October 26, 2026 - By Rachel Martin - In his obesity medicine practice, David Feldshon, MD, assistant professor of medicine (digestive diseases), sees many patients with metabolic dysfunction-associated steatotic liver disease (MASLD), a condition in which excess fat is stored in the liver. If the disease is not treated, it can eventually lead to liver inflammation and damage.

Rates of the disease continue to rise, with some estimates showing that nearly one in three adults in the United States has MASLD, though many have not received a formal diagnosis.

Although there are several treatment options available to patients, such as endoscopic procedures for weight loss, bariatric surgery, and medication management, exercise plays an important role in preventing and managing the disease.

“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 shares four things everyone with liver disease or who is at risk should know about exercise.

Find motivation to move

Physicians know that it can be challenging for people to start or increase their activity levels. “Most people don’t avoid exercise because they’re lazy; they avoid it because life gets in the way,” says Feldshon. “Maybe there’s not enough time, or they have pain in their knees or hips. Maybe they are exhausted after work or school, or can’t afford a gym.”

In his practice, he uses motivational interviewing, a well-studied technique to help patients explore the barriers that make it hard for them to exercise and the benefits that might motivate them.

Small improvements produce real health benefits

Exercising doesn’t mean people need to run as if they are training for a marathon, Feldshon says. Walking at a moderate pace on most days of the week is enough to reach an activity level linked with health benefits. “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%,” says Feldshon. Research also shows that combining cardiovascular exercise with strength training results in the greatest reduction in mortality risk—up to 40%.

It’s not too late to start

Feldshon says some of his patients worry that they are too old to start exercising, but research shows that older adults often receive even greater health benefits from exercise than younger people. In addition to protecting the liver, regular exercise can help prevent both falls and dementia. It is also protective against many cancers.

Other patients worry that exercise will worsen their existing pain, but studies consistently show that, in most cases, regular exercise helps reduce pain, including pain caused by arthritis.

Exercise is beneficial, even without weight loss

Although weight loss is often recommended for people with MASLD, the benefits of regular exercise extend well beyond losing weight. Regular exercise can remove fat from the liver, reduce liver inflammation, and, in some cases, even reverse liver damage—even without weight loss.

The important thing is to keep moving, Feldshon says. “If there were a pill that lowered blood pressure, improved cholesterol, reduced inflammation, strengthened the heart, improved energy, and helped people live longer, it would probably become one of the most prescribed medications in the world. Exercise does all of those things.”

Source: Yale School of Medicine