Effect of Hypoxic Exercise with Different Oxygen Concentrations on Metabolic Outcomes in Obesity: A Systematic Review and Network Meta-Analysis

Objective: This study aimed to systematically evaluate the effects of hypoxic exercise at different oxygen concentrations on body composition, glucose metabolism, and lipid metabolism in individuals with obesity, and to explore potential optimal oxygen concentration ranges to inform personalized hypoxic exercise prescriptions. Methods: We searched databases including the Cochrane Library, PubMed, Web of Science, Embase, and CNKI for randomized controlled trials and pre-post studies on hypoxic exercise interventions in obese populations published before 30 June 2025. A network meta-analysis was performed using Stata 18.0 software to assess the effects of various oxygen concentrations on BMI, FBG, FINS, HOMA-IR, TG, LDL-C, and HDL-C. Subgroup analyses were conducted to explore sources of heterogeneity. Results: Fourteen studies with a total sample size of 189 participants were included. The meta-analysis revealed that exercise in a moderate hypoxic environment (12–14% FiO2) significantly reduced BMI, FBG, TG, and LDL-C. Notably, hypoxic exercise did not show a statistically significant effect on HDL-C. In contrast, a higher oxygen concentration (≥15% FiO2) was more effective for improving FINS and HOMA-IR. Conclusion: Hypoxic exercise can significantly improve the body composition, glucose metabolism and lipid metabolism indicators of obese people. Tailored exercise in specific hypoxic environments provides preliminary evidence for a non-pharmacological intervention strategy in obesity management.