Elevated fasting and postprandial serum triglyceride concentrations are associated with cardiovascular disease morbidity and mortality. Aerobic exercise reduces serum triglyceride concentrations in the presence or absence of weight loss. Although pharmacological interventions are often used in combination with aerobic exercise to achieve target triglyceride concentrations, information on the combined effects of aerobic exercise and lipid-modifying agents on serum triglycerides is limited. This review examines the independent and combined effects of both interventions on serum fasting and postprandial triglyceride concentrations from the available literature. Reductions in serum triglycerides after aerobic exercise are associated with an increase in skeletal muscle lipoprotein lipase activity and a decrease in hepatic triglyceride and very-low-density lipoprotein (VLDL) synthesis and secretion. Lipid-modifying agents such as niacin, omega-3 fatty acids, and statins also decrease fasting and postprandial triglycerides by increasing lipoprotein lipase (LPL) activity and/or decreasing VLDL synthesis. When combined, lipid-modifying agents may reduce fasting and postprandial triglyceride secretion to an extent in which aerobic exercise cannot provide any additional benefit. These observations indicate that aerobic exercise and pharmacological strategies reduce serum triglycerides by similar mechanisms, which may attenuate the triglyceride-lowering capacity of the concordant treatment. © The Physicians and Sportsmedicine.