OBJECTIVE: This study aimed to evaluate the effects and ranking of different exercise modalities, with or without dietary restriction, on adipokine levels (leptin and adiponectin) in overweight and obese individuals. Additionally, the independent contribution of dietary restriction to adipokine level improvement was analyzed. METHODS: A systematic search of randomized controlled trials (RCTs) published between January 2000 and November 2024 was conducted in Cochrane Library, Embase, PubMed, Web of Science, and EBSCO databases. A network meta-analysis (NMA) was performed to integrate the results. RESULTS: A total of 87 RCTs were included. The regulatory effects of different exercise modalities and their combinations with dietary restriction on adipokine levels varied. Nearly all interventions reduced leptin levels and increased adiponectin levels. Among them, dietary restriction combined with resistance training (D plus RT) exhibited the most significant effect on reducing leptin levels. Regarding adiponectin, dietary restriction combined with combined exercise (D plus COM) showed the greatest improvement. Notably, dietary restriction combined with exercise (D plus Ex) was more effective in reducing leptin levels, whereas the mechanisms underlying adiponectin enhancement were more complex, suggesting that HIIT, RT, and COM alone may be preferable choices. CONCLUSION: Exercise interventions, particularly when combined with dietary restriction, are more effective in reducing leptin levels, while HIIT, COM, and RT alone appear to be more effective in increasing adiponectin levels. These findings provide scientific evidence for personalized obesity management strategies and highlight the synergistic role of exercise and dietary restriction in adipokine regulation.

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