Unveiling the perfect workout: exercise modalities and dosages to combat visceral adipose tissue in individuals with overweight and obesity – a systematic review with pairwise, network, and dose-response meta-analyses

Visceral adipose tissue (VAT) plays a crucial role in obesity-related metabolic diseases, making its reduction an important target for obesity treatment. Although exercise has been shown to significantly reduce visceral fat, the specific mechanisms underlying the effects of different exercise modalities and exercise doses on VAT reduction remain unclear, particularly regarding the dose-response relationship, which has not been systematically explored. This study aims to systematically compare the effects of different exercise modalities on visceral adipose tissue (VAT) reduction and to explore in depth the dose–response relationship between exercise dose and VAT decrease, thereby providing scientific evidence for optimizing individualized exercise prescriptions in obesity treatment. A systematic search of randomized controlled trials (RCTs) up to November 2024 was conducted (search updated in September 2025). Network meta-analysis (NMA) was employed to compare the effects of different exercise interventions on VAT, while Bayesian network meta-analysis (MBNMA) was used for dose-response analysis to evaluate the impact of exercise intensity, frequency, and duration on VAT reduction. This study included 61 RCTs involving 4,136 participants. The NMA results indicated that all exercise interventions significantly reduced VAT compared to the control group. Among them, HIIT was the most effective in reducing VAT (SMD = -0.84, 95% CI [-1.08, -0.61], p < 0.0001, GRADE: Moderate; SUCRA = 99.3%, GRADE: High), followed by AE + RT (SMD = -0.54, 95% CI [-0.75, -0.32], p < 0.0001, GRADE: Moderate; SUCRA = 59.1%, GRADE: High), AE (SMD = -0.53, 95% CI [-0.68, -0.38], p < 0.001, GRADE: Low; SUCRA = 58.9%, GRADE: High), and RT (SMD = -0.41, 95% CI [-0.63, -0.20], p < 0.001, GRADE: Moderate; SUCRA = 32.7%, GRADE: High). The dose-response analysis showed a significant nonlinear dose-response relationship between total exercise volume and VAT, with the minimum effective dose being 730 METs min/week. Furthermore, the minimum effective doses for different exercise types varied. Specifically, HIIT significantly reduced VAT at a lower dose (400 METs min/week), while AE and AE + RT required a higher dose (1100 METs min/week) for significant reduction. This study reveals a nonlinear dose-response relationship between exercise dose and VAT reduction, demonstrating that HIIT is the most effective exercise modality for reducing VAT, with significant effects at low doses. AE and AE + RT are also effective but require higher doses (1100 METs min/week) to achieve significant VAT reduction. These findings provide specific dosage recommendations for exercise prescriptions for individuals with obesity, helping to optimize treatment plans and improve obesity management outcomes.