Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is a liver condition linked to metabolic risk factors, like Type 2 diabetes and obesity, and characterised by excessive fat build-up, known as steatosis.
Often causing no symptoms, if left untreated, MASLD can ultimately lead to cirrhosis or even cancer. It is predicted that, by 2040, the MASLD prevalence rate amongst adults is expected to increase by more than 55%, and, thus, is an increasingly pertinent subject of study.
Resistance Training for Metabolic Dysfunction
With the aim of systematically assessing the impact of exercise, specifically resistance training, on patients diagnosed with MASLD, Chen at al. analysed a number of randomised controlled trials, sourced from multiple different databases, which focused on resistance training for MASLD.
To conduct this analysis, the authors utilised the Cochrane Risk of Bias Tool (Cochrane Rob 2 Tool) for quality evaluation and Review Manager (RevMan 5.3) software for meta-analysis.
Exercise and Decreased Alanine Aminotransferase Levels
Across 11 randomised controlled trials, 395 participants were included in the analysis. Following resistance exercise training, the meta-analysis exhibited that alanine aminotransferase levels had decreased significantly amongst the participants (MD=-4.44 U/L, 95% CI:-8.84–-0.03, Z=1.98, P=0.05), whilst aspartate aminotransferase levels showed no significant difference (MD=-0.18 U/L, 95% CI: -6.70–6.34, Z=0.05, P=0.96).
Additionally, amongst eight imaging assessment studies conducted, seven reported substantial reductions in liver fat content, whilst the final study indicated no effect.
Since high levels of alanine aminotransferase are a significant biomarker of liver injury, this analysis points to the benefits of resistance exercise in patients with MASLD, as the authors observed a noticeable decline in alanine aminotransferase levels.
They recommend a minimum effective dosage of whole-body multi-muscle training as 8-10 exercises at 60%-80% of one-repetition maximum intensity, performed at least three times weekly for a minimum of 12 weeks. The authors point out the particular advantage of this exercise on patients with elevated alanine aminotransferase levels, who are unable to participate in aerobic exercise.
Future Projections
Looking to the future, further research, consisting of larger sample sizes and longer durations, could serve to further validate these findings and confirm the long-term efficacy of resistance training in patients with MASLD.
References
Younossi ZM et al. Epidemiology of metabolic dysfunction-associated steatotic liver disease. Clin Mol Hepatol. 2025;31(Suppl):S32-S50.
Chen Y et al. Resistance training for metabolic dysfunction – associated steatotic liver disease: a systematic review and meta-analysis. Front Physiol. 2026;16:1679094.
