{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T08:09:18Z","timestamp":1789805358935,"version":"4.0.1"},"reference-count":61,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The comparative effectiveness of different exercise modalities on systemic inflammation in patients with metabolic syndrome (MetS) remains poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To systematically evaluate and rank the effects of aerobic exercise (AE), resistance training (RT), and combined training (COM) on inflammatory markers (C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-\u03b1), and interleukin-6 (IL-6) in MetS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A network meta-analysis of 28 randomized controlled trials (RCTs) was conducted. Data were synthesized using frequentist random-effects models. Treatment efficacy was ranked using the Surface Under the Cumulative Ranking Curve (SUCRA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Compared to the control group, all exercise modalities were associated with reductions in TNF-\u03b1 levels, though the strength of this evidence is limited by high heterogeneity and potential publication bias. Among the interventions, COM showed the greatest effect (SMD\u2009=\u2009\u22121.74; 95% CI: \u22123.06 to \u22120.43; SUCRA\u2009=\u200975.7%), followed by RT and AE. For CRP, significant reductions were observed in COM (SMD\u2009=\u2009\u22120.79; 95% CI: \u22121.36 to \u22120.21; SUCRA\u2009=\u200986.8%) and AE (SMD\u2009=\u2009\u22120.64; 95% CI: \u22120.95 to \u22120.32), while RT demonstrated a smaller effect. No modalities reached statistical significance for IL-6, although RT ranked highest in SUCRA (75.8%). Notably, CRP findings were robust with moderate certainty and no publication bias (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.86), whereas TNF-\u03b1 and IL-6 exhibited significant publication bias (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and extreme heterogeneity (\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009&gt;\u200990%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Exercise, particularly COM, appears to be a promising intervention for reducing CRP and TNF-\u03b1 in MetS. While the findings for CRP are robust, results for TNF-\u03b1 should be interpreted with caution due to observed heterogeneity and potential publication bias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10815589261483685","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T07:08:17Z","timestamp":1787382497000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of aerobic, resistance, and combined exercise on inflammatory markers in patients with metabolic syndrome: A systematic review and network meta-analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8622-1968","authenticated-orcid":false,"given":"Shih-Ming","family":"Chuang","sequence":"first","affiliation":[{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan"},{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, MacKay Medical University, Taipei, Taiwan"},{"name":"Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Liong","family":"Chien","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Saklayen MG. 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