The role of exercise intensity in the regulation of the gut microbiota and liver function in metabolic dysfunction–associated steatotic liver disease

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Abstract

Metabolic dysfunction–associated steatotic liver disease is currently regarded as one of the most prevalent metabolic disorders, closely linked to obesity, insulin resistance, and disturbances of the gut microbiome. Physical exercise is a key nonpharmacological strategy capable of modulating energy and metabolic homeostasis through its effects on interorgan communication along the gut–liver axis. This review summarizes experimental and clinical evidence regarding the effects of different types of physical activity, such as moderate-intensity continuous training and high-intensity interval training, on intestinal barrier integrity, hepatic lipid metabolism, mitochondrial and endoplasmic reticulum homeostasis, and systemic inflammation. Preclinical studies demonstrate that both training modalities increase the expression of tight junction proteins (ZO-1, occludin, JAM-A), enhance gut microbiota diversity, reduce endotoxemia, and attenuate the severity of steatosis. High-intensity interval training was superior in stimulating mitochondrial biogenesis, β-oxidation, and irisin secretion, as well as in reducing endoplasmic reticulum stress and macrophage-mediated inflammation. Clinical data confirm that regular physical activity, regardless of intensity, decreases hepatic fat accumulation and improves insulin sensitivity and cardiovascular function. However, clinical evidence remains limited, underscoring the need for further investigation of the molecular regulation mechanisms of the gut–liver axis. Overall, physical activity, particularly high-intensity interval training, is an effective, safe, and affordable approach for the prevention and treatment of metabolic dysfunction–associated steatotic liver disease, contributing to the restoration of metabolic balance and hepatic homeostasis.

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About the authors

Anna S. Stepanova

Samara State Medical University

Author for correspondence.
Email: annast2003.06@yandex.ru
ORCID iD: 0009-0000-5849-8057
Russian Federation, Samara

Ilmir A. Shaidullin

I.N. Ulyanov Chuvash State University

Email: shaidullinilmir@gmail.com
ORCID iD: 0009-0006-0757-3006
Russian Federation, Cheboksary

Liliya R. Sharafutdinova

I.N. Ulyanov Chuvash State University

Email: remka.lil.shar@gmail.com
ORCID iD: 0009-0006-6566-8847
Russian Federation, Cheboksary

Evgeny G. Prokopyev

I.N. Ulyanov Chuvash State University

Email: rikudasanin01@mail.ru
ORCID iD: 0009-0002-8229-1915
Russian Federation, Cheboksary

Yulia R. Romanova

I.N. Ulyanov Chuvash State University

Email: julia-romanova06@mail.ru
ORCID iD: 0009-0008-5753-9556
Russian Federation, Cheboksary

Renata I. Murzakaeva

Bashkir State Medical University

Email: sasha.ponomarenko.17@mail.ru
ORCID iD: 0009-0004-4889-5912
Russian Federation, Ufa

Kseniya A. Gerasimova

Bashkir State Medical University

Email: Ke1dji@yandex.ru
ORCID iD: 0009-0008-8869-7928
Russian Federation, Ufa

Sofia A. Safina

Bashkir State Medical University

Email: s_safina@internet.ru
ORCID iD: 0009-0004-6834-6910
Russian Federation, Ufa

Elina R. Abdrakhmanova

Bashkir State Medical University

Email: elli2202@mail.ru
ORCID iD: 0009-0002-0815-5667
Russian Federation, Ufa

Yana M. Samatova

Ryazan State Medical University

Email: yana.yana-2003@mail.ru
ORCID iD: 0009-0005-3573-8878
Russian Federation, Ryazan

Ekaterina S. Bashlykova

Voronezh State Medical University named after N.N. Burdenko

Email: katya31072002@bk.ru
ORCID iD: 0009-0008-4113-0422
Russian Federation, Voronezh

Maria V. Naumova

Voronezh State Medical University named after N.N. Burdenko

Email: voropaeva.2002@inbox.ru
ORCID iD: 0000-0002-5420-635X
Russian Federation, Voronezh

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