Construction of an “Exercise Snacks” Intervention Program Based on Metabolic Phenotype Stratification for Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Construction of an “Exercise Snacks” Intervention Program Based on Metabolic Phenotype Stratification for Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease
Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
1 Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
2 Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Objective : To construct an “exercise snacks” intervention program based on metabolic phenotype stratification for patients with metabolic dysfunction-associated steatotic liver disease (MASLD), so as to provide a reference for overcoming the bottleneck of poor exercise adherence and implementing precise exercise management in this population. Methods : Following a prespecified evidence-synthesis protocol—with reproducible eligibility criteria; systematic searches of PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and the Wanfang Data Knowledge Service Platform from inception to June 2025; dual independent study selection; and quality appraisal using AGREE II, AMSTAR 2, and the Cochrane RoB 2 tool—evidence on exercise snacks and exercise intervention for MASLD was retrieved and synthesized. Guided by self-efficacy theory and informed by documented barriers to exercise among patients with MASLD, a draft program was developed and then finalized after two rounds of multidisciplinary panel discussion. Results : The program consisted of five modules: metabolic phenotype assessment and classification, phenotype-matched exercise snack prescriptions, a standardized movement library, a digital support system, and exercise safety monitoring. Based on bioelectrical impedance analysis and transient elastography, patients were classified through an explicit stepwise algorithm into three mutually exclusive metabolic phenotypes—sarcopenic obesity, central obesity, and mixed—and matched with resistance-dominant, aerobic interval-dominant, or balanced exercise snacks prescriptions, each delivered as an initial dose (weeks 1 - 4) progressing to a target dose, with weekly volumes computed as bouts/day × min/bout × 7 days. A movement library containing 20 standardized movements across 3 intensity levels was established, together with a “prompt-action-feedback” digital closed-loop support system, explicit intensity control parameters, safety termination criteria, and a home-based escalation pathway for red-flag symptoms. Conclusion : Grounded in evidence and behavioral theory, the program combines fragmented exercise with metabolic phenotype stratification and is a theory-informed, potentially feasible tool for precise exercise management. Its clinical effectiveness and implementation fidelity remain to be verified in prospective studies.
Chinese Society of Hepatology, Chinese Medical Association (2024) Guidelines for the Prevention and Treatment of Metabolic Dysfunction-Associated (Non-Alcoholic) Fatty Liver Disease (2024 Edition). Chinese Journal of Hepatology , 32, 418-434. (In Chinese)
Zhou, J., Zhou, F., Wang, W., Zhang, X., Ji, Y., Zhang, P., et al . (2020) Epidemiological Features of NAFLD from 1999 to 2018 in China. Hepatology , 71, 1851-1864. https://doi.org/10.1002/hep.31150
Younossi, Z.M., Golabi, P., Paik, J.M., Henry, A., Van Dongen, C. and Henry, L. (2023) The Global Epidemiology of Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH): A Systematic Review. Hepatology , 77, 1335-1347. https://doi.org/10.1097/hep.0000000000000004
Rinella, M.E., Neuschwander-Tetri, B.A., Siddiqui, M.S., Abdelmalek, M.F., Caldwell, S., Barb, D., et al . (2023) AASLD Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease. Hepatology , 77, 1797-1835. https://doi.org/10.1097/hep.0000000000000323
Chalasani, N., Younossi, Z., Lavine, J.E., Charlton, M., Cusi, K., Rinella, M., et al . (2018) The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance from the American Association for the Study of Liver Diseases. Hepatology , 67, 328-357. https://doi.org/10.1002/hep.29367
Keating, S.E., Chawla, Y., De, A. and George, E.S. (2024) Lifestyle Intervention for Metabolic Dysfunction-Associated Fatty Liver Disease: A 24-H Integrated Behavior Perspective. Hepatology International , 18, 959-976. https://doi.org/10.1007/s12072-024-10663-9
Stine, J.G., DiJoseph, K., Pattison, Z., Harrington, A., Chinchilli, V.M., Schmitz, K.H., et al . (2023) Exercise Training Is Associated with Treatment Response in Liver Fat Content by Magnetic Resonance Imaging Independent of Clinically Significant Body Weight Loss in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. American Journal of Gastroenterology , 118, 1204-1213. https://doi.org/10.14309/ajg.0000000000002098
Keating, S.E., Hackett, D.A., George, J. and Johnson, N.A. (2012) Exercise and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Journal of Hepatology , 57, 157-166. https://doi.org/10.1016/j.jhep.2012.02.023
European Association for the Study of the Liver, European Association for the Study of Diabetes and European Association for the Study of Obesity (2024) EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Journal of Hepatology , 81, 492-542.
Self-Efficacy
Nursing Care
Islam, H., Gibala, M.J. and Little, J.P. (2022) Exercise Snacks: A Novel Strategy to Improve Cardiometabolic Health. Exercise and Sport Sciences Reviews , 50, 31-37. https://doi.org/10.1249/jes.0000000000000275
Francois, M.E., Baldi, J.C., Manning, P.J., Lucas, S.J.E., Hawley, J.A., Williams, M.J.A., et al . (2014) ‘Exercise Snacks’ before Meals: A Novel Strategy to Improve Glycaemic Control in Individuals with Insulin Resistance. Diabetologia , 57, 1437-1445. https://doi.org/10.1007/s00125-014-3244-6
Thyfault, J.P. and Rector, R.S. (2020) Exercise Combats Hepatic Steatosis: Potential Mechanisms and Clinical Implications. Diabetes , 69, 517-524. https://doi.org/10.2337/dbi18-0043
Little, J.P., Gillen, J.B., Percival, M.E., Safdar, A., Tarnopolsky, M.A., Punthakee, Z., et al . (2011) Low-Volume High-Intensity Interval Training Reduces Hyperglycemia and Increases Muscle Mitochondrial Capacity in Patients with Type 2 Diabetes. Journal of Applied Physiology , 111, 1554-1560. https://doi.org/10.1152/japplphysiol.00921.2011
MacInnis, M.J. and Gibala, M.J. (2017) Physiological Adaptations to Interval Training and the Role of Exercise Intensity. The Journal of Physiology , 595, 2915-2930. https://doi.org/10.1113/jp273196
Rodríguez, M.Á., Quintana-Cepedal, M., Cheval, B., Thøgersen-Ntoumani, C., Crespo, I. and Olmedillas, H. (2026) Effect of Exercise Snacks on Fitness and Cardiometabolic Health in Physically Inactive Individuals: Systematic Review and Meta-Analysis. British Journal of Sports Medicine , 60, 133-141. https://doi.org/10.1136/bjsports-2025-110027
Stamatakis, E., Ahmadi, M.N., Gill, J.M.R., Thøgersen-Ntoumani, C., Gibala, M.J., Doherty, A., et al . (2022) Association of Wearable Device-Measured Vigorous Intermittent Lifestyle Physical Activity with Mortality. Nature Medicine , 28, 2521-2529. https://doi.org/10.1038/s41591-022-02100-x
Peng, T., Wu, L., Chen, W., Liaw, F., Chang, Y. and Kao, T. (2019) Nonalcoholic Fatty Liver Disease and Sarcopenia in a Western Population (NHANES III): The Importance of Sarcopenia Definition. Clinical Nutrition , 38, 422-428. https://doi.org/10.1016/j.clnu.2017.11.021
Mantovani, A., Scorletti, E., Mosca, A., Alisi, A., Byrne, C.D. and Targher, G. (2020) Complications, Morbidity and Mortality of Nonalcoholic Fatty Liver Disease. Metabolism , 111, Article ID: 154170. https://doi.org/10.1016/j.metabol.2020.154170
Hallsworth, K., Fattakhova, G., Hollingsworth, K.G., Thoma, C., Moore, S., Taylor, R., et al . (2011) Resistance Exercise Reduces Liver Fat and Its Mediators in Non-Alcoholic Fatty Liver Disease Independent of Weight Loss. Gut , 60, 1278-1283. https://doi.org/10.1136/gut.2011.242073
Kim, D., Chung, G.E., Kwak, M., Seo, H.B., Kang, J.H., Kim, W., et al . (2016) Body Fat Distribution and Risk of Incident and Regressed Nonalcoholic Fatty Liver Disease. Clinical Gastroenterology and Hepatology , 14, 132-138.e4. https://doi.org/10.1016/j.cgh.2015.07.024
Joo, S.K. and Kim, W. (2023) Interaction between Sarcopenia and Nonalcoholic Fatty Liver Disease. Clinical and Molecular Hepatology , 29, S68-S78. https://doi.org/10.3350/cmh.2022.0358
Ferguson, T., Olds, T., Curtis, R., Blake, H., Crozier, A.J., Dankiw, K., et al . (2022) Effectiveness of Wearable Activity Trackers to Increase Physical Activity and Improve Health: A Systematic Review of Systematic Reviews and Meta-Analyses. The Lancet Digital Health , 4, e615-e626. https://doi.org/10.1016/s2589-7500(22)00111-x
Bandura, A. (1977) Self-Efficacy: Toward a Unifying Theory of Behavioral Change. Psychological Review , 84, 191-215. https://doi.org/10.1037/0033-295x.84.2.191
Chen, L., Woo, J., Assantachai, P., Auyeung, T., Chou, M., Iijima, K., et al . (2020) Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. Journal of the American Medical Directors Association , 21, 300-307.e2. https://doi.org/10.1016/j.jamda.2019.12.012
Sultana, R.N., Sabag, A., Keating, S.E. and Johnson, N.A. (2019) The Effect of Low-Volume High-Intensity Interval Training on Body Composition and Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis. Sports Medicine , 49, 1687-1721. https://doi.org/10.1007/s40279-019-01167-w