Exercise May Improve Fatty Liver Health In A Way You Didn't Expect
Exercise is often recommended for people with fatty liver disease, but which aspects of the condition does it actually improve?
Does it reduce the fat stored in the liver, improve liver function, or mainly benefit other areas of metabolic health?
A new systematic review and meta-analysis1 pooled data from 25 clinical trials to find out which health markers respond to exercise in people with fatty liver disease, and which remain unchanged.
About the review
Researchers focused on metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease.
MASLD develops when excess fat builds up in the liver and is often linked to metabolic issues such as insulin resistance and higher blood sugar. Over time, it can contribute to liver inflammation and damage.
To understand how exercise might help, researchers pooled results from 25 randomized controlled trials comparing structured exercise programs with groups that didn't exercise.
The programs included aerobic exercise, strength training, interval workouts, yoga, and Pilates.
They assessed seven health markers, including liver enzymes, liver fat, insulin resistance, HbA1c (a measure of average blood sugar over roughly three months), BMI, and cardiorespiratory fitness (how efficiently your body uses oxygen during exercise).
Exercise improved three important health markers
Exercise training was associated with improvements in three areas:
- Lower liver enzymes: Participants had lower ALT and AST levels, two enzymes that can indicate stress or damage to liver cells.
- Lower BMI: Exercise was associated with a reduction in body mass index, a measure of weight relative to height.
- Better cardiorespiratory fitness: Participants became more efficient at using oxygen during physical activity, reflecting improved cardiovascular fitness.
Interestingly, liver fat, insulin resistance, and HbA1c didn't improve significantly across the pooled trials.
So, exercise didn't reliably reduce the amount of fat stored in the liver or improve these particular measures of blood sugar regulation.
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Why these improvements still matter
It's easy to assume that the only way to measure progress with fatty liver disease is to see less fat on a liver scan. But there's more to liver health than that.
ALT and AST are enzymes released into the bloodstream when liver cells are stressed or damaged.
Lower levels can suggest less liver cell injury, although they don't tell you exactly how much fat is in the liver or whether MASLD has resolved.
Cardiorespiratory fitness is important, too. It reflects how well your heart, lungs, and muscles work together to deliver and use oxygen. Better fitness supports cardiovascular and metabolic health, while making everyday activities feel easier.
Together, these improvements suggest exercise can benefit your overall health even when liver fat measurements don't change significantly.
What kind of exercise should you do?
The review included several types of exercise, so there's no single workout everyone with MASLD needs to follow. A combination of aerobic activity and strength training is a good place to start.
- Get your heart rate up: Brisk walking, cycling, swimming, and dancing can help improve cardiovascular fitness.
- Build muscle: Strength training with weights, resistance bands, or bodyweight exercises supports muscle health and metabolism.
- Progress gradually: Start with manageable sessions and increase the duration or intensity as your fitness improves.
If you have MASLD, check with your healthcare provider before starting a new exercise program. They can help tailor your routine to your fitness level, other health conditions, and physical limitations.
The takeaway
Your liver isn't the only thing that benefits when you get moving.
Exercise can improve liver enzyme levels, BMI, and cardiovascular fitness, even when liver fat doesn't significantly decrease. Think of it as progress happening on more than one front.
