The Effects of Tai Chi on Metabolic Dysfunction-associated Fatty Liver Disease in Middle-Aged and Older Adults

Inclusion Criteria: 1. Age between 40 and 75 years; 2. Liver fat content measured by mDixon QUANT is ≥5%; 3. Diagnosis of metabolic associated fatty liver disease; 4. Overweight/obesity (BMI ≥ 24 kg/m²); 5. Signed written informed consent. Exclusion Criteria: 1. Excessive alcohol consumption (definition: in the past 6 months, males have consumed more than 140g of alcohol per week, and females have consumed more than 70g); 2. Fatty liver due to other causes: such as alcoholic fatty liver, acute and chronic viral hepatitis, drug-induced hepatitis, autoimmune hepatitis, etc.; 3. Severe cardiovascular diseases, including myocardial infarction within the past 6 months; 4. Heart failure (NYHA classification: III - IV); 5. Biliary diseases: such as obstructive biliary diseases; 6. Other diseases affecting glucose and lipid metabolism: diabetes, hyperthyroidism, hypothyroidism, Cushing's syndrome, etc.; 7. Poorly controlled blood pressure: SBP ≥ 180 mmHg, DBP ≥ 100 mmHg; 8. Chronic kidney disease or severe renal impairment, defined as serum creatinine of 135 µmol/L (1.5 mg/dL) for males and 110 µmol/L (1.3 mg/dL) for females; 9. Patients unable to communicate normally, such as those with dementia or cognitive impairment; 10. Currently pregnant or planning to become pregnant in the near future; 11. Other conditions preventing participation in follow-up interventions; 12. Other clinical diseases that make participation in exercise unsuitable, such as inability to cooperate with exercise therapy due to severe pain or joint deformities, or the use of medications that may interfere with the assessment of exercise effects (such as corticosteroids, liver protection drugs, etc.), or medications that affect heart rate (such as beta-blockers).