OBJECTIVE: Research has shown that aerobic exercise is effective for adults and the elderly with overweight and obesity. However, specific evidence for children and adolescents remains limited. This study aims to evaluate the effects of aerobic exercise on improving body composition in children and adolescents with overweight and obesity. METHODS: A systematic search was conducted across five Major databases, namely PubMed, Embase, Cochrane Library, Web of Science, and EBSCO, to identify all relevant studies published up to June 10, 2025. This search specifically focused on randomized controlled trials (RCTs) that investigated the effects of aerobic exercise interventions on body composition indicators in children and adolescents with overweight and obesity. The search covered all records available in each database from their inception. RESULTS: A total of 1772 relevant articles were retrieved, and 15 studies were ultimately included for meta-analysis. The results showed that aerobic exercise significantly reduced BF% (MD -2.15, 95% CI -3.09 to -1.20, I2 95%, p < 0.001), FM (MD -2.74, 95% CI -5.45 to 0.03, I2 80%, p = 0.05), VAT (SMD -1.53, 95% CI -2.55 to -0.51, I2 90%, p = 0.003), LLF (SMD -0.89, 95% CI -1.38 to -0.40, I2 55%, p < 0.001), BW (MD -2.06, 95% CI -3.16 to -0.96, I2 79%, p < 0.001), BMI (MD -1.65, 95% CI -2.42 to -0.88, I2 94%, p < 0.001), and WC (MD -2.89, 95% CI -4.61 to -1.16, I2 82%, p = 0.001), but improvements in SAAT, FFM, and body muscle weight were not significant. CONCLUSION: Aerobic exercise can significantly improve body composition in overweight and obese children and adolescents, primarily reflected in BF%, FM, VAT, and LLF. It also significantly reduces BW, BMI, and WC. Therefore, aerobic exercise should be regarded as an important, safe, and cost-effective way to improve body composition and promote healthy growth in overweight and obese children and adolescents. REGISTRATION: PROSPERO, registration number: CRD420251072290.

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