BACKGROUND AND PURPOSE: Non-high-density lipoprotein cholesterol (non-HDL-C) is associated with an increased risk for cerebrovascular disease. However, the effects of three community-deliverable lifestyle interventions [diet (D), aerobic exercise (E), or both (DE)] on non-HDL-C in adults are not known. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap. METHODS:A priori study eligibility included randomized controlled trials >4 weeks that included a D, E, DE and control (C) group in adults >18 years of age in which data for total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were available for calculating non-HDL-C. Studies were retrieved by searching nine electronic databases, cross-referencing and expert review. Dual data selection and extraction were conducted. A mixed effects model was employed whereby a random-effects approach was used to combine effect size (ES) results within each subgroup while a fixed-effect approach was used to compare subgroups (Qb). Heterogeneity was examined using the Q and I2statistics and 95% confidence intervals (CI) were also calculated. Statistical significance was set at p < 0.05 while a trend for statistical significance was set between p >0.05 to < 0.10. RESULTS: Overall, a statistically significant exercise minus control group decrease in non-HDL-C was found for DE (7 ESs, 389 participants, mean, -11.1 mg/dl, 95% CI, -21.7 to -0.6, p=0.04, Q=2.4, p=0.88, I2=0%), a trend for the D group (7 ESs, 402 participants, mean, -8.5 mg/dl, 95% CI, -18.6 to 1.6, p=0.10, Q=0.76, p=0.99, I2=0%) and no change for the E group (7 ESs, 387 participants, mean, 3.0 mg/dl, 95% CI, -7.1 to 13.1, p=0.56, Q=0.78, p=0.99, I2=0%). Relative changes were -6.5%, -5.6%, and 0.8% respectively, for DE, D and E groups. Overall, no statistically significant between-group differences were found (Qb = 4.1, p = 0.12). There was a trend for decreases in non-HDL-C to be greater in the DE versus E group (Qb = 3.6, p = 0.06) with no statistically significant differences between D and E (Qb = 2.5, p = 0.12) or DE and D (Qb = 0.1, p = 0.72) groups. CONCLUSIONS: Combined DE reduces non-HDL-C in adults.