Secreted from white adipose tissue, circulating concentrations of adiponectin are reduced in the presence of metabolic and cardiovascular disease such as obesity and type 2 diabetes. The aim of this systematic review is to assess the body of evidence critically for the effects of exercise on adiponectin levels. Literature searches using the Medline, CINAHL, Cochrane Controlled Trials registry, EMBASE, and SportDiscus databases were conducted from 1966 to September 2006 using keywords pertaining to “adiponectin” and “exercise.” Thirty-three trials met the inclusion criteria. Study designs consisted of 5 cross-sectional studies, 7 trials of acute exercise, 11 uncontrolled trials, 2 non-randomized controlled trials, and 8 randomized controlled trials (RCTs). Exercise of varying prescription has been shown to increase serum adiponectin in 38% of RCTs, demonstrating small-to-moderate effect sizes (ESs). One study reported a dose–response effect of resistance training intensity and the augmentation of adiponectin. Inconsistent support in the literature exists for increasing adiponectin levels after short-term exposure to robust aerobic or resistance training of moderate-to-high intensities. Particular attention should be directed toward high-risk cohorts, in whom augmentation of the anti-inflammatory cytokine adiponectin may assume critical importance.