Metabolic-associated fatty liver disease (MAFLD) is the most prevalent chronic liver disease worldwide, affecting 25% of people globally and up to 80% of people with obesity. MAFLD is characterised by fat accumulation in the liver (hepatic steatosis) with varying degrees of inflammation and fibrosis. MAFLD is strongly linked with cardiometabolic disease and lifestyle-related cancers, in addition to heightened liver-related morbidity and mortality. This position statement examines evidence for exercise in the management of MAFLD and describes the role of the exercise professional in the context of the multi-disciplinary care team. The purpose of these guidelines is to equip the exercise professional with a broad understanding of the pathophysiological underpinnings of MAFLD, how it is diagnosed and managed in clinical practice, and to provide evidence- and consensus-based recommendations for exercise therapy in MAFLD management. The majority of research evidence indicates that 150–240 min per week of at least moderate-intensity aerobic exercise can reduce hepatic steatosis by ~ 2–4% (absolute reduction), but as little as 135 min/week has been shown to be effective. While emerging evidence shows that high-intensity interval training (HIIT) approaches may provide comparable benefit on hepatic steatosis, there does not appear to be an intensity-dependent benefit, as long as the recommended exercise volume is achieved. This dose of exercise is likely to also reduce central adiposity, increase cardiorespiratory fitness and improve cardiometabolic health, irrespective of weight loss. Resistance training should be considered in addition to, and not instead of, aerobic exercise targets. The information in this statement is relevant and appropriate for people living with the condition historically termed non-alcoholic fatty liver disease (NAFLD), regardless of terminology.

代谢相关脂肪肝病 (MAFLD) 是全球最常见的慢性肝病，影响全球 25% 的人口以及高达 80% 的肥胖人群。 MAFLD 的特点是肝脏脂肪堆积（肝脂肪变性），并伴有不同程度的炎症和纤维化。除了与肝脏相关的发病率和死亡率升高之外，MAFLD 还与心脏代谢疾病和生活方式相关的癌症密切相关。本立场声明审查了 MAFLD 管理中运动的证据，并描述了运动专业人员在多学科护理团队中的作用。这些指南的目的是让运动专业人士对 MAFLD 的病理生理学基础、如何在临床实践中诊断和管理有广泛的了解，并为 MAFLD 管理中的运动治疗提供基于证据和共识的建议。大多数研究证据表明，每周 150-240 分钟至少中等强度的有氧运动可以将肝脏脂肪变性减少约 2-4%（绝对减少），但每周 135 分钟就已被证明是有效的。虽然新出现的证据表明，高强度间歇训练（HIIT）方法可能对肝脂肪变性具有相当的益处，但只要达到推荐的运动量，似乎就不存在强度依赖性的益处。无论体重是否减轻，这种运动量也可能减少中心性肥胖，增强心肺健康并改善心脏代谢健康。除了有氧运动目标外，还应考虑抗阻训练，而不是代替有氧运动目标。 无论术语如何，本声明中的信息对于历史上称为非酒精性脂肪肝病 (NAFLD) 的患者来说都是相关且适当的。