Optimal exercise modality and dose for reducing visceral adipose tissue in overweight or obese adults: a network meta-analysis and dose-response study

OBJECTIVE: This study aimed to evaluate the effects of different exercise interventions on reducing visceral adipose tissue in overweight or obese adults and to explore the exercise dose-response relationship. METHODS: We searched PubMed, Web of Science, Embase, and the Cochrane Library from inception to February 2026 for randomized controlled trials (RCTs). Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0). Standardized mean differences (SMDs) with 95% confidence intervals (95% CI) were used to estimate the relative effects of different exercise modalities on visceral adipose tissue (VAT), and treatments were ranked using the surface under the cumulative ranking curve (SUCRA). Exercise dose was further quantified as weekly metabolic equivalent of task minutes (MET-min/week), and a Bayesian dose-response model was constructed to evaluate the overall dose and the dose-response relationships for different exercise modalities. RESULTS: A total of 60 RCTs involving 3308 overweight or obese adults were included. The network meta-analysis showed that, compared with the control group, all four exercise interventions significantly reduced VAT in overweight or obese adults. Based on the SUCRA ranking, high-intensity interval training (HIIT) had the highest cumulative probability (SUCRA = 72.5%), followed by combined aerobic and resistance training (COM) (SUCRA = 69.1%), aerobic exercise (AE) (SUCRA = 59.0%), and resistance training (RT) (SUCRA = 49.5%). Dose-response analysis indicated a nonlinear U-shaped association between total exercise dose and VAT outcomes, with an optimal dose of 1100 MET-min/week. The overall effect reached statistical significance when the dose ranged from 430 to 1420 MET-min/week, and the optimal dose and effective dose intervals differed across exercise modalities. CONCLUSION: All four exercise interventions reduced VAT in overweight or obese adults to varying degrees, with high-intensity interval training showing the most favorable overall efficacy ranking. A U-shaped association was observed between total exercise dose and VAT in overweight or obese adults, suggesting that a moderate exercise load is beneficial for reducing VAT. These findings provide a theoretical basis for developing individualized and feasible exercise prescriptions for this population.