Non-alcoholic fatty liver disease (NAFLD) is characterised by triglyceride accumulation and steatosis [1]. Moreover, liver fats within NAFLD patients are in a long-term chronic inflammatory state resulting in damage to the insulin sensitivity of the liver via release of inflammatory factors, such as interleukin (IL)-6 and tumour necrosis factor (TNF)-α. Thus, NAFLD is associated with sugar and lipid metabolism disorders, as well as accelerated liver damage and liver fibrosis progression [2]. China has experienced a particularly rapid and sustained increase in NAFLD prevalence. In fact, China is expected to experience a 29.1% increase in NAFLD cases, from 246.33 M (2016) to 314.58 M (2030) cases [3]. Nevertheless, exercise has proven to be an effective preventative and therapeutic strategy for NAFLD. However, long-term adherence to exercise is often impeded by various barriers associated with rehabilitation-based sports therapy, including accessing transportation, and funding. These barriers have become particularly evident during the COVID-19 pandemic, during which patients have been restricted to home-based interventions, thus, increasing accessibility to exercise service for patients with NAFLD is necessary [4].

Remote monitoring comprises the delivery of therapeutic services via telecommunication technologies, i.e., telephone, internet, and video conferencing [4], [5], [6], [7]. Remote monitoring models enhance the availability of exercise therapy and have been successfully tested in patients with various cardiopulmonary diseases; indeed, their efficacy, feasibility, and safety have been confirmed. For instance, Rita Hwang et al. [4]12-week remote exercise supervision for patients with chronic heart failure through online video conferencing software, and compared the results with traditional rehabilitation centre treatment. The study found that the attendance rate of the remote exercise group was higher, while the improvement on related parameters was comparable between groups. Moreover, Arianna Mazzotti et al. [8] found that implementation of e-learning platforms to conduct 6-month remote exercise monitoring of NAFLD patients was associated with weight reduction, as well as improved liver enzymes and fibrosis levels that were comparable to those observed following in-person, small group interventions. Still further, Tincopa et al. [9] implemented Fitbit mobile technology for patients with NAFLD and reported that during the six months of remote exercise intervention, the patients’ physical activity level significantly improved, as did their triglyceride levels and FibroScan liver stiffness scores. Hence, this intervention has proven effective in patients with NAFLD. However, few studies have reported on the efficacy of remote monitoring in patients with differing levels of NAFLD clinical severity.

The current study sought to explore the effects of exercise intervention-based remote monitoring in patients with varying levels of NAFLD severity. To this end, NAFLD patients were recruited from the physical examination department of a municipal people's hospital. The effects of the intervention were then assessed on body composition, serum glycolipid metabolism, liver function, inflammatory makers, and steatosis. Collectively, the findings of this study provide novel insights regarding the efficacy of remote monitoring strategies as a means to support NAFLD patients in sustained exercise therapy.