OBJECTIVES: Determine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m2, fat mass and per cent body fat) in overweight and obese children and adolescents. DESIGN: Network meta-analysis of randomised exercise intervention trials. SETTING: Any setting where a randomised trial could be conducted. PARTICIPANTS: Overweight and obese male and/or female children and adolescents 2 to 18 years of age. INTERVENTIONS: Randomised exercise intervention trials 4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training. PRIMARY OUTCOMES: Changes in BMI in kg/m2, fat mass and per cent body fat. RESULTS: Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2,792 participants (1,667 exercise, 1,125 control) met the criteria for inclusion. Length of training (mean +/- SD) averaged 14.1 +/- 6.2 weeks, frequency, 3.3 +/- 1.1 days per week and duration 42.0 +/- 21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI mean, 95% CI -1.0, 1.4 to -0.6; fat mass -2.1, -3.3 to -1.0 kg; per cent fat -1.5, -2.2 to -0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, -1.4 to -0.1; fat mass -2.5, -4.1 to -1.0 kg; per cent fat -2.2, -3.2 to -1.2%). A significant reduction in per cent fat was also found for strength versus control comparisons (-1.3, -2.5 to -0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI. CONCLUSIONS: Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents. PROSPERO REGISTRATION NUMBER: CRD42017073103.
Reproduced with permission from the BMJ Publishing Group.

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