Frontiers in public health · 2026
Exercise training modalities for cardiorespiratory fitness and blood pressure in children and adolescents with obesity: a systematic review and network meta-analysis.
СтатьяСистематический обзорNetwork Meta-AnalysisНазвание и аннотация: Перевод пока не подготовлен
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Wang Xinyin, Lv Renchao, Hou Bin
Аннотация
BACKGROUND: The optimal exercise modality for improving cardiorespiratory fitness and blood pressure in children and adolescents with obesity remains uncertain.
METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials comparing exercise interventions in individuals aged 5-19 years with obesity. PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to December 27, 2025. Outcomes included VO2peak, VO2max, maximal aerobic speed (MAS), systolic blood pressure (SBP), diastolic blood pressure (DBP), maximal heart rate (HRmax), and resting heart rate (RHR). Random-effects models were applied, interventions were ranked using SUCRA, and evidence certainty was assessed using CINeMA.
RESULTS: Forty-five trials involving 2,635 participants were included. For cardiorespiratory fitness, HIIT significantly improved VO2peak (MD 3.81 mL/kg/min, 95% CI 2.41 to 5.22) and MAS (MD 1.22 m/s, 95% CI 0.75 to 1.68) versus SOC, and ranked highest for both outcomes. HIIT combined with MICT was most likely to improve VO2max (MD 5.20 mL/kg/min, 95% CI 0.28 to 10.12). Combined high-intensity and resistance-based strategies also showed favorable effects. For cardiovascular outcomes, MICT was most effective for lowering SBP (MD -7.75 mmHg, 95% CI -13.08 to -2.42), whereas MIIT showed the greatest reduction in DBP (MD -4.03 mmHg, 95% CI -6.74 to -1.32). No major global inconsistency was detected. Certainty of evidence ranged from high to very low.
CONCLUSIONS: High-intensity exercise modalities, especially HIIT and combined high-intensity protocols, may provide the greatest benefit for cardiorespiratory fitness in youths with obesity, while moderate-intensity exercise appears more effective for blood pressure reduction. Exercise prescriptions in pediatric obesity should therefore be individualized according to target outcomes.
METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials comparing exercise interventions in individuals aged 5-19 years with obesity. PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to December 27, 2025. Outcomes included VO2peak, VO2max, maximal aerobic speed (MAS), systolic blood pressure (SBP), diastolic blood pressure (DBP), maximal heart rate (HRmax), and resting heart rate (RHR). Random-effects models were applied, interventions were ranked using SUCRA, and evidence certainty was assessed using CINeMA.
RESULTS: Forty-five trials involving 2,635 participants were included. For cardiorespiratory fitness, HIIT significantly improved VO2peak (MD 3.81 mL/kg/min, 95% CI 2.41 to 5.22) and MAS (MD 1.22 m/s, 95% CI 0.75 to 1.68) versus SOC, and ranked highest for both outcomes. HIIT combined with MICT was most likely to improve VO2max (MD 5.20 mL/kg/min, 95% CI 0.28 to 10.12). Combined high-intensity and resistance-based strategies also showed favorable effects. For cardiovascular outcomes, MICT was most effective for lowering SBP (MD -7.75 mmHg, 95% CI -13.08 to -2.42), whereas MIIT showed the greatest reduction in DBP (MD -4.03 mmHg, 95% CI -6.74 to -1.32). No major global inconsistency was detected. Certainty of evidence ranged from high to very low.
CONCLUSIONS: High-intensity exercise modalities, especially HIIT and combined high-intensity protocols, may provide the greatest benefit for cardiorespiratory fitness in youths with obesity, while moderate-intensity exercise appears more effective for blood pressure reduction. Exercise prescriptions in pediatric obesity should therefore be individualized according to target outcomes.