Exercise Prescription in Metabolic Dysfunction - Associated Steatotic Liver Disease: Aerobic Training, Resistance Exercise and High-Intensity Interval Training - A Narrative Review

Background. Exercise is a first-line component of care for metabolic dysfunction-associated steatotic liver disease (MASLD), but modality-specific prescriptions remain uncertain. Aim. To compare evidence for aerobic training, resistance exercise and high-intensity interval training (HIIT), and provide a phenotype-oriented framework for frequency, intensity, time, type, safety and monitoring. Material and methods. A structured, PubMed-focused narrative search was conducted from database inception to 8 June 2026 using prespecified disease and exercise terms; reference lists of major guidelines, reviews and trials were searched. Adult human guidelines, evidence syntheses and intervention studies were assessed by one reviewer using SANRA-informed narrative methods. Results. Exercise reduces liver fat and improves cardiorespiratory fitness and several cardiometabolic outcomes, often without clinically significant weight loss. Aerobic and resistance training are both effective; HIIT is time-efficient and generally comparable, not clearly superior, to moderate-intensity continuous training. Evidence for fibrosis regression, histological MASH resolution and long-term clinical events remains limited. Conclusions. A patient-centered program should usually combine ≥150 min/week of moderate aerobic activity with resistance training on 2-3 non-consecutive days. HIIT is an optional, progressively introduced alternative for appropriately screened patients. Adherence, comorbidity, functional capacity and safety should determine modality selection.