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Randomised controlled trial
High-intensity exercise offers no additional benefit to moderate-intensity exercise in reducing liver fat in patients with non-alcoholic fatty liver disease
  1. Daniel J Cuthbertson,
  2. Victoria S Sprung
  1. Department of Musculoskeletal Biology II, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Daniel J Cuthbertson, Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool L9 7AL, UK; Daniel.cuthbertson{at}

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Commentary on: Zhang HJ, He J, Pan LL, et al. Effects of moderate and vigorous exercise on non-alcoholic fatty liver disease: a randomized clinical trial. JAMA Intern Med 2016;176:1074–82.


Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of liver morbidity and mortality, type 2 diabetes mellitus and cardiovascular disease (CVD). Lifestyle modification is the mainstay of treatment, with uncertainty regarding the effectiveness of drug therapy for patients with NAFLD.1 Exercise intervention studies demonstrate that exercise effectively reduces liver fat, even in the absence of significant weight loss. In free-living individuals, higher exercise frequency is associated with a lower risk NAFLD and higher rates of resolution of existing NAFLD over 5 years of follow-up.2 However, widespread implementation of exercise as a therapeutic modality …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.