Time-efficient exercise strategies to reduce visceral adipose tissue in children and adolescents with overweight or obesity: evidence from a pairwise and network meta-analysis.

High-quality meta-analyses focusing specifically on exercise-induced changes in visceral adipose tissue (VAT) in children and adolescents with overweight or obesity (CAO) remain limited. This study compared the relative effects of four common exercise modalities and identified potentially promising strategies for reducing VAT in CAO. Seven databases were searched from inception to September 2025 for studies comparing exercise interventions with controls on VAT in CAO. A multi-level and network meta-analysis were performed to estimate effect sizes and rank exercise modalities. Subgroup and meta-regression analyses explored the influence of various moderators. Risk of bias, publication bias, sensitivity, and certainty of evidence were also assessed. A two-dimensional analysis was conducted to compare efficacy, acceptability, and time efficiency across different exercise modalities. A total of 34 studies and 2060 participants were included. High-intensity interval training (HIIT) showed the most pronounced effect (g = -0.78 [-1.24 to -0.32]) on reducing VAT, followed by aerobic combined resistance training (g = -0.65 [-1.01 to -0.29]) and aerobic exercise (g = -0.42 [-0.63 to -0.21]), while resistance training showed no significant benefit. Exploratory subgroup analyses suggested greater VAT reductions in interventions conducted at least three times per week and lasting 12 weeks or longer. Meta-regression identified study-level associations of VAT reduction with baseline BMI, changes in cardiorespiratory fitness, and sex distribution. Network and two-dimensional analyses suggested that HIIT had the highest ranking probability for VAT reduction and was associated with the shortest weekly intervention time and the lowest dropout rate, although the certainty of evidence was low to very low. The effects of different exercise modalities on VAT vary, with intervention efficacy influenced by duration and individual characteristics. HIIT may be a promising and time-efficient exercise option for reducing VAT in CAO; however, this finding should be interpreted cautiously given the low to very low certainty of evidence.