SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Exercise Physiology
This article is part of the Research TopicWorld Hepatitis Day - Advances in Hepatitis Research: Bridging Gaps and Exploring New FrontiersView all 6 articles
Resistance training for metabolic dysfunction-associated steatotic liver disease:a systematic review and meta-analysis
Provisionally accepted
- Nanjing Sport Institute, Nanjing, China
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Objective: The aim is to systematically assess the impact of resistance exercise on patients diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD).Methods: Randomized controlled trials (RCTs) focusing on resistance exercise for MASLD/NAFLD were sourced from PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and CNKI databases, (covering all entries from inception to March 18, 2025. The Cochrane Risk of Bias Tool was utilized for quality evaluation, and RevMan 5.3 software was used for conducting the meta-analysis.Results: Eleven RCTs, involving 395 participants, were included in the analysis. The meta-analysis revealed that alanine aminotransferase (ALT) levels were significantly decreased (MD = -4.44 U/L, 95% CI = -8.84 to -0.03, Z = 1.98, P = 0.05). No significant difference was observed in aspartate aminotransferase (AST) levels (MD = -0.18 U/L, 95% CI = -6.70 to 6.34, Z = 0.05, P = 0.96). Among the eight imaging assessment studies, seven reported substantial reductions in liver fat content, whereas one study indicated no effect. No significant difference in clinical compliance was detected between the groups (RR = 0.99, 95% CI = 0.89 to 1.10, P = 0.92), and no serious adverse events were documented.Conclusion: Resistance exercise notably enhances ALT levels and hepatic steatosis in patients with MASLD. The recommended minimum effective dosage is whole-body multi-muscle training, consisting of 8–10 exercises at 60%–80% of one-repetition maximum (1RM) intensity, performed at least three times weekly for a minimum of 12 weeks. This intervention is particularly advantageous for patients with elevated ALT levels who are unable to tolerate aerobic exercise, and it appears to be safe. Nonetheless, further research involving larger sample sizes is required to confirm its long-term efficacy.
Keywords: Resistance Training, MASLD, randomized controlled trial, Exercise, metabolic dysfunction associated steatotic liver disease
Received: 04 Aug 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Yun, Xiaoya, Xinyi, Gangrui, Xu and Dai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiansong Dai, 2003080031@nsi.edu.cn
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