Effects of exercise on body composition, fitness, and blood pressure in overweight or obese patients with MASLD: A systematic review and meta-analysis.

OBJECTIVE

To systematically evaluate the effects of exercise on body composition, cardiorespiratory fitness, and blood pressure in overweight or obese patients with metabolic dysfunction-associated steatotic liver disease (MASLD), to provide evidence-based guidance for individualized exercise prescription.

METHODS

A systematic search was conducted in PubMed, Embase, the Cochrane Library, and Web of Science for randomized controlled trials published from database inception to April 2025. Eligible studies included overweight or obese patients with MASLD, and the intervention consisted of various types of exercise training. The primary outcome measures included body mass index (BMI), body fat percentage, waist circumference, maximal oxygen uptake (VO₂ max), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Meta-analysis was performed using Review Manager version 5.4 and Stata version 16.

RESULTS

A total of 26 articles comprising 29 studies and 1123 participants were included. The meta-analysis showed that, exercise interventions were associated with a significant reduction in BMI (SMD = -0.28, P = 0.000) and waist circumference (SMD = -0.41, P = 0.000), while the reduction in body fat percentage did not reach statistical significance (SMD = -0.25, P = 0.061). Regarding blood pressure, exercise significantly decreased DBP (SMD = -0.38, P = 0.000), while the decrease in SBP showed a non-significant trend toward reduction (SMD = -0.26, P = 0.071). In terms of cardiorespiratory fitness, exercise interventions significantly improved VO₂ max (SMD = 0.75, P = 0.000), indicating a notable enhancement in cardiovascular function.

CONCLUSION

Exercise interventions have a positive impact on body composition, cardiorespiratory fitness, and blood pressure in overweight or obese patients with MASLD. The most pronounced effects were observed in the improvement of VO₂ max, waist circumference, and DBP.