Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Eligibility Criteria
2.3. Data Extraction
2.4. Study Quality
2.5. Statistical Analysis
3. Results
3.1. Study Selection
3.2. Study and Participant Characteristics
Participants | |||||||
---|---|---|---|---|---|---|---|
Author, Year | Country | Disease | Ex (CON) | BMI | Gender (M/F) | Age | Outcome Assumed |
Abdelbasset et al., 2019 [26] | Egypt | NAFLD | 16 (16) | 36.1 | M F | 54.8 | ALT, HBA1c, FBG, HOMA-IR |
Cuthbertson et al., 2016 [42] | UK | NAFLD | 30 (20) | 30.15 | M F | 51 | ALT, AST, FBG, HOMA-IR, Insulin |
Eckard et al., 2013 [37] | USA | NAFLD | 9 (11) | 33.3 | M | 51.5 | ALT, AST, FBG, HOMA-IR, Insulin |
George et al., 2008 [36] | Australia | NAFLD | 109 (34) | 31.7 | M | 48.12 | ALT, AST, FBG, HOMA-IR, Insulin |
Hallsworth et al., 2011 [43] | UK | NAFLD | 11 (8) | 32.3 | M F | 57 | ALT, FBG, HOMA-IR, Insulin |
Hatami et al., 2016 [35] | Iran | NAFLD | 16 (16) | 28 | M | 32.93 | ALT, AST |
Hoseini et al., 2020 [38] | Iran | NAFLD | 10 (10) | 34.11 | F | 62.3 | ALT, AST, FBG, HOMA-IR, Insulin |
Houghton et al., 2017 [44] | Australia | NAFLD | 12 (12) | 33.00 | M F | 52.00 | ALT, AST, FBG, HOMA-IR |
Javanmardi Fard et al., 2015 [45] | Iran | NAFLD | 30 (30) | 28.65 | M F | 19 | ALT, AST |
Keating et al., 2015 [46] | Australia | NAFLD | 36 (12) | 33.42 | M F | 43.6 | ALT, AST, FBG, Insulin |
Khaoshbaten et al., 2013 [47] | Iran | NAFLD | 45 (45) | 29.2 | M F | 37.6 | ALT, AST, FBG |
Mohammadi et al., 2019 [34] | Iran | NAFLD | 10 (10) | 32.58 | M | 37.2 | ALT, AST |
Moradi Kelardeh et al., 2017 [33] | Iran | NAFLD | 12 (12) | 29.27 | M | 38.24 | ALT, AST |
Moradi Kelardeh et al., 2020 [39] | Iran | NAFLD | 12 (11) | 27.36 | F | 65.27 | ALT, AST |
Nourian et al., 2020 [48] | Iran | NAFLD | 36 (33) | 32.19 | M F | 48.84 | ALT, AST |
Pugh et al., 2014 [49] | UK | NAFLD | 34 (20) | 30.5 | M F | 47.5 | ALT, AST, FBG, HOMA-IR, Insulin |
Rezende et al., 2016 [40] | Brazil | NAFLD | 19 (21) | 33.05 | F | 55.3 | ALT, AST, FBG, HOMA-IR, Insulin |
Sadeghi et al., 2019 [32] | Iran | NAFLD | 11 (11) | 26.96 | M | 40.8 | ALT, AST |
Shamsoddini et al., 2015 [31] | Iran | NAFLD | 20 (10) | 28.96 | M | 43.8 | ALT, AST, HOMA-IR |
Shojaee-Moradie et al., 2016 [30] | UK | NAFLD | 15 (12) | 31.65 | M | 52.6 | ALT, AST, FBG, HOMA-IR, Insulin |
Sreenivasa Baba et al., 2006 [29] | India | NAFLD | 44 (15) | 27.1 | M | 38.7 | ALT, AST |
Sullivan et al., 2012 [50] | USA | NAFLD | 12 (6) | 38.1 | M F | 48.05 | ALT |
Takahashi et al., 2015 [51] | Japan | NAFLD | 31 (22) | 28.35 | M F | 53.45 | ALT, AST, FBG, HOMA-IR, Insulin |
Valizadeh et al., 2011 [28] | Iran | NAFLD | 12 (12) | NR | M | 32.5 | ALT, AST |
Yao et al., 2018 [52] | China | NAFLD | 60 (31) | 26.26 | M F | 58.38 | ALT, FBG, Insulin |
Zhang et al., 2016 [41] | China | NAFLD | 146 (74) | 28.0 | F | 53.9 | ALT, AST, FBG |
3.3. Intervention Characteristics
3.4. Effect of Exercise on Hepatic Enzyme Parameters
3.4.1. ALT Levels
3.4.2. AST Levels
3.5. Effect of Physical Activity on Glucose Metabolism Parameters
3.5.1. FBG Levels
3.5.2. Insulin levels
3.5.3. HOMA-IR
3.6. Study Quality
3.7. Heterogeneity and Publication Bias
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Intervention | ||||||
---|---|---|---|---|---|---|
Study | Groups | Mode | Frequency (Days) | Intervention Duration (Weeks) | Duration of Each Session (Min) | Intensity |
Abdelbasset et al., 2019 [26] | HIIT CON | Exercise program was performed on a cycle ergometer | 3/7 | 8 | 40 min | HIIT group: 80–85% VO2max CON group: No intervention |
Cuthbertson et al., 2016 [42] | AE CON | Aerobic exercise (treadmill, cross-trainer, bike ergometer, rower) | 3–5/7 | 12 | 30–45 min | AE group: 30–60% HRmax CON group: No intervention |
Eckard et al., 2013 [37] | AE CON | Participants followed an 18-step program, including warm up, exercise bicycle, walking on a treadmill, various arm and leg strength exercises, and cool down, with gradual ramp up over the 6 months | 4–7/7 | 24 | 20–60 min | AE group: Moderate exercise CON group: No intervention |
George et al., 2008 [36] | LI MI CON | Participants were encouraged to increase both planned and incidental moderate-intensity PA to achieve at least 150 min/week for general health and to target more than 200 min/week for weight loss | 3/7 6/7 | 4 10 | 45–60 min | LI group: 35–40% VO2max MI group: 70–75% VO2max CON group: No intervention |
Hallsworth et al., 2011 [43] | RT CON | The program consisted of eight exercises: biceps curl; calf raise; triceps press; chest press; seated hamstrings curl; shoulder press; leg extension; and lateral pull down | 3/7 | 8 | 45–60 min | RT group: 50–70% 1RM CON group: No intervention |
Hatami et al., 2016 [35] | AE + RT CON | The aerobic training section consisted of rhythmic movements and the resistance training section consisted of biceps, triceps, pectoralis, quadriceps, and hamstring muscles in the position of dumbbell biceps (seated concentration curl), dumbbell triceps (triceps kickback), bench press, knee extension, and knee flexion | 3/7 | 8 | 40 min | AE + RT group: 3 sets/8–12 reps at 60–80% 1RM 65–85% HRmax CON group: No intervention |
Hoseini et al., 2020 [38] | AE CON | Walking and jogging/running | 3/7 | 8 | 20–40 min | AE group: 60–75%, HRmax CON group: No intervention |
Houghton et al., 2017 [44] | AE + RT CON | The exercise program consisted of aerobic (cycling) and resistance training | 3/7 | 12 | 60 min | AE + RT group: Moderate vigorous Activity CON group: No intervention |
Javanmardi Fard et al., 2015 [45] | AE CON | The physical activities included jogging, cycling, aerobic exercise or any other activity that is of a similar intensity | 4–5/7 | 12 | 30 min | AE group: Moderate physical activities CON group: No intervention |
Keating et al., 2015 [46] | HILO LOHI LOLO CON | Performed continuous cycling on the ergometer/brisk walk | 3–4/7 | 8 | 45–60 min | LO:HI group: 50% VO2peak HI:LO group: 70% VO2peak LO:LO group: 50% VO2peak CON group: No intervention |
Khaoshbaten et al., 2013 [47] | AE CON | Walking/running | 3/7 | 12 | 30 min | AE group: Maximal heart rate CON group: No intervention |
Mohammadi et al., 2019 [34] | CRT CON | The resistance training included three circles with nine stations per circle | 3/7 | 12 | 30–45 min | CRT group: 3 sets/10–20 reps at 40–80% 1RM CON group: No intervention |
Moradi Kelardeh et al., 2017 [33] | RT CON | Knee extension, bench press, incline bench press, seated row, dead lift, pulley crunches, lat pull-downs, calf raise, hamstring curl, press behind neck, upright row, arm curl | 3/7 | 12 | 45–60 min | RT group: 1–3 sets/2–20 reps at 40–95% 1RM CON group: No intervention |
Moradi Kelardeh et al., 2020 [39] | RT CON | Knee extension, bench press, incline bench press, seated row, dead lift, pulley crunches, lat pull-downs, calf raise, hamstring curl, press behind neck, upright row, arm curl | 3/7 | 12 | 60–70 min | RT group: 1–4 sets/2–20 reps at 40–95% 1RM CON group: No intervention |
Nourian et al., 2020 [48] | AE CON | The educational content of each session was presented to participants by using a short lecture, slide show, pamphlet, and discussion. | 5/7 | 8 | 30–60 min | AE group: Lifestyle modification education training CON group: No intervention |
Pugh et al., 2014 [49] | AE CON | Exercise training comprised a combination of treadmill and cycle ergometer-based exercise, which progressively increased in both intensity and duration throughout the course of the intervention | 3–5/7 | 12 | 30–45 min | AE group: 30–60 HRmax CON group: No intervention |
Rezende et al., 2016 [40] | AE CON | Aerobic exercise on treadmill | 2/7 | 24 | 120 min | AE group: Increased from VAT up to 10% below RCP CON group: No intervention |
Sadeghi et al., 2019 [32] | RT CON | These exercises include TRX plank on elbows, TRX T deltoid fly, TRX chest press, TRX high row, TRX triceps press, TRX biceps curl, TRX squat, and TRX hip press | 3/7 | 8 | 60 min | RT group: 3 sets/8 reps at 70–100% 1RM CON group: No intervention |
Shamsoddini et al., 2015 [31] | AE RT CON | Running on treadmill/seven exercises with machine: triceps press, biceps curl, calf raise, leg press, leg extension, lat pull down, and sit-ups | 3/7 | 8 | 45 min | AE group: 60–75% HRmax RT group: 50–70% 1RM CON group: No intervention |
Shojaee-Moradie et al., 2016 [30] | AE CON | Types of activities were either gym-based aerobic plus resistance exercise or outdoor aerobic activities and resistance exercise | 4–5/7 | 16 | 20–60 min | AE group: 40–60% HRmax CON group: No intervention |
Sreenivasa Baba et al., 2006 [29] | AE CON | Brisk walking/jogging or rhythmic aerobic exercises set to beat music | 5/7 | 12 | 20–45 min | AE group: 60–70% HRmax CON group: No intervention |
Sullivan et al., 2012 [50] | AE CON | Brisk walk/walking on a treadmill | 5/7 | 16 | 30–60 min | AE group: 45–55% VO2peak CON group: No intervention |
Takahashi et al., 2015 [51] | RT CON | Resistance exercise comprising push-ups and squats at the beginning of the study. | 3/7 | 12 | 20–30 min | RT group: 3 sets/10 reps CON group: No intervention |
Valizadeh et al., 2011 [28] | AE CON | Walking/running | 5/7 | 8 | 45 min | AE group: 50–70% VO2max CON group: No intervention |
Yao et al., 2018 [52] | AE RT CON | Walking/running Elastic band was used as the load instrument | 3/7 | 22 | 40–60 min | AE group: 60–70% HRmax RT group: 3 sets/10 reps; 60–70% 1RM CON group: No intervention |
Zhang et al., 2016 [41] | ME VME CON | Jogged on a treadmill and gradually increased exercise intensity | 5/7 | 48 | 30 min | ME group: 65–80% HRmax CON group: No intervention |
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Hejazi, K.; Hackett, D. Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 2023, 12, 3011. https://doi.org/10.3390/jcm12083011
Hejazi K, Hackett D. Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine. 2023; 12(8):3011. https://doi.org/10.3390/jcm12083011
Chicago/Turabian StyleHejazi, Keyvan, and Daniel Hackett. 2023. "Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" Journal of Clinical Medicine 12, no. 8: 3011. https://doi.org/10.3390/jcm12083011