The purpose of the present study was to determine whether absolute and relative measurements of regional adiposity differ in their responses to exercise intervention and which measures are most predictive of changes in plasma lipids, insulin sensitivity and adiposity. Thirteen middle-aged men (BMI 30.4 +/- 1.5 kg/m2, age 47.2 +/- 1.5 years, mean +/- s.e.) were examined before and after 14 weeks of endurance-oriented physical activity (3-4 days/week, 30-45 min/day). Significant (P < 0.05) decreases in the absolute measures of chest, waist and hip girths and sagittal diameter were evident. The waist-to-hip ratios (WHR) of umbilicus/maximal hip and minimal waist/maximal hip decreased significantly (P < 0.05). However, the WHRs of umbilicus/anterior superior iliac spine and umbilicus/greater trochanters did not change due to parallel decreases in waist and hip girths. Trunk and extremity skinfolds decreased significantly (P < 0.05); however, trunk/extremity skinfold ratios were virtually unaltered. The training programme significantly (P < 0.05) increased insulin sensitivity (60%) and HDL (8%), and reduced triglyceride (25%) and total cholesterol/HDL (8%). Changes in these variables were related to changes in sagittal diameter and waist girth. These data indicate different responses to physical activity between measurements of regional adiposity, and emphasize the need for considering absolute central girths such as waist circumference and sagittal diameter when assessing fat topography and cardiovascular risk.