Exercise dose and triglyceride reduction in postmenopausal women: a systematic review and model-based network meta-analysis.

Background: Cardiovascular disease constitutes a leading cause of morbidity and mortality among women following menopause, with triglyceride (TG) dysregulation serving as a critical pathophysiological contributor. Despite accumulating evidence supporting the efficacy of structured exercise interventions, consensus regarding the optimal modality and "dose" required to maximize TG reduction in this demographic remains elusive. Methods: We systematically searched PubMed, Scopus, The Cochrane Library, Web of Science, CNKI, Wanfang Database, Weipu Database, and Chinese Biomedical Database through December 2025. Eligible studies comprised randomized controlled trials (RCTs) enrolling postmenopausal women, comparing aerobic exercise (AE), combined exercise (CE), resistance training (RT), high-intensity interval training (HIIT), and control (CON). A random-effects model was employed for network meta-analysis (NMA), computing mean differences (MD) and 95% credible intervals (CrI). Treatment hierarchies were established via surface under the cumulative ranking curve (SUCRA). Exercise doses were standardized to metabolic equivalent task minutes per week (MET-min/week), and a dose-response meta-analytic framework was applied to characterize potential non-linear relationships between exercise volume and TG modification. Results: 51 RCTs encompassing 2,046 participants were included. Network meta-analysis demonstrated that HIIT (MD: -0.23 mmol/L, 95% CrI: -0.44 to -0.03), AE (MD: -0.20 mmol/L, 95% CrI: -0.27 to -0.13), and CE (MD: -0.17 mmol/L, 95% CrI: -0.31 to -0.03) significantly reduced TG relative to CON, whereas RT did not reach statistical significance (MD: -0.10 mmol/L, 95% CrI: -0.25 to 0.05). SUCRA rankings identified HIIT as the most efficacious intervention (79.44%), followed by AE (73.03%), CE (60.63%), and RT (34.16%), though the HIIT estimate was based on only three studies and is therefore uncertain. Dose-response modeling suggested a non-linear association between exercise volume and TG reduction, with tentative optimal therapeutic ranges: HIIT at 1,000-1,300 MET-min/week, AE at 830-1,000 MET-min/week, and CE at 830-1,200 MET-min/week, beyond which effects appeared to plateau. Conclusions: This investigation provides preliminary evidence suggesting a non-linear dose-response relationship between exercise volume and TG reduction in postmenopausal women. HIIT demonstrated the highest relative efficacy in SUCRA rankings, though this conclusion is based on limited evidence and wide credible intervals. All active interventions produced clinically meaningful TG lowering within tentative dose ranges, but the observed non-linear pattern should be interpreted cautiously given the low-to-moderate certainty of evidence. These findings challenge the simplistic "more is better" paradigm and offer hypothesis-generating guidance for precision exercise prescription, pending confirmation by future high-quality RCTs.