Comparative Effects of Different Exercise Modalities on Lipid Profiles in Obese Children and Adolescents: A 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 : Following the PRISMA guidelines, randomized controlled trials (RCTs) published between 1999 and 2025 were retrieved from databases including Web of Science and PubMed. 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. Conclusion :Exercise interventions can effectively improve dyslipidemia, with the effects varying by exercise modality. Individualized exercise prescriptions should be tailored to the type of lipid abnormality. Future guidelines should further specify recommendations on exercise modality, beyond duration, to enhance the precision of cardiovascular health interventions.