Extended Abstract
Introduction
Nonalcoholic fatty liver disease is a type of accumulation of fat in the liver cells. High plasma levels of blood lipids (cholesterol, triglycerides, LDL) lead to increased lipid synthesis in the liver; eventually, it results in fat accumulation and fatty liver formation [6]. There is no definitive strategy for the prevention or treatment of fatty liver disease. Recommended treatment for this disease includes regular exercise alongside a healthy diet and the use of herbs, like purslane [9-7]. Portulaca oleracea has hypolipidemic properties; thus, the present study aimed to investigate the effect of combination training and portulaca oleracea supplementation on plasma lipid profile and liver ultrasound in obese women with nonalcoholic fatty liver.
Materials and Methods 
The study population consisted of 40 to 60-year-old obese women with nonalcoholic fatty liver disease. In total, 40 obese women with nonalcoholic fatty liver disease were randomly selected and divided into 4 groups including training (n=10), training with supplementation (n=10), placebo (n=10(., and supplementation (n=10). Before and after the intervention, sonography of the liver and blood tests were performed. Portulaca oleracea was consumed daily as two 500 mg/d before lunch and dinner. Combined exercises were conducted for 12 weeks, 3 sessions per week which included aerobic exercise (with 60% to 80% maximal heart rate) [18] and resistance training (with 40% to 60% maximal repetition) for 90 minutes [6]. The Paired Samples t-test and Analysis of Variance (ANOVA) were used to analyze the obtained data. The significance level was set at  P<0.05.

Results 
Considering the significance of the achieved data, the results of Paired Samples t-test indicated that 12 weeks of portulaca oleracea supplementation and combined training significantly decreased plasma cholesterol (P=0.001), triglyceride (P=0.00), and LDL (P=0.00), and significantly increased serum HDL (P=0.00) in the combination training with portulaca oleracea supplementation, combination training, and portulaca oleracea supplement (P<0.05) groups. Additionally, liver ultrasound data were improved in the combination training with portulaca oleracea supplementation (P=0.02) and the combination training (P=0.00) (P<0.05) groups. One-way ANOVA results also revealed a significant difference between the study groups (P<0.05) (Table 1). 
Therefore, considering the intergroup differences in the one-way ANOVA data, the Tukey posthoc test was used for more precise analysis and comparing the two test findings Between the training with supplementation group and the placebo group, as well as the placebo group and the training group; in terms of changes in triglyceride levels, there were significant differences between the training and the supplementation groups and the placebo group. Moreover, in terms of HDL enzyme rate, a significant difference was observed between the training and the supplementation groups as well as the placebo group, training, and supplementation group; also between the placebo and exercise groups (P<0.05).

Discussion 
Portulaca oleracea contains high levels of antioxidant compounds as well as omega-3 and omega-6 fats, which inhibit lipid peroxidation. Studies have reported that polyphenols and omega-3 fatty acids found in portulaca oleracea increase energy consumption in fatty liver disease. Moreover, portulaca oleracea extract could reduce the expression of acetyl coenzyme A carboxylase and FAS in the liver. This effect is induced by restrictive fatty acid staining enzymes and the expression of the sterol regulatory element-binding protein that controls the expression of these restriction enzymes. Furthermore, phytoestrogens present in the portulaca oleracea plant reduce cholesterol and LDL-C by increasing unsaturated fatty acids [9]. Therefore, due to different compounds and the beneficial effects of portulaca oleracea supplementation with combination training, it could be used as adjunctive therapy for other clinical parameters related to the fatty liver disease.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Islamic Azad University, Rasht Branch, Iran (Code: IR.IAU.RASHT.REC.1397.034). Also, it was registered at the Iranian Registry of Clinical Trials (IRCT) (Code: IRCT201903090429871).
Funding
This study was extracted from thesis of the first author, Narges aliniya approved by the department of physical education and sports science, Islamic azad university, science and research branch
Authors' contributions
All authors met standard writing standards on the recommendation of the International Committee of Medical Journal Publishers.
Conflicts of interest
The authors declared no conflicts of interest.
Acknowledgments
The authors are grateful to all the study participants for their generous contribution to this research.