Table 2.

Exercise prescription recommendations for MAFLD

Management goal		Aerobic only	Resistance only	Practical considerations
	Reduction in hepatic steatosis	Moderate to vigorousa intensity aerobic (e.g. brisk walking, jogging, cycling)b exercise for at least 135 min per week of moderate intensity across 3–5 days per week; ideally progressing to 150–240 min per week. Strong evidence And/or High-intensity interval training (HIIT) involving 1–5 high-intensity intervalsa of 2–4 min interspersed with 2–3 min lower-intensity recoveryc between intervals on 3–5 days per week. Moderate evidence	Insufficient evidence	Aerobic exercise and/or HIIT should be prioritised for the management of hepatic steatosis The benefits of resistance training in isolation are unclear. Resistance training should be included in addition to the recommended volume of aerobic exercise but not instead of it. Clinicians aiming to prescribe resistance training to individuals with cardiometabolic disorders may find appropriate resources elsewhere [137, 138]
	Reduction in central adiposity (waist circumference as a surrogate for VAT)	Moderate to vigorousa intensity aerobic (e.g. brisk walking, jogging, cycling)b exercise for at least 150–240 min per week of moderate intensity across 3–5 days per week. Weak–moderate evidence	Insufficient evidence	As little as 60 min of weekly vigorous intensity activity may provide equivalent benefit Practical considerations for resistance training as per hepatic steatosis
	Improvement in cardiorespiratory fitness	Moderate to vigorousa intensity aerobic (e.g. brisk walking, jogging, cycling)b exercise for at least 135 min per week of moderate intensity across 3–5 days per week Strong evidence	Insufficient evidence	Emerging evidence suggests HIIT may equally improve cardiorespiratory fitness in people with MAFLD
	Weight loss	Moderate to vigorousa intensity aerobic (e.g. brisk walking, jogging, cycling)b exercise for at least 150–240 min per week of moderate intensity across 3–5 days per week. Strong evidence	Insufficient evidence	Important to appropriately communicate the modest magnitude of weight loss (~ 2–3 kg or ~ 1.5%) expected with exercise intervention of this volume in isolation Practical considerations for resistance training as per hepatic steatosis

MAFLD metabolic-associated fatty liver disease, HIIT high-intensity interval training, VAT visceral adipose tissue, VO₂R rate of oxygen consumption reserve, HRR heart rate reserve, RPE rating of perceived exertion, VO₂peak peak rate of oxygen consumption

^aRecommended intensity based on the research papers on which the evidence was based. Moderate: 40–60% of ${\dot{\text{V}}\text{O}}_2$R or HRR, or 12–13 RPE; vigorous: 60–84% of ${\dot{\text{V}}\text{O}}_2$R or HRR, or 14–16 RPE; high intensity: ≥ 85–100% ${\dot{\text{V}}\text{O}}_2$peak or ≥ 15 RPE

^bThere is no evidence for comparative efficacy of these aerobic exercise training modalities

^cNo studies have used passive recovery periods