SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Nutrition and Metabolism
Comparison of the impact of exercise training with dietary intervention versus dietary intervention alone in patients with obesity and metabolic syndrome: a systematic review
Provisionally accepted
- 1Nanjing Xiaozhuang University, Nanjing, China
- 2Nanjing Sport Institute, Nanjing, China
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Background Metabolic syndrome (MetS) is characterized by a cluster of metabolic risk factors, including abdominal obesity, raised triglycerides (TGs), lowered high-density lipoprotein cholesterol (HDL-c), hypertension, and impaired glucose tolerance. Multifaceted interventions, including dietary intervention (DI) and exercise training (Ex), are recommended as treatments for MetS. Objective Our work is a systematic review and meta-analysis comparing the efficacy of DI alone vs that of DI with Ex (DI+Ex) by using body composition, blood pressure (BP), and other cardiometabolic risk factors in patients with obesity and MetS. Method We searched PubMed, Web of Science, SPORTDiscus, and the Cochrane Library from their inception to August 10, 2025, for randomized controlled trials. We calculated mean differences (MD) or standardized mean differences (SMD) and 95% confidence interval (CI) by employing random or fixed effect models (depending on heterogeneity). The major outcome was the improvement in MetS risk factors, including changes in waist circumference (WC), TGs, HDL-c, BP, and fasting plasma glucose (FPG) levels. The secondary outcomes were body weight, body mass index (BMI), body fat (BF), fasting insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and glycated hemoglobin. Results In this meta-analysis of 16 studies involving 902 individuals diagnosed as obesity with MetS, DI+Ex group demonstrated a significant advantage over DI for improving specific MetS risk factors. Specifically, the DI+Ex group showed superior efficacy in reducing WC (MD = 2.11 cm, 95% CI [0.99, 3.23]) and FPG (SMD = 0.22, 95% CI [0.03, 0.40]). However, the addition of exercise did not confer a significant benefit for HDL-c, BP, or TG. Beyond the primary MetS factors, the combined intervention was also more effective for a range of secondary outcomes, including body weight, BMI, BF, TC, and LDL-c. Conclusion Our findings demonstrate that DI+Ex interventions yield significant improvements in multiple MetS risk factors among individuals with obesity. We recommend that healthcare providers and public health initiatives prioritize these integrated programs to optimize cardiometabolic health outcomes in this population.
Keywords: Diet intervention, exercise training, metabolic syndrome, Obesity, Weight Loss
Received: 11 Sep 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Cao, Xu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jie Zhang, zhangjiegzty@126.com
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