Proof of concept exercise and life style verses Lifestyle and electro-stimulation of muscles to resolve NASH- the ELVIS project

The pathogenic process of the disease is insulin resistance, and this can be reversed with intense exercise or programmed electrical stimulation of muscle. Most patients cannot achieve or sustain the level of aerobic exercise required to achieve reversal of NASH; resistance exercise is more sustainable and similarly effective, but again is beyond many patients due to co-morbidities. All patients can receive electro-muscle stimulation. The aim of all these interventions is to move the patient from an insulin resistant, pro-inflammatory state, to a less dangerous metabolic steady state which should be easier to maintain, with conventional exercise and diet. In this study we will investigate if programs of electrical stimulation can reverse insulin resistance and steato-hepatitis resolving NASH in patients. The project will measure a range of physiological changes and dose response relationships, as prelude to demonstrating their effectiveness in real world settings.