Comparative effects of exercise modalities on visceral adipose tissue in children and adolescents with overweight or obesity: a systematic review and three-level meta-analysis
- 1Jishou University
- 2Zhangjiajie People’s Hospital
- 3Medical School of Jishou University
Abstract
Objective: Previous syntheses included broader age ranges and heterogeneous exercise classifications, leaving uncertainty about comparative effects across exercise modalities in pediatric populations. This review examined whether exercise modalities differ in their effects on visceral adipose tissue (VAT) and waist circumference (WC) in children and adolescents with overweight or obesity, and whether any modality shows superior effectiveness.
Methods: Randomized and partially randomized controlled trials were identified from PubMed, Embase, the Cochrane Library, Web of Science, SPORTDiscus, and CNKI. VAT and WC were primary outcomes; SAT, body fat percentage, BMI, body weight, fat mass, and VO₂max were secondary outcomes. Hedges’ g was synthesized using three-level random-effects models to accommodate dependent effect sizes within studies. Risk of bias was assessed with the Cochrane tool.
Results: Twenty-one trials involving 1,754 participants were included. Exercise interventions were associated with lower VAT (g = −0.725, 95% CI [−1.120, −0.330], p < 0.001) and WC (g = −0.692, 95% CI [−0.984, −0.400], p < 0.001). HIIT showed the largest VAT point estimate (g = −1.332, 95% CI [−1.874, −0.789]), but between-modality differences were not significant for VAT ( p = 0.116) or WC ( p = 0.184). Prediction intervals for both primary outcomes crossed the null, indicating uncertainty across study settings. Secondary outcomes generally favored exercise.
Conclusion: Exercise-based interventions were associated with reductions in VAT and WC, but current evidence does not establish the superiority of any single modality. Although HIIT showed the largest VAT point estimate, non-significant between-modality tests and prediction intervals crossing the null preclude firm conclusions about an optimal exercise modality.
Systematic review registration: CRD420261431627, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261431627 .
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BibTeX
@article{chen2026comparative,
title = {{Comparative effects of exercise modalities on visceral adipose tissue in children and adolescents with overweight or obesity: a systematic review and three-level meta-analysis}},
author = {Chuan Chen and Wei Zhang and Kaihua Liu and Xianming Ding and Peng Tong},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1922842},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1922842/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative effects of exercise modalities on visceral adipose tissue in children and adolescents with overweight or obesity: a systematic review and three-level meta-analysis
AU - Chuan Chen
AU - Wei Zhang
AU - Kaihua Liu
AU - Xianming Ding
AU - Peng Tong
PY - 2026
DA - 2026/10/22
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1922842
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1922842/full
AB - Objective: Previous syntheses included broader age ranges and heterogeneous exercise classifications, leaving uncertainty about comparative effects across exercise modalities in pediatric populations. This review examined whether exercise modalities differ in their effects on visceral adipose tissue (VAT) and waist circumference (WC) in children and adolescents with overweight or obesity, and whether any modality shows superior effectiveness. Methods: Randomized and partially randomized controlled trials were identified from PubMed, Embase, the Cochrane Library, Web of Science, SPORTDiscus, and CNKI. VAT and WC were primary outcomes; SAT, body fat percentage, BMI, body weight, fat mass, and VO₂max were secondary outcomes. Hedges’ g was synthesized using three-level random-effects models to accommodate dependent effect sizes within studies. Risk of bias was assessed with the Cochrane tool. Results: Twenty-one trials involving 1,754 participants were included. Exercise interventions were associated with lower VAT (g = −0.725, 95% CI [−1.120, −0.330], p < 0.001) and WC (g = −0.692, 95% CI [−0.984, −0.400], p < 0.001). HIIT showed the largest VAT point estimate (g = −1.332, 95% CI [−1.874, −0.789]), but between-modality differences were not significant for VAT ( p = 0.116) or WC ( p = 0.184). Prediction intervals for both primary outcomes crossed the null, indicating uncertainty across study settings. Secondary outcomes generally favored exercise. Conclusion: Exercise-based interventions were associated with reductions in VAT and WC, but current evidence does not establish the superiority of any single modality. Although HIIT showed the largest VAT point estimate, non-significant between-modality tests and prediction intervals crossing the null preclude firm conclusions about an optimal exercise modality. Systematic review registration: CRD420261431627, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261431627 .
SN - 2296-2565
ER -