Purposeful weight loss continues to be the primary focus for treating obesity. However, this strategy appears to be inadequate as obesity rates continue to rise and a myriad of benefits of physical activity that affect multiple health outcomes related to obesity and associated comorbidities are not integrated into treatment strategies. There are emerging correlational data in individuals with obesity that demonstrate physical activity can be beneficial to many critical health markers, independent of weight loss or changes in BMI. This systematic review investigates interventional studies that examine health markers, independent of weight loss, in individuals with obesity. Fourteen studies were identified that utilized a variety of physical activity interventions with primary endpoints that included cellular, metabolic, systemic and brain health outcomes. The review of the literature demonstrates that for individuals with obesity, there are both small-scale and large-scale physiologic benefits that occur with increased physical activity of various modalities. Focusing on these benefits, rather than a narrow focus of weight loss alone, may increase physical activity behavior and health for individuals with obesity.

Context: As healthcare costs rise, supervised exercise therapy (SET) that is individually tailored and delivered in small-group programs can be a cost-effective intervention. However, few economic evaluations have focused on physical activity interventions. Objective: This review systematically evaluated the cost-effectiveness of SET programs for US adults with chronic conditions (cancer, depression/anxiety, hypertension, diabetes, obesity, or increased risk of falls). Design: An electronic literature search was conducted in June 2024 using PubMed, SCOPUS, and PsycINFO databases for articles published from January 1, 2004, to June 5, 2024. The protocol was registered with PROSPERO (CRD42024534657). Eligibility Criteria: Included articles were original, full-text economic evaluations of SET programs for US adults with chronic conditions compared with usual care, nonsupervised exercise, or other treatments. Main Outcome Measures: Primary outcomes were cost-effectiveness metrics and health outcomes, including return on investment (ROI), cost savings from reduced healthcare costs, and improvements in chronic condition management through supervised exercise. Additional outcomes included total costs, healthcare utilization, and health benefit differences between intervention and comparator groups. Results: A narrative synthesis was used to summarize findings due to heterogeneity across studies. This review included eight studies: four randomized clinical trials, three modeling studies, and one retrospective cohort study. Intervention periods ranged from 7 wk to 3 yr, with follow-up from 12 wk to 3 yr. Studies included the intended target populations and community, assisted living, and hospital settings. Sample sizes ranged from 15 to over 3000 individuals. The review showed consistent, positive ROI (1.15:1 to 1.7:1), and cost savings ($121–$2834) through reduced healthcare costs or treatment charges. Conclusion: SET programs are cost-effective across chronic conditions and settings, with positive ROI and economic benefits supporting broader public health implementation. Future research should standardize economic evaluation methods in SET studies for comparison across diverse interventions, settings, and populations.