This network meta-analysis (34 RCTs, n=2,060) compared four exercise modalities — HIIT, aerobic exercise, resistance training, and combined aerobic+resistance training — for reducing visceral adipose tissue (VAT) in children and adolescents with overweight or obesity, using databases searched through September 2025.
HIIT produced the largest VAT reduction (Hedges' g = −0.78 [−1.24 to −0.32]), followed by combined aerobic+resistance training (g = −0.65 [−1.01 to −0.29]) and aerobic exercise alone (g = −0.42 [−0.63 to −0.21]); resistance training alone showed no significant benefit. HIIT also had the highest network ranking, shortest weekly intervention time, and lowest dropout rate, though certainty of evidence was low to very low.
- Certainty of evidence rated low to very low across modalities, limiting confidence in effect estimates. - Subgroup and meta-regression findings are exploratory and based on study-level data, not individual patient data. - Network meta-analysis assumes transitivity across indirect comparisons, which may not fully hold given heterogeneous study designs.
For youth with overweight or obesity, HIIT appears to be the most time-efficient option to reduce visceral fat — consider prioritizing it over aerobic or resistance training alone when feasible. Aim for at least 3 sessions per week over 12 or more weeks, but counsel patients that evidence certainty is low and individual factors (baseline BMI, sex, fitness level) may influence response.
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