Obese individuals are characterized by low circulating adiponectin concentrations and an increased number of macrophages in adipose tissue, which is believed to be causally associated with chronic low-grade inflammation and insulin resistance. Regular physical exercise decreases overall morbidity in obese subjects which may be due to modulations of inflammatory pathways. In this randomized clinical trial we investigated the separate effects of endurance training-induced weight loss, diet-induced weight loss and endurance training per se (without weight loss) on plasma adiponectin multimer composition (Western blotting) and adipose tissue macrophage content (immunohistochemistry) in young, moderately overweight men. Weight loss and endurance training per se decreased whole body fat percentage in an additive manner. No intervention-induced changes were observed for plasma total adiponectin. Surprisingly, endurance training, irrespectively of any associated weight loss, shifted the adiponectin multimer distribution towards a lower molecular weight (21% decrease in HMW/LMW, P=0.015) whereas diet-induced weight loss shifted the distribution towards a higher molecular weight (42% increase in HMW/MMW, P<0.001). Furthermore, endurance training per se increased the number of anti-inflammatory CD163+ macrophages (from 12.7 [2.1] (mean [SE]) to 16.1 [3.1] CD163+ cells/100 adipocytes, P=0.013), whereas diet-induced weight loss tended to decrease CD68+ macrophages in subcutaneous abdominal adipose tissue. Thus, regular physical exercise influences systemic and adipose tissue inflammatory pathways differently than diet-induced weight loss in younger, moderately overweight men. Our data suggest that some of the health benefits of a physically active lifestyle may occur through modulations of anti- rather than pro-inflammatory pathways in young, overweight men.