Exercise training modalities for cardiorespiratory fitness and blood pressure in children and adolescents with obesity

A systematic review and network meta-analysis

Bibliographic Data

ID22072709
AuthorsX J Wang (0009-0000-8722-1575, Central China Normal University), Xinyin Wang (Central China Normal University), Renchao Lv (Kunming University), Bin Hou (0000-0002-4311-6017, Central China Normal University, corresponding author)
Year2026
Volume14
Pages1842123-1842123
Publication date2026-05-20
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2026.1842123
PMID42245371
OpenAlexW7161801177
LanguageEN
References cited58

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 VO 2 peak, VO 2 max, 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 VO 2 peak (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 VO 2 max (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

Aerobic exercise · Blood pressure · Cardiorespiratory fitness · Heart rate · Meta-analysis · Physical fitness · Psychological intervention · Randomized controlled trial · Cardiovascular and exercise physiology · Heart Rate Variability and Autonomic Control · Obesity, Physical Activity, Diet

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