Summary This systematic review and meta‐analysis determined the impact of exercise training on adipose tissue insulin sensitivity in adults. Its scope extended to studies measuring whole‐body and localized subcutaneous adipose tissue insulin sensitivity using validated techniques. Consensus from four studies demonstrates that exercise training improved whole‐body adipose tissue insulin sensitivity when measured via stable‐isotope lipid tracers (rate of appearance suppression in response to hyperinsulinemia). Meta‐analysis of 20 studies (26 intervention arms) employing the adipose tissue insulin resistance index (ADIPO‐IR) supported these findings (−10.63 [−14.12 to −7.15] pmol·L−1 × mmol·L−1). With ADIPO‐IR, this response was greater in studies documenting weight loss and shorter sampling time (≤48 h) post‐training. Overall, exercise training did not affect whole‐body adipose tissue insulin sensitivity in seven studies (11 intervention arms) measuring the suppression of circulating non‐esterified fatty acids in response to insulin infusion (1.51 [−0.12 to 3.14]%); however, subgroup analysis identified an enhanced suppression post‐training in trials reporting weight loss. From four microdialysis studies, consensus indicates no effect of exercise training on localized (abdominal/femoral) adipose tissue insulin sensitivity, potentially suggesting that enhanced whole‐body responses are related to improvements in central adipose depots. However, heterogeneity within microdialysis protocols dictates that findings must be viewed with caution.

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