Objective: To synthesize evidence published from 2020 through August 2026 concerning the effects of physical activity and structured exercise on hepatic steatosis, liver enzymes, glucose-insulin homeostasis, lipid profile, body composition, inflammatory biomarkers, muscle-related outcomes, and cardiorespiratory fitness in adults with NAFLD/MASLD.
Methods: A PRISMA 2020-informed systematic-review framework was used. Eligible evidence included adult studies evaluating aerobic exercise, moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), resistance training, combined aerobic-resistance training, walking, home-based exercise, or hybrid programs. The review focused on liver fat/steatosis, ALT, AST, GGT, glucose, insulin, HOMA-IR, HbA1c, lipids, anthropometry, body composition, fitness, inflammation, and muscle outcomes. Because the manuscript source did not contain the final database export, screening log, or completed PRISMA counts, these values are deliberately not fabricated.
Results: The available evidence consistently supports exercise as a clinically relevant component of MASLD management. Prior meta-analytic evidence shows reductions in intrahepatic lipid and ALT. A 2024 network meta-analysis of 43 studies and 2,070 participants found modality-specific patterns, with aerobic plus resistance exercise ranking favorably for several lipid outcomes, aerobic exercise for ALT and HDL-C, and resistance exercise for AST.
Conclusion: Exercise should be considered a multidomain intervention rather than a strategy aimed solely at weight loss. No single modality is consistently superior for every outcome. HIIT may offer additional advantages for cardiorespiratory fitness, whereas MICT may provide an accessible hepatic benefit; resistance and combined training provide complementary metabolic and muscular effects.