High-intensity interval training and moderate-intensity continuous training are effective, feasible, and safe for patients with metabolic dysfunction-associated steatotic liver disease (MASLD): A systematic review and meta-analysis

Wang B, Zeng X, Deng H, Qiu B, Xu K, Tao M, Zhang Y, Zheng H, Xu Q, Li S, Zhong Y, Zhang X, Li H, Yan H, Song J, Zhang Z, Liang Z, Sun Q, Wu B, Zhang X, Batrakoulis A, Reljic D, Yin M (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Metabolism-Clinical and Experimental WB Saunders

Book Volume: 182

Article Number: 156677

DOI: 10.1016/j.metabol.2026.156677

Abstract

Purpose This meta-analysis evaluated the efficacy and feasibility of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and identified key moderators. Methods Controlled trials were systematically searched (PubMed, Web of Science, CNKI; initially in Feb 2025 and updated Jan 2026). Random-effects meta-analyses used SMDs; risk of bias, methodological quality, and evidence certainty were systematically assessed. Results Thirty-seven trials (1546 participants, 51% female, moderate quality) showed HIIT significantly improved 12 outcomes vs. controls, including body composition (g − 0.94 to −0.52), cardiometabolic parameters (−1.56 to 1.34), and liver markers (−1.06 to −0.50), while MICT benefited 18 outcomes, including body composition (−0.84 to −0.60), cardiometabolic parameters (−1.42 to 1.79), and liver markers (−0.72 to −0.67). HIIT was superior for total cholesterol reduction (g − 0.44, p ' 0.05). Subgroup analyses identified significant moderation by obesity status, training frequency, exercise modality, and progression. Meta-regression revealed MICT effects moderated by age, BMI, and prescription parameters (e.g., session duration, weekly time, program length), with significant associations for body fat, lipids, and glycemic control changes. Exploratory nonlinear meta-regression showed distinct dose-response patterns for liver enzyme biomarker improved emerging beyond baseline, 260–280 MET-min per MICT session. Feasibility was high (adherence 83.4%, completion 83.9%), and safety was relatively high. Conclusion Both HIIT and MICT effectively improve anthropometric, metabolic parameters, and liver function indicators in patients with MASLD, while demonstrating high feasibility and safety. Moderators' analyses identified key moderators and dose-response, informing evidence-based exercise prescription considerations for MASLD management. Registered PROSPERO (CRD42025646755).

Authors with CRIS profile

Dejan Reljic Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology

Involved external institutions

Tianjin University (TJU) / 天津大学 CN China (CN) Shanghai University of Sport CN China (CN) University of Malaya (UM) / Universiti Malaya MY Malaysia (MY) Beijing Sport University CN China (CN) Universidad de Granada ES Spain (ES) Sichuan Agricultural University (SAU) / 四川农业大学 CN China (CN) Southwest University (SWU) / 西南大学 CN China (CN) Shanghai Normal University / 上海师范大学 CN China (CN) Jinshan Hospital of Fudan University / 复旦大学附属金山医院 CN China (CN) Macao Polytechnic University (MPU) MO Macao (MO) Jilin University (JLU) / 吉林大学 CN China (CN) Hengyang Normal University CN China (CN) Chengdu Sport University / 成都体育学院 CN China (CN) European University Cyprus (EUC) / Ευρωπαϊκό Πανεπιστήμιο Κύπρου CY Cyprus (CY) Jinan University (JNU) / 暨南大学 CN China (CN)

How to cite

APA:

Wang, B., Zeng, X., Deng, H., Qiu, B., Xu, K., Tao, M.,... Yin, M. (2026). High-intensity interval training and moderate-intensity continuous training are effective, feasible, and safe for patients with metabolic dysfunction-associated steatotic liver disease (MASLD): A systematic review and meta-analysis. Metabolism-Clinical and Experimental, 182. https://doi.org/10.1016/j.metabol.2026.156677

MLA:

Wang, Bo, et al. "High-intensity interval training and moderate-intensity continuous training are effective, feasible, and safe for patients with metabolic dysfunction-associated steatotic liver disease (MASLD): A systematic review and meta-analysis." Metabolism-Clinical and Experimental 182 (2026).

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