Alabdul Razzak Iyiad, Fares Ahmed, Stine Jonathan G, Trivedi Hirsh D
Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts, USA.
Liver Int. 2025 Jan;45(1):e16220. doi: 10.1111/liv.16220.
The increasing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), parallels the rise in sedentary lifestyles. MASLD is the most common form of steatotic liver disease (SLD), which represents the umbrella beneath which the vast majority of chronic liver diseases fall, including alcohol-related liver disease and their overlap. These conditions are the leading contributors to chronic liver disease, significantly impacting global morbidity and mortality. Despite the emergence of new pharmacotherapies, exercise represents the foundation of MASLD treatment.
This review aims to provide an updated perspective on the role of exercise in the management of SLD, highlight its molecular and clinical benefits, and explore its benefits and safety in the stage of cirrhosis.
Evidence from pre-clinical and clinical studies was reviewed to evaluate the impact of exercise on SLD (mainly MASLD), advanced chronic liver disease stages, and its relevance in the context of evolving therapies such as Resmetirom and incretin-based anti-obesity medications.
Exercise remains a cornerstone intervention in the management of MASLD, with suggested benefits even for patients who have progressed to cirrhosis. Personalized exercise regimens should be prioritized for all patients, including those receiving pharmacotherapy. Further research is needed to refine exercise protocols and investigate their impact on histologic and clinical outcomes, as well as their potential synergistic effects with emerging treatments.
代谢功能障碍相关脂肪性肝病（MASLD），以前称为非酒精性脂肪性肝病（NAFLD），其患病率不断上升，与久坐不动的生活方式增加并行。MASLD是脂肪性肝病（SLD）最常见的形式，而SLD是绝大多数慢性肝病的统称，包括酒精性肝病及其重叠情况。这些病症是慢性肝病的主要原因，对全球发病率和死亡率有重大影响。尽管出现了新的药物治疗方法，但运动仍是MASLD治疗的基础。
本综述旨在提供关于运动在SLD管理中的作用的最新观点，强调其分子和临床益处，并探讨其在肝硬化阶段的益处和安全性。
回顾临床前和临床研究的证据，以评估运动对SLD（主要是MASLD）、晚期慢性肝病阶段的影响，以及其在诸如Resmetirom和基于肠促胰岛素的抗肥胖药物等不断发展的治疗方法背景下的相关性。
运动仍然是MASLD管理的基石性干预措施，即使对于已进展至肝硬化的患者也有潜在益处。应优先为所有患者制定个性化运动方案，包括接受药物治疗的患者。需要进一步研究以完善运动方案，并调查其对组织学和临床结局的影响，以及其与新兴治疗方法的潜在协同作用。
