Optimizing Exercise Strategies for Insulin Resistance in Children and Adolescents With Overweight or Obesity: A Network Meta-Analysis.

HIIT was the most effective exercise modality for reducing fasting insulin in children and adolescents with overweight or obesity.

• HIIT produced an SMD of -0.80 (95% CI: -1.22, -0.37) for fasting insulin (FINS)
• Analysis based on 63 RCTs with n=3286 participants
• SUCRA ranking was used to determine relative effectiveness across modalities
• Random-effects models were used to calculate standardized mean differences

HIIT was the most effective exercise modality for reducing HOMA-IR in children and adolescents with overweight or obesity.

• HIIT produced an SMD of -1.21 (95% CI: -1.76, -0.65) for HOMA-IR
• This represented the largest effect size observed across all exercise modalities for HOMA-IR
• 63 RCTs (n=3286) published through August 2025 were included following PRISMA guidelines
• SUCRA was used to rank effectiveness across aerobic exercise, resistance training, HIIT, and combined training

Combined training (COM) was the most effective exercise modality for reducing fasting blood glucose in children and adolescents with overweight or obesity.

• Combined training produced an SMD of -0.41 (95% CI: -0.66, -0.15) for fasting glucose (FBG)
• Publication bias for FBG was described as minimal
• Combined training incorporates both aerobic and resistance components
• RT alone lacked significant effects but enhanced metabolic benefits when incorporated into combined training

Aerobic exercise improved all three insulin resistance markers (fasting glucose, fasting insulin, and HOMA-IR).

• AE showed significant improvements across FBG, FINS, and HOMA-IR
• AE is characterized as a 'foundational intervention' in the paper
• This was in contrast to RT alone, which lacked significant effects on insulin resistance markers
• The analysis included 63 RCTs with 3286 participants across all exercise modalities

Resistance training alone did not produce significant effects on insulin resistance markers but enhanced metabolic benefits when included in combined training.

• RT as a standalone intervention lacked significant effects on FBG, FINS, and HOMA-IR
• RT was described as providing 'crucial support within combined programs'
• Combined training, which includes RT, was the best modality for FBG reduction (SMD = -0.41)
• The complementary role of RT was identified through the network meta-analysis framework comparing all four modalities

Minor small-study effects were detected for fasting insulin and HOMA-IR outcomes, while publication bias for fasting glucose was minimal.

• Small-study effects for FINS and HOMA-IR were described as 'minor'
• Publication bias assessment for FBG was described as 'minimal'
• The network meta-analysis included 63 RCTs (n=3286) published through August 2025
• PRISMA guidelines were followed for study selection and reporting

The network meta-analysis included 63 randomized controlled trials with 3286 participants examining exercise effects on insulin resistance in youth with overweight or obesity.

• Studies were published through August 2025
• Four exercise modalities were compared: aerobic exercise (AE), resistance training (RT), high-intensity interval training (HIIT), and combined training (COM)
• Outcomes included fasting blood glucose (FBG), fasting insulin (FINS), and HOMA-IR
• Standardized mean differences and 95% confidence intervals were calculated using random-effects models
• SUCRA (Surface Under the Cumulative Ranking) was used to rank the effectiveness of interventions