Network meta-analysis compares exercise types for insulin resistance in youth with overweight or obesityWhich exercise works best for insulin resistance in kids with extra weight?

This network meta-analysis synthesized evidence from 63 randomized controlled trials involving 3,286 children and adolescents with overweight or obesity. It compared the effects of aerobic exercise (AE), resistance training (RT), high-intensity interval training (HIIT), and combined training (COM) on markers of insulin resistance, including fasting glucose (FBG), fasting insulin (FINS), and HOMA-IR. The analysis did not specify a primary comparator, follow-up duration, or study setting.

For lowering fasting insulin, HIIT showed the largest effect (standardized mean difference [SMD] = -0.80, 95% CI [-1.22, -0.37]). HIIT was also most effective for reducing HOMA-IR (SMD = -1.21, 95% CI [-1.76, -0.65]). For lowering fasting glucose, combined training was most effective (SMD = -0.41, 95% CI [-0.66, -0.15]). The analysis noted that aerobic exercise improved all three markers, while resistance training alone lacked significant effects but enhanced metabolic benefits when included in combined programs.

Safety and tolerability data were not reported. Key limitations include the presence of minor small-study effects for the FINS and HOMA-IR outcomes, though publication bias for FBG was minimal. The evidence represents an association, not proof of causality. In practice, aerobic exercise may serve as a foundational intervention, with HIIT and combined training acting as potential intensification strategies for specific metabolic targets. Resistance training appears to provide crucial support within combined programs. Future research is needed to define optimal exercise intensity and duration.