Kalyana Chakravarthy Bairapareddy,1 Arun G Maiya,1 Padma Kumar,2 Krishnananda Nayak,3 Vasudeva Guddattu,4 Vidya Nayak3 1Department of Physiotherapy, SOAHS, Manipal Academy of Higher Education, Manipal, India; 2Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India; 3Department of Cardiovascular Technology, SOAHS, Manipal Academy of Higher Education, Manipal, India; 4Department of Biostatistics, Manipal Academy of Higher Education, Manipal, India Background: Epicardial adipose tissue thickness (EATT) measured by echocardiography is a reliable indicator of visceral adipose tissue in the body and metabolic syndrome. The objective of this work was to study the effect of 12-week aerobic exercise training on echocardiographic epicardial adipose tissue thickness (EEATT), body composition and other metabolic parameters in asymptomatic overweight adults. Methods: A total of 170 overweight and mild obese individuals were randomly allocated to 12-week aerobic exercise program (intervention group) or no supervised exercise (control group). The body fat percentage and visceral fat levels were measured by bioelectric impedance analyzer, and blood tests were conducted to measure lipids, fasting blood sugar (FBS) and high-sensitivity C-reactive protein (Hs-CRP). The participants also underwent transthoracic echocardiography to measure EATT. All the outcomes were measured after 12 weeks. Repeated measures were analyzed using ANOVA and Mann–Whitney U-test were used to analyze the data. Results: EEATT values significantly reduced by −16.24% (3.12±1.18 to 2.70±1.04, p<0.05) following 12 weeks of aerobic exercise along with a reduction in weight by 2.96% (80.66±12.12 to 78.27±12.31, p<0.05), body mass index by 3.11% (29.20±2.71 to 28.29±2.81, p<0.05) and waist circumference by 2.29% (94.82±7.23 to 92.64±7.33, p<0.05) and improved Hs-CRP values. Conclusion: The 12-week aerobic exercise was found to be effective in reducing EEATT in overweight and mild obese individuals. There was significant improvement in body composition, blood lipids, FBS, Hs-CRP and exercise capacity in intervention group compared to control group. Keywords: aerobic exercise, epicardial adipose tissue, echocardiography, overweigh