Optimizing obesity treatment in adolescent: a network meta-analysis and meta-regression of HIIT vs. other exercise modalities on cardiometabolic markers

Abstract Background Obesity continues to rise globally and is projected to affect more than 3 billion adults by 2030. High-Intensity Interval Training (HIIT) has demonstrated benefits in reducing adiposity and improving metabolic health. Other modalities, such as SIT, MICT, Supra-HIIT, and dietary approaches, may also be effective. This study compares HIIT with other exercise interventions in improving body composition and cardiometabolic outcomes in youth and examines potential confounding moderators. Methods his network meta-analysis included 18 randomized controlled trials (RCTs) with 1,195 participants aged 5–24 years with BMI ≥ 25 kg/m² who underwent HIIT or alternative exercise modalities, with or without dietary intervention. Outcomes assessed included BMI, weight, body fat percentage, fat and fat-free mass, blood pressure, VO₂ max, lipid profile, glucose, insulin, and HOMA-IR. Studies were published between 2015 and 2025. Risk of bias was evaluated using ROB-2, and analyses were performed using JAMOVI and R. Results HIIT consistently demonstrated improvements across multiple outcomes and ranked within the top three interventions. SUCRA rankings showed beneficial effects on BMI, body composition, blood pressure, insulin, and glucose metabolism. Meta-regression identified significant confounding factors, including age, gender, sample size, session frequency, exercise duration, and follow-up length, influencing treatment response. Conclusion HIIT ranks among the most effective interventions for improving cardiometabolic and body composition outcomes in youth with obesity, with MICT and SIT also showing strong potential. Further high-quality trials with standardized protocols and balanced intervention comparisons are needed to optimize recommendations and identify individual response factors.