Effects of exercise interventions on metabolic and hepatic function markers in overweight or obese patients with MASLD: a systematic review and meta-analysis.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition strongly associated with overweight or obesity, often accompanied by dyslipidemia, insulin resistance, and elevated liver enzymes. Exercise is recommended as a first-line lifestyle intervention, but evidence on the effects of different modalities, frequencies, and durations on metabolic and hepatic markers remains inconsistent. This study conducted a systematic review and meta-analysis to quantify overall effects and compare intervention strategies. OBJECTIVE: To evaluate the effects of exercise interventions on metabolic and hepatic function markers in overweight or obese patients with MASLD. METHODS: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from inception to March 15, 2025, to identify randomized controlled trials (RCTs) evaluating the effects of exercise on metabolic and hepatic function markers in overweight or obese patients with MASLD. Backward citation tracking and manual searches were additionally performed to capture eligible studies through April 2025. Meta-analysis was performed using Review Manager version 5.4 and Stata version 16. RESULTS: A total of 23 articles comprising 26 trials with 1,012 participants were included. The meta-analysis showed that exercise interventions significantly reduced total cholesterol (SMD = - 0.22, P = 0.004), triglycerides (SMD = - 0.27, P = 0.044) and low-density lipoprotein cholesterol (SMD = - 0.22, P = 0.005), while significantly increasing high-density lipoprotein cholesterol (SMD = 0.24, P = 0.001). For liver function markers, exercise markedly improved alanine aminotransferase (SMD = - 0.40, P = 0.024), whereas the reductions in aspartate aminotransferase (SMD = - 0.29, P = 0.087) and γ-glutamyl transferase (SMD = - 0.29, P = 0.217) did not reach statistical significance. Regarding glucose metabolism, exercise significantly improved homeostasis model assessment of insulin resistance (SMD = - 0.35, P = 0.001), fasting glucose (SMD = - 0.15, P = 0.039) and insulin (SMD = - 0.19, P = 0.038). Subgroup analyses indicated that interventions with a frequency of three sessions per week, moderate duration (8-12 weeks), and combined training modalities yielded greater improvements in triglycerides and alanine aminotransferase. CONCLUSION: Exercise interventions exert beneficial effects on lipid profiles, liver function, and glucose metabolism in overweight or obese patients with MASLD, with combined training performed at a moderate frequency over an 8-12-week period may show a more consistent pattern of improvement. TRIAL REGISTRATION: The study protocol has been prospectively registered in the International Prospective Register of Systematic Reviews, ID: CRD420251051095.