ObjectiveTo 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. MethodsThe 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. ResultsA 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. ConclusionExercise 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.