Effect of exercise training on liver function in adults who are overweight or exhibit fatty liver disease: a systematic review and meta-analysis
Open accessAbstract
Objective: Exercise training has been shown to have beneficial effects on liver function in adults overweight or with fatty liver disease. To establish which exercise programme characteristics were likely to elicit optimal improvements. Design: Systematic review and meta-analysis of randomised, controlled trials. Data sources: PubMed, CINAHL and Cochrane controlled trials registry searched (1966 to 2 October 2015). Eligibility criteria for selecting studies: Exercise intervention, with or without dietary intervention, versus usual care in adults undertaking, exercise training, who were overweight, obese or exhibited fatty liver disease (non-alcoholic fatty liver disease or non-alcoholic steatohepatitis). Results: We included 21 randomised controlled trials, totalling 1530 participants. Exercise intervention studies with total exercise programme workload >10 000 kcal produced significant improvements in intrahepatic fat, −3.46% (95% CI −5.20% to −1.73%), p<0.0001, I 2=73%; effect size (standardised mean difference, SMD) −1.77 (−3.11 to −0.42), p=0.01, I 2=77%. When data from only exercise studies were pooled, there was a reduction in fasting free fatty acids (FFAs) −74.15 µmol/L (95% CI −118.47 to −29.84), p=0.001, I 2=67% with a large effect size (SMD) −0.94 (−1.36 to −0.52), p<0.0001, I 2=0%. When data from only exercise studies were pooled, there was a significant reduction in insulin MD −1.88 UL (95% CI −3.43 to −0.34), p=0.02, I 2=31%. The liver enzymes, alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transpeptidase, were not significantly altered with exercise. Conclusions: Exercise training reduces intrahepatic fat and FFAs while increasing cardiorespiratory fitness. An aggregate exercise programme energy expenditure (>10 000 kcal) may be required to promote reductions in intrahepatic fat.
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Exercise with diet-induced weight loss improves the lipid profile.
“Work has shown that, in people who are overweight, attenuation of exercise training-induced changes in lipids may occur [9], while exercise with diet-induced weight loss has been shown to improve the lipid profile [38].”
From The Effect of Exercise Training on Blood Lipids: A Systematic Review and Meta-analysis (2025) · cites this paper as [38]
The Results (Total cholesterol; page unavailable) report reductions in some intervention groups and a significant pooled reduction for exercise-only studies. They do not establish that exercise combined with diet-induced weight loss improves the broader lipid profile; the Discussion also says the effects of diet and exercise are difficult to separate. (LLM, conf=0.80)
Experimental — accuracy not yet measuredA meta-analysis by Smart et al. showed no significant changes in levels of ALT and AST following aerobic and resistance exercise interventions.
“Findings from a meta-analysis by Smart et al. [104] showed no significant changes in the levels of ALT and AST following the aerobic and resistance exercise interventions.”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [104]
The Discussion reports no overall change in the primary liver enzymes with exercise training, supporting the general finding for ALT and AST. But the Discussion also says the data did not permit modality subanalyses or a meta-analysis comparing aerobic with resistance exercise, so the paper does not establish a separate null finding for each modality. (LLM, conf=0.85)
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- Authors
- Smart, N. A., King, N., McFarlane, J. R., Graham, P. L., & Dieberg, G.
- Affiliations
- University of New England (AU)
- University of Plymouth (GB)
- Macquarie University (AU)
- Corresponding author
- Smart, N A
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2016-06-17
- Volume
- 52
- Issue
- 13
- Pages
- 834-843
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- PMC
- PMC6029644
- OpenAlex
- W2442427634
- Cited by
- 140
- References
- 53
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 10 · 2023: 19 · 2022: 28 · 2021: 15 · 2020: 13 · 2019: 13 · 2018: 6 · 2017: 6 · 2016: 1
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- British Journal of Sports Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- PEARL (University of Plymouth) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- RUNE (Research UNE) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- exercise training, non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, overweight, obesity, intrahepatic fat, free fatty acids, cardiorespiratory fitness, liver enzymes, energy expenditure, dietary intervention
- MeSH terms
- Exercise Therapy, Fatty Acids, Humans, Liver, Randomized Controlled Trials as Topic, Adiposity, Overweight, Non-alcoholic Fatty Liver Disease
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