OBJECTIVES: When dealing with children and adolescents living with obesity, it is vital to be aware that exercise provides benefits in the prevention and control of non-communicable diseases and general well-being. The growing prevalence of childhood obesity makes it necessary to develop strategies aimed at controlling the barriers that limit the performance of exercise, which is why we designed a plan of exercise prescription through videos that could be accessible, free, and designed for exercise at home, as a complement to a multidisciplinary intervention program for lifestyle change. This study aimed to compare the effects of a video-based exercise prescription program (EPV) versus free-choice exercise (FCE) on anthropometric and metabolic indicators. METHODS: We conducted an open-label, randomized, controlled clinical trial. Patients aged eight to 16 years with obesity from the Child Unit of the General Hospital of Mexico were included. Forty-two participants finished the follow-up; 20 were boys, and 22 were girls. All patients were included in a multi-component program of healthy lifestyle changes and randomized to receive EPV (n = 22) or FCE (n = 20) for six months. RESULTS: The primary outcomes in both groups were a decrease in body mass index (BMI) (p < 0.001), a reduction in body fat mass (p < 0.001), and an increase in lean body mass (p = 0.003). Other outcomes observed were: in EPV, there was a decrease in low density lipid (LDL) (p = 0.04); alanine aminotransferase (ALT) (p = 0.002), aspartate aminotransferase (AST) (p = 0.001) and uric acid (p = 0.003) and an increase in high density lipid (HDL) (p = 0.002), while in FCE there was a decrease in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (p = 0.006), insulin (p = 0.006), LDL (p = 0.02), ALT (p = 0.002), AST (p = 0.004) and gamma-glutamyl transferase (GGT) (p = 0.025). CONCLUSION: Both EPV and FCE exercise prescription programs, as part of a multidisciplinary intervention for childhood obesity, had favorable effects on body composition and metabolic parameters.

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