Background and Objective: Systemic inflammation is an important factor in the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Blood cell–based indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammatory response index (SIRI), are recognized as simple, low-cost, and accessible markers of systemic inflammation. Despite the importance of these indices in MASLD, evidence regarding the effects of exercise on these markers remains limited. Therefore, the present study aimed to investigate the effects of 12 weeks of combined exercise on systemic inflammatory indices and selected anthropometric and hepatic markers in individuals with MASLD.

Methods: In this study, 20 individuals with MASLD, including 13 men and 7 women, were randomly assigned to either a combined resistance training plus high-intensity interval training group (RT+HIIT; n=10; age: 40.99 ± 6.99 years) or a control group (n=10; age: 37.90 ± 6.77 years). The RT+HIIT group participated in a 12-week supervised exercise program consisting of three sessions per week under the supervision of an exercise physiologist. The intervention included resistance training combined with high-intensity interval training. NLR, PLR, MLR, and SIRI, as well as body weight, body mass index (BMI), and the liver enzymes ALT and AST, were measured before and after the intervention. Post-intervention outcomes were compared between the two groups using analysis of covariance (ANCOVA), with baseline values included as covariates.

After 12 weeks, NLR, PLR, MLR, and SIRI were significantly reduced in the exercise group compared with the control group (P=0.02, P=0.009, P=0.015, and P=0.024, respectively). Body weight, BMI, ALT, and AST also showed significant reductions in the exercise group (P<0.05).

Conclusion: Twelve weeks of combined resistance training and high-intensity interval training (RT+HIIT) were associated with reductions in body weight, BMI, ALT, and AST, as well as decreases in complete blood count-derived inflammatory indices, including NLR, PLR, MLR, and SIRI, in individuals with MASLD. These findings suggest that RT+HIIT may be considered as an exercise approach for improving selected anthropometric and biochemical measures and inflammation-related indices in individuals with MASLD.