Optimal exercise dose for reducing visceral fat in overweight and obese children and adolescents: a Bayesian dose–response network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LU Donglei ^1,2,3 ,  LIU Mingyi ^1,2,3 , KONG Nianxin ^1,2,3 , ZHANG Kaiyi ^1,2,3 , PENG Liao ^1,2,3 , DU Zhiwei ^1,2,3

1. China Youth Sports and the Integration of Sports and Education Public Policy Research Center, Wuhan Sports University, Wuhan 430079, P. R. China;
2. College of Sports Training, Wuhan Sports University, Wuhan 430079, P. R. China;
3. The Research Center for High-Quality Development of Characteristic Competitive Sports, Wuhan Sports University, Wuhan 430079, P. R. China;

Corresponding?author：

LIU Mingyi, Email: mingyi84@aliyun.com

Keywords：

Children and adolescents; Visceral fat; Exercise intervention; Network meta-analysis

DOI：

10.7507/1672-2531.202509075

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the effectiveness of different exercise modalities in reducing visceral adipose tissue (VAT) among overweight and obese children and adolescents, and to determine the optimal exercise dose. Methods The CNKI, WanFang Data, Web of Science, PubMed, and Science Direct databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to September 2025. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The dose-response network meta-analysis was then performed by using R 4.3.1 software and the MBNMAdose package. Results A total of 34 RCTs involving 2 269 subjects were included. The results of network meta-analysis showed that all exercise types, involving high-intensity interval training (HIIT), sided games (SG), moderate-intensity continuous training (MICT), combined exercise (CE), resistance exercise (RE), and aerobic exercise (AE), significantly reduced VAT compared with controls. The cumulative area under the sorting curve (SUCRA) results showed that the efficacy ranking from high to low was: HIIT>SG>MICT>CE>RE>AE. Dose-response analysis revealed an L-shaped non-linear association, with a minimal clinically important dose (MCID) of 630 MET min/week. HIIT (430 MET min/week) and SG (470 MET min/week) achieved benefit at lower doses. Conclusion Exercise interventions are effective in reducing VAT in overweight and obese children and adolescents, with substantial variation in optimal dose across modalities. HIIT achieves clinically meaningful benefits at lower doses and may warrant priority in practical implementation.

Citation： LU Donglei, LIU Mingyi, KONG Nianxin, ZHANG Kaiyi, PENG Liao, DU Zhiwei. Optimal exercise dose for reducing visceral fat in overweight and obese children and adolescents: a Bayesian dose–response network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2026, 26(4): 414-421. doi: 10.7507/1672-2531.202509075 Copy

1.	吳東哲, 瞿超藝, 饒志堅, 等. 中國及全球成年人歸因于超重和肥胖的疾病負擔變化趨勢與未來風險預測. 體育科學, 2025, 45(5): 3-16.
2.	洪燁, 傅君芬. 中國兒童肥胖健康報告與防控策略. 中國兒童保健雜志, 2025, 33(2): 117-126.
3.	董彥會, 陳力, 劉婕妤, 等. 1985-2019年中國7-18歲兒童青少年超重與肥胖的流行趨勢及預測研究. 中華預防醫學雜志, 2023, 57(4): 461-469.
4.	李抒, 曹甍, 鄒昱, 等. 高強度間歇訓練對肥胖兒童內臟脂肪和心肺適能的影響. 體育學刊, 2023, 30(4): 138-144.
5.	李冉浩, 李宏鑫, 楊兆軍, 等. 二甲雙胍聯合利拉魯肽治療兒童HAIR-AN綜合征1例并文獻復習. 中南大學學報(醫學版), 2023, 48(9): 1425-1431.
6.	國家衛生健康委員會肥胖癥診療指南編寫委員會, 張忠濤, 紀立農. 肥胖癥診療指南(2024年版). 中國循環雜志, 2025, 40(1): 6-30.
7.	萬乃君, 張田. 兒童青少年肥胖干預措施的研究進展. 中華預防醫學雜志, 2023, 57(5): 760-765.
8.	Lee S, Deldin AR, White D, et al. Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial. Am J Physiol Endocrinol Metab, 2013, 305(10): E1222-E1229.
9.	Lee S, Bacha F, Hannon T, et al. Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: a randomized, controlled trial. Diabetes, 2012, 61(11): 2787-2795.
10.	Campos RM, de Mello MT, Tock L, et al. Aerobic plus resistance training improves bone metabolism and inflammation in adolescents who are obese. J Strength Cond Res, 2014, 28(3): 758-766.
11.	曹甍, 唐玉成, 李抒, 等. 高強度間歇訓練對肥胖兒童身體成分、心肺適能和血液指標的影響. 中國運動醫學雜志, 2022, 41(2): 109-117.
12.	邵威, 費加明. 不同運動方式對肥胖青少年減肥效果的比較. 中國應用生理學雜志, 2017, 33(3): 211-213.
13.	喬媛媛, 王曉晨. 不同強度足球鍛煉對壯族肥胖小學生體成分及血液生化指標的干預效果評價. 中國學校衛生, 2019, 40(8): 1238-1241.
14.	Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc, 2011, 43(8): 1575-1581.
15.	Watt JA, Del Giovane C, Jackson D, et al. Incorporating dose effects in network meta-analysis. BMJ, 2022, 376: e067003.
16.	Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
17.	Chandler J, Cumpston M, Li T, et al. Cochrane handbook for systematic reviews of interventions. Res Synth Methods, 2019, 4(1002): 14651858.
18.	Pedder H, Boucher M, Dias S, et al. Performance of model-based network meta-analysis (MBNMA) of time-course relationships: a simulation study. Res Synth Methods, 2020, 11(5): 678-697.
19.	梁晉裕, 郝亮. 高強度間歇運動對肥胖兒童身體成分血壓及血清Chemerin的影響. 中國學校衛生, 2018, 39(11): 1729-1732.
20.	曹甍, 于豐源, 高榕蔓, 等. 高強度間歇訓練運動對肥胖小學生身體健康影響. 中國學校衛生, 2023, 44(12): 1863-1866.
21.	曹甍, 于豐源, 鄒昱, 等. 肥胖青少年間歇訓練中的情感反應: 一項隨機對照研究. 中國運動醫學雜志, 2024, 43(7): 527-536.
22.	Barbeau P, Johnson MH, Howe CA, et al. Ten months of exercise improves general and visceral adiposity, bone, and fitness in black girls. Obesity (Silver Spring), 2007, 15(8): 2077-2085.
23.	Bocca G, Corpeleijn E, Stolk RP, et al. Results of a multidisciplinary treatment program in 3-year-old to 5-year-old overweight or obese children: a randomized controlled clinical trial. Arch Pediatr Adolesc Med, 2012, 166(12): 1109-1115.
24.	Machado E, Jannuzzi F, Telles S, et al. A recreational swimming intervention during the whole school year improves fitness and cardiometabolic risk in children and adolescents with overweight and obesity. Int J Environ Res Public Health, 2022, 19(24): 17093.
25.	Staiano AE, Marker AM, Beyl RA, et al. A randomized controlled trial of dance exergaming for exercise training in overweight and obese adolescent girls. Pediatr Obes, 2017, 12(2): 120-128.
26.	Mitchell BM, Gutin B, Kapuku G, et al. Left ventricular structure and function in obese adolescents: relations to cardiovascular fitness, percent body fat, and visceral adiposity, and effects of physical training. Pediatrics, 2002, 109(5): E73.
27.	Cao M, Tang Y, Zou Y. Integrating high-intensity interval training into a school setting improve body composition, cardiorespiratory fitness and physical activity in children with obesity: a randomized controlled trial. J Clin Med, 2022, 11(18): 5436.
28.	Deldin A, Kuk JL, Lee S. Influence of sex on the changes in regional fat and skeletal muscle mass in response to exercise training in adolescents with obesity. Child Obes, 2019, 15(3): 216-222.
29.	da Silveira Campos RM, Landi Masquio DC, Campos Corgosinho F, et al. Homeostasis model assessment-adiponectin: the role of different types of physical exercise in obese adolescents. J Sports Med Phys Fitness, 2017, 57(6): 831-838.
30.	Davis CL, Pollock NK, Waller JL, et al. Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial. JAMA, 2012, 308(11): 1103-1112.
31.	Saelens BE, Grow HM, Stark LJ, et al. Efficacy of increasing physical activity to reduce children's visceral fat: a pilot randomized controlled trial. Int J Pediatr Obes, 2011, 6(2): 102-112.
32.	Meng C, Yucheng T, Shu L, et al. Effects of school-based high-intensity interval training on body composition, cardiorespiratory fitness and cardiometabolic markers in adolescent boys with obesity: a randomized controlled trial. BMC Pediatr, 2022, 22(1): 112.
33.	Wang S, Liu B, Liu J. Effects of school soccer training on the health and fitness of obese children. Rev Bras Med Esporte, 2023, 29: e2022_0794.
34.	Wang W, Geok SK. Effects of high-intensity interval training on body composition of obese adolescent girls in China. J Sports Med Phys Fitness, 2023, 63(5): 698-706.
35.	Yu WW, Lee S, Arslanian S, et al. Effects of exercise on resting metabolic rate in adolescents with overweight and obesity. Child Obes, 2021, 17(4): 249-256.
36.	Lee S, Libman I, Hughan K, et al. Effects of exercise modality on insulin resistance and ectopic fat in adolescents with overweight and obesity: a randomized clinical trial. J Pediatr, 2019, 206: 91-98.
37.	Lee S, Libman I, Hughan KS, et al. Effects of exercise modality on body composition and cardiovascular disease risk factors in adolescents with obesity: a randomized clinical trial. Appl Physiol Nutr Metab, 2020, 45(12): 1377-1386.
38.	Gutin B, Barbeau P, Owens S, et al. Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents. Am J Clin Nutr, 2002, 75(5): 818-826.
39.	Alberga AS, Prud'homme D, Kenny GP, et al. Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial. Int J Obes (Lond), 2015, 39(10): 1494-1500.
40.	Cadenas-Sanchez C, Cabeza R, Idoate F, et al. Effects of a family-based lifestyle intervention plus supervised exercise training on abdominal fat depots in children with overweight or obesity: a secondary analysis of a nonrandomized clinical trial. JAMA Netw Open, 2022, 5(11): e2243864.
41.	Owens S, Gutin B, Allison J, et al. Effect of physical training on total and visceral fat in obese children. Med Sci Sports Exerc, 1999, 31(1): 143-148.
42.	Dias KA, Ingul CB, Tj?nna AE, et al. Effect of high-intensity interval training on fitness, fat mass and cardiometabolic biomarkers in children with obesity: a randomised controlled trial. Sports Med, 2018, 48(3): 733-746.
43.	Park SK, Park JH, Kwon YC, et al. The effect of aerobic exercise on visceral fat and cardiac function in obese adolescent. J Phys Educ Med, 2003, 4(1): 1-10.
44.	Monteiro PA, Chen KY, Lira FS, et al. Concurrent and aerobic exercise training promote similar benefits in body composition and metabolic profiles in obese adolescents. Lipids Health Dis, 2015, 14: 153.
45.	Damaso AR, da Silveira Campos RM, Caranti DA, et al. Aerobic plus resistance training was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than aerobic training in obese adolescents. J Sports Sci, 2014, 32(15): 1435-1445.
46.	劉陽, 梅佳順, 何玉秀. 高強度間歇訓練通過不同部位HSL磷酸化差異性激活減少內臟脂肪積累的機制研究. 體育科學, 2018, 38(9): 56-64.
47.	劉陽, 張賽, 董高芳, 等. 高強度間歇訓練通過支配內臟脂肪的交感神經活動促進白色脂肪組織棕色化. 中國體育科技, 2020, 56(2): 15-23.
48.	Strasser B, Arvandi M, Siebert U. Resistance training, visceral obesity and inflammatory response: a review of the evidence. Obes Rev, 2012, 13(7): 578-591.

1. 吳東哲, 瞿超藝, 饒志堅, 等. 中國及全球成年人歸因于超重和肥胖的疾病負擔變化趨勢與未來風險預測. 體育科學, 2025, 45(5): 3-16.
2. 洪燁, 傅君芬. 中國兒童肥胖健康報告與防控策略. 中國兒童保健雜志, 2025, 33(2): 117-126.
3. 董彥會, 陳力, 劉婕妤, 等. 1985-2019年中國7-18歲兒童青少年超重與肥胖的流行趨勢及預測研究. 中華預防醫學雜志, 2023, 57(4): 461-469.
4. 李抒, 曹甍, 鄒昱, 等. 高強度間歇訓練對肥胖兒童內臟脂肪和心肺適能的影響. 體育學刊, 2023, 30(4): 138-144.
5. 李冉浩, 李宏鑫, 楊兆軍, 等. 二甲雙胍聯合利拉魯肽治療兒童HAIR-AN綜合征1例并文獻復習. 中南大學學報(醫學版), 2023, 48(9): 1425-1431.
6. 國家衛生健康委員會肥胖癥診療指南編寫委員會, 張忠濤, 紀立農. 肥胖癥診療指南(2024年版). 中國循環雜志, 2025, 40(1): 6-30.
7. 萬乃君, 張田. 兒童青少年肥胖干預措施的研究進展. 中華預防醫學雜志, 2023, 57(5): 760-765.
8. Lee S, Deldin AR, White D, et al. Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial. Am J Physiol Endocrinol Metab, 2013, 305(10): E1222-E1229.
9. Lee S, Bacha F, Hannon T, et al. Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: a randomized, controlled trial. Diabetes, 2012, 61(11): 2787-2795.
10. Campos RM, de Mello MT, Tock L, et al. Aerobic plus resistance training improves bone metabolism and inflammation in adolescents who are obese. J Strength Cond Res, 2014, 28(3): 758-766.
11. 曹甍, 唐玉成, 李抒, 等. 高強度間歇訓練對肥胖兒童身體成分、心肺適能和血液指標的影響. 中國運動醫學雜志, 2022, 41(2): 109-117.
12. 邵威, 費加明. 不同運動方式對肥胖青少年減肥效果的比較. 中國應用生理學雜志, 2017, 33(3): 211-213.
13. 喬媛媛, 王曉晨. 不同強度足球鍛煉對壯族肥胖小學生體成分及血液生化指標的干預效果評價. 中國學校衛生, 2019, 40(8): 1238-1241.
14. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc, 2011, 43(8): 1575-1581.
15. Watt JA, Del Giovane C, Jackson D, et al. Incorporating dose effects in network meta-analysis. BMJ, 2022, 376: e067003.
16. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
17. Chandler J, Cumpston M, Li T, et al. Cochrane handbook for systematic reviews of interventions. Res Synth Methods, 2019, 4(1002): 14651858.
18. Pedder H, Boucher M, Dias S, et al. Performance of model-based network meta-analysis (MBNMA) of time-course relationships: a simulation study. Res Synth Methods, 2020, 11(5): 678-697.
19. 梁晉裕, 郝亮. 高強度間歇運動對肥胖兒童身體成分血壓及血清Chemerin的影響. 中國學校衛生, 2018, 39(11): 1729-1732.
20. 曹甍, 于豐源, 高榕蔓, 等. 高強度間歇訓練運動對肥胖小學生身體健康影響. 中國學校衛生, 2023, 44(12): 1863-1866.
21. 曹甍, 于豐源, 鄒昱, 等. 肥胖青少年間歇訓練中的情感反應: 一項隨機對照研究. 中國運動醫學雜志, 2024, 43(7): 527-536.
22. Barbeau P, Johnson MH, Howe CA, et al. Ten months of exercise improves general and visceral adiposity, bone, and fitness in black girls. Obesity (Silver Spring), 2007, 15(8): 2077-2085.
23. Bocca G, Corpeleijn E, Stolk RP, et al. Results of a multidisciplinary treatment program in 3-year-old to 5-year-old overweight or obese children: a randomized controlled clinical trial. Arch Pediatr Adolesc Med, 2012, 166(12): 1109-1115.
24. Machado E, Jannuzzi F, Telles S, et al. A recreational swimming intervention during the whole school year improves fitness and cardiometabolic risk in children and adolescents with overweight and obesity. Int J Environ Res Public Health, 2022, 19(24): 17093.
25. Staiano AE, Marker AM, Beyl RA, et al. A randomized controlled trial of dance exergaming for exercise training in overweight and obese adolescent girls. Pediatr Obes, 2017, 12(2): 120-128.
26. Mitchell BM, Gutin B, Kapuku G, et al. Left ventricular structure and function in obese adolescents: relations to cardiovascular fitness, percent body fat, and visceral adiposity, and effects of physical training. Pediatrics, 2002, 109(5): E73.
27. Cao M, Tang Y, Zou Y. Integrating high-intensity interval training into a school setting improve body composition, cardiorespiratory fitness and physical activity in children with obesity: a randomized controlled trial. J Clin Med, 2022, 11(18): 5436.
28. Deldin A, Kuk JL, Lee S. Influence of sex on the changes in regional fat and skeletal muscle mass in response to exercise training in adolescents with obesity. Child Obes, 2019, 15(3): 216-222.
29. da Silveira Campos RM, Landi Masquio DC, Campos Corgosinho F, et al. Homeostasis model assessment-adiponectin: the role of different types of physical exercise in obese adolescents. J Sports Med Phys Fitness, 2017, 57(6): 831-838.
30. Davis CL, Pollock NK, Waller JL, et al. Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial. JAMA, 2012, 308(11): 1103-1112.
31. Saelens BE, Grow HM, Stark LJ, et al. Efficacy of increasing physical activity to reduce children's visceral fat: a pilot randomized controlled trial. Int J Pediatr Obes, 2011, 6(2): 102-112.
32. Meng C, Yucheng T, Shu L, et al. Effects of school-based high-intensity interval training on body composition, cardiorespiratory fitness and cardiometabolic markers in adolescent boys with obesity: a randomized controlled trial. BMC Pediatr, 2022, 22(1): 112.
33. Wang S, Liu B, Liu J. Effects of school soccer training on the health and fitness of obese children. Rev Bras Med Esporte, 2023, 29: e2022_0794.
34. Wang W, Geok SK. Effects of high-intensity interval training on body composition of obese adolescent girls in China. J Sports Med Phys Fitness, 2023, 63(5): 698-706.
35. Yu WW, Lee S, Arslanian S, et al. Effects of exercise on resting metabolic rate in adolescents with overweight and obesity. Child Obes, 2021, 17(4): 249-256.
36. Lee S, Libman I, Hughan K, et al. Effects of exercise modality on insulin resistance and ectopic fat in adolescents with overweight and obesity: a randomized clinical trial. J Pediatr, 2019, 206: 91-98.
37. Lee S, Libman I, Hughan KS, et al. Effects of exercise modality on body composition and cardiovascular disease risk factors in adolescents with obesity: a randomized clinical trial. Appl Physiol Nutr Metab, 2020, 45(12): 1377-1386.
38. Gutin B, Barbeau P, Owens S, et al. Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents. Am J Clin Nutr, 2002, 75(5): 818-826.
39. Alberga AS, Prud'homme D, Kenny GP, et al. Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial. Int J Obes (Lond), 2015, 39(10): 1494-1500.
40. Cadenas-Sanchez C, Cabeza R, Idoate F, et al. Effects of a family-based lifestyle intervention plus supervised exercise training on abdominal fat depots in children with overweight or obesity: a secondary analysis of a nonrandomized clinical trial. JAMA Netw Open, 2022, 5(11): e2243864.
41. Owens S, Gutin B, Allison J, et al. Effect of physical training on total and visceral fat in obese children. Med Sci Sports Exerc, 1999, 31(1): 143-148.
42. Dias KA, Ingul CB, Tj?nna AE, et al. Effect of high-intensity interval training on fitness, fat mass and cardiometabolic biomarkers in children with obesity: a randomised controlled trial. Sports Med, 2018, 48(3): 733-746.
43. Park SK, Park JH, Kwon YC, et al. The effect of aerobic exercise on visceral fat and cardiac function in obese adolescent. J Phys Educ Med, 2003, 4(1): 1-10.
44. Monteiro PA, Chen KY, Lira FS, et al. Concurrent and aerobic exercise training promote similar benefits in body composition and metabolic profiles in obese adolescents. Lipids Health Dis, 2015, 14: 153.
45. Damaso AR, da Silveira Campos RM, Caranti DA, et al. Aerobic plus resistance training was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than aerobic training in obese adolescents. J Sports Sci, 2014, 32(15): 1435-1445.
46. 劉陽, 梅佳順, 何玉秀. 高強度間歇訓練通過不同部位HSL磷酸化差異性激活減少內臟脂肪積累的機制研究. 體育科學, 2018, 38(9): 56-64.
47. 劉陽, 張賽, 董高芳, 等. 高強度間歇訓練通過支配內臟脂肪的交感神經活動促進白色脂肪組織棕色化. 中國體育科技, 2020, 56(2): 15-23.
48. Strasser B, Arvandi M, Siebert U. Resistance training, visceral obesity and inflammatory response: a review of the evidence. Obes Rev, 2012, 13(7): 578-591.

Chinese Journal of Evidence-Based Medicine

Optimal exercise dose for reducing visceral fat in overweight and obese children and adolescents: a Bayesian dose–response network meta-analysis

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