Abstract
BACKGROUND: Exercise is a non-pharmacological strategy for enhancing cognitive function among various populations. The aim of our systematic review was to synthesise evidence of the effects of exercise on cognitive function in children and adolescents with overweight or obesity. METHODS: A comprehensive search of four databases (Web of Science, PubMed, Scopus, EMBASE was conducted from each database inception through 1 April, 2025. This review investigates the impact of exercise intervention on the cognitive function of children and adolescents with overweight or obesity through randomized controlled trials (RCTs). The quality of the included studies was evaluated using the Cochrane Risk of Bias Tool 2, and the treatment effects were analyzed through random-effects or fixed-effects models, with Hedges' g serving as the metric for effect size estimation. I(2) statistics assessed heterogeneity, and leave-one-out analysis verified result stability. Subgroup analyses were conducted based on the FITT principle, including exercise frequency, intensity, and time. RESULTS: The meta-analysis of 15 RCTs, including 1,210 children and adolescents with overweight or obesity revealed that exercise significantly improved executive function (g = 0.39, 95% CI:0.12 to 0.66, p = 0.0043). No significant effects were observed for other aspects of attention and memory (p>0.05). Subgroup analysis identified that exercise with a frequency of >3 sessions per week (g = 0.39, p = 0.0257), moderate-to-vigorous intensity (g = 0.50, p = 0.0132), exercise interventions ≥10 weeks (g = 0.41, p = 0.0184), single session duration >30 min (g = 0.41, p = 0.0139), and weekly exercise volume > 120 min (g = 0.28, p = 0.00236) had higher effect sizes in improving executive function in children and adolescents with overweight or obesity. Subgroup analyses revealed that exercise frequencies <5 sessions/week (g = 0.98), single-session durations ≥40 min (g = 0.60), weekly volumes ≥120 min (g = 0.60), and intervention periods >15 weeks (g = 0.98) significantly enhanced attention (p < 0.05). CONCLUSION: This study demonstrates that exercise interventions significantly improve executive function and attention in children and adolescents with overweight or obesity. In particular, moderate-intensity aerobic exercise performed more than three times per week, for over 30 min per session, and sustained for at least 10 weeks appears to represent the optimal training parameters for improving executive function. These findings support the use of exercise as a cognitive enhancement strategy. However, larger-scale studies are needed to confirm its effects on other cognitive domains. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251078572, Identifier: CRD420251078572.