Introduction: The paper aims to assess the effects of GLP-1 RAs, structured exercise, and their combination on body composition and cardiometabolic outcomes in adults with overweight or obesity. Methods: PubMed, Web of Science, Scopus, and EBSCO were searched through April 2026 for English-language RCTs using terms related to obesity, GLP-1 RAs, exercise, and glucolipid metabolism outcomes. We included RCTs of adults (18–65 years, BMI ≥ 25 kg/m2) without major comorbidities, except for type 2 diabetes, testing GLP-1 RAs, structured exercise, or both. Of 2508 screened articles, nine studies comprising 1009 participants met eligibility criteria. Participants included 589F/420M, with a weighted mean age of 43.8 ± 12.2 years and weighted mean BMI of 32.6 ± 3.0 kg/m2. Risk of bias was assessed using RoB 2. A frequentist random-effects model calculated SMDs. Primary outcomes were changes in body weight, waist-to-hip ratio, and fat mass. Secondary outcomes included fasting glucose, HOMA-IR, triglycerides, LDL-C, and HDL-C. Meta-regression assessed weight loss as a predictor of metabolic outcomes. Results: The combination of GLP-1 receptor agonists and exercise was associated with the greatest effects on weight (SMD −1.04; 95% CI −1.24 to −0.83), fat mass (SMD −1.01; 95% CI −1.27 to −0.75), and waist-to-hip ratio (SMD −0.55; 95% CI −0.91 to −0.18) compared with placebo. For fasting glucose, the SMD was −0.49 (95% CI −1.52 to 0.55); for HOMA-IR, −0.59 (95% CI −0.89 to −0.29). For lipid outcomes, no statistically significant differences were observed for triglycerides or LDL-C, whereas HDL-C increased compared with placebo (SMD 0.32; 95% CI 0.04 to 0.61). Confidence in the evidence was high for body weight and fat mass, moderate for waist-to-height ratio and most lipid outcomes, and very low for fasting glucose. Conclusions: Combined GLP-1 RA and structured exercise interventions improved weight, insulin sensitivity, and selected lipid parameters more than monotherapies or placebo.
Comparative Efficacy of GLP-1 Receptor Agonists, Exercise, and Their Combination on Body Composition and Glucolipid Metabolism in Adults With Overweight or Obesity: A Network Meta-Analysis of Randomized Controlled Trials
Vandoni M.;Gatti A.
;Giuriato M.;Calcaterra V.
2026-01-01
Abstract
Introduction: The paper aims to assess the effects of GLP-1 RAs, structured exercise, and their combination on body composition and cardiometabolic outcomes in adults with overweight or obesity. Methods: PubMed, Web of Science, Scopus, and EBSCO were searched through April 2026 for English-language RCTs using terms related to obesity, GLP-1 RAs, exercise, and glucolipid metabolism outcomes. We included RCTs of adults (18–65 years, BMI ≥ 25 kg/m2) without major comorbidities, except for type 2 diabetes, testing GLP-1 RAs, structured exercise, or both. Of 2508 screened articles, nine studies comprising 1009 participants met eligibility criteria. Participants included 589F/420M, with a weighted mean age of 43.8 ± 12.2 years and weighted mean BMI of 32.6 ± 3.0 kg/m2. Risk of bias was assessed using RoB 2. A frequentist random-effects model calculated SMDs. Primary outcomes were changes in body weight, waist-to-hip ratio, and fat mass. Secondary outcomes included fasting glucose, HOMA-IR, triglycerides, LDL-C, and HDL-C. Meta-regression assessed weight loss as a predictor of metabolic outcomes. Results: The combination of GLP-1 receptor agonists and exercise was associated with the greatest effects on weight (SMD −1.04; 95% CI −1.24 to −0.83), fat mass (SMD −1.01; 95% CI −1.27 to −0.75), and waist-to-hip ratio (SMD −0.55; 95% CI −0.91 to −0.18) compared with placebo. For fasting glucose, the SMD was −0.49 (95% CI −1.52 to 0.55); for HOMA-IR, −0.59 (95% CI −0.89 to −0.29). For lipid outcomes, no statistically significant differences were observed for triglycerides or LDL-C, whereas HDL-C increased compared with placebo (SMD 0.32; 95% CI 0.04 to 0.61). Confidence in the evidence was high for body weight and fat mass, moderate for waist-to-height ratio and most lipid outcomes, and very low for fasting glucose. Conclusions: Combined GLP-1 RA and structured exercise interventions improved weight, insulin sensitivity, and selected lipid parameters more than monotherapies or placebo.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
