High-Intensity Interval Training is Safe, Feasible and Efficacious in Nonalcoholic Steatohepatitis: A Randomized Controlled Trial

Shelley E Keating; Ilaria Croci; Matthew P Wallen; Emily R Cox; Moe Thuzar; Uyen Pham; Gregore I Mielke; Jeff S Coombes; Graeme A Macdonald; Ingrid J Hickman

doi:10.1007/s10620-022-07779-z

High-Intensity Interval Training is Safe, Feasible and Efficacious in Nonalcoholic Steatohepatitis: A Randomized Controlled Trial

Dig Dis Sci. 2023 May;68(5):2123-2139. doi: 10.1007/s10620-022-07779-z. Epub 2022 Dec 20.

Authors

Shelley E Keating¹, Ilaria Croci^{2

3

4}, Matthew P Wallen^{5

6}, Emily R Cox⁷, Moe Thuzar^{8

9}, Uyen Pham^{10

11

12}, Gregore I Mielke¹³, Jeff S Coombes², Graeme A Macdonald^{12

14}, Ingrid J Hickman^{12

15}

Affiliations

¹ Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia. s.keating@uq.edu.au.
² Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
³ Department of Circulation and Medical Imaging, Faculty of Medicine, K.G. Jebsen Center of Exercise in Medicine- Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
⁵ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
⁶ Institute of Health and Wellbeing, Federation University, Mount Helen, Australia.
⁷ School of Environmental and Life Sciences, University of Newcastle, Ourimbah, Australia.
⁸ Department of Endocrinology & Diabetes, Princess Alexandra Hospital, Brisbane, Australia.
⁹ Endocrine Hypertension Research Centre, Faculty of Medicine, University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia.
¹⁰ Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Australia.
¹¹ Mater Research Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia.
¹² Faculty of Medicine, The University of Queensland, Brisbane, Australia.
¹³ School of Public Health, The University of Queensland, Brisbane, Australia.
¹⁴ Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia.
¹⁵ Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia.

Abstract

Background: High-Intensity Interval Training (HIIT) involves bursts of high-intensity exercise interspersed with lower-intensity exercise recovery. HIIT may benefit cardiometabolic health in people with nonalcoholic steatohepatitis (NASH).

Aims: We aimed to examine the safety, feasibility, and efficacy of 12-weeks of supervised HIIT compared with a sham-exercise control (CON) for improving aerobic fitness and peripheral insulin sensitivity in biopsy-proven NASH.

Methods: Participants based in the community [(n = 14, 56 ± 10 years, BMI 39.2 ± 6.7 kg/m², 64% male), NAFLD Activity Score 5 (range 3-7)] were randomized to 12-weeks of supervised HIIT (n = 8, 4 × 4 min at 85-95% maximal heart rate, interspersed with 3 min active recovery; 3 days/week) or CON (n = 6, stretching; 3 days/week). Safety (adverse events) and feasibility determined as ≥ 70% program completion and ≥ 70% global adherence (including session attendance, interval intensity adherence, and duration adherence) were assessed. Changes in cardiorespiratory fitness (V̇O₂peak), exercise capacity (time-on-test) and peripheral insulin sensitivity (euglycemic hyperinsulinemic clamp) were assessed. Data were analysed using ANCOVA with baseline value as the covariate.

Results: There were no HIIT-related adverse events and HIIT was globally feasible [program completion 75%, global adherence 100% (including adherence to session 95.4 ± 7.3%, interval intensity 95.3 ± 6.0% and duration 96.8 ± 2.4%)]. A large between-group effect was observed for exercise capacity [mean difference 134.2 s (95% CI 19.8, 248.6 s), ƞ² 0.44, p = 0.03], improving in HIIT (106.2 ± 97.5 s) but not CON (- 33.4 ± 43.3 s), and for peripheral insulin sensitivity [mean difference 3.4 mg/KgLegFFM/min (95% CI 0.9,6.8 mg/KgLegFFM/min), ƞ² 0.32, p = 0.046], improving in HIIT (1.0 ± 0.8 mg/KgLegFFM/min) but not CON (- 3.1 ± 1.2 mg/KgLegFFM/min).

Conclusions: HIIT is safe, feasible and efficacious for improving exercise capacity and peripheral insulin sensitivity in people with NASH.

Clinical trial registration number: Australian New Zealand Clinical Trial Registry (anzctr.org.au) identifier ACTRN12616000305426 (09/03/2016).

Keywords: Exercise; Insulin resistance; Lifestyle; Metabolic-associated fatty liver disease; NAFLD; Nonalcoholic fatty liver disease.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Australia
Exercise / physiology
Female
High-Intensity Interval Training*
Humans
Insulin Resistance*
Male
Non-alcoholic Fatty Liver Disease* / therapy

Associated data

ANZCTR/ACTRN12616000305426