The Best Exercises for People With MASLD
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The best fitness routine to help slow the progression of a common chronic health problem known as metabolic dysfunction–associated steatotic liver disease (MASLD) should include a mix of aerobic and muscle-building workouts, a new study suggests.
MASLD is caused by an accumulation of fat in the liver that typically occurs when people have overweight or obesity. It develops when fat builds up in the liver, causing inflammation and tissue damage that can lead to fibrosis, or scarring. As fibrosis progresses, people may develop severe disease, including MASH or cirrhosis that may require a liver transplant.
Regular physical activity has long been recommended to help prevent MASLD and to stop the condition from getting worse, says Jonathan Stine, MD, an associate professor and director of the Fatty Liver Program at Penn State Health–Milton S. Hershey Medical Center in Pennsylvania.
“When people with MASLD exercise, several beneficial things happen including improvement in liver fat, fitness, muscle mass, blood flow and blood sugar control,” says Dr. Stine, who wasn’t involved in the new study.
“We see this in parallel with a loss of body fat,” Stine adds. “In essence, exercise plays a pivotal role in managing MASLD by addressing the key factors contributing to this leading cause of global liver disease and promotes overall liver health.”
What’s less clear, however, is the exact type of exercise that might work best to prevent MASLD from progressing to more severe liver disease. For the new analysis, researchers examined data from 43 studies testing the health impacts of four different exercise routines on almost 2,100 adults with MASLD:
- Aerobic workouts
- Resistance training
- A combination of aerobic and resistance exercises
- High intensity interval training (HIIT)
The Benefits of Aerobic Exercise and Resistance Training
According to the research, when people did a mix of aerobic exercise and resistance training, they experienced significant improvements in several factors that can contribute to worsening MASLD symptoms including levels of total cholesterol levels; triglycerides, or fats; and low density lipoprotein cholesterol (LDL-C), the bad kind that accumulates in blood vessels and can lead to clots and heart attacks.
One limitation of the study is that it only focused on blood tests to measure factors that can impact the progression of liver disease, without using liver tissue samples to objectively assess which specific activities might slow down the development of liver damage like fibrosis, the researchers wrote in Scientific Reports.
Another drawback is that the smaller studies included in the analysis varied too much in the exact type, intensity and frequency of workouts to draw broad conclusions about an ideal exercise regimen to prescribe for MASLD, the researchers note.
Like most other adults, people with this common liver disease should aim to get at least 150 minutes a week of moderate-to-vigorous physical activity, says Andres Duarte-Rojo, MD, PhD, a professor of gastroenterology, hepatology, and organ transplantation at Northwestern Medicine–Feinberg School of Medicine in Chicago.
“In general, it is recommended to combine both aerobic and resistance training, which can be split into three to five sessions with two or three of them incorporating resistance training,” says Dr. Duarte-Rojo, who wasn’t involved in the new study.
“The rate of liver fat reduction from exercise is similar to that seen in MASLD drug trials, and exercise can help MASLD even for those patients in whom a genetic component takes precedence,” Duarte-Rojo adds.
People with MASLD can benefit from both ordinary physical activity — anything that gets them moving more and reduces sedentary time — and from planned workout sessions designed to build aerobic capacity and improve muscle function, Duarte-Rojo says. And for people who don’t regularly move throughout the day, even a little bit of activity can make a difference.
“Liver improvements can be seen even after only a few weeks of routine exercise, especially if associated with other lifestyle changes that would include becoming more physically active along with dietary improvements,” Duarte-Rojo says. “We have observed improvements even in patients who decide to adopt walking as their primary activity.”
Starting Exercise Gradually
People with sedentary lifestyles or physical limitations can absolutely benefit from starting gradually. They can aim for very short walks, going as fast as they can until the pace or distance makes it difficult to breathe or carry on a conversation, Duarte-Rojo advises.
Because many people with MASLD are physically inactive, they should see a health care provider before they start an exercise routine, Stine says. This is an opportunity to develop an exercise plan that fits their current fitness levels, amount of free time, and preferred activities.
“It’s essential to begin gradually and build up momentum over time,” Stine says. “Starting small with manageable activities that a person enjoys and can easily be incorporated into their daily routine is one strategy for success. This could be as simple as taking short walks around your neighborhood or doing light household chores.”
Setting realistic goals is also critical to help people develop sustainable workout routines that can help them achieve meaningful improvement in liver health over time, Stine adds.
That’s because even small amounts of exercise can have positive effects on liver health, Stine says. He advises patients to begin with just 10 minutes a day of light exercise like walking, then gradually increase the intensity and duration of workouts over time.
“While more structured and higher-intensity workouts may offer additional benefits, starting with gentle activities like walking is a great way to begin reaping the rewards of physical activity,” Stine says.
The most important thing is to pick am activity that’s possible to do consistently. “You can’t see benefits if you don’t do the exercise,” Stine says. “So, focusing on establishing a regular exercise routine is more important in my opinion than going out hard and pushing the intensity initially.”
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