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Exercise-responsive endocrine-metabolic mediators are predominantly adipokines, cytokines, and myokines in obesity and diabetes researchExercise Impacts Key Hormones and Proteins in Obesity and Diabetes

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Key Takeaway
Note that while exercise-responsive mediators are well-documented, evidence regarding their specific pathways is limited.

This systematic scoping review synthesized 365 reports representing 363 underlying studies to characterize the structure of evidence and biological relations of exercise-responsive endocrine-metabolic mediators. The review focuses on mediators associated with obesity and diabetes, identifying that obesity or overweight status was represented in 78.0% of the studies.

Among 308 studies with named mediators, the most frequently reported types were adipokines (58.4%), cytokines/chemokines (32.1%), and myokines (25.6%). The most frequently represented named mediators were adiponectin, leptin, IL-6, and irisin. Regarding evidence types, the review found high frequencies for exercise responsiveness (90.9%) and cardiometabolic associations (87.0%). However, evidence for source/secretion (18.5%), receptor/pathway (9.7%), functional perturbation (11.4%), and formal mediation (0.3%) was notably lower.

Exercise types reported included chronic training (81.6%) and aerobic/endurance exercise (63.4%). The authors highlight a concentration of research on specific adipokines, cytokines, and myokines while noting a lack of evidence regarding source, pathway, and formal mediation. These findings suggest that while the link between exercise and metabolic mediators is well-documented, the underlying mechanisms of action remain under-researched.

How this fits prior evidence

This scoping review addresses a gap in the understanding of the biological mechanisms behind exercise-responsive mediators in obesity and diabetes. While prior coverage established that orforglipron 36 mg achieves greater weight and metabolic reductions than 12 mg in obese adults, this review highlights that the specific pathways and formal mediation of exercise-responsive mediators like adiponectin and irisin are currently under-represented in the literature.

A large review of 363 studies looked at how physical activity affects the body's metabolic signals. The researchers focused on how exercise changes certain proteins and hormones, such as adipokines, cytokines, and myokines, which play important roles in how the body handles energy and health.

Most of the studies included people who were overweight or had obesity. The findings show that while many studies confirm that exercise changes these markers, much of the research is focused on a few specific types. For example, the review found a lot of data on adiponectin and leptin, but very little information on the specific pathways or how these changes actually cause improvements.

Most of the research looked at long-term training and aerobic exercise. Because this was a scoping review of existing reports, it shows what is currently known in the scientific community rather than testing a new treatment. It highlights that while exercise is linked to many positive changes, more research is needed to understand the exact biological pathways involved.

What this means for you:
Exercise is linked to changes in several hormones and proteins that affect metabolism in people with obesity.

Common questions

What specific hormones are affected by exercise?

The review identified several types of mediators. These include adipokines (58.4%), cytokines or chemokines (32.1%), and myokines (25.6%). The most frequently reported specific markers were adiponectin, leptin, IL-6, and irisin.

What types of exercise were studied?

The majority of the research focused on chronic training (81.6%) and aerobic or endurance exercise (63.4%). These types of exercise were most commonly linked to changes in the body's metabolic signals.

How much evidence is there for the biological pathways of exercise?

While 90.9% of studies showed exercise responsiveness, there is much less evidence regarding specific pathways. Only 9.7% of studies looked at receptor pathways, and only 0.3% provided evidence for formal mediation.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BackgroundExercise-responsive endocrine-metabolic mediators may contribute to the systemic cardiometabolic adaptations induced by physical activity, but the literature spans diverse mediator classes, exercise paradigms, disease contexts, and experimental models. We conducted a systematic scoping review and evidence map to characterize the structure of this evidence and the biological relations examined across the field.MethodsPubMed/MEDLINE, Web of Science Core Collection, and Scopus were searched from database inception through 7 August 2026. Titles and abstracts, followed by full texts, were independently assessed by two reviewers, with third-reviewer adjudication where required. Eligible primary reports underwent a separate round of independent full-text data charting using a relational framework linking reports, exercise contrasts, and mediator evidence. Cardiometabolic contexts and outcome domains were coded using multi-label rules, synonymous mediator terminology was harmonized, and companion publications were linked before study-level synthesis. Six potentially co-occurring evidence relations were mapped: exercise responsiveness, cardiometabolic association, source/secretion evidence, receptor/pathway evidence, functional perturbation, and formal mediation.ResultsThe searches yielded 3,388 records, of which 1,535 unique records underwent title/abstract screening and 397 reports underwent full-text assessment. The final primary evidence map comprised 365 reports representing 363 underlying studies, 413 exercise contrasts, 776 mediator-evidence observations, and 103 harmonized named mediators. Obesity/overweight was represented in 78.0% of studies. Among the 308 studies contributing named mediators, adipokines were represented in 58.4%, cytokines/chemokines in 32.1%, and myokines in 25.6%. Adiponectin, leptin, IL-6, and irisin were the most frequently represented named mediators. Exercise-responsive evidence and cardiometabolic associations were identified in 90.9% and 87.0% of contributing studies, respectively, whereas source/secretion evidence (18.5%), receptor/pathway evidence (9.7%), functional perturbation (11.4%), and formal mediation (0.3%) were less frequently represented. Chronic training accounted for 81.6% of exercise contrasts and aerobic/endurance exercise for 63.4%.ConclusionsExercise-responsive mediator research in cardiometabolic disease comprises a concentrated group of recurrent adipokines, cytokines, and myokines alongside a broad, sparsely studied mediator landscape. Exercise-responsive evidence and cardiometabolic associations were frequently represented, whereas direct investigation of tissue source, downstream pathways, functional perturbation, and formal mediation was less common. Studies integrating well-characterized exercise exposures with serial mediator assessment, source validation, and mechanistic testing may help define how exercise-responsive signaling contributes to cardiometabolic adaptation.
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