Telemonitoring-Supported Exercise Training May Improve Liver Inflammation, Fibrosis in Metabolic Syndrome

Doctor on the computer laptop screen.
Doctor on the computer laptop screen. Telemedicine or telehealth concept.
Investigators assessed the effects of an exercise program with telemonitoring-based supervision on liver inflammation and risk for metabolic-associated fatty liver disease.

In individuals with metabolic syndrome, a 6-month lifestyle intervention based on exercise training with specialized telemonitoring-based supervisions can help improve liver inflammation and fibrosis, according to study results published in Clinical and Translational Gastroenterology.

Metabolic syndrome is a major global health concern and risk factor for metabolic-associated fatty liver disease. The increasing prevalence of metabolic syndrome and metabolic-associated fatty liver disease require technology-aided interventions to fortify long-term compliance with physical activity and lifestyle changes.

Previously, a team of investigators conducted a randomized controlled trial ( Identifier: NCT03293264) in employees with metabolic syndrome using a 6-month lifestyle intervention to monitor reduced disease severity.

In this current secondary analysis, the investigators assessed whether the intervention, which included exercise training with individualized telemonitoring-based supervision, could also improve liver parameters and reduce the risk for metabolic-associated fatty liver disease.

Volunteers who had metabolic syndrome were randomly assigned to either a 6-month lifestyle intervention or a waiting-list (control) group. Of the 314 employees who were included in the study, 274 completed the intervention: 132 patients in the intervention cohort and 142 in the control cohort.

During the 6-month intervention, exercise activity increased more for participants in the exercise group than in the control group. There were no differences reported between groups for energy intake, macronutrient intake, and alcohol consumption at baseline. Although the exercise group had a reduction in total energy intake, as well as fats and carbohydrates, no significant differences were noted between the 2 groups over time. Blood parameters and renal function were also similar between the 2 groups.

At baseline, both cohorts had slightly increased levels of alanine aminotransferase; however, alanine aminotransferase and aspartate aminotransferase levels significantly decreased after 6 months of physical activity intervention in the exercise group compared with the control group. In addition, alkaline phosphatase and gamma-glutamyl transferases significantly decreased in the exercise cohort. These levels did not decrease for the control cohort, thereby significantly increasing the differences between the cohorts over time.

Changes in body mass index were associated with changes in alanine aminotransferase (P <.01) and aspartate aminotransferase (P <.01) in the exercise group. Improved exercise capacity was also linked to improved aminotransferase levels for patients in the exercise cohort.

“We observed that the activity duration and intensity as well as applied telemonitoring systems were well accepted, with attrition rates in line with those commonly observed for exercise programs,” the researchers wrote. “As [metabolic syndrome] and [metabolic-associated fatty liver disease] also carry a large economic burden with rising prevalence, a telemonitoring-guided intervention might also be a cost-effective approach to support treatment of both diseases independent of residence or workplace,” the investigators concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Haufe S, Hupa-Breier KL, Bayerle P, et al. Telemonitoring-supported exercise training in employees with metabolic syndrome improves liver inflammation and fibrosis. Clin Transl Gastroenterol. 2021;12(6):e00371. doi:10.14309/ctg.0000000000000371