BACKGROUND: The prevalence of obesity in children and adolescents is associated with the accumulation of liver fat. The purpose of this meta-analysis is to investigate the effect of exercise training on liver fat accumulation and insulin resistance in children and adolescents with overweight and obesity. METHOD(S): A comprehensive search was conducted in PubMed, Web of Science, Google Scholar, Magiran, and NoorMags databases from the inception to January 21, 2023. The inclusion criteria for the present meta-analysis included (1) children and adolescents, (2) exercise training, (3) overweight and obesity, (4) studies with a control group or with values measured in the pre-test stage and, (5) liver fat as the main variable. To calculate the effect size, standardized mean differences (SMD), weighted mean differences (WMD), and 95% confidence intervals (CIs) were calculated using the random effect model. FINDING(S): A total, of nine studies with eighteen exercise interventions including 621 children and adolescents were included in the meta-analysis. Exercise results in a decrease in liver fat with a large effect size (SMD -0.85 (CI -1.26 to -0.43), p = 0.001), insulin (WMD -1.32 microU/ml (CI -2.35 to -0.30), p = 0.01) and insulin resistance (WMD -0.61 (CI -1.06 to -0.17), p = 0.007). While the reduction of glucose was not statistically significant (WMD -0.52 mg/dl (CI -1.47 to 0.40), p = 0.26). CONCLUSION(S): Exercise training results in the reduction of liver fat accumulation and improvement of insulin resistance in children and adolescents with overweight and obesity, which is recommended as a main strategy to reduce liver fat and improve metabolism.

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