Can regular physical activity keep metabolic dysfunction-associated steatotic liver disease and its complications away before and/or after transplantation

PURPOSE OF REVIEW: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading reason for liver transplantation (LT) worldwide. With limited donor availability and rising posttransplant morbidity due to chronic noncommunicable disease, preventive strategies are urgently needed. This review highlights the role of physical activity in MASLD before and after LT. RECENT FINDINGS: Epidemiologic and interventional studies show that regular physical activity reduces liver fat, improves insulin sensitivity, and lowers aminotransferases, even without significant weight loss, in individuals with noncirrhotic MASLD. Physical activity also enhances muscle strength, physical performance, and quality of life. Although most research has focused on earlier disease stages, physical activity remains feasible and beneficial for patients with advanced chronic liver disease (advCLD) due to MASLD, improving performance, reducing frailty, and maintaining transplant candidacy. Following LT, preliminary studies suggest that regular physical activity may reduce cardiometabolic complications and improve functional recovery, though data on preventing recurrent MASLD or improving long-term outcomes is inconclusive. SUMMARY: Physical activity should be integrated into clinical pathways before and after LT for individuals living with MASLD. Future studies should address the unmet needs in both the advCLD and post-LT populations where maintaining LT candidacy and optimizing survival, quality of life, and long-term outcomes remains of high public health significance.