

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Abstract

Exercise training improves nonalcoholic fatty liver disease (NAFLD) as well as obesity and metabolic diseases. Although it is difficult to eliminate the effects of body weight reduction and increased energy expenditure, which are among the pleiotropic effects of exercise training, a number of clinical and experimental studies involving either aerobic exercise training or resistance training programs show improvements in NAFLD that are independent of the improvements in obesity and insulin resistance. In vivo studies have identified effects of exercise training on the liver, which may help to explain the “direct” or “independent” effect of exercise training on NAFLD. Exercise training increases peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) expression, improves mitochondrial function and leads to reduced hepatic steatosis, inflammation, fibrosis, and tumor genesis. Crosstalk of liver to adipose tissue, skeletal muscle and the microbiome is also a possible mechanism for the effect of exercise training on NAFLD. Although numerous clinical and experimental studies have reported benefits of exercise training on NAFLD, the optimal duration and intensity of exercise for the prevention or treatment of NAFLD have not been established. Maintaining adherence of NAFLD patients to exercise training is another issue to be resolved. The use of comprehensive analytical approaches to identify biomarkers such as hepatokines that specifically reflect the effect of exercise training on liver may help to monitor the exercise effect on NAFLD, and thereby improve adherence of NAFLD patients to exercise training. Exercise training is a robust approach for improving NAFLD pathogenesis, though further clinical and experimental study is required.

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Figure 1 Systematic review of training protocols. Effect of changes in body mass index (BMI) (A) and diet consultation (B) on liver steatosis measured by 1H magnetic resonance (1HMR) imaging in exercise training programs for treating patients with nonalcoholic fatty liver disease (NAFLD). In (A), the blue, red, yellow, and gray dots represent training protocols with aerobic, resistance, aerobic plus resistance, and stretching exercises, respectively. Effects of the total training time (C), protocol period (D), training duration/session (E), and frequency of training (F) on liver steatosis measured by 1HMR imaging in exercise training programs for subjects with NAFLD. Blue, red and yellow dots represent protocols with aerobic, resistance and combined exercise training, respectively.CC BY · PubMed Central

Figure 2 Classical effect of training on subjects with NAFLD.CC BY · PubMed Central

Figure 3 Hepatokines and organ crosstalk in exercise training for subjects with nonalcoholic fatty liver disease (NAFLD).CC BY · PubMed Central

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Authors: Takahashi, H., Kotani, K., Tanaka, K., Egucih, Y., & Anzai, K.
Affiliations: Saga University (JP)
Jichi Medical University (JP)
Corresponding author: Anzai, Keizo
ORCID: Takahashi, Hirokazu
Kotani, Kazuhiko
Tanaka, Kenichi
Anzai, Keizo
Venue: Frontiers in Endocrinology
Publisher: Frontiers Media SA
Published: 2018-10-15
Volume: 9
Pages: 588-588
ISSN: 1664-2392 (ISSN-L)
DOI: 10.3389/fendo.2018.00588
PMC: PMC6196235
OpenAlex: W2897133585
Cited by: 55
References: 233
Citations by year: 2026: 5 · 2025: 3 · 2024: 6 · 2023: 7 · 2022: 5 · 2021: 12 · 2020: 9 · 2019: 8
FWCI: 1.04
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: Frontiers in Endocrinology (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Japan Society for the Promotion of Science (16H07070, 18K15754)
Topics: Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
Health Sciences › Medicine › Physiology (medical) › Exercise and Physiological Responses
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
Keywords: non-alcoholic fatty liver disease, exercise training, aerobic exercise, resistance training, PGC-1α, mitochondrial function, hepatic steatosis, liver fibrosis, liver inflammation, gut-liver axis, microbiome, hepatokines, exercise adherence, biomarkers, obesity, insulin resistance

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Therapeutic Approaches to Nonalcoholic Fatty Liver Disease: Exercise Intervention and Related Mechanisms

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