Liver Enzymes in Non -Alcoholic Fatty Liver Di seases: Response to Pyram idal Versus Continuous Aerobic Training

Purpose: The effect of choosing the type of exercise — the first-line conservative non-pharmacological therapy in managing non-alcoholic fatty liver disease (NAFLD) — on improving liver enzymes has not been fully investigated.: This was a comparative trial aimed to examine the response of liver enzymes to pyramidal progressive-intensity (interval) versus continuous moderate-intensity aerobic training in NAFLD women. Materials and Methods: Thirty-eight NAFLD women were randomized into a pyramidal training group (n=19) and a group of continuous moderate-intensity exercise (n=19). Both groups followed a reviewed 12-week low-calorie diet and received exercise training thrice weekly. Besides body mass index (BMI) and abdominal circumference (AC), NAFLD patients’ serum alanine transaminase enzyme (ALTE), alkaline phosphatase enzyme (ALPE), high-density lipoprotein (HDL), aspartate transaminase enzyme (ASTE), triglycerides (TGs), and gamma-glutamyl-transpeptidase enzyme (GGTE) were assessed before and after 12 weeks. Results: Significant improvements in all outcomes occurred after finishing both training forms. The pyramidal aerobic form produced more significant and pronounced improvements in the tested outcomes compared to the other form of exercise, moderate-intensity aerobic exercise. Conclusion: Both training forms, moderate-intensity aerobic exercise or pyramidal training, significantly improved NAFLD patients’ ALTE, BMI, ASTE, HDL, GGTE, AC, ALPE, and TGs, but the pyramidal form of exercise is more efficient than the continuous moderate-intensity form.

1. Ismail AMA, Saad AE, Draz RS. Effect of low-calorie diet on psoriasis severity index, triglycerides, liver enzymes, and quality of life in psoriatic patients with non-alcoholic fatty liver disease. Reumatologia. 2023;61(2):116-122. doi: 10.5114/reum/162995.

2. Draz RS, Serry ZMH, Rahmy AF, El Bardesi MS, Taha MM. Electroacupuncture Versus Aerobic Interval Training on Liver Functions in Patients with Nonalcoholic Fatty Liver. J Altern Complement Med. 2020;26:51-7. doi: 10.1089/acm.2019.0182.

3. Ismail AMA. Virtual Reality-Based Exercise in Adolescents with Polycystic Ovarian Syndrome-Induced Fatty Liver: An Interesting and Entertaining Method Requiring More Attention. Current Women’s Health Reviews 2024. doi: 10.2174/0115734048339094241106052337

4. Teng ML, Ng CH, Huang DQ, Chan KE, Tan DJ, Lim WH, et al. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2023;29:32-42. doi: 10.3350/cmh.2022.0365

5. Huh Y, Cho YJ, Nam GE. Recent Epidemiology and Risk Factors of Nonalcoholic Fatty Liver Disease. J Obes Metab Syndr 2022;31:17-27. doi: 10.7570/jomes22021

6. Fan JG, Farrell GC. Epidemiology of non-alcoholic fatty liver disease in China. J Hepatol. 2009;50:204-10. doi: 10.1016/j.jhep.2008.10.010

7. Younossi ZM, Zelber-Sagi S, Henry L, Gerber LH. Lifestyle interventions in nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol. 2023;20:708-22. doi: 10.1038/s41575-023-00800-4

8. Ahmed IA, Mikail MA, Mustafa MR, Ibrahim M, Othman R. Lifestyle interventions for non-alcoholic fatty liver disease. Saudi J Biol Sci. 2019;26:1519-24. doi: 10.1016/j.sjbs.2018.12.016

9. Ibrahim AA, Abdelbasset WK. The role of physical exercise in treating people with non-alcoholic fatty liver disease. JAPER 2020;10(2):64-70. https://japer.in/storage/models/article/rrtKEWZttl3G7n3OyAtku9ijayD0mmMN3stGHDpnNhHE05ZoolF9qZELkKkJ/the-role-of-physical-exercise-in-treating-people-with-nonalcoholic-fatty-liver-disease.pdf

10. Hashida R, Kawaguchi T, Bekki M, Omoto M, Matsuse H, Nago T, et al. Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: A systematic review. J Hepatol. 2017; 66:142-52. doi: 10.1016/j.jhep.2016.08.023

11. Sobhy C, Elsayed M, Naoum L, Obaya H. Effect of pyramidal training on selected risk factors of atherosclerosis in women with central obesity. Benha Int J Phys Ther 2024;2:7-17. doi: 10.21608/bijpt.2024.269820.1017

12. Nonino-Borges CB, Maduro IP, Bavaresco M, Borges RM, Suen VM, Marchini JS. A low-calorie diet improves the rate of nutrient oxidation, lowers body fat, and maintains lean mass in morbidly obese Brazilian women. Nutr Res 2006;26:437-42. doi: 10.1016/j.nutres.2006.07.005

13. Ismail Hamed DE. Erectile dysfunction and metabolic syndrome components in obese men with psoriasis: response to a 12-week randomized controlled lifestyle modification program (exercise with diet restriction). Ir J Med Sci. 2024;193(1):523-9. doi: 10.5114/pg.2023.130334

14. Ismail Ali M, Nadia Saad Sayed Ahmed El Gressy, Mona Darwish Hegazy, Ahmed Mohamed Abdel-Halim Elfahl, and Omnia Saeed Mahmoud Ahmed. 2023. “Randomized controlled effect of treadmill walking exercise on liver enzymes, psychological burden, and erectile dysfunction in men with hepatitis C”. Gastroenterology Review/Przegląd Gastroenterologiczny 2023. doi: 10.5114/pg.2023.130334.

15. Ghanbari-Niaki, A., Behzad Khameslo, M, Tayebi SM. Effect of pyramidal training on plasma lipid profile and fibrinogen, and blood viscosity of untrained young men. Ann Appl Sport Sci 2013;1:47-56. http://aassjournal.com/article-1-83-en.html

16. Ismail AM, Mahmoud Nasr Tolba A, Essam El-Sayed Felaya E. Effect of aerobic exercise training on leptin and liver enzymes in non-diabetic overweight hepatitis C men. Adv in Rehabilit 2021;35:17-23. doi: 10.5114/areh.2021.106027

17. Ismail AMA. Metabolic syndrome components response to the conducted 16-week randomised-controlled training trial on an elliptical trainer. Eur J Physiother 2022;25:147–53. doi: 10.1080/21679169.2021.2022756

18. Pooranfar S, Shakoor E, Shafahi M, Salesi M, Karimi M, Roozbeh J, et al. The effect of exercise training on quality and quantity of sleep and lipid profile in renal transplant patients: a randomized clinical trial. Int J Organ Transplant Med. 2014;5:157-65. https://pmc.ncbi.nlm.nih.gov/articles/PMC4243047/

19. Gallo-Villegas J, Aristizabal JC, Estrada M, Valbuena LH, NarvaezSanchez R, Osorio J, et al. Efficacy of high-intensity, low-volume interval training compared to continuous aerobic training on insulin resistance, skeletal muscle structure and function in adults with metabolic syndrome: study protocol for a randomized controlled clinical trial (Intraining-MET). Trials. 2018;19:144. doi: 10.1186/s13063-018-2541-7

20. Ghalavand A, Ghobadi MR, Motamedi P, Delaramnasab M. Reduction of fetuin B in adaptation to pyramidal aerobic exercises and its role in modulating insulin resistance and serum aminotransferases in patients with type 2 diabetes. EBNESINA 2023;25:13-20. doi: 10.22034/25.1.13

21. Song X, Cui X, Su W, Shang X, Tao M, Wang J, et al. Comparative effects of high-intensity interval training and moderateintensity continuous training on weight and metabolic health in college students with obesity. Sci Rep. 2024 ;14:16558. doi: 10.1038/s41598-024-67331-z

22. Hassabi M, Sadeghi A, Abedy Yekta AH, Salehi S, Mahdaviani B, Asgari A, et al. The role of moderate- and high-intensity supervised aerobic training in reducing steatosis and hepatic fibrosis in patients with non-alcoholic fatty liver disease; a randomized controlled trial. Gastroenterol Hepatol Bed Bench. 2023;16:509-19. doi: 10.22037/ghfbb.v16i1.2466

23. Liu Y, Zhang L, Wang Q, Liu H, Zhu X, Li H, Zhang H. The effects of high-intensity interval training/moderate-intensity continuous training on the inhibition of fat accumulation in rats fed a high-fat diet during training and detraining. Lipids Health Dis. 2024;23(1):221. doi: 10.1186/s12944-024-02209-7

24. Mohammad P, Esfandiar KZ, Abbas S, Ahoora R. Effects of moderate-intensity continuous training and high-intensity interval training on serum levels of Resistin, Chemerin and liver enzymes in Streptozotocin-Nicotinamide induced Type-2 diabetic rats. J Diabetes Metab Disord. 2019;18:379-87. doi: 10.1007/s40200-019-00422-1

25. Wang N, Liu Y, Ma Y, Wen D. High-intensity interval versus moderate-intensity continuous training: Superior metabolic benefits in diet-induced obesity mice. Life Sci. 2017;191:122-31. doi: 10.1016/j.lfs.2017.08.023

26. Bagheri MH, Azamian-Jazi A, Banitalebi E, Kazeminasab F, NasrEsfahani MH. Both high-intensity interval training and lowintensity endurance training decrease intrahepatic lipid deposits via alterations of the expression of HIF-1α, HIG2 in a murine model of non alcoholic fatty liver disease (NAFLD). Sci Sports, 2021;36:120-8. doi: 10.1016/j.scispo.2020.01.006

27. Rahmati-Ahmadabad S, Azarbayjani MA, Farzanegi P, Moradi L. High-intensity interval training has a greater effect on reverse cholesterol transport elements compared with moderateintensity continuous training in obese male rats. Eur J Prev Cardiol. 2021;28:692-701. doi: 10.1177/2047487319887828

28. Paahoo A, Tadibi V, Behpoor N. Effectiveness of Continuous Aerobic Versus High-Intensity Interval Training on Atherosclerotic and Inflammatory Markers in Boys With Overweight/Obesity. Pediatr Exerc Sci. 2021;33:132-38. doi: 10.1123/pes.2020-0138

29. Mazurek K, Krawczyk K, Zmijewski P, Norkowski H, Czajkowska A. Effects of aerobic interval training versus continuous moderate exercise programme on aerobic and anaerobic capacity, somatic features and blood lipid profile in collegate females. Ann Agric Environ Med 2014;21:844-9. doi: 10.5604/123 21966.1129949

30. Racil G, Ben Ounis O, Hammouda O, Kallel A, Zouhal H, Chamari K, et al. Effects of high vs. moderate exercise intensity during interval training on lipids and adiponectin levels in obese young females. Eur J Appl Physiol. 2013;113:2531-40. doi: 10.1007/s00421-013-2689-5

31. Trombold JR, Christmas KM, Machin DR, Kim IY, Coyle EF. Acute high-intensity endurance exercise is more effective than moderate- intensity exercise for attenuation of postprandial triglyceride elevation. J Appl Physiol (1985). 2013;114:792-800. doi: 10.1152/japplphysiol.01028.2012

32. Zhu X, Jiao J, Liu Y, Li H, Zhang H. The Release of Lipolytic Hormones during Various High-Intensity Interval and Moderate-Intensity Continuous Training Regimens and Their Effects on Fat Loss. J Sports Sci Med 2024;23:559-70. doi: 10.52082/jssm.2024.559

33. Keating SE, Hackett DA, Parker HM, O’Connor HT, Gerofi JA, Sainsbury A, et al. Effect of aerobic exercise training dose on liver fat and visceral adiposity. J Hepatol. 2015;63:174-82. doi: 10.1016/j.jhep.2015.02.022

34. Farbod M, Eizadi M, Davoodzadeh S. Protective Effects of Aerobic Intervention on the Profile of Liver Enzymes with Emphasis on AST to ALT ratio in Adult Females with Obesity. Women Health Bulletin 2018;5:1-7. doi: 10.5812/whb.57194

35. Sawyer BJ, Tucker WJ, Bhammar DM, Ryder JR, Sweazea KL, Gaesser GA. Effects of high-intensity interval training and moderate-intensity continuous training on endothelial function and cardiometabolic risk markers in obese adults. J Appl Physiol (1985). 2016 ;121: 279-88. doi: 10.1152/japplphysiol.00024.2016