Muscle tissue typically contains only small amounts of adipose tissue, and the excess deposition of adiposity is considered a pathological phenomenon termed myosteatosis. Several studies have assessed the effects of exercise alone on the severity of myosteatosis, and some studies have reported promising results. We performed a systematic review and meta-analysis to investigate the effects of exercise interventions on myosteatosis (ie, lipid infiltration and muscle attenuation). Studies were identified through a systematic search of three databases and limited to randomized controlled trials (RCTs) focused on evaluating the effect of exercise interventions on lipid infiltration and/or muscle attenuation in adults. Thirteen studies met the inclusion criteria and twelve were included in the meta-analysis (n = 465, 84.7% women). The volume of lipid infiltration was decreased in the exercise group compared to the control group (Hedges 'g = -0.45, 95% confidence interval (CI) -0.74 to -0.16, p = 0.008, I2 = 0%), and the degree of muscle attenuation was increased (Hedges' g = 0.67, 95% CI 0.22 to 1.13, p = 0.009, I2 = 59.3%). Based on meta-regression analyses, there were no significant effects of mean age at baseline (lipid infiltration beta -0.008, 95% CI -0.035 to 0.019; p = 0.495; muscle attenuation beta -0.013, 95% CI -0.036 to 0.011; p = 0.248) and intervention duration (lipid infiltration beta -0.008, 95% CI -0.028 to 0.010; p = 0.311; muscle attenuation beta -0.018, 95% CI -0.050 to 0.014; p = 0.230) on the effect sizes estimates. Overall, our findings indicate that exercise can significantly improve muscle quality in populations at risk of developing obesity and sarcopenia-related disability.

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