Abstract Purpose of review This review aims to clarify the role of exercise as a therapeutic intervention for metabolic dysfunction associated steatotic liver disease (MASLD). It addresses unresolved questions regarding optimal exercise modality, dose, progression, clinically meaningful outcomes, and integration with pharmacologic and multidisciplinary care, while translating recent international guideline recommendations into practical strategies. We put forward an innovative approach to be validated: REMEDHE. Recent findings Updated guidelines (EASL–EASD–EASO 2024; AASLD 2023) and recent randomized trials show that aerobic, resistance, and high-intensity interval training improve intrahepatic lipid content, liver enzymes, noninvasive fibrosis markers, cardiometabolic risk, and body composition, including sarcopenia and myosteatosis. Benefits occur even without weight loss, although variability in exercise prescriptions and outcome measures remains a challenge. Summary Exercise is a disease-modifying therapy in MASLD with multisystem benefits. Individualized, structured, and progressive programs are key. The proposed REMEDHE (REhabilitation for MEtabolic and hepatic Dysfunction) framework may standardize care, enhance implementation, and guide future research toward harmonized, clinically relevant endpoints.
Rodriguez et al. (Tue,) studied this question.