Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://gr.elmerpub.com

Original Article

Volume 19, Number 2, April 2026, pages 74-84

A Supervised, Online, Home-Based Eccentric Resistance Exercise Program for Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease

↓ Figure 1. Comparison between exercise (E) and control (C) groups for percent changes in (a) controlled attenuation parameter (CAP), (b) gamma-glutamyl transferase (GGT) activity, (c) fatty liver index, (d) body mass, (e) body mass index (BMI), (f) triglyceride glucose waist index (TyG-WC), (g) waist circumference, and (h) hip circumference from baseline to 8 weeks later. *A statistically significant within-group change from baseline (P < 0.05). The figure illustrates group trends and inter-individual variability; formal between-group comparisons were not statistically significant.

↓ **Table 1.** Baseline Characteristics of Participants in the Exercise and Control Groups
	Exercise group	Control group	P value
Values are expressed as mean ± SD along with the lowest-highest values of the participants or number of participants, and its percentage in the group participants. P value indicates the result of Mann–Whitney U test to compare between groups. *Significant (P < 0.05) difference between groups. BMI: body mass index; SD: standard deviation; TSI: Torres Strait Islander.
Age (years)	57.4 ± 15.5 (26–78)	47.4 ± 23.0 (24–91)	0.22
Gender (male/female)	5/4	3/4	0.62
Ethnicity (n, %)			0.64
Indian	1 (11%)	2 (29%)
Asian	2 (22%)	-
Caucasian	5 (56%)	3 (43%)
African	-	-
Aboriginal & TSI	1 (11%)	-
Others	-	2 (29%)
Body mass (kg)	89.4 ± 13.0 (70–115)	91.0 ± 32.5 (63–157)	0.63
BMI (kg/m²)	32.4 ± 4.5 (23.4–39.7)	32.7 ± 6.4 (23.5–41.7)	0.95
Diabetes mellitus (n, %)	8 (89%)	2 (29%)	0.01*
Dyslipidemia (n, %)	4 (44%)	4 (57%)	0.62
Steatosis grade (n, %)			0.39
S1	-	-
S2	1 (11%)	2 (29%)
S3	8 (89%)	5 (71%)
Fibrosis grade (n, %)			0.05
F0	5 (56%)	7 (100%)
F1	3 (33%)	-
F2	1 (11%)	-

↓ Table 1. Baseline Characteristics of Participants in the Exercise and Control Groups

Exercise group

Control group

P value

Values are expressed as mean ± SD along with the lowest-highest values of the participants or number of participants, and its percentage in the group participants. P value indicates the result of Mann–Whitney U test to compare between groups. *Significant (P < 0.05) difference between groups. BMI: body mass index; SD: standard deviation; TSI: Torres Strait Islander.

Age (years)

57.4 ± 15.5 (26–78)

47.4 ± 23.0 (24–91)

0.22

Gender (male/female)

5/4

3/4

0.62

Ethnicity (n, %)

0.64

Indian

1 (11%)

2 (29%)

Asian

2 (22%)

Caucasian

5 (56%)

3 (43%)

African

Aboriginal & TSI

1 (11%)

Others

2 (29%)

Body mass (kg)

89.4 ± 13.0 (70–115)

91.0 ± 32.5 (63–157)

0.63

BMI (kg/m²)

32.4 ± 4.5 (23.4–39.7)

32.7 ± 6.4 (23.5–41.7)

0.95

Diabetes mellitus (n, %)

8 (89%)

2 (29%)

0.01*

Dyslipidemia (n, %)

4 (44%)

4 (57%)

0.62

Steatosis grade (n, %)

0.39

1 (11%)

2 (29%)

8 (89%)

5 (71%)

Fibrosis grade (n, %)

0.05

5 (56%)

7 (100%)

3 (33%)

1 (11%)

↓ **Table 2.** Changes of Variables From Baseline to 8 Weeks Later for the Exercise (n = 9) and Control (n = 7) Groups
Variable	Group	Baseline	8-week
Values are expressed as mean ± standard deviation (SD), with ranges showing the lowest and highest values for each variable. *Significant (P < 0.05) difference from the baseline. Between-group differences are described in the Results text; table values reflect within-group changes only. ALT: alanine transaminase; AST: aspartate aminotransferase; BMI: body mass index; CAP: controlled attenuation parameter; Fib-4: fibrosis-4 index; FLI: fatty liver index; GGT: gamma-glutamyl transferase; HbA1c: glycosylated hemoglobin; HDL: high-density lipoprotein; HOMA-IR: homeostasis model assessment of insulin resistance; LDL: low-density lipoprotein; LSM: liver stiffness measurement; TG: triglycerides; TyG-WC: triglyceride-glucose waist circumference index; WC: waist circumference.
Body mass (kg)	Exercise	89.4 ± 13.0 (70–115)	88.5 ± 13.1* (69–114)
	Control	91.0 ± 32.5 (63–157)	91.5 ± 34.8 (62–163)
BMI (kg/m²)	Exercise	32.4 ± 4.5 (23.4–39.7)	32.1 ± 4.5* (23.1–38.9)
	Control	32.7 ± 6.4 (23.5–41.7)	32.8 ± 7.0 (23.1–43.3)
WC (cm)	Exercise	103.5 ± 10.2 (89–117)	99.1 ± 9.6* (85–110)
	Control	104.0 ± 15.1 (85–133)	101.5 ± 17.7 (82–135)
Hip circumference (cm)	Exercise	112.8 ± 9.1 (97–127)	109.8 ± 8.5* (92–118)
	Control	117.0 ± 16.4 (98–139)	114.7 ± 17.2* (95–139)
ALT (U/L)	Exercise	58.1 ± 36.9 (22–146)	51.0 ± 42.2 (19–153)
	Control	55.1 ± 32.0 (12–109)	49.4 ± 41.2 (19–141)
AST (U/L)	Exercise	39.6 ± 15.1 (21–64)	37.3 ± 19.5 (21–80)
	Control	39.0 ± 13.5 (19–60)	38.7 ± 19.2 (17–66)
GGT (U/L)	Exercise	62.7 ± 32.06 (20–115)	47.7 ± 22.4* (23–78)
	Control	65.5 ± 83.0 (13–252)	69.5 ± 94.4* (12–282)
Triglycerides (mmol/L)	Exercise	1.3 ± 0.4 (0.8–2.1)	1.2 ± 0.3 (0.8–1.7)
	Control	1.3 ± 0.4 (0.9–2.2)	1.5 ± 0.4 (0.9–1.9)
HDL (mmol/L)	Exercise	1.1 ± 0.1 (1–1.5)	1.2 ± 0.2 (1.1–1.5)
	Control	1.1 ± 0.1 (0.9–1.4)	1.18 ± 0.2 (1–1.5)
LDL (mmol/L)	Exercise	2.8 ± 0.9 (1.1–4.2)	2.9 ± 0.9 (1.5–4.3)
	Control	2.5 ± 0.6 (1.8–3.5)	2.6 ± 0.8 (1.6–4.2)
Glucose (mmol/L)	Exercise	7.7 ± 3.6 (5.1–17.1)	7.1 ± 3.0 (4.9–14.4)
	Control	5.2 ± 0.4 (4.7–6.1)	5.2 ± 0.5 (4.7–6.0)
Insulin (mIU/L)	Exercise	13.1 ± 4.6 (7–23)	12.2 ± 5.8 (4–20)
	Control	12.5 ± 6.7 (4–24)	9.8 ± 4.4 (4–16)
HOMA-IR	Exercise	3.8 ± 1.4 (2.1–6.7)	3.4 ± 2.2 (1.1–8.0)
	Control	3.0 ± 1.8 (0.8–6.5)	2.3 ± 1.1 (0.8–4.1)
HbA1c (%)	Exercise	6.7 ± 1.8 (5.4–11.2)	6.6 ± 1.8 (5.2–11.2)
	Control	5.7 ± 0.5 (4.7–6.2)	5.6 ± 0.3 (5.0–6.0)
CAP (dB/m)	Exercise	342 ± 28.2 (300–388)	297.1 ± 37.7* (243–341)
	Control	327.8 ± 23.7 (305–376)	292.4 ± 53.6 (243–399)
LSM (kPa)	Exercise	5.9 ± 1.6 (3.5–8.3)	5.4 ± 1.08 (4.1–7.7)
	Control	5.3 ± 1.1 (3–6.6)	5.9 ± 1.0 (4.9–7.3)
TyG-WC	Exercise	498.6 ± 63.7 (412–614)	469.3 ± 57.9* (392–561)
	Control	481.4 ± 65.6 (395–599)	479.0 ± 85.4 (399–647)
FLI	Exercise	78.7 ± 17.6 (45–95)	70.6 ± 21.9* (37–93)
	Control	75.8 ± 22.3 (33–97)	73.8 ± 23.9 (35–99)
Fib-4 index	Exercise	1.3 ± 0.7 (0.6–2.5)	1.3 ± 0.7 (0.5–2.5)
	Control	1.0 ± 0.9 (0.4–3.0)	1.19 ± 1.2 (0.3–3.9)

↓ Table 2. Changes of Variables From Baseline to 8 Weeks Later for the Exercise (n = 9) and Control (n = 7) Groups

Variable

Group

Baseline

8-week

Values are expressed as mean ± standard deviation (SD), with ranges showing the lowest and highest values for each variable. *Significant (P < 0.05) difference from the baseline. Between-group differences are described in the Results text; table values reflect within-group changes only. ALT: alanine transaminase; AST: aspartate aminotransferase; BMI: body mass index; CAP: controlled attenuation parameter; Fib-4: fibrosis-4 index; FLI: fatty liver index; GGT: gamma-glutamyl transferase; HbA1c: glycosylated hemoglobin; HDL: high-density lipoprotein; HOMA-IR: homeostasis model assessment of insulin resistance; LDL: low-density lipoprotein; LSM: liver stiffness measurement; TG: triglycerides; TyG-WC: triglyceride-glucose waist circumference index; WC: waist circumference.

Body mass (kg)

Exercise

89.4 ± 13.0 (70–115)

88.5 ± 13.1* (69–114)

Control

91.0 ± 32.5 (63–157)

91.5 ± 34.8 (62–163)

BMI (kg/m²)

Exercise

32.4 ± 4.5 (23.4–39.7)

32.1 ± 4.5* (23.1–38.9)

Control

32.7 ± 6.4 (23.5–41.7)

32.8 ± 7.0 (23.1–43.3)

WC (cm)

Exercise

103.5 ± 10.2 (89–117)

99.1 ± 9.6* (85–110)

Control

104.0 ± 15.1 (85–133)

101.5 ± 17.7 (82–135)

Hip circumference (cm)

Exercise

112.8 ± 9.1 (97–127)

109.8 ± 8.5* (92–118)

Control

117.0 ± 16.4 (98–139)

114.7 ± 17.2* (95–139)

ALT (U/L)

Exercise

58.1 ± 36.9 (22–146)

51.0 ± 42.2 (19–153)

Control

55.1 ± 32.0 (12–109)

49.4 ± 41.2 (19–141)

AST (U/L)

Exercise

39.6 ± 15.1 (21–64)

37.3 ± 19.5 (21–80)

Control

39.0 ± 13.5 (19–60)

38.7 ± 19.2 (17–66)

GGT (U/L)

Exercise

62.7 ± 32.06 (20–115)

47.7 ± 22.4* (23–78)

Control

65.5 ± 83.0 (13–252)

69.5 ± 94.4* (12–282)

Triglycerides (mmol/L)

Exercise

1.3 ± 0.4 (0.8–2.1)

1.2 ± 0.3 (0.8–1.7)

Control

1.3 ± 0.4 (0.9–2.2)

1.5 ± 0.4 (0.9–1.9)

HDL (mmol/L)

Exercise

1.1 ± 0.1 (1–1.5)

1.2 ± 0.2 (1.1–1.5)

Control

1.1 ± 0.1 (0.9–1.4)

1.18 ± 0.2 (1–1.5)

LDL (mmol/L)

Exercise

2.8 ± 0.9 (1.1–4.2)

2.9 ± 0.9 (1.5–4.3)

Control

2.5 ± 0.6 (1.8–3.5)

2.6 ± 0.8 (1.6–4.2)

Glucose (mmol/L)

Exercise

7.7 ± 3.6 (5.1–17.1)

7.1 ± 3.0 (4.9–14.4)

Control

5.2 ± 0.4 (4.7–6.1)

5.2 ± 0.5 (4.7–6.0)

Insulin (mIU/L)

Exercise

13.1 ± 4.6 (7–23)

12.2 ± 5.8 (4–20)

Control

12.5 ± 6.7 (4–24)

9.8 ± 4.4 (4–16)

HOMA-IR

Exercise

3.8 ± 1.4 (2.1–6.7)

3.4 ± 2.2 (1.1–8.0)

Control

3.0 ± 1.8 (0.8–6.5)

2.3 ± 1.1 (0.8–4.1)

HbA1c (%)

Exercise

6.7 ± 1.8 (5.4–11.2)

6.6 ± 1.8 (5.2–11.2)

Control

5.7 ± 0.5 (4.7–6.2)

5.6 ± 0.3 (5.0–6.0)

CAP (dB/m)

Exercise

342 ± 28.2 (300–388)

297.1 ± 37.7* (243–341)

Control

327.8 ± 23.7 (305–376)

292.4 ± 53.6 (243–399)

LSM (kPa)

Exercise

5.9 ± 1.6 (3.5–8.3)

5.4 ± 1.08 (4.1–7.7)

Control

5.3 ± 1.1 (3–6.6)

5.9 ± 1.0 (4.9–7.3)

TyG-WC

Exercise

498.6 ± 63.7 (412–614)

469.3 ± 57.9* (392–561)

Control

481.4 ± 65.6 (395–599)

479.0 ± 85.4 (399–647)

FLI

Exercise

78.7 ± 17.6 (45–95)

70.6 ± 21.9* (37–93)

Control

75.8 ± 22.3 (33–97)

73.8 ± 23.9 (35–99)

Fib-4 index

Exercise

1.3 ± 0.7 (0.6–2.5)

1.3 ± 0.7 (0.5–2.5)

Control

1.0 ± 0.9 (0.4–3.0)

1.19 ± 1.2 (0.3–3.9)

↓ **Table 3.** Changes of Variables From Baseline to After 8-Week Training (Post-Training) for the Exercise Group
Variable	Baseline	Post-training
Values are expressed as mean ± standard deviation (SD) of nine participants and their lowest and highest values in the brackets. *Significant (P < 0.05) difference from the baseline value.
2-min step (n)	86.3 ± 13.0 (56–98)	118.7 ± 15.7* (79–134)
Sit-to-stand (n)	14.8 ± 2.5 (12–19)	18.4 ± 4.2* (11–25)
Single-leg balance (s)	39.7 ± 24.4 (7–60)	49.7 ± 15.2* (23–60)
Hand grip (kg)	40 ± 16.4 (19–63)	40.1 ± 16.5 (20–66)
Timed up and go (s)	6.4 ± 0.6 (5.3–7.5)	5.4 ± 0.9* (4.6–7.3)

↓ Table 3. Changes of Variables From Baseline to After 8-Week Training (Post-Training) for the Exercise Group

Variable

Baseline

Post-training

Values are expressed as mean ± standard deviation (SD) of nine participants and their lowest and highest values in the brackets. *Significant (P < 0.05) difference from the baseline value.

2-min step (n)

86.3 ± 13.0 (56–98)

118.7 ± 15.7* (79–134)

Sit-to-stand (n)

14.8 ± 2.5 (12–19)

18.4 ± 4.2* (11–25)

Single-leg balance (s)

39.7 ± 24.4 (7–60)

49.7 ± 15.2* (23–60)

Hand grip (kg)

40 ± 16.4 (19–63)

40.1 ± 16.5 (20–66)

Timed up and go (s)

6.4 ± 0.6 (5.3–7.5)

5.4 ± 0.9* (4.6–7.3)