Effects of Aerobic Exercise-Based Interventions on Physical and Mental Health in Overweight and Obese Children and Adolescents: A Three-Level Meta-Analysis.

This review used a three-level meta-analysis to synthesize evidence from controlled trials on aerobic exercise-based interventions in overweight/obese children and adolescents (6-18 years). Databases were searched from inception to December 31, 2025, and 39 studies (n = 3,446) were included. The included interventions comprised exercise only programs and a small number of multicomponent programs combining aerobic exercise with dietary modification. Overall, aerobic exercise-based interventions were associated with improvements in anthropometric and body-composition outcomes, including reductions in weight, waist circumference, body mass index-related indicators, and body fat%, as well as increased cardiorespiratory fitness, as reflected by peak oxygen uptake (VO2peak). However, because diet-plus-exercise trials were included in the primary synthesis, these pooled estimates should be interpreted as effects of intervention programs including aerobic exercise rather than as effects of aerobic exercise alone. No significant effects were observed for blood pressure or glycolipid metabolic markers. Evidence for mental health outcomes was limited: depression showed a small pooled reduction, but this finding was not robust and should be interpreted cautiously, whereas evidence for self-esteem was sparse and inconclusive. Given substantial heterogeneity and overall low certainty of evidence, these findings should be interpreted cautiously and well-designed studies with standardized reporting and longer follow-up are needed.