While exercise training at maximal fat oxidation intensity (FATmax) is recognized as an effective strategy for improving body composition in people with overweight or obesity, its efficacy regarding cardiometabolic health and optimal prescription warrants systematic evaluation. We conducted a PRISMA-conform systematic review and meta-analysis (PROSPERO: CRD420251036468), reviewing literature from PubMed, Cochrane Library, Embase, SPORTDiscus, and Web of Science through December 6, 2025. A three-level random-effects model with restricted maximum likelihood (REML) was applied. Study quality was assessed with the TESTEX scale and Cochrane RoB 2. 0, and certainty with GRADE. Nineteen randomized trials (N = 644; overweight/obesity) were included, with overall moderate methodological quality. Compared with controls, exercise training at FATmax reduced body weight (-3. 66 kg, p 2, p V ̇ O 2 max V̇O₂ (SMD = 1. 45, p max can effectively improve body composition and cardiometabolic health, but standardized assessment protocols are needed to mitigate methodological heterogeneity and refine tailored FITT-VP exercise prescriptions.
Jiang et al. (Sun,) studied this question.