Comparative Effects of 12 Exercise Modalities on Body Mass Index and Body Fat Percentage in Youth With Overweight or Obesity: A Systematic Review and Network Meta-Analysis.

Abstract

This study aimed to compare 12 exercise interventions on body mass index (BMI) and body fat percentage (BF%) in youth with overweight or obesity using a network meta-analysis to inform intervention and weight management strategies. We conducted a search of Scopus, Embase, Cochrane Library, PubMed, and Web of Science databases for randomized controlled trials examining exercise interventions on body composition in children and adolescents with overweight or obesity, covering all studies available up to October 24, 2025. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Statistical analysis was performed using R. Sixty-three randomized controlled trials involving 2724 children and adolescents with overweight or obesity were included in the analysis. Pairwise meta-analysis revealed that 40% of exercise types showed no significant impact on BMI, and 30% showed no significant impact on BF%. The results from the network meta-analysis were largely consistent with those from pairwise meta-analysis when compared to control groups. The top five interventions for reducing BMI were moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), combined aerobic-resistance training (CT), moderate-to-vigorous aerobic exercise (MVAE), and multicomponent exercise (MCE). For BF%, the top five interventions were CT, resistance training (RT), MICT, HIIT, and MVAE. MICT, CT, and HIIT performed favorably, with outcome-specific advantages. MICT ranked highest for BMI, CT was highest for BF% (SUCRA), and HIIT offered time-efficient benefits across outcomes versus control; results support tailoring modality choice to goals and feasibility to improve adherence.