Effect of Exercise Training on Body Composition and Inflammatory Cytokine Levels in Overweight and Obese Individuals: A Systematic Review and Network Meta-Analysis

Objective This study aimed to compare and rank the effectiveness of aerobic exercise (AE), resistance training (RT), combined aerobic and resistance training (CT), and high-intensity interval training (HIIT) on body composition and inflammatory cytokine levels in overweight and obese individuals by using network meta-analysis (NMA). Methods We searched the PubMed, Cochrane, Embase, Web of Science, and EBSCO databases to identify randomized controlled trials investigating the effects of exercise training on inflammatory cytokines in overweight and obese patients. The retrieval period was from inception to November 2021. Two reviewers independently screened the retrieved articles, extracted the pertinent data, and assessed the risk of bias of the included studies; then, they used Stata 16.0 and Review Manager 5.3 to perform an NMA. Results A total of 38 studies involving 1317 patients were included in this study. The results of the NMA indicated that AE had the greatest effect on weight loss (SUCRA=78.3; SMD=−0.51, 95% CI: −0.70, −0.33); CT had the greatest effect on reducing body mass index (SUCRA=70.7; SMD=−0.46, 95% CI: −0.81, −0.10), waist circumference (SUCRA=93.4; SMD=−1.86, 95% CI: −2.80, −0.93), percentage body fat (SUCRA=79.6; SMD=−1.38, 95% CI: −2.29, −0.48), interleukin-6 level (SUCRA=86.4; SMD=−1.98, 95% CI: −3.87, −0.09), and tumor necrosis factor-α level (SUCRA=79.4; SMD=−2.08, 95% CI: −3.75, −0.42); AE (SMD=0.51, 95% CI: −1.68, 2.69), RT (SMD=0.15, 95% CI: −3.01, 3.32), CT (SMD=1.78, 95% CI: −1.35, 4.92), and HIIT (SMD=2.29, 95% CI: −1.27, 5.86) did not significantly increase the adiponectin level. Conclusion The current results suggest that CT is the best exercise modality for improving body composition and inflammatory status in overweight and obese individuals. More rigorous randomized control trials are needed for further validation. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022303165.

10-11 Figure S2-14. Interval plot and cumulative ranking probability plots of network meta-analysis. Table S6. Ranking of exercise interventions in order of effectiveness.
23-26 Figure S29-37. Sensitivity analyses of pairwise meta-analysis 27-31  #1(TS=(obesity or overweight) ) AND Language: (English) AND Publication Type: (Article) #2 (TS=(exercise or exercises or training or trainings or resistance training or strength training or combined training or high-intensity interval training) ) AND Language: (English) AND Publication Type: (Article) #3(TS=( inflammation or inflammat or inflammations or inflammatory or inflammatory response or inflammatory medium or inflammatory factor or inflammatory factors or inflammatory marker or inflammatory markers or inflammatory cytokine or inflammatory cytokines or C-reactive protein or CReactiveProtein or reactive protein or CRP or interleukins or Interleukin or IL-6 or IL-8 or Tumor Necrosis Factor-alpha or Tumor Necrosis Factor alpha or tumour necrosis factor or TNFalpha or TNF-alpha or TNFα) ) AND Language: (English) AND Publication Type: (Article) #3 AND #2 AND #1 inflammations':ab,ti OR 'inflammatory':ab,ti OR 'inflammatory response':ab,ti OR 'inflammatory medium':ab,ti OR 'inflammatory factor':ab,ti OR 'inflammatory factors':ab,ti) AND 'inflammatory marker':ab,ti) OR 'inflammatory markers':ab,ti OR 'inflammatory cytokine':ab,ti OR 'inflammatory cytokines':ab,ti OR 'c reactive protein'/exp OR 'c-reactive protein':ab,ti OR 'reactive protein':ab,ti OR 'crp':ab,ti OR 'interleukin derivative'/exp OR 'interleukins':ab,ti OR 'interleukin':ab,ti OR 'il-6':ab,ti OR 'il-8':ab,ti OR 'tumor necrosis factor'/exp OR 'tumor necrosis factoralpha':ab,ti OR 'tumor necrosis factor alpha':ab,ti OR 'tnfalpha':ab,ti OR 'tnfalpha':ab,ti OR 'tnf-α':ab,ti) AND ('randomized controlled trial':ab,ti OR 'randomized':ab,ti OR 'placebo':ab,ti) EBSCO (798) (AB ( (obesity or overweight) ) ) AND AB ( (exercise or exercises or training or trainings or resistance training or strength training or combined training or highintensity interval training) ) AND AB ( ( inflammation or inflammat or inflammations or inflammatory or inflammatory response or inflammatory medium or inflammatory factor or inflammatory factors or inflammatory marker or inflammatory markers or inflammatory cytokine or inflammatory cytokines or C-reactive protein or CReactiveProtein or reactive protein or CRP or interleukins or Interleukin or IL-6 or IL-8 or Tumor Necrosis Factor-alpha or Tumor Necrosis Factor alpha or tumour necrosis factor or TNFalpha or TNF-alpha or TNF-α) )) AND (S2 OR S4)

Type Definition
Aerobic exercise (AE) Exercise training designed to improve the efficiency and capacity of the cardiorespiratory system, such as walking, basketball, soccer(1).

Resistance training (RT)
Exercise training designed to improve the strength, power, endurance, and size of skeletal muscles, such as elastic bands, weight machines(1).

Combined aerobic and resistance training (CT)
A combination of aerobic exercise and resistance training.
20 Figure S15. Local inconsistency for body weight.