Exercise training improves hepatic enzymes, body mass index, and cardiorespiratory fitness in adults with metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis
- 1School of Physical Education, Jiangxi Normal University Science and Technology College , , ,
Abstract
Background: Exercise is recommended for metabolic dysfunction-associated steatotic liver disease (MASLD). Recent reviews have addressed specific exercise modalities or selected outcome domains, but an updated integrated appraisal of hepatic, metabolic, and cardiorespiratory responses across randomized trials remains needed.
Method: We conducted a PRISMA 2020-compliant systematic review and meta-analysis of randomized controlled trials in adults with MASLD or legacy diagnoses of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. PubMed, Embase, CENTRAL, Scopus, Web of Science, and SPORTDiscus were searched from inception to June 2026. Post-intervention mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled. Risk of bias was assessed using RoB 2 and certainty using GRADE.
Results: Twenty-five trials were included. Exercise reduced alanine aminotransferase (ALT; MD −7.33 U/L, 95% CI −10.71 to −3.95), aspartate aminotransferase (AST; MD −5.52 U/L, 95% CI −10.24 to −0.79), and BMI (random-effects MD −1.54 kg/m², 95% CI −2.28 to −0.80), and improved VO2peak/VO2max (MD 4.08 mL/kg/min, 95% CI 1.00 to 7.16). Pooled effects for liver fat/steatosis, HOMA-IR, and HbA1c were not statistically significant. Egger testing showed no significant asymmetry for ALT or AST, whereas BMI showed funnel-plot asymmetry consistent with possible small-study effects.
Conclusion: Exercise training improves hepatic enzymes, BMI, and cardiorespiratory fitness in adults with MASLD/NAFLD, whereas evidence for liver fat and glycemic outcomes remains less certain. PROSPERO: CRD420261416397.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261416397.
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BibTeX
@article{long2026exercise,
title = {{Exercise training improves hepatic enzymes, body mass index, and cardiorespiratory fitness in adults with metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis}},
author = {Sai Long and Yao Li},
journal = {Frontiers in physiology},
year = {2026},
month = oct,
doi = {10.3389/fphys.2026.1976073},
url = {https://europepmc.org/article/PMC/PMC13719568},
note = {CC BY},
}
RIS
TY - JOUR
TI - Exercise training improves hepatic enzymes, body mass index, and cardiorespiratory fitness in adults with metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis
AU - Sai Long
AU - Yao Li
PY - 2026
DA - 2026/10/16
JO - Frontiers in physiology
DO - 10.3389/fphys.2026.1976073
UR - https://europepmc.org/article/PMC/PMC13719568
AB - Background: Exercise is recommended for metabolic dysfunction-associated steatotic liver disease (MASLD). Recent reviews have addressed specific exercise modalities or selected outcome domains, but an updated integrated appraisal of hepatic, metabolic, and cardiorespiratory responses across randomized trials remains needed. Method: We conducted a PRISMA 2020-compliant systematic review and meta-analysis of randomized controlled trials in adults with MASLD or legacy diagnoses of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. PubMed, Embase, CENTRAL, Scopus, Web of Science, and SPORTDiscus were searched from inception to June 2026. Post-intervention mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled. Risk of bias was assessed using RoB 2 and certainty using GRADE. Results: Twenty-five trials were included. Exercise reduced alanine aminotransferase (ALT; MD −7.33 U/L, 95% CI −10.71 to −3.95), aspartate aminotransferase (AST; MD −5.52 U/L, 95% CI −10.24 to −0.79), and BMI (random-effects MD −1.54 kg/m², 95% CI −2.28 to −0.80), and improved VO2peak/VO2max (MD 4.08 mL/kg/min, 95% CI 1.00 to 7.16). Pooled effects for liver fat/steatosis, HOMA-IR, and HbA1c were not statistically significant. Egger testing showed no significant asymmetry for ALT or AST, whereas BMI showed funnel-plot asymmetry consistent with possible small-study effects. Conclusion: Exercise training improves hepatic enzymes, BMI, and cardiorespiratory fitness in adults with MASLD/NAFLD, whereas evidence for liver fat and glycemic outcomes remains less certain. PROSPERO: CRD420261416397. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261416397.
SN - 1664-042X
ER -