Background: Central obesity is linked to atherosclerosis, diabetes, and cardiovascular disease. Atherosclerosis improved with aerobic exercise intensity and diet restriction. Previously, progressive aerobic (pyramidal) training was not tested on specific atherosclerosis risk factors in centrally obese women. Purpose: To examine the influence of pyramidal training exercise on a specific risk factor for atherosclerosis in women with central obesity. Methods: The study included 50 centrally obese women aged 30–40 with a BMI between 30 and 34.9 kg/m2. They were randomly assigned to two equal groups: the study group received pyramidal treadmill training for 40 minutes three times a week for eight weeks, and the control group received diet health advice only for eight weeks. BMI, waist circumference, and waist hip ratio, as well as laboratory measurements (lipid profile and Homeostatic Model Assessment for Insulin Resistance), were measured pre- and post-intervention for 8 weeks. Results: After 8 weeks of intervention, the study group showed significant decreases in BMI, waist circumference, waist hip ratio, and laboratory variables such as total cholesterol, LDL, triglycerides, AIP, and HOMA IR. The control group had significantly lower waist-hip ratio, total cholesterol, LDL, triglycerides, and AIP. Pre- and post-intervention BMI, waist circumference, and HOMA IR were not significantly different in the control group. BMI, HDL, and LDL didn't differ significantly between the study and control groups after treatment. Conclusion: This study found pyramidal training improves BMI, waist circumference, waist hip ratio, lipid profile, and HOMA IR in centrally obese women with selected risk factors for atherosclerosis, so we recommend pyramidal training.