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Techniques and Methods

The intensity of exercise and inflammation markers in women with overweight & obesity: a systematic review and network meta-analysis

International Journal of Obesity volume 49, pages 1229–1239 (2025)Cite this article

Subjects

Abstract

Objectives

The purpose of this network meta-analysis (NMA) of randomized controlled trials (RCT) was to examine the effects of different exercise intensities on inflammatory markers in women with overweight/obesity.

Methods

A systematic search for RCTs that met the inclusion criteria for the period up to October 2024. random effects NMA was performed within a frequency-based framework.

Results

A total of 75 RCTs were included (3989 participants). High-intensity exercise significantly modulated leptin and adiponectin levels, but had a nonsignificant effect on TNF-α, CRP, and IL-6 levels. Moderate-intensity exercise significantly modulated TNF-α, CRP, IL-6, leptin, and adiponectin levels. Surface under the cumulative ranking curve (SUCRA) probability ranking showed that moderate-intensity exercise was the most recommended exercise intensity for reducing TNF-α, CRP, IL-6, and leptin levels, and for modulating adiponectin levels, moderate-intensity exercise also had a SUCRA value of 65.4%, so we believe that moderate-intensity exercise may be the most robust type of exercise intensity in terms of the breadth of effects. Subgroup analysis showed that moderate-intensity aerobic exercise (MAE) significantly reduced TNF-α levels. Moderate-intensity resistance training (MRT) is the most recommended type for decreasing IL-6 and leptin levels. Moderate-intensity combined exercise (MCE) is the best type of exercise for managing CRP and adiponectin levels.

Conclusions

There were significant differences in the effects of different exercise intensities on specific inflammatory markers in women living with overweight and obesity. Moderate-intensity exercise may be the most robust type of exercise intensity. Future studies should consider the importance of exercise duration and volume (e.g., in MET* minutes/week) to better understand the relationship between exercise intensity and inflammatory markers. The effects of combining exercise and diet on inflammatory markers in women with overweight and obesity should also be explored in greater depth.

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Fig. 1
Fig. 2: Forest plot of post-intervention TNF-α value comparison between experimental and control groups.
Fig. 3: Diagram of network meta-analysis comparisons.
Fig. 4: Network meta-analysis matrix of results.
Fig. 5: Subgroup network meta-analysis results matrix.

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Data availability

The datasets analyzed in the current study are available from the corresponding author upon reasonable request.

References

  1. Ferrucci L, Fabbri E. Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nat Rev Cardiol. 2018;15:505–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hotamisligil GS. Inflammation, metaflammation and immunometabolic disorders. Nature. 2017;542:177–85.

    Article  CAS  PubMed  Google Scholar 

  3. Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Res Clin Pract. 2014;105:141–50.

    Article  CAS  PubMed  Google Scholar 

  4. Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Investig. 2017;127:1–4.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chen X, He H, Xie K, Zhang L, Cao C. Effects of various exercise types on visceral adipose tissue in individuals with overweight and obesity: A systematic review and network meta-analysis of 84 randomized controlled trials. Obes Rev. 2024;25:e13666.

    Article  CAS  PubMed  Google Scholar 

  6. Morales PE, Bucarey JL, Espinosa A. Muscle lipid metabolism: role of lipid droplets and perilipins. J Diabetes Res. 2017;2017:1789395.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Blüher M. The inflammatory process of adipose tissue. Pediatr Endocrinol Rev. 2008;6:24–31.

    PubMed  Google Scholar 

  8. Winn NC, Cottam MA, Wasserman DH, Hasty AH. Exercise and adipose tissue immunity: outrunning inflammation. Obesity. 2021;29:790–801.

    Article  PubMed  Google Scholar 

  9. Karalis KP, Giannogonas P, Kodela E, Koutmani Y, Zoumakis M, Teli T. Mechanisms of obesity and related pathology: linking immune responses to metabolic stress. FEBS J. 2009;276:5747–54.

    Article  CAS  PubMed  Google Scholar 

  10. Boutens L, Stienstra R. Adipose tissue macrophages: going off track during obesity. Diabetologia. 2016;59:879–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Frank AP, de Souza Santos R, Palmer BF, Clegg DJ. Determinants of body fat distribution in humans may provide insight about obesity-related health risks. J Lipid Res. 2019;60:1710–9.

    Article  CAS  PubMed  Google Scholar 

  12. Tan L, Yan W, Zhang B, Zhao Z, Lipowski M, Ossowski Z. Comparative efficacy of different exercise types on inflammatory markers in women with overweight and obesity: A systematic review and network meta-analysis of randomized controlled trials. J Sci Med Sport. 2024;27:458–65.

    Article  PubMed  Google Scholar 

  13. Abd El-Kader SM, Al-Jiffri OH. Impact of aerobic versus resisted exercise training on systemic inflammation biomarkers and quality of Life among obese post-menopausal women. Afr Health Sci. 2019;19:2881–91.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chedraui P, Escobar GS, Pérez-López FR, Palla G, Montt-Guevara M, Cecchi E, et al. Angiogenesis, inflammation and endothelial function in postmenopausal women screened for the metabolic syndrome. Maturitas. 2014;77:370–4.

    Article  CAS  PubMed  Google Scholar 

  15. Blomquist C, Alvehus M, Burén J, Ryberg M, Larsson C, Lindahl B, et al. Attenuated low‐grade inflammation following long‐term dietary intervention in postmenopausal women with obesity. Obesity. 2017;25:892–900.

    Article  CAS  PubMed  Google Scholar 

  16. Macciò A, Madeddu C. Obesity, inflammation, and postmenopausal breast cancer: therapeutic implications. Sci World J. 2011;11:2020–36.

    Article  Google Scholar 

  17. Martins FM, de Paula Souza A, Nunes PRP, Michelin MA, Murta EFC, Resende E, et al. High-intensity body weight training is comparable to combined training in changes in muscle mass, physical performance, inflammatory markers and metabolic health in postmenopausal women at high risk for type 2 diabetes mellitus: A randomized controlled clinical trial. Exp Gerontol. 2018;107:108–15.

    Article  PubMed  Google Scholar 

  18. Vella CA, Taylor K, Drummer D. High-intensity interval and moderate-intensity continuous training elicit similar enjoyment and adherence levels in overweight and obese adults. Eur J Sport Sci. 2017;17:1203–11.

    Article  PubMed  Google Scholar 

  19. Hayashino Y, Jackson JL, Hirata T, Fukumori N, Nakamura F, Fukuhara S, et al. Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metab Clin Exp. 2014;63:431–40.

    Article  CAS  PubMed  Google Scholar 

  20. Khalafi M, Symonds ME. The impact of high-intensity interval training on inflammatory markers in metabolic disorders: A meta-analysis. Scand J Med Sci Sports. 2020;30:2020–36.

    Article  PubMed  Google Scholar 

  21. Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777–84.

    Article  PubMed  Google Scholar 

  22. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391:1357–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JP. Evaluating the quality of evidence from a network meta-analysis. PLoS ONE. 2014;9:e99682.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Higgins J. Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration and John Wiley & Sons Ltd 2008.

  26. Jackson D, Riley R, White IR. Multivariate meta-analysis: potential and promise. Stat Med. 2011;30:2481–98.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth methods. 2012;3:80–97.

    Article  PubMed  Google Scholar 

  29. Rücker G, Schwarzer G. Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med Res Methodol. 2015;15:58.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jansen JP, Naci H. Is network meta-analysis as valid as standard pairwise meta-analysis? It all depends on the distribution of effect modifiers. BMC Med. 2013;11:159.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Chaimani A, Higgins JP, Mavridis D, Spyridonos P, Salanti G. Graphical tools for network meta-analysis in STATA. PLoS ONE. 2013;8:e76654.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Shim S, Yoon BH, Shin IS, Bae JM. Network meta-analysis: application and practice using Stata. Epidemiol health. 2017;39:e2017047.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64:163–71.

    Article  PubMed  Google Scholar 

  34. Mbuagbaw L, Rochwerg B, Jaeschke R, Heels-Andsell D, Alhazzani W, Thabane L, et al. Approaches to interpreting and choosing the best treatments in network meta-analyses. Syst Rev. 2017;6:79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Rose GL, Skinner TL, Mielke GI, Schaumberg MA. The effect of exercise intensity on chronic inflammation: A systematic review and meta-analysis. J Sci Med Sport. 2021;24:345–51.

    Article  PubMed  Google Scholar 

  36. Fischer CP. Interleukin-6 in acute exercise and training: what is the biological relevance? Exerc Immunol Rev. 2006;12:6–33.

    PubMed  Google Scholar 

  37. Tremblay A, Simoneau JA, Bouchard C. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metab Clin Exp. 1994;43:814–8.

    Article  CAS  PubMed  Google Scholar 

  38. Bhol NK, Bhanjadeo MM, Singh AK, Dash UC, Ojha RR, Majhi S, et al. The interplay between cytokines, inflammation, and antioxidants: mechanistic insights and therapeutic potentials of various antioxidants and anti-cytokine compounds. Biomed Pharmacother. 2024;178:117177.

    Article  CAS  PubMed  Google Scholar 

  39. Tyciakova S, Valova V, Svitkova B, Matuskova M. Overexpression of TNFα induces senescence, autophagy and mitochondrial dysfunctions in melanoma cells. BMC Cancer. 2021;21:507.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Rose-John S, Winthrop K, Calabrese L. The role of IL-6 in host defence against infections: immunobiology and clinical implications. Nat Rev Rheumatol. 2017;13:399–409.

    Article  CAS  PubMed  Google Scholar 

  41. Salazar J, Martínez MS, Chávez-Castillo M, Núñez V, Añez R, Torres Y, et al. C-Reactive protein: an in-depth look into structure, function, and regulation. Int Sch Res Not. 2014;2014:653045.

    PubMed Central  Google Scholar 

  42. Obradovic M, Sudar-Milovanovic E, Soskic S, Essack M, Arya S, Stewart AJ, et al. Leptin and obesity: role and clinical implication. Front Endocrinol. 2021;12:585887.

    Article  Google Scholar 

  43. Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011;11:85–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Tan L, Mei J, Tang R, Huang D, Qi K, Ossowski Z, et al. Can exercise as a complementary technique manage inflammatory markers in women with breast cancer who are overweight and obese? A systematic review and meta-analysis. Complement Ther Med. 2025;88:103119.

    Article  PubMed  Google Scholar 

  45. Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89:2548–56.

    Article  CAS  PubMed  Google Scholar 

  46. Yadav A, Kataria MA, Saini V, Yadav A. Role of leptin and adiponectin in insulin resistance. Clin Chim Acta. 2013;417:80–4.

    Article  CAS  PubMed  Google Scholar 

  47. Henneman P, Janssens AC, Zillikens MC, Frolich M, Frants RR, Oostra BA, et al. Menopause impacts the relation of plasma adiponectin levels with the metabolic syndrome. J Intern Med. 2010;267:402–9.

    Article  CAS  PubMed  Google Scholar 

  48. Cerqueira É, Marinho DA, Neiva HP, Lourenço O. Inflammatory effects of high and moderate intensity exercise-a systematic review. Front Physiol. 2019;10:1550.

    Article  PubMed  Google Scholar 

  49. Ansar W, Ghosh S, Ansar W, Ghosh S. Inflammation and inflammatory diseases, markers, and mediators: Role of CRP in some inflammatory diseases. Biol C React Protein Health disease 2016: 67–107.

  50. Bobbert T, Wegewitz U, Brechtel L, Freudenberg M, Mai K, Möhlig M, et al. Adiponectin oligomers in human serum during acute and chronic exercise: relation to lipid metabolism and insulin sensitivity. Int J Sports Med. 2007;28:1–8.

    Article  CAS  PubMed  Google Scholar 

  51. Tilg H, Ianiro G, Gasbarrini A, Adolph TE. Adipokines: masterminds of metabolic inflammation. Nature Rev Immunol 2024;1–16

  52. Fisher G, Brown AW, Bohan Brown MM, Alcorn A, Noles C, Winwood L, et al. High intensity interval- vs moderate intensity- training for improving cardiometabolic health in overweight or obese males: a randomized controlled trial. PLoS ONE. 2015;10:e0138853.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Bogdanis GC, Philippou A, Stavrinou PS, Tenta R, Maridaki M. Acute and delayed hormonal and blood cell count responses to high-intensity exercise before and after short-term high-intensity interval training. Res Sports Med. 2022;30:400–14.

    Article  PubMed  Google Scholar 

  54. Tan L, Yan W, Yang W, Kamionka A, Lipowski M, Zhao Z, et al. Effect of exercise on inflammatory markers in postmenopausal women with overweight and obesity: A systematic review and meta-analysis. Exp Gerontol. 2023;183:112310.

    Article  CAS  PubMed  Google Scholar 

  55. Khalafi M, Malandish A, Rosenkranz SK. The impact of exercise training on inflammatory markers in postmenopausal women: A systemic review and meta-analysis. Exp Gerontol. 2021;150:111398.

    Article  CAS  PubMed  Google Scholar 

  56. Chen C, Zhang D, Ye M, You Y, Song Y, Chen X. Effects of various exercise types on inflammatory response in individuals with overweight and obesity: a systematic review and network meta-analysis of randomized controlled trials. Int J Obes 2024;49:214–25.

  57. Son WH, Park HT, Jeon BH, Ha MS. Moderate intensity walking exercises reduce the body mass index and vascular inflammatory factors in postmenopausal women with obesity: a randomized controlled trial. Sci Rep. 2023;13:20172.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Tilg H, Moschen AR. Inflammatory mechanisms in the regulation of insulin resistance. Mol Med. 2008;14:222–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Dieli-Conwright CM, Parmentier JH, Sami N, Lee K, Spicer D, Mack WJ, et al. Adipose tissue inflammation in breast cancer survivors: effects of a 16-week combined aerobic and resistance exercise training intervention. Breast Cancer Res Treat. 2018;168:147–57.

    Article  PubMed  Google Scholar 

  60. Phillips MD, Patrizi RM, Cheek DJ, Wooten JS, Barbee JJ, Mitchell JB. Resistance training reduces subclinical inflammation in obese, postmenopausal women. Med Sci Sports Exerc. 2012;44:2099–110.

    Article  CAS  PubMed  Google Scholar 

  61. Shaw I, Triplett T, Shaw BS. Resistance training and weight management: Rationale and efficacy. In: Weight Management-Challenges and Opportunities. IntechOpen, 2022.

  62. Rosety-Rodriguez M, Camacho A, Rosety I, Fornieles G, Rosety MA, Diaz AJ, et al. Resistance circuit training reduced inflammatory cytokines in a cohort of male adults with Down syndrome. Med Sci Monit. 2013;19:949–53.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Falcone PH, Tai CY, Carson LR, Joy JM, Mosman MM, McCann TR, et al. Caloric expenditure of aerobic, resistance, or combined high-intensity interval training using a hydraulic resistance system in healthy men. J Strength Cond Res. 2015;29:779–85.

    Article  PubMed  Google Scholar 

  64. Bronczek GA, Soares GM, de Barros JF, Vettorazzi JF, Kurauti MA, Marconato-Júnior E, et al. Resistance exercise training improves glucose homeostasis by enhancing insulin secretion in C57BL/6 mice. Sci Rep. 2021;11:8574.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Wang S, Zhou H, Zhao C, He H. Effect of exercise training on body composition and inflammatory cytokine levels in overweight and obese individuals: a systematic review and network meta-analysis. Front Immunol. 2022;13:921085.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Zhao H, Cheng R, Teng J, Song G, Huang C, Yuan S, et al. A meta-analysis of the effects of different training modalities on the inflammatory response in adolescents with obesity. Int J Environ Res Public Health. 2022;19:13224.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Alizaei Yousefabadi H, Niyazi A, Alaee S, Fathi M, Mohammad Rahimi GR. Anti-inflammatory effects of exercise on metabolic syndrome patients: a systematic review and meta-analysis. Biol Res Nurs. 2021;23:280–92.

    Article  CAS  PubMed  Google Scholar 

  68. You T, Arsenis NC, Disanzo BL, Lamonte MJ. Effects of exercise training on chronic inflammation in obesity : current evidence and potential mechanisms. Sports Med. 2013;43:243–56.

    Article  PubMed  Google Scholar 

  69. Pahomov N, Kostunina D, Artemenkov A. The influence of physical activity on the level of chronic inflammation in health and in noninfectious diseases. Hum Physiol. 2024;50:293–9.

    Article  Google Scholar 

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Funding

2023 Jiangxi Province Key Research Base of Philosophy and Social Sciences: Research Center for Sports Health and Industrial Development (General Project): Research on Strategies to Address the Contradiction of Inadequate Follow-up of Digital Technology in Community Sports in Jiangxi Province under the Background of Aging Population (23ZXSKJD37).

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Authors and Affiliations

  1. Gdansk University of Physical Education and Sport, 80-336, Gdansk, Poland

    Liang Tan & Zbigniew Ossowski

  2. Sports Health and Industrial Development Research Center, School of Physical Education, Shangrao Normal University, 334001, Shangrao, China

    Duo Huang

  3. College of Physical Education, Hunan Normal University, 410012, Changsha, China

    Bo Liu

  4. School of Physical Education, Dalian University of Foreign Languages, 116044, Dalian, China

    Ning Wang

  5. School of Management, Beijing Sport University, 100084, Beijing, China

    Weihua Yan

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  1. Liang Tan
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  2. Duo Huang
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  3. Bo Liu
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  4. Zbigniew Ossowski
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  5. Ning Wang
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  6. Weihua Yan
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Contributions

Liang Tan: conceptualization, methodology, formal analysis, writing—original draft; Duo Huang: conceptualization, supervision, writing—review and editing; Bo Liu: conceptualization, methodology, writing—original draft; Zbigniew Ossowski: formal analysis, writing—review and editing; Ning Wang: methodology; Weihua Yan: conceptualization, supervision, writing—review and editing.

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Correspondence to Duo Huang.

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Tan, L., Huang, D., Liu, B. et al. The intensity of exercise and inflammation markers in women with overweight & obesity: a systematic review and network meta-analysis. Int J Obes 49, 1229–1239 (2025). https://doi.org/10.1038/s41366-025-01777-7

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