Background: Cardiovascular disease (CVD) in women is the leading cause of mortality in the United States, and less than optimal lipid and lipoprotein levels are major risk factors for CVD. The purpose of this study was to use the meta-analytic approach to examine the effects of aerobic exercise on lipids and lipoproteins in women. Methods: Studies were retrieved via computerized literature searches, review of reference lists, hand searching selected journals, and expert review of our reference list. The inclusion of studies was limited to randomized controlled trials published in the English language literature between January 1955 and January 2003 in which aerobic exercise was used as the primary intervention in adult women aged > or =18 years. One or more of the following lipids and lipoproteins were assessed: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). Results: Using a random effects model, statistically significant improvements were observed for all lipids and lipoproteins (TC, +/- SEM, -4.3 +/- 1.3 mg/dl, 95% CI -6.9 to -1.7 mg/dl; HDL-C, +/- SEM, 1.8 +/- 0.9 mg/dl, 95% CI 0.1 to 3.5 mg/dl; LDL-C, +/- SEM, -4.4 +/- 1.1 mg/dl, 95% CI -6.5 to -2.2 mg/dl; TG, +/- SEM, -4.2 +/- 2.1 mg/dl, 95% CI -8.4 to -0.1 mg/dl). Reductions of approximately 2%, 3%, and 5%, respectively, were observed for TC, LDL-C, and TG, whereas an increase of 3% was observed for HDL-C. Conclusions: Aerobic exercise is efficacious for increasing HDL-C and decreasing TC, LDL-C, and TG in women.