Implementation of aerobic exercise intervention in patients with metabolic associated fatty liver disease: A prospective study / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the intervention effect of moderate-intensity aerobic exercise on patients with metabolic associated fatty liver disease (MAFLD) and preliminary intervention regimens, and to provide a theoretical basis and new ideas for the effective prevention and treatment of MAFLD. MethodsA total of 158 MAFLD patients who underwent physical examination in Health Management Center of Sichuan Provincial People’s Hospital from May to August 2019 or who were recruited through the WeChat official account of “Health Management Center of Sichuan Provincial People’s Hospital” were enrolled as subjects, and the patients were divided into control group with 52 patients, monthly follow-up group with 54 patients, and weekly follow-up group with 52 groups using a random number table. The patients in the control group were given health education alone on admission, and those in the monthly follow-up group and the weekly follow-up group were received the intervention of moderate-intensity aerobic exercise; in the monthly follow-up group and the weekly follow-up group, a sports bracelet was used to monitor the exercise and follow-up was performed through the WeChat platform at a frequency of once a month and once a week, respectively. The noninvasive liver fibrosis diagnosis system FibroTouch was used to evaluate the degree of fatty liver disease before and after intervention. The three groups were compared in terms of the changes in body mass index (BMI), waist circumference, hepatic fat attenuation index, liver stiffness, blood pressure, aspartate aminotransferase, alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), fasting plasma glucose (FPG), uric acid (UA), total cholesterol (TG), triglyceride (TG), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol after 3 months of intervention. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the paired t-test was used for comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Nemenyi test or Wilcoxon signed rank-sum test was used for comparison between two groups. ResultsA total of 147 patients completed the trial, with 49 patients in the control group (3 were lost to follow-up), 49 in the monthly follow-up group (5 were lost to follow-up), and 49 in the weekly follow-up group (3 were lost to follow-up). With the amount of exercise, which reached the target heart rate, 5 times a week for more than 30 minutes each time as the criteria, the rate of reaching the standard was 66.7% in the monthly follow-up group and 93.2% in the weekly follow-up group. There were no significant differences in each index between the three groups before intervention (all P＞0.05). The monthly follow-up group had a significant reduction in waist circumference after intervention (9339±9.24 cm vs 94.24±8.89 cm, t=2.590, P＜0.05). After intervention, the weekly follow-up group had significant reductions in BMI (26.46±3.36 kg/m2 vs 27.63±3.46 kg/m2, t=8.534, P＜0.001), waist circumference (87.04±8.84 cm vs 91.47±8.08 cm, t=6.854, P＜0.001), hepatic fat attenuation index (260.08±31.07 dB/m vs 287.88±23.28 dB/m, t=8.521, P＜0.001), diastolic blood pressure (76.78±11.23 mm Hg vs 79.27±12.36 mm Hg, t=2.106, P=0.040), ALT ［32(20-43) U/L vs 43(28-59) U/L, Z=-3.973, P＜0001］, GGT ［25(19-40) U/L vs 34(24-47) U/L, Z=-3.847, P＜0.001］, TG ［1.48 (1.20-2.02) mmol/L vs 2.04 (1.63-2.80) mmol/L, Z=-3.873, P＜0.001］, UA (381.53±71.89 μmol/L vs 414.37±81.27 μmol/L, t=3.953, P＜0.001), and FPG (5.05±0.58 mmol/L vs 5.21±0.71 mmol/L, t=2.185, P=0034). ConclusionModerate-intensity aerobic exercise can significantly reduce the serum levels of TG, ALT, and GGT and alleviate the degree of fatty liver disease in MAFLD patients, and weekly follow-up has a better management effect than monthly follow-up. The method of remote management based on sports bracelet and WeChat software is simple and easy, with a high level of acceptance among MAFLD patients.