Efficacy of Exercise-Based Interventions for Metabolic Syndrome: An Umbrella Review With Meta-Analyses

Regular exercise is a first-line nonpharmacological strategy for managing metabolic syndrome (MetS), but varied exercise modalities and outcomes across studies have led to inconsistent findings that limit clinical guidance.

To synthesize up-to-date evidence on the efficacy of exercise-based interventions in improving MetS components and cardiometabolic health in individuals with MetS.

Following the Preferred Reporting Items for Overviews of Reviews guideline, we searched seven databases from inception to May 2025 for systematic reviews with meta-analyses evaluating various types of exercise-based interventions (aerobic, high-intensity interval training [HIIT], resistance, mind-body, and combined aerobic and resistance training). [Correction added on 1 May 2026, after first online publication: The previous sentence has been corrected in this version.] Outcomes included MetS components-waist circumference (WC), systolic/diastolic blood pressure (SBP/DBP), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting blood glucose (FBG)-along with other clinically relevant cardiometabolic parameters.

Twelve systematic reviews with meta-analyses, representing 122 primary studies (9639 participants), were included. Overall, exercise-based interventions significantly improved all MetS components and secondary cardiometabolic outcomes (all p < 0.001). Subgroup analyses showed aerobic and mind-body exercises improved all MetS components, whereas resistance, HIIT, and combined training enhanced specific components. Compared to usual care, combined training elicited larger effects on reducing FBG (-0.73 mmol/L, 95% CI: -1.43 to -0.02), TG (-0.26 mmol/L, 95% CI: -0.48 to -0.05), SBP (-4.25 mmHg, 95% CI: -7.16 to -1.34), and DBP (-3.69 mmHg, 95% CI: -5.18 to -2.20) than aerobic or resistance exercise alone.

This umbrella review represents the largest evaluation specific to patients with MetS to date, indicating that exercise-based interventions, across various modalities, significantly improve MetS components. The findings underscore the versatility of exercise, supporting tailored, patient-centered prescriptions for managing MetS.