Effect of treadmill walking on cardiometabolic risk factors and liver function markers in older adults with MASLD: a randomized controlled trial

Abstract Background Regular walking has been reported to improve metabolically-associated steatotic liver disease (MASLD) by altering the metabolic environment. However, no studies to date have focused on older individuals in both conditions. Therefore, this study aimed to investigate the effects of a 12-week walking intervention on metabolic syndrome risk factors, liver function indicators, and liver ultrasound findings in older adults with both metabolic syndrome and MASLD. Methods A total of 66 participants aged 65–85 years had average ages, heights, and weights of 75.3 ± 5.8 years, 159.3 ± 9.3 cm, and 68.6 ± 6.8 kg, respectively. The participants resided in four senior living communities, and their diets were uniform. The participants from two facilities were assigned to the control group (CON, n = 33), whereas those from the other two facilities were allocated to the treadmill walking program group (WPG, n = 33). Each group comprised 13 males and 20 females. The intervention consisted of a low- to moderate-intensity walking program, conducted for 30 min per day, 6 days per week, totaling 180 min per week. The total daily calorie expenditure was recorded based on the values calculated from the treadmill. The walking intensity was adjusted by modifying the treadmill incline according to each participant’s heart rate corresponding to their maximal oxygen consumption (VO₂max). The exercise intensity was set at 50% on Mondays and Fridays, 60% on Tuesdays and Thursdays, and 70% on Wednesdays and Saturdays. Sundays were designated as rest days. Results Although there were no significant differences in caloric intake between the groups, the WPG exhibited a 52.5% increase in physical activity levels (p < 0.001), resulting in significant reductions in body weight (-10.2%), fat mass (-17.2%), and abdominal fat (-4.8%). The WPG showed a 16.1% increase in VO₂max, along with significant reductions in systolic blood pressure (-9.6%) and blood glucose (-16.9%), as well as notable improvements in lipid profiles (p < 0.001). The WPG also demonstrated significant reductions in aspartate aminotransferase (-40%), alanine aminotransferase (-23.5%), total protein (-14.4%), albumin (-8.1%), bilirubin (-17.6%), and liver ultrasound scores (-31.8%), with all changes showing significant intergroup differences (p < 0.001). Conclusions Along with a consistent diet, a 12-week walk has been shown to induce significant changes in the body composition and cardiometabolic factors of older adults, as well as notable improvements in liver function markers and imaging findings. Trial registration This study was registered with the Clinical Research Information Service of the Korea Centers for Disease Control and Prevention under Clinical Trials KCT0010079 on 26/12/2024.