Combination of aerobic, resistance exercise best for reducing liver fat
Review: Individualized plans needed as effects vary from person to person
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A combination of aerobic exercise and resistance exercise is most effective for reducing liver fat, according to a review of data from appropriately controlled clinical trials.
Aerobic exercise includes jogging and cycling, while resistance exercises include weightlifting.
“Combined aerobic and resistance exercise holds both therapeutic and dosage advantages for reducing hepatic steatosis [excess liver fat],” as it “may harness the complementary and synergistic effects of aerobic and resistance exercise to deliver more comprehensive benefits than either type alone,” Chunxiang Qin, PhD, the study’s senior author at the Third Xiangya Hospital of Central South University in China, said in a press release.
Synergy refers to the combined effect of two or more entities that is greater than the sum of their individual effects.
Researchers calculated that to achieve meaningful reductions in liver fat, people with fatty liver disease generally need to do moderate-intensity exercise five times per week, or high-intensity exercise at least twice per week. However, researchers cautioned that the effect of exercise on liver fat varies from person to person, so individualized plans are needed.
The study, “Dose‒response relationship between exercise and hepatic steatosis: A systematic review with Bayesian network meta-analysis of randomized controlled trials,” was published in the Journal of Sport and Health Science.
MASLD treatment generally involves diet, exercise
Metabolic dysfunction-associated steatotic liver disease (MASLD) is marked by the atypical buildup of fat in the liver in people who typically have underlying metabolic conditions such as diabetes or obesity. This buildup of liver fat, known as hepatic steatosis, can lead to inflammation and scarring in the liver, setting the stage for serious liver injury.
Treatment of MASLD generally involves interventions such as diet and exercise to help the patient lose weight. The logic is straightforward: If the total body fat is reduced, liver fat will also decrease. But what specific type of exercise is best for burning off liver fat?
To find out, scientists in China systematically reviewed studies published up to May 2025 that reported on the effects of exercise interventions in people with MALSD within appropriately controlled clinical trials.
A total of 24 clinical trials, covering 961 patients, were included in the final analysis, which used a Bayesian network meta-analysis to compare outcomes across studies.
The trials were conducted across eight countries, with the U.K. and China being the most common. Participants had an average age of 50.59 years and an average body mass index (a ratio of height and weight) of 31.83, indicating obesity.
‘Ceiling effect’ seen after a certain amount of exercise
Studies included five types of exercises: moderate-intensity continuous aerobic training, high-intensity continuous aerobic training, high-intensity interval training (HIIT), resistance exercise, and combined aerobic-resistance exercise. Interventions occurred two to five times per week for one month to nearly six months.
Aerobic exercise, including jogging, cycling, and brisk walking, increases heart rate and oxygen consumption to improve cardiovascular health and endurance, and to aid calorie burning. HIIT is a training protocol alternating short periods of intense or explosive anaerobic exercise with brief recovery. Resistance training, also called strength or weight training, is meant to build muscle strength, endurance, and bone density by using resistance to muscular contraction.
Pooled results indicated that all evaluated exercise types had an effect on liver fat, but some were more impactful than others. Specifically, a combination of aerobic and resistance exercise showed the best overall impact on reducing liver fat. Second-best was moderate-intensity continuous aerobic training alone, followed by resistance exercise alone.
There was also a nonlinear dose-dependent relationship between exercise and hepatic steatosis, in which people who exercised more tended to burn off more liver fat, but after a certain amount of exercise, there was a “ceiling” effect, in which benefits would stabilize or even be reduced.
Subgroup analysis showed that the optimal exercise dose for liver benefits varies by individual characteristics.
The team noted that this finding aligns with the “Extreme Exercise Hypothesis,” indicating the existence of minimum and maximum safe exercise doses for producing benefits.
In addition, “subgroup analysis showed that the optimal exercise dose for liver benefits varies by individual characteristics,” the researchers wrote. For example, data indicated that people with certain metabolic conditions needed to exercise more to achieve the same reduction in liver fat as those without those conditions.
“Exercise efficacy was multifactorial, it is necessary to recommend exercise prescriptions based on individual characteristics to maximize individual benefits,” the researchers wrote.
With this variability as a notable caveat, the researchers calculated the average amount of exercise needed to achieve a meaningful reduction in liver fat. Their results suggested either moderate-intensity exercise for 20 to 40 minutes five times per week, or vigorous-intensity exercise for 30 minutes two to four times per week.
“While evidence-based synthesis has identified the optimal exercise dose and type for reducing hepatic steatosis, future research should validate the interaction between exercise dose and type through clinical trials,” said Xinyun Tan, the study’s first author at the Xiangya School of Nursing in China.
