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Aerobic Exercise Training Leads to MASH Resolution as Defined by the MASH Resolution Index
Theja Channapragada1, Sarah Batra2, Breianna L Hummer2,3
1Department of Medicine, Penn State Health-Milton S. Hershey Medical Center, Hershey, PA, USA.
Digestive Diseases and Sciences
|September 3, 2025
Summary
Exercise training significantly improves metabolic dysfunction-associated steatotic liver disease (MASH) resolution. This intervention leads to MASH resolution at higher rates than standard care, as measured by the MASH Resolution Index (MASH-RI).
Area of Science:
- Hepatology
- Metabolic Disorders
- Exercise Physiology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASH) affects a significant portion of the population.
- Exercise training is recommended, but its effect on liver histology independent of weight loss is debated.
- Non-invasive biomarkers are increasingly used to assess liver histology, necessitating validation of composite scores like the MASH Resolution Index (MASH-RI).
Purpose of the Study:
- To investigate if exercise training improves MASH histology using the MASH Resolution Index (MASH-RI).
- To assess the efficacy of exercise training in achieving MASH resolution independent of body weight loss.
- To evaluate the MASH-RI as a surrogate for liver histology in response to exercise intervention.
Main Methods:
- A post hoc analysis of the NASHFit trial was conducted.
- Adults with biopsy-proven MASH were randomized to moderate-intensity aerobic exercise or standard of care for 20 weeks.
- The MASH Resolution Index (MASH-RI) was used to measure changes in liver biomarkers, comparing outcomes between groups (n=23).
Main Results:
- Exercise training resulted in MASH resolution in 33% of participants, compared to 13% in the standard care group (p<0.01).
- Participants undergoing exercise training achieved MASH resolution nearly three times more often.
- Exercise training led to improvements in individual biomarkers within the MASH-RI, including ALT, AST, and MRI-PDFF.
Conclusions:
- Exercise training is an effective intervention for achieving MASH resolution, surpassing standard lifestyle counseling.
- The MASH Resolution Index (MASH-RI) demonstrates utility in identifying MASH resolution.
- Further research is required to optimize the use of the MASH-RI for monitoring therapeutic responses to lifestyle interventions.
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