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doi:10.1007/s12264-016-0081-2

During exercise, the muscle signals its energy requirements to the liver by changing the concentration of acylcarnitine in the blood, and the liver adjusts its metabolic activity to increase the synthesis and release of energy substances [223, 224], support muscle contraction and meet the energy demands of exercise [225, 226]

The clinical significance of L-carnitine in ameliorating insulin resistance (IR) lies in its intervention in a core pathogenic feature of MASLD: hepatic IR

[Evaluation of efficacy of propionyl-L-carnitine in chronic oral administration on cardiac muscle efficiency, on tolerance to exercise and on life quality of patients with chronic cardiac failure

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10.1007/s002030050649