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.
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