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Exercise-Based Interventions for Metabolic Dysfunction-Associated Fatty Liver Disease: An Umbrella Review of
Xinjuan Huang1, Ruoling Yu1, Manjie Guo1
1Xiangya School of Nursing, Central South University, and Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China.
Nutrition Reviews
|November 21, 2025
Summary
Exercise 4-5 times weekly at moderate-to-high intensity, combining aerobic and resistance training, best improves lipid profiles in metabolic dysfunction-associated fatty liver disease (MAFLD) patients. Longer adherence to 30-60 minute sessions yields better outcomes.
Area of Science:
- Hepatology
- Exercise Physiology
- Public Health
Background:
- Metabolic dysfunction-associated fatty liver disease (MAFLD) prevalence is rising globally.
- Exercise is a key treatment, but optimal protocols are undefined.
- This study synthesizes evidence on exercise prescription for MAFLD.
Purpose of the Study:
- To systematically review and synthesize evidence on exercise prescription (frequency, intensity, duration, type) for MAFLD.
- To evaluate the methodological quality and evidence level of existing systematic reviews.
- To provide evidence-based recommendations for exercise in MAFLD management.
Main Methods:
- Systematic search of 6 databases (PubMed, Embase, etc.) for systematic reviews and meta-analyses up to April 2024.
- Data extraction on exercise prescription variables and outcomes, assessed using AMSTAR-2 and GRADE.
- Included 23 systematic reviews from 506 identified studies, with backward citation tracking.
Main Results:
- Optimal exercise frequency: 2-5 sessions/week (4-5 sessions for best lipid improvements).
- Recommended intensity: moderate-to-high; duration: 30-60 minutes per session.
- Combined aerobic and resistance training advised; longer adherence improves outcomes.
- 82% of studies were low-to-critically low quality; overall evidence quality was low-to-moderate.
Conclusions:
- MAFLD patients benefit from 4-5 weekly sessions of moderate-to-high intensity exercise, particularly for lipid profile improvement.
- A combination of aerobic and resistance exercise is recommended when feasible.
- Adherence to 30-60 minute sessions is optimal, with longer duration potentially enhancing benefits.
- Further high-quality research is needed to refine exercise prescriptions and conduct dose-response analyses.
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