Liu Chieh, Liu Chun-Jen
Department of Family Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
J Obes Metab Syndr. 2025 Jul 30;34(3):239-252. doi: 10.7570/jomes25028. Epub 2025 Jul 11.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent liver disorder globally, including in Asia-Pacific countries. In addition to contributing to severe liver disorders, MASLD increases the risk of various complications. Currently, resmetirom is the only U.S. Food and Drug Administration-approved treatment for MASLD-related fibrosis in the United States. Therefore, lifestyle modifications, particularly regular exercise, remain a crucial approach in managing MASLD. Exercise is generally classified into two types: aerobic and resistance. The two forms offer benefits for individuals with MASLD, despite the difference between their effects and underlying mechanisms. Aerobic exercise is accessible, low cost, and promotes high energy expenditure, improving several MASLD-related clinical parameters. However, associated fatigue and discomfort can reduce long-term adherence. Resistance exercise, referring to muscle contractions performed to counteract external resistance, enhances muscle strength, muscle mass, and bone mineral density while also helping to correct metabolic derangement. It is especially suitable for subjects with MASLD who cannot conduct aerobic exercise or have poor cardiorespiratory function. Mechanistically, aerobic exercise enhances insulin sensitivity, while resistance exercise improves metabolic flexibility through adenosine monophosphate-activated protein kinase activation, muscle fiber adaptation, and muscle-liver cross-talk. In terms of aerobic training, traditional moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) have shown comparable benefits. This review is designed to offer refreshed perspectives on the advantages of exercise, compare the effects and mechanisms of aerobic and resistance exercise, and evaluate the advantages and disadvantages of MICT and HIIT, with emphasis on their impact on hepatic steatosis in subjects with MASLD.
代谢功能障碍相关脂肪性肝病（MASLD）是一种在全球范围内普遍存在的肝脏疾病，包括亚太国家。除了导致严重的肝脏疾病外，MASLD还增加了各种并发症的风险。目前，resmetirom是美国食品药品监督管理局批准的唯一用于治疗美国MASLD相关纤维化的药物。因此，生活方式的改变，特别是定期锻炼，仍然是管理MASLD的关键方法。运动通常分为两种类型：有氧运动和抗阻运动。尽管这两种运动的效果和潜在机制有所不同，但它们都对患有MASLD的个体有益。有氧运动容易进行、成本低，并能促进高能量消耗，改善一些与MASLD相关的临床参数。然而，相关的疲劳和不适可能会降低长期依从性。抗阻运动是指为抵抗外部阻力而进行的肌肉收缩，可增强肌肉力量、肌肉质量和骨密度，同时也有助于纠正代谢紊乱。它特别适合那些无法进行有氧运动或心肺功能较差的MASLD患者。从机制上讲，有氧运动可增强胰岛素敏感性，而抗阻运动则通过激活腺苷酸活化蛋白激酶、肌肉纤维适应和肌肉-肝脏相互作用来改善代谢灵活性。在有氧训练方面，传统的中等强度持续训练（MICT）和高强度间歇训练（HIIT）已显示出类似的益处。本综述旨在就运动的优势提供新的观点，比较有氧运动和抗阻运动的效果及机制，并评估MICT和HIIT的优缺点，重点关注它们对MASLD患者肝脏脂肪变性的影响。
