{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:51:32Z","timestamp":1791251492659,"version":"4.1.0"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare associations between different exercise training modalities\u2014aerobic training (AT), resistance training (RT), combined training (CT) and high\u2010intensity interval training (HIIT)\u2014and changes in insulin\u2010resistance biomarkers in adults with overweight\/obesity and to evaluate the dose\u2013response relationship for optimal exercise dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials and Web of Science from inception to May 2026. Two reviewers independently selected randomised controlled trials (RCTs) comparing exercise interventions in overweight\/obese adults. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2.0 (RoB 2.0) and confidence in the network meta\u2010analysis evidence was evaluated using the CINeMA framework. Data were synthesised using frequentist network meta\u2010analysis, with consistency assessed via the node\u2010splitting method and dose\u2013response meta\u2010regression using restricted cubic spline models was performed to examine the relationship between exercise volume and biomarker changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 86 RCTs involving 4358 adults (68% women) were included. The RoB 2.0 assessment revealed that the most common concerns were blinding of participants and personnel (performance bias) and missing outcome data. CINeMA ratings indicated that the certainty of evidence across comparisons ranged from low to moderate. Node\u2010splitting analyses showed no significant inconsistency (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05), supporting the consistency assumption of the network. Compared with usual care, all exercise modalities significantly reduced fasting insulin (FINS) and Homeostasis Model Assessment of Insulin Resistance (HOMA\u2010IR), with HIIT demonstrating the greatest effects (FINS: MD\u2009=\u2009\u22122.24 \u03bcU\/mL; HOMA\u2010IR: MD\u2009=\u2009\u22120.67). HIIT, AT and RT also significantly lowered Fasting Blood Glucose (FBG). Notably, exercise plus caloric restriction showed no significant additional benefit over exercise alone for insulin\u2010resistance markers, but this low\u2010confidence indirect evidence (CINeMA) warrants caution. Dose\u2013response analyses revealed nonlinear associations. The optimal exercise dose associated with the greatest improvement in fasting insulin was approximately 1265 MET\u2010min\/week, while for HOMA\u2010IR, it was approximately 1091 MET\u2010min\/week. These findings translate to a practical recommendation of approximately 1000\u20131200 MET\u2010minutes per week. No significant dose\u2013response relationship was observed for FBG. In the probability ranking, HIIT ranked first for reducing FINS (SUCRA: 85.1%), FBG (SUCRA: 97.8%) and HOMA\u2010IR (SUCRA: 80.0%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This systematic review and network meta\u2010analysis indicate that HIIT, AT, RT and CT are all associated with improvements in insulin\u2010resistance markers among adults with overweight\/obesity, with an optimal weekly dose of approximately 1000\u20131200 MET\u2010minutes. HIIT demonstrated the highest probability of being among the more effective modalities evaluated, while CT and RT represent reasonable alternatives. Given the low\u2010to\u2010moderate certainty of evidence (CINeMA), these findings should be interpreted cautiously and warrant confirmation in future head\u2010to\u2010head trials, particularly those comparing different exercise modalities or combined interventions and those assessing long\u2010term adherence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71340","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:04:36Z","timestamp":1791248676000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exercise and Insulin\u2010Resistance Biomarkers in Adults With Overweight\/Obesity: A Network Meta\u2010Analysis of Randomised Controlled Trials"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2550-9980","authenticated-orcid":false,"given":"Bolun","family":"Jiao","sequence":"first","affiliation":[{"name":"Department of Endocrinology The First Affiliated Hospital of Xinjiang Medical University  Urumqi Xinjiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Affiliated Hospital of Xinjiang Medical University  Urumqi Xinjiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangmin","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Affiliated Hospital of Xinjiang Medical University  Urumqi Xinjiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengli","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Karamay People's Hospital  Karamay Xinjiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Affiliated Hospital of Xinjiang Medical University  Urumqi Xinjiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"10481","key":"e_1_2_15_2_1","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/S0140-6736(25)00355-1","article-title":"Global, Regional, and National Prevalence of Adult Overweight and Obesity, 1990\u20102021, With Forecasts to 2050: A Forecasting Study for the Global Burden of Disease Study 2021","volume":"405","author":"GBD ABC","year":"2025","journal-title":"Lancet"},{"issue":"1","key":"e_1_2_15_3_1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1614362","article-title":"Health Effects of Overweight and Obesity in 195 Countries Over 25\u2009Years","volume":"377","author":"GBD OC","year":"2017","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnesp.2022.06.001"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106304"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.17525"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00271-3"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12532"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00843.2011"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.3.431"},{"issue":"1","key":"e_1_2_15_11_1","doi-asserted-by":"crossref","first-page":"10005","DOI":"10.1038\/s41598-020-67004-7","article-title":"Semaphorin 3C Is a Novel Adipokine Representing Exercise\u2010Induced Improvements of Metabolism in Metabolically Healthy Obese Young Males","volume":"10","author":"Nam J. 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