Yale Medicine Professor Explains Why Exercise Matters for Liver Health

Key points

• Nearly one in three adults in the United States has metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as fatty liver disease.
• Several treatment options exist for this form of liver disease, and exercise is particularly important.
• Even when weight loss does not occur, regular physical activity can help slow disease progression and reduce the risk of premature death.

“Research has shown that being inactive is one of the strongest predictors of disease progression and early death. That may sound scary, but it’s actually encouraging, because unlike our genes or our age, our activity level is something we can control and change,” said David Feldshon, MD.

In his obesity medicine practice, David Feldshon, MD, assistant professor of medicine in digestive diseases, often treats patients with metabolic dysfunction-associated steatotic liver disease (MASLD), a condition in which excess fat builds up in the liver. If left untreated, it can lead to inflammation and lasting liver damage.

Rates of MASLD continue to climb, and estimates suggest that nearly one in three adults in the United States has the condition, although many people have never been formally diagnosed.

There are several ways to treat the disease, including endoscopic weight-loss procedures, bariatric surgery, and medication management, but exercise remains an important part of both prevention and care.

“Research has shown that being inactive is one of the strongest predictors of disease progression and early death,” Feldshon says. “That may sound scary, but it’s actually encouraging, because unlike our genes or our age, our activity level is something we can control and change.”

Below, Feldshon outlines four things people with liver disease, or those at risk for it, should know about exercise.

Find motivation to move

Doctors understand that starting or increasing physical activity can be difficult. “Most people don’t avoid exercise because they’re lazy; they avoid it because life gets in the way,” Feldshon says. “Maybe there isn’t enough time, or they have pain in their knees or hips. Maybe they’re tired after work or school, or can’t afford a gym.”

In his practice, he uses motivational interviewing, a research-backed approach that helps patients identify the barriers standing in the way of exercise and the reasons that may encourage them to begin.

Small improvements can still bring real benefits

Exercise does not have to mean marathon-level training, Feldshon says. A moderate walk on most days of the week can be enough to reach an activity level linked to health gains. “When people get about 30 to 60 minutes of moderate activity most days, they have reduced their chance of dying over the next several years by roughly 20%,” Feldshon says. Research also shows that combining cardiovascular exercise with strength training produces the greatest reduction in mortality risk, by as much as 40%.

It is never too late to begin

Some patients worry they are too old to start exercising, but research suggests older adults often gain even more from exercise than younger people do. Beyond supporting liver health, regular activity can help prevent falls and dementia, and it also offers protection against many cancers.

Other patients fear exercise will make existing pain worse, but studies consistently show that in most cases, regular movement helps ease pain, including pain caused by arthritis.