Abstract
BACKGROUND: While numerous studies have explored the effectiveness of exercise interventions in improving health outcomes in populations with obesity, comparisons of different exercise modalities remain limited. This study aimed to address this gap through a network meta-analysis (NMA) to evaluate the impact of various exercise modalities on health status in children and adolescents with overweight and obesity. METHODS: Two researchers (XC and KD) systematically searched databases including PubMed, Cochrane Library, Embase and others for randomized controlled trials (RCTs) published up to May 2024. The studies analyzed the effects of exercise interventions on body composition, lipid profiles, glucose metabolism, and cardiorespiratory fitness (CRF) in children and adolescents with overweight and obesity. Study quality was assessed using the Cochrane tools, and the random-effects NMA was conducted within a Bayesian framework. RESULTS: A total of 51 studies with 2263 participants were included, covering four exercise modalities: aerobic exercise (AE), resistance exercise (RE), combined exercise (CE), and high-intensity interval training (HIIT). HIIT was relatively more effective for improving CRF, including oxygen uptake peak (VO(2peak)) [MD = 3.33, 95% CI (2.36, 4.26)] and heart rate (HR) [MD = -8.09, 95% CI (-10.92, -5.37)]. AE demonstrated substantial reductions in weight, body mass index (BMI), and waist circumference (WC). CE may be most effective in reducing body fat percentage (BF%), waist-to-hip ratio (WHR), and improving fat-free mass (FFM), as well as controlling fasting glucose (FG) and insulin resistance. RE showed a significant impact on improving lipid profiles. CONCLUSION: HIIT is the relatively effective modality for enhancing CRF, while AE and CE are notably effective for improving body composition. RE is regarded as a preferable choice for lipid regulation, and CE tends to provide superior outcomes for glucose and insulin control. These findings provide comparative evidence for clinical and policy recommendations, though further high-quality research is needed for validation.