Fatty liver disease: why moving more matters, even if the scales don't budge

From the SMA & ACSEP Conference 2026, Brisbane

Around one in three Australian adults has fatty liver disease. It usually has no symptoms, so it often turns up by chance on a blood test or a scan done for something else.

At the Sports Medicine Australia and ACSEP Conference in Brisbane, we sat in on a symposium on exercise, diet and sleep in chronic disease, chaired by Professor Peter Brukner.

Associate Professor Shelley Keating (University of Queensland) presented on fatty liver disease, and her message was really encouraging: exercise works, and you don't need to lose a lot of weight to see a benefit in your liver.

Who would've thought that at a sport's conference we'd find out such helpful information for our patients who are really struggling to get moving! 🤷🙌

A/Prof Shelley Keating presenting at the SMA & ACSEP Conference 2026, Brisbane

What is MASLD?

You may have heard it called "fatty liver" or NAFLD (non-alcoholic fatty liver disease). In 2023, international liver societies renamed it MASLD: metabolic dysfunction-associated steatotic liver disease. "Steatotic" simply means fat build-up.

The new name puts the focus on what's driving it. MASLD is diagnosed when there's extra fat in the liver along with at least one cardiometabolic risk factor, such as:

• a larger waist measurement

• higher blood pressure

• raised blood sugar or type 2 diabetes

• raised triglycerides or low HDL ("good") cholesterol

When fat stores around the organs (visceral fat) overflow, fat spills into the liver and pancreas. Over time this can make the body less responsive to insulin. MASLD is linked with type 2 diabetes, heart disease and a higher risk of liver cancer. Associate Professor Keating described it as the canary in the coal mine: an early warning sign worth paying attention to.

Why getting started can feel so hard

People living with MASLD often find exercise harder than others do. They may have:

• a lower exercise capacity

• exercise that feels harder for the same effort

• more fatigue

• deconditioning from being less active

That can create a loop: exercise feels hard, so we do less, so it feels even harder. Breaking that loop is the first step, and the right support can make a real difference.

Getting started (and keeping going) can feel really hard. You're not alone.

When Associate Professor Keating's team asked people living with MASLD what gets in the way of keeping up exercise, they named five barriers, all ranked as equally important:[8]

• musculoskeletal aches and pain

• no access to exercise equipment or facilities

• cost

• competing priorities (work, family, life!)

• low energy

They also said support from an exercise professional was one of the biggest things that helped them keep going.

The good news: exercise works, with or without weight loss

In a 2015 study, inactive adults carrying extra weight were given one of three 8-week aerobic exercise programs, or a placebo (stretching) program:

Program	Intensity	Time	Days per week
Lower intensity, higher volume	Moderate (50% of fitness)	60 min	4
Higher intensity, lower volume	Vigorous (70% of fitness)	45 min	3
Lower intensity, lower volume	Moderate (50% of fitness)	45 min	3

All three exercise programs reduced liver fat and visceral fat, while liver fat went up slightly in the placebo group. There was no significant difference between the three programs, and the changes happened without meaningful weight loss.[1]

The take-home message: the best exercise for your liver is the one you'll actually do.

Exercise & Sports Science Australia's position statement agrees. Most research shows 150 to 240 minutes (2½ to 4 hours) a week of at least moderate aerobic exercise can reduce liver fat, with benefits seen from as little as 135 minutes (2 hours 15 minutes) a week. Strength training is recommended as well as aerobic exercise, not instead of it.[2]

Not sure what "moderate" feels like? Try the talk test: you can still talk, but you couldn't sing.

And the benefits go well beyond the liver. Associate Professor Keating described exercise as a therapy in its own right for MASLD, with benefits for heart health, body composition, fitness and quality of life too.

Short on time? Short bursts can help too

High-intensity interval training (HIIT) means short bursts of hard effort with easier recovery in between.

• Just 4 minutes, 3 times a week. In adults with type 2 diabetes, one 4-minute high-intensity effort (after a warm-up), three days a week for 12 weeks, reduced liver fat and improved blood sugar (HbA1c) and fitness. The results were similar to 45 minutes of moderate exercise, again without weight loss.[3]

• The "4 x 4". A 5-minute warm-up, then four 4-minute hard efforts (85–95% of maximum heart rate) with 3 minutes of easier recovery between each, then a cool-down. In people with a more advanced form of the condition, this was safe and achievable, and it improved exercise capacity and how the body handles insulin.[4]

Two newer ideas were also covered:

• Exercise snacks. A 5-minute warm-up, six 1-minute hard efforts, then a 5-minute cool-down, about 30 minutes before a main meal, three times a week.

• Everyday bursts ("VILPA"). Short bursts of vigorous activity in your normal day: taking the stairs briskly, walking fast to catch the bus, carrying the shopping, playing actively with the kids or the dog. In a UK study of more than 22,000 adults who didn't do any formal exercise, about 4 minutes a day of these bursts was linked with a 36% lower risk of developing type 2 diabetes.[9]

The key in the research was tailoring it: "hard" was set to each person's own fitness and checked with heart rate and how hard it felt. If you have MASLD, diabetes or heart concerns, check in with your GP before starting vigorous exercise.

Weight-loss medications and exercise

Many people are now using GLP-1 medications for weight loss. A 2024 Danish trial found that people who combined a GLP-1 medication with regular supervised exercise were more likely to keep their weight loss off a year after stopping treatment than those who used the medication alone.[5]

If you're taking, or thinking about, one of these medications, talk to your GP about building regular exercise in alongside it.

You can't out-run a bad diet

What you eat changes what happens inside your liver, and across your whole metabolism.

In a small Melbourne trial, people with fatty liver followed a Mediterranean-style diet (plenty of vegetables, legumes, wholegrains, fish and olive oil) for 6 weeks. Their liver fat dropped by 39%, compared with 7% on a standard low-fat diet, even though their weight didn't change. Their bodies also became more responsive to insulin, which matters because insulin resistance is one of the key drivers behind type 2 diabetes and heart disease.[10]

Xavier's go-to: a tray of veggies, herbs, olive oil and quality protein.

Exercise and food work best together. The symposium's advice was simple: smaller meals built around fibre, protein and good-quality whole foods. For a plan that suits you, your GP or an accredited practising dietitian is a great place to start.

Don't forget sleep

Sleep is the third piece of the puzzle. Losing sleep, and big swings in your bed and wake times, are linked with poorer metabolic health. Keeping your sleep routine consistent may matter as much as how long you sleep. We covered this in our recent article on sleep trackers.

Five ways to get started

1. Ask your GP. If you have risk factors like a larger waist, high blood pressure, raised blood sugar or cholesterol, ask whether a liver check is right for you.

2. Start where you are. A brisk walk counts. Build up gradually towards 150 minutes a week.

3. Try short intervals once you're comfortable, with your GP's OK: even a few minutes of harder effort, three times a week.

4. Add strength training two or more days a week, alongside your aerobic exercise.

5. Keep your sleep regular, with similar bed and wake times every day.

How we can help

Helping people get more active is one of the things we're most passionate about at Prom Health, both as osteopaths in the clinic and as instructors in our gym. We know that when you're dealing with the metabolic "headache" of fatty liver, blood sugar or weight concerns, just getting started can feel like the hardest part.

Aches and pains were one of the top barriers people with MASLD named, so that's often where we start. If a sore back, knees, hips or shoulders are holding you back, our osteopaths can assess what's going on and help you find ways to move more comfortably. From there, our gym instructors can help you find a starting point that suits your body, your energy and your schedule, and build up gradually.

Laura coaching step-ups in the Prom Health gym.

We work alongside your GP and other health professionals, so you can focus on what matters most: finding a way to move that you can keep doing.

You don't have to overhaul everything at once. Small, regular steps add up, for your liver and for the rest of you.

This article is general information only and isn't a substitute for individual medical advice. Please speak with your GP about your own health.

References

1. Keating SE, Hackett DA, Parker HM, et al. Effect of aerobic exercise training dose on liver fat and visceral adiposity. J Hepatol. 2015;63(1):174–182.

2. Keating SE, Sabag A, Hallsworth K, et al. Exercise in the management of metabolic-associated fatty liver disease (MAFLD) in adults: a position statement from Exercise and Sport Science Australia. Sports Med. 2023;53:2347–2371.

3. Sabag A, Way KL, Sultana RN, et al. The effect of a novel low-volume aerobic exercise intervention on liver fat in type 2 diabetes: a randomized controlled trial. Diabetes Care. 2020;43(10):2371–2378.

4. Keating SE, Croci I, Wallen MP, et al. High-intensity interval training is safe, feasible and efficacious in nonalcoholic steatohepatitis: a randomized controlled trial. Dig Dis Sci. 2023;68(5):2123–2139.

5. Jensen SBK, Blond MB, Sandsdal RM, et al. Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment. eClinicalMedicine. 2024;69:102475.

6. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542–1556.

7. Vaz K, Clayton-Chubb D, Kemp WW, et al. Fatty liver disease in Australia: a narrative review. Med J Aust. 2026;224(5):e70195.

8. Keating SE, de Boer J, Catsoulis G, et al. Co-designing approaches to sustainable exercise care for people with metabolic dysfunction-associated steatotic liver disease. J Clin Transl Hepatol. 2025;13(9):707–722.

9. Chong KH, Ahmadi MN, Biswas RK, et al. Dose-response associations of intermittent lifestyle physical activity micropatterns and incident type 2 diabetes. Diabetes Care. 2026.

10. Ryan MC, Itsiopoulos C, Thodis T, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol. 2013;59(1):138–143.