Efficacy of Exercise‐Based Interventions for Metabolic Syndrome: An Umbrella Review With Meta‐Analyses

BACKGROUND: Regular exercise is a first-line nonpharmacological strategy for managing metabolic syndrome (MetS), but varied exercise modalities and outcomes across studies have led to inconsistent findings that limit clinical guidance. OBJECTIVE: To synthesize up-to-date evidence on the efficacy of exercise-based interventions in improving MetS components and cardiometabolic health in individuals with MetS. METHODS: Following the Preferred Reporting Items for Overviews of Reviews guideline, we searched seven databases from inception to May 2025 for systematic reviews with meta-analyses evaluating various types of exercise-based interventions (aerobic, aerobic, high-intensity interval training [HIIT], resistance, mind-body, and combined aerobic and resistance training). [Correction added on 1 May 2026, after first online publication: The previous sentence has been corrected in this version.] Outcomes included MetS components-waist circumference (WC), systolic/diastolic blood pressure (SBP/DBP), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting blood glucose (FBG)-along with other clinically relevant cardiometabolic parameters. RESULTS: Twelve systematic reviews with meta-analyses, representing 122 primary studies (9639 participants), were included. Overall, exercise-based interventions significantly improved all MetS components and secondary cardiometabolic outcomes (all p < 0.001). Subgroup analyses showed aerobic and mind-body exercises improved all MetS components, whereas resistance, HIIT, and combined training enhanced specific components. Compared to usual care, combined training elicited larger effects on reducing FBG (-0.73 mmol/L, 95% CI: -1.43 to -0.02), TG (-0.26 mmol/L, 95% CI: -0.48 to -0.05), SBP (-4.25 mmHg, 95% CI: -7.16 to -1.34), and DBP (-3.69 mmHg, 95% CI: -5.18 to -2.20) than aerobic or resistance exercise alone. CONCLUSION: This umbrella review represents the largest evaluation specific to patients with MetS to date, indicating that exercise-based interventions, across various modalities, significantly improve MetS components. The findings underscore the versatility of exercise, supporting tailored, patient-centered prescriptions for managing MetS.