Optimal Exercise Frequency to Reduce Liver Fat in Centrally Obese Adults With Non-Alcoholic Fatty Liver Disease

This study aims to examine the comparative effectiveness of different exercise frequencies (once-a-week vs. thrice-a-week) for reducing liver fat in centrally obese adults with non-alcoholic fatty liver disease (NAFLD), with weekly exercise volumes aligned with the World Health Organization's physical activity recommendations.

Inclusion Criteria:Cantonese, Mandarin, or English speaking Chinese;Aged 18-69;Male or female;Centrally obese according to the Asian-specific cut-off (waist circumference ≥90 cm for males; ≥80 cm for females) and with BMI ≥23;With NAFLD (defined as >5% intrahepatic triglycerides assessed by 1H-MRS);Willing to participate in exercise training to improve NAFLD.Exclusion Criteria:Regular exercise training (>3 sessions of >60 min of moderate-intensity exercise training weekly) in the past 6 months;Medical history of cardiovascular disease, chronic pulmonary or kidney disease, heart failure, cancer, and/or liver disease except NAFLD;Somatic conditions that limit exercise participation (e.g., limb loss);Impaired mobility due to chronic disease (e.g., chronic arthritis/osteoarthritis, neurological, musculoskeletal, and autoimmune diseases);Daily smoking habit;Excess alcohol consumption (daily ≥20 g of alcohol for men and ≥10 g for women) in the past 1 year;Consumption of certain drugs (e.g., tamoxifen and estrogen) known to be secondary causes of steatosis;Surgery, therapy, or medication for obesity or weight loss in the past 6 months (e.g., gastric bypass, gastric band, sleeve gastrectomy, gastric reduction duodenal switch, or dietitian-prescribed dietary program);Physical changes that considerably affect body composition and weight (e.g., anorexia nervosa, bulimia nervosa, prolonged gastrointestinal and digestive disorders) during the study period.