The effect of exercise intervention on atherosclerosis prevention in overweight or obese adults: A Bayesian network meta-analysis of randomized controlled trials.

Exercise interventions significantly improved Flow-Mediated Dilation (FMD) compared to control in overweight/obese adults.

• SMD = 0.99, 95% CI 0.69–1.29
• Based on 51 randomized controlled trials with n = 2,638 participants
• Participants were adults aged 18–65 years with overweight or obesity
• Interventions lasted ≥4 weeks
• Certainty of evidence rated as low confidence using CINeMA

Exercise interventions significantly reduced Pulse Wave Velocity (PWV) compared to control in overweight/obese adults.

• SMD = -0.31, 95% CI -0.44 to -0.18
• Reduction in PWV indicates improvement in arterial stiffness
• Based on the same network meta-analysis of 51 RCTs (n = 2,638)
• Certainty of evidence rated as low confidence using CINeMA

Exercise interventions significantly decreased Carotid Intima-Media Thickness (CIMT) compared to control in overweight/obese adults.

• SMD = -0.20, 95% CI -0.36 to -0.05
• Reduction in CIMT reflects structural vascular remodeling
• Based on the same network meta-analysis of 51 RCTs (n = 2,638)
• Certainty of evidence rated as low confidence using CINeMA

Hybrid exercise (HYB) was the most effective modality for improving endothelial function as measured by FMD.

• Network meta-analysis identified HYB as ranking highest for FMD improvement
• Exercise modalities compared included CET, RT, INT, CT, and HYB versus usual lifestyle/standard care
• HYB combines elements of multiple exercise types
• Effects were synthesized as SMDs with 95% CIs across modalities

Interval training (INT) was the most effective modality for reducing arterial stiffness as measured by PWV.

• Network meta-analysis identified INT as ranking highest for PWV reduction
• INT represents high-intensity interval-type exercise protocols
• Comparison was made across CET, RT, INT, CT, and HYB modalities
• Certainty of evidence was rated as low confidence

Continuous endurance training (CET) and resistance training (RT) exhibited similar effects on CIMT reduction.

• Network meta-analysis found no meaningful difference between CET and RT for CIMT
• Both modalities showed comparable effects on structural vascular remodeling
• CIMT overall effect SMD = -0.20, 95% CI -0.36 to -0.05 across all exercise interventions
• Certainty of evidence rated as low confidence

Subgroup analyses indicated that the effects of exercise on vascular outcomes were more pronounced in women and in Asian populations.

• Subgroup analyses were pre-specified as part of the network meta-analysis approach
• Effects were more pronounced both by sex (women) and by ethnicity (Asian populations)
• Specific subgroup SMDs or CIs were not reported in the abstract
• These findings suggest potential effect modification by demographic characteristics

The systematic review included 51 RCTs with 2,638 participants meeting eligibility criteria.

• Databases searched included PubMed, Web of Science, Cochrane Library, and EBSCO SPORTDiscus from inception to 31 May 2025
• Google Scholar and reference screening supplemented the database search
• Eligible trials enrolled adults aged 18–65 years with overweight or obesity
• Risk of bias was assessed using RoB 2
• Protocol was prospectively registered in PROSPERO (CRD420251066443)