Modality-specific effects of structured exercise on immunometabolic biomarkers in postmenopausal obesity: a Bayesian network meta-analysis.

<h4>Objective</h4>The present Bayesian network meta-analysis (NMA) aims to evaluate and compare the efficacy of aerobic training (AT), resistance training (RT), high-intensity interval training (HIIT), and combined training (CT) on biomarkers of chronic low-grade systemic inflammation (CLGSI) in postmenopausal women with overweight or obesity.<h4>Methods</h4>Five databases were systematically searched from inception to November 2025 (PROSPERO: CRD420251237915) for randomized controlled trials (RCTs). Inclusion required strict clinical verification of postmenopausal status and adiposity. Standardized mean differences (SMDs) with 95% credible intervals (CrIs) quantified comparative efficacy. Surface Under the Cumulative Ranking curve (SUCRA) established probabilistic hierarchical rankings, and the GRADE framework evaluated the certainty of evidence.<h4>Results</h4>Synthesis of 39 RCTs (<i>N</i> = 2,714; mean age: 58.8 ± 9.2 years) indicated biomarker-specific adaptations. RT produced the largest reduction in systemic C-reactive protein (CRP) (SMD = -0.97, 95% CrI [-1.52, -0.42]), followed by AT (SMD = -0.57, 95% CrI [-1.16, -0.02]). CT downregulated circulating interleukin-6 (IL-6) (SMD = -1.58, 95% CrI [-2.62, -0.56]) and demonstrated the highest probability of suppressing circulating tumor necrosis factor-α (TNF-α) (SMD = -0.99, 95% CrI [-1.71, -0.23]), followed by AT (SMD = -0.75, 95% CrI [-1.20, -0.31]). Sparse direct evidence for HIIT yielded wide credible intervals crossing the null. Systemic leptin levels remained unchanged. The overall certainty of evidence was rated as low to very low.<h4>Conclusion</h4>Distinct exercise modalities elicit biomarker-specific anti-inflammatory responses in postmenopausal women with overweight or obesity. Based on probabilistic rankings, RT demonstrates the highest potential for mitigating systemic CRP, whereas CT appears most effective in attenuating IL-6 and TNF-α. The stability of systemic leptin levels indicates that physical activity alone may be insufficient to reverse hyperleptinemia. Given the low to very low certainty of evidence, these modality-specific efficacies should be interpreted cautiously as probabilistic targets to inform biomarker-guided exercise prescriptions.<h4>Systematic review registration</h4>https://www.crd.york.ac.uk/prospero/, identifier CRD420251237915.