Effects of different exercise modalities on lipid profiles in overweight and obese children and adolescents: a systematic review and network meta-analysis of randomized controlled trials

OBJECTIVE: This study aimed to systematically compare, through a network meta-analysis (NMA), the effects of different exercise modalities-including aerobic exercise (AE), resistance training (RT), high-intensity interval training (HIIT), and combined training (COM)-on the lipid profile of overweight/obese children and adolescents. METHODS: The study followed the PRISMA-NMA guidelines and systematically searched randomized controlled trials (RCTs) published from 1999 to August 31, 2025 in the PubMed, Embase, Cochrane, Web of Science, and EBSCO databases. A total of 35 RCTs (n = 1601 participants) were included. Random-effects models in Stata 16.0 were applied to calculate pooled effect sizes with 95% confidence intervals (CIs). Network meta-analysis was performed to synthesize and analyze the data, and intervention effects were ranked using the Surface Under the Cumulative Ranking (SUCRA) curve. RESULTS: The findings revealed differential effects of exercise modalities on lipid regulation. RT ranked highest for reducing total cholesterol (TC). AE was the only intervention that significantly increased high-density lipoprotein cholesterol (HDL-C). HIIT demonstrated the greatest efficacy in lowering low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). COM showed no superior effect for any single outcome among the four indicators. From an integrated perspective, AE intervention was most effective in elevating HDL-C but relatively weak in reducing LDL-C. Conversely, although RT and HIIT were less effective for raising HDL-C, they exhibited the strongest effects in reducing LDL-C. Compared with the no-exercise control group (CON), resistance training (RT) and high-intensity interval training (HIIT) significantly reduced total cholesterol (TC) levels in individuals with overweight or obesity. Aerobic exercise (AE) significantly increased HDL-C levels in this population. HIIT and combined exercise (COM) significantly reduced LDL-C levels, while HIIT, AE, and COM significantly lowered triglyceride (TG) levels. CONCLUSION: The findings suggest that different exercise modalities may exert differential effects on specific lipid parameters. These distinct patterns offer preliminary support for phenotype-targeted exercise prescription, providing an evidence base for refining clinical guidelines and enhancing the precision of cardiovascular health interventions.