human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Nonalcoholic fatty liver disease ( NAFLD ) has different prevalence rates in various parts of the world and is a risk factor for diabetes and cardiovascular disease that could progress to nonalcoholic steatohepatitis , cirrhosis , and liver failure . Objectives : The current study aim ed to investigate the effect of Aerobic Training ( AT ) and resistance training ( RT ) on hepatic fat content and liver enzyme levels in Iranian men . Patients and Methods : In a r and omized clinical trial study , 30 men with clinical ly defined NAFLD were allocated into three groups ( aerobic , resistance and control ) . An aerobic group program consisted of 45 minutes of aerobic exercise at 60 % - 75 % maximum heart rate intensity , a resistance group performed seven resistance exercises at intensity of 50 % - 70 % of 1 repetition maximum ( 1RM ) and the control group had no exercise training program during the study . Before and after training , anthropometry , insulin sensitivity , liver enzymes and hepatic fat were elevated . Results : After training , hepatic fat content was markedly reduced , to a similar extent , in both the aerobic and resistance exercise training groups ( P ≤ 0.05 ) . In the two exercise training groups , alanine amino transferase and aspartate amino transferase serum levels were significantly decreased compared to the control group ( P = 0.002 ) and ( P = 0.02 ) , respectively . Moreover , body fat ( % ) , fat mass ( kg ) , homeostasis model assessment insulin resistance ( HOMI-IR ) were all improved in the AT and RT . These changes in the AT group were independent of weight loss . Conclusions : This study demonstrated that RT and AT are equally effective in reducing hepatic fat content and liver enzyme levels among patients with NAFLD . However , aerobic exercise specifically improves NAFLD independent of any change in body weight The optimal exercise modality for reductions of abdominal obesity and risk factors for  type 2 diabetes in youth is unknown . We examined the effects of aerobic exercise ( AE ) versus resistance exercise ( RE ) without caloric restriction on abdominal adiposity , ectopic fat , and insulin sensitivity and secretion in youth . Forty-five obese adolescent boys were r and omly assigned to one of three 3-month interventions : AE , RE , or a nonexercising control . Abdominal fat was assessed by magnetic resonance imaging , and intrahepatic lipid and intramyocellular lipid were assessed by proton magnetic resonance spectroscopy . Insulin sensitivity and secretion were evaluated by a 3-h hyperinsulinemic-euglycemic clamp and a 2-h hyperglycemic clamp . Both AE and RE prevented the significant weight gain that was observed in controls . Compared with controls , significant reductions in total and visceral fat and intrahepatic lipid were observed in both exercise groups . Compared with controls , a significant improvement in insulin sensitivity ( 27 % ) was observed in the RE group . Collapsed across groups , changes in visceral fat were associated with changes in intrahepatic lipid ( r = 0.72 ) and insulin sensitivity ( r = −0.47 ) . Both AE and RE alone are effective for reducing abdominal fat and intrahepatic lipid in obese adolescent boys . RE but not AE is also associated with significant improvements in insulin sensitivity Background : To investigate the effects of varied therapeutic lifestyle programs on patients with ultrasound‐diagnosed nonalcoholic fatty liver disease ( NAFLD ) . Methods : A prospect i ve , case‐controlled study was conducted . A total of 54 subjects with NAFLD were subdivided into 3 groups : ( 1 ) diet plus exercise group ( DPE group , n = 16 ) ; ( 2 ) exercise group ( E group , n = 23 ) ; and ( 3 ) control group ( C group , n = 15 ) . The DPE group received a low‐calorie balanced diet and regular high‐intensity stationary bicycle exercise program for 10 weeks , while the E group received the same exercise protocol as the DPE group but without any changes in diet . Anthropometric indices , biochemical data , physical fitness data and liver ultrasound findings were recorded . A generalized estimating equation method was used to determine the differences among groups . Results : Compared with the C group , the DPE group demonstrated significant improvements in anthropometric indices , total cholesterol , insulin sensitivity , liver biochemistry , ultrasound finding and physical fitness , while the E group showed significant improvements in anthropometric indices , insulin sensitivity status , ultrasound finding and physical fitness but not liver biochemistry . Compared with the E group , the DPE group showed greater reduction in anthropometric indices ( body mass index , body weight , abdominal circumference , hip circumference ) , total cholesterol , alanine aminotransferase , and γ‐glutamyltransferase . Conclusion : Our data suggest that both 10‐week diet‐plus‐exercise and exercise‐only therapeutic lifestyle programs are effective for improving anthropometric indices , insulin sensitivity , ultrasound findings and physical fitness in ultrasound‐diagnosed NAFLD patients . However , the range of improvement in patients on the diet‐plus‐exercise program is more obvious than that in patients on the exercise‐only program . Moreover , the diet‐plus‐exercise program result ed in significant improvement in liver biochemistry , but the exercise‐only program did not . In summary , diet plus exercise is more efficacious than exercise alone in the lifestyle modification treatment of NAFLD BACKGROUND & AIMS Aerobic exercise reduces liver fat and visceral adipose tissue ( VAT ) . However , there is limited data from r and omized trials to inform exercise programming recommendations . This study examined the efficacy of commonly prescribed exercise doses for reducing liver fat and VAT using a r and omized placebo-controlled design . METHODS Inactive and overweight/obese adults received 8 weeks of either ; i ) low to moderate intensity , high volume aerobic exercise ( LO : HI , 50 % VO 2peak , 60 min , 4d/week ) ; ii ) high intensity , low volume aerobic exercise ( HI : LO , 70 % VO 2peak , 45 min , 3d/week ) ; iii ) low to moderate intensity , low volume aerobic exercise ( LO : LO , 50 % VO 2peak , 45 min , 3d/week ) ; or iv ) placebo ( PLA ) . Liver fat ( spectroscopy ) and VAT ( magnetic resonance imaging ) were measured before and after intervention . RESULTS Forty-seven of the 48 ( n = 12 in each group ) participants completed the trial . There were no serious adverse events . There was a significant change in group × time interaction in liver fat , which reduced in HI : LO by 2.38 ± 0.73 % , in LO : HI by 2.62 ± 1.00 % , and in LO : LO by 0.84 ± 0.47 % but not in PLA ( increase of 1.10 ± 0.62 % ) ( p = 0.04 ) . There was a significant reduction in VAT in HI : LO ( -258.38 ± 87.78 cm(3 ) ) , in LO : HI ( -386.80 ± 119.5 cm(3 ) ) , and in LO : LO ( -212.96 ± 105.54 cm(3 ) ) , but not in PLA ( 92.64 ± 83.46 cm(3 ) ) ( p = 0.03 ) . There were no significant differences between the dose or intensity of the exercise regimen and reductions in liver fat or VAT ( p > 0.05 ) . CONCLUSION The study found no difference in efficacy of liver fat reduction by either aerobic exercise dose or intensity . All of the aerobic exercise regimens employed reduced liver fat and VAT by a small amount without clinical ly significant weight loss Increased hepatocyte apoptosis is a hallmark of nonalcoholic fatty liver disease ( NAFLD ) and contributes to the profibrogenic state responsible for the progression to nonalcoholic steatohepatitis ( NASH ) . Strategies aim ed at reducing apoptosis may result in better outcomes for individuals with NAFLD . We therefore examined the effect of a short-term exercise program on markers of apoptosis-plasma cytokeratin 18 ( CK18 ) fragments , alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , soluble Fas ( sFas ) , and sFas lig and (sFasL)-in  13 obese individuals with NAFLD [ body mass index 35.2 ± 1.2 kg/m(2 ) , > 5 % intrahepatic lipid ( IHL ) assessed by (1)H-MR spectroscopy ]  . Exercise consisted of treadmill walking for 60 min/day on 7 consecutive days at ∼85 % of maximal heart rate . Additionally , subjects underwent an oral glucose tolerance test and a maximal oxygen consumption ( Vo(2max ) ) test before and after the exercise intervention . The Matsuda index was used to assess insulin sensitivity . We observed significant decreases in CK18 fragments ( 558.4 ± 106.8 vs. 323.4 ± 72.5 U/l , P < 0.01 ) and ALT ( 30.2 ± 5.1 vs. 24.3 ± 4.8 U/l , P < 0.05 ) , and an increase in whole body fat oxidation ( 49.3 ± 6.1 vs. 69.4 ± 7.1 mg/min , P < 0.05 ) , while decreases in circulating sFasL approached statistical significance ( 66.5 ± 6.0 vs. 63.0 ± 5.7 pg/ml , P = 0.06 ) , as did the relationship between percent change in circulating CK18 fragments and ALT ( r = 0.55 , P = 0.05 ) . We also observed a significant correlation between changes in fat oxidation and circulating sFasL ( rho = -0.65 , P < 0.05 ) . There was no change in IHL following the intervention ( 18.2 ± 2.5 vs. 17.5 ± 2.1 % , NS ) . We conclude that short-term exercise reduces a circulatory marker of hepatocyte apoptosis in obese individuals with NAFLD and propose that changes in the proapoptotic environment may be mediated through improved insulin sensitivity and increased oxidative capacity OBJECTIVE To determine the efficacy of high-intensity progressive resistance training ( PRT ) on glycemic control in older adults with type 2 diabetes . RESEARCH DESIGN AND METHODS We performed a 16-week r and omized controlled trial in 62 Latino older adults ( 40 women and 22 men ; mean + /- SE age 66 + /- 8 years ) with type 2 diabetes r and omly assigned to supervised PRT or a control group .  Glycemic control , metabolic syndrome abnormalities , body composition , and muscle glycogen stores were determined before and after the intervention . RESULTS Sixteen weeks of PRT ( three times per week ) result ed in reduced plasma glycosylated hemoglobin levels ( from 8.7 + /- 0.3 to 7.6 + /- 0.2 % ) , increased muscle glycogen stores ( from 60.3 + /- 3.9 to 79.1 + /- 5.0 mmol glucose/kg muscle ) , and reduced the dose of prescribed diabetes medication in 72 % of exercisers compared with the control group , P = 0.004 - 0.05 . Control subjects showed no change in glycosylated hemoglobin , a reduction in muscle glycogen ( from 61.4 + /- 7.7 to 47.2 + /- 6.7 mmol glucose/kg muscle ) , and a 42 % increase in diabetes medications . PRT subjects versus control subjects also increased lean mass ( + 1.2 + /- 0.2 vs. -0.1 + /- 0.1 kg ) , reduced systolic blood pressure ( -9.7 + /- 1.6 vs. + 7.7 + /- 1.9 mmHg ) , and decreased trunk fat mass ( -0.7 + /- 0.1 vs. + 0.8 + /- 0.1 kg ; P = 0.01 - 0.05 ) . CONCLUSIONS PRT as an adjunct to st and ard of care is feasible and effective in improving glycemic control and some of the abnormalities associated with the metabolic syndrome among high-risk older adults with type 2 diabetes Background In adipose cells , adipose triglyceride lipase ( ATGL ) catalyzes the first step in adipocyte triacylglyceride hydrolysis , thereby regulating both basal and hormone-stimulated lipolysis . However , little is known about the molecular mechanism(s ) underlying habitual exercise-induced adaptive modulation of ATGL in white adipocytes via alteration in transcription regulator and lipolytic cofactors . Methodology /Principal Results Male Wistar rats were r and omly divided into 2 groups a sedentary control group ( CG ) and a habitual exercise group ( EG ) . The EG was subjected to running on a treadmill set at 5 days per week for 9 weeks . The CG was not subjected to running on a treadmill . In the EG , levels of ATGL mRNA and protein were elev 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Nonalcoholic fatty liver disease ( NAFLD ) has different prevalence rates in various parts of the world and is a risk factor for diabetes and cardiovascular disease that could progress to nonalcoholic steatohepatitis , cirrhosis , and liver failure . Objectives : The current study aim ed to investigate the effect of Aerobic Training ( AT ) and resistance training ( RT ) on hepatic fat content and liver enzyme levels in Iranian men . Patients and Methods : In a r and omized clinical trial study , 30 men with clinical ly defined NAFLD were allocated into three groups ( aerobic , resistance and control ) . An aerobic group program consisted of 45 minutes of aerobic exercise at 60 % - 75 % maximum heart rate intensity , a resistance group performed seven resistance exercises at intensity of 50 % - 70 % of 1 repetition maximum ( 1RM ) and the control group had no exercise training program during the study . Before and after training , anthropometry , insulin sensitivity , liver enzymes and hepatic fat were elevated . Results : After training , hepatic fat content was markedly reduced , to a similar extent , in both the aerobic and resistance exercise training groups ( P ≤ 0.05 ) . In the two exercise training groups , alanine amino transferase and aspartate amino transferase serum levels were significantly decreased compared to the control group ( P = 0.002 ) and ( P = 0.02 ) , respectively . Moreover , body fat ( % ) , fat mass ( kg ) , homeostasis model assessment insulin resistance ( HOMI-IR ) were all improved in the AT and RT . These changes in the AT group were independent of weight loss . Conclusions : This study demonstrated that RT and AT are equally effective in reducing hepatic fat content and liver enzyme levels among patients with NAFLD . However , aerobic exercise specifically improves NAFLD independent of any change in body weight The optimal exercise modality for reductions of abdominal obesity and risk factors for  type 2 diabetes in youth is unknown . We examined the effects of aerobic exercise ( AE ) versus resistance exercise ( RE ) without caloric restriction on abdominal adiposity , ectopic fat , and insulin sensitivity and secretion in youth . Forty-five obese adolescent boys were r and omly assigned to one of three 3-month interventions : AE , RE , or a nonexercising control . Abdominal fat was assessed by magnetic resonance imaging , and intrahepatic lipid and intramyocellular lipid were assessed by proton magnetic resonance spectroscopy . Insulin sensitivity and secretion were evaluated by a 3-h hyperinsulinemic-euglycemic clamp and a 2-h hyperglycemic clamp . Both AE and RE prevented the significant weight gain that was observed in controls . Compared with controls , significant reductions in total and visceral fat and intrahepatic lipid were observed in both exercise groups . Compared with controls , a significant improvement in insulin sensitivity ( 27 % ) was observed in the RE group . Collapsed across groups , changes in visceral fat were associated with changes in intrahepatic lipid ( r = 0.72 ) and insulin sensitivity ( r = −0.47 ) . Both AE and RE alone are effective for reducing abdominal fat and intrahepatic lipid in obese adolescent boys . RE but not AE is also associated with significant improvements in insulin sensitivity Background : To investigate the effects of varied therapeutic lifestyle programs on patients with ultrasound‐diagnosed nonalcoholic fatty liver disease ( NAFLD ) . Methods : A prospect i ve , case‐controlled study was conducted . A total of 54 subjects with NAFLD were subdivided into 3 groups : ( 1 ) diet plus exercise group ( DPE group , n = 16 ) ; ( 2 ) exercise group ( E group , n = 23 ) ; and ( 3 ) control group ( C group , n = 15 ) . The DPE group received a low‐calorie balanced diet and regular high‐intensity stationary bicycle exercise program for 10 weeks , while the E group received the same exercise protocol as the DPE group but without any changes in diet . Anthropometric indices , biochemical data , physical fitness data and liver ultrasound findings were recorded . A generalized estimating equation method was used to determine the differences among groups . Results : Compared with the C group , the DPE group demonstrated significant improvements in anthropometric indices , total cholesterol , insulin sensitivity , liver biochemistry , ultrasound finding and physical fitness , while the E group showed significant improvements in anthropometric indices , insulin sensitivity status , ultrasound finding and physical fitness but not liver biochemistry . Compared with the E group , the DPE group showed greater reduction in anthropometric indices ( body mass index , body weight , abdominal circumference , hip circumference ) , total cholesterol , alanine aminotransferase , and γ‐glutamyltransferase . Conclusion : Our data suggest that both 10‐week diet‐plus‐exercise and exercise‐only therapeutic lifestyle programs are effective for improving anthropometric indices , insulin sensitivity , ultrasound findings and physical fitness in ultrasound‐diagnosed NAFLD patients . However , the range of improvement in patients on the diet‐plus‐exercise program is more obvious than that in patients on the exercise‐only program . Moreover , the diet‐plus‐exercise program result ed in significant improvement in liver biochemistry , but the exercise‐only program did not . In summary , diet plus exercise is more efficacious than exercise alone in the lifestyle modification treatment of NAFLD BACKGROUND & AIMS Aerobic exercise reduces liver fat and visceral adipose tissue ( VAT ) . However , there is limited data from r and omized trials to inform exercise programming recommendations . This study examined the efficacy of commonly prescribed exercise doses for reducing liver fat and VAT using a r and omized placebo-controlled design . METHODS Inactive and overweight/obese adults received 8 weeks of either ; i ) low to moderate intensity , high volume aerobic exercise ( LO : HI , 50 % VO 2peak , 60 min , 4d/week ) ; ii ) high intensity , low volume aerobic exercise ( HI : LO , 70 % VO 2peak , 45 min , 3d/week ) ; iii ) low to moderate intensity , low volume aerobic exercise ( LO : LO , 50 % VO 2peak , 45 min , 3d/week ) ; or iv ) placebo ( PLA ) . Liver fat ( spectroscopy ) and VAT ( magnetic resonance imaging ) were measured before and after intervention . RESULTS Forty-seven of the 48 ( n = 12 in each group ) participants completed the trial . There were no serious adverse events . There was a significant change in group × time interaction in liver fat , which reduced in HI : LO by 2.38 ± 0.73 % , in LO : HI by 2.62 ± 1.00 % , and in LO : LO by 0.84 ± 0.47 % but not in PLA ( increase of 1.10 ± 0.62 % ) ( p = 0.04 ) . There was a significant reduction in VAT in HI : LO ( -258.38 ± 87.78 cm(3 ) ) , in LO : HI ( -386.80 ± 119.5 cm(3 ) ) , and in LO : LO ( -212.96 ± 105.54 cm(3 ) ) , but not in PLA ( 92.64 ± 83.46 cm(3 ) ) ( p = 0.03 ) . There were no significant differences between the dose or intensity of the exercise regimen and reductions in liver fat or VAT ( p > 0.05 ) . CONCLUSION The study found no difference in efficacy of liver fat reduction by either aerobic exercise dose or intensity . All of the aerobic exercise regimens employed reduced liver fat and VAT by a small amount without clinical ly significant weight loss Increased hepatocyte apoptosis is a hallmark of nonalcoholic fatty liver disease ( NAFLD ) and contributes to the profibrogenic state responsible for the progression to nonalcoholic steatohepatitis ( NASH ) . Strategies aim ed at reducing apoptosis may result in better outcomes for individuals with NAFLD . We therefore examined the effect of a short-term exercise program on markers of apoptosis-plasma cytokeratin 18 ( CK18 ) fragments , alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , soluble Fas ( sFas ) , and sFas lig and (sFasL)-in  13 obese individuals with NAFLD [ body mass index 35.2 ± 1.2 kg/m(2 ) , > 5 % intrahepatic lipid ( IHL ) assessed by (1)H-MR spectroscopy ]  . Exercise consisted of treadmill walking for 60 min/day on 7 consecutive days at ∼85 % of maximal heart rate . Additionally , subjects underwent an oral glucose tolerance test and a maximal oxygen consumption ( Vo(2max ) ) test before and after the exercise intervention . The Matsuda index was used to assess insulin sensitivity . We observed significant decreases in CK18 fragments ( 558.4 ± 106.8 vs. 323.4 ± 72.5 U/l , P < 0.01 ) and ALT ( 30.2 ± 5.1 vs. 24.3 ± 4.8 U/l , P < 0.05 ) , and an increase in whole body fat oxidation ( 49.3 ± 6.1 vs. 69.4 ± 7.1 mg/min , P < 0.05 ) , while decreases in circulating sFasL approached statistical significance ( 66.5 ± 6.0 vs. 63.0 ± 5.7 pg/ml , P = 0.06 ) , as did the relationship between percent change in circulating CK18 fragments and ALT ( r = 0.55 , P = 0.05 ) . We also observed a significant correlation between changes in fat oxidation and circulating sFasL ( rho = -0.65 , P < 0.05 ) . There was no change in IHL following the intervention ( 18.2 ± 2.5 vs. 17.5 ± 2.1 % , NS ) . We conclude that short-term exercise reduces a circulatory marker of hepatocyte apoptosis in obese individuals with NAFLD and propose that changes in the proapoptotic environment may be mediated through improved insulin sensitivity and increased oxidative capacity OBJECTIVE To determine the efficacy of high-intensity progressive resistance training ( PRT ) on glycemic control in older adults with type 2 diabetes . RESEARCH DESIGN AND METHODS We performed a 16-week r and omized controlled trial in 62 Latino older adults ( 40 women and 22 men ; mean + /- SE age 66 + /- 8 years ) with type 2 diabetes r and omly assigned to supervised PRT or a control group .  Glycemic control , metabolic syndrome abnormalities , body composition , and muscle glycogen stores were determined before and after the intervention . RESULTS Sixteen weeks of PRT ( three times per week ) result ed in reduced plasma glycosylated hemoglobin levels ( from 8.7 + /- 0.3 to 7.6 + /- 0.2 % ) , increased muscle glycogen stores ( from 60.3 + /- 3.9 to 79.1 + /- 5.0 mmol glucose/kg muscle ) , and reduced the dose of prescribed diabetes medication in 72 % of exercisers compared with the control group , P = 0.004 - 0.05 . Control subjects showed no change in glycosylated hemoglobin , a reduction in muscle glycogen ( from 61.4 + /- 7.7 to 47.2 + /- 6.7 mmol glucose/kg muscle ) , and a 42 % increase in diabetes medications . PRT subjects versus control subjects also increased lean mass ( + 1.2 + /- 0.2 vs. -0.1 + /- 0.1 kg ) , reduced systolic blood pressure ( -9.7 + /- 1.6 vs. + 7.7 + /- 1.9 mmHg ) , and decreased trunk fat mass ( -0.7 + /- 0.1 vs. + 0.8 + /- 0.1 kg ; P = 0.01 - 0.05 ) . CONCLUSIONS PRT as an adjunct to st and ard of care is feasible and effective in improving glycemic control and some of the abnormalities associated with the metabolic syndrome among high-risk older adults with type 2 diabetes Background In adipose cells , adipose triglyceride lipase ( ATGL ) catalyzes the first step in adipocyte triacylglyceride hydrolysis , thereby regulating both basal and hormone-stimulated lipolysis . However , little is known about the molecular mechanism(s ) underlying habitual exercise-induced adaptive modulation of ATGL in white adipocytes via alteration in transcription regulator and lipolytic cofactors . Methodology /Principal Results Male Wistar rats were r and omly divided into 2 groups a sedentary control group ( CG ) and a habitual exercise group ( EG ) . The EG was subjected to running on a treadmill set at 5 days per week for 9 weeks . The CG was not subjected to running on a treadmill . In the EG , levels of ATGL mRNA and protein were elev 
    Output:
    