**1. Introduction**

The mechanisms behind the clinical improvements following exercise and the possible roles of endothelium and adipose tissue towards tissue re-modeling and regeneration are poorly understood.

The cellular changes resulting from exercise in overweight or obese population are not fully documented. However, the incidence of overweight and obese population who are insulin resistant is gradually increasing. There seems to be an intimate relationship between fat hypertrophy, fat inflammation, and vascular supply in metabolic syndrome states such as prediabetes. The vasculature and endothelium in metabolic syndrome or subjects with prediabetes and insulin resistance are prone to ROS accumulation and inflammation. Exercise appears to improve endothelial dysfunction in insulin resistant cohort though cell-based data is lacking. The favorable impact of exercise on cardio-metabolic health depends in part on the concomitant exercise-induced reduction of adiposity and fat-based inflammation and insulin resistance.
