Effects of combined aerobic and resistance training on cardiometabolic risk factors in overweight/obese adolescents: a systematic review and meta-analysis

Background and objective Implementing scientific exercise interventions during childhood and adolescence holds long-term value for vascular protection. This study aimed to systematically evaluate the actual effects of combined aerobic and resistance training (CART) on glucose metabolism parameters, lipid profiles, and blood pressure dynamics in adolescents with overweight or obesity. Methods Electronic databases including PubMed, Web of Science, Embase, The Cochrane Library, and Scopus were searched from inception up to May 13, 2026, to collect randomized controlled trials (RCTs) investigating CART interventions in adolescents with overweight or obesity. Data analysis was performed using R software. Mean difference (MD) and 95% confidence intervals (CI) were uniformly employed as effect measures, with change-from-baseline values entered into the models. Hierarchical subgroup analyses based on control group type were conducted utilizing the Hartung-Knapp-Sidik-Jonkman (HKSJ) random-effects model, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results A total of 12 RCTs were included. Regarding glucose metabolism, fasting insulin showed a significant reduction in the CART vs. non-exercise control (CON) subgroup (MD = −17.90 μU/mL, 95% CI: −26.04 to −9.76, P < 0.0001), and also demonstrated a notable tendency toward improvement in the CART vs. aerobic exercise (AE) subgroup (MD = −2.70 μU/mL, 95% CI: −4.61 to −0.79, P = 0.01), with a statistically significant difference observed between the two subgroups ( P = 0.0004). The homeostatic model assessment of insulin resistance (HOMA-IR) demonstrated a tendency toward improvement in the CART vs. AE subgroup (MD = −0.57, 95% CI: −1.01 to −0.12, P = 0.01). Adiponectin demonstrated a notable tendency toward elevation in the CART vs. AE subgroup (MD = 2.37 μg/mL, 95% CI: 1.53 to 3.21, P < 0.0001). Fasting glucose showed no notable change in either subgroup and exhibited extremely high heterogeneity, making it inappropriate to draw substantial conclusions. Regarding blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP) both demonstrated a notable tendency toward reduction in the CART vs. CON subgroup (SBP: MD = −3.51 mmHg, 95% CI: −6.23 to −0.80, P = 0.01; DBP: MD = −3.72 mmHg, 95% CI: −6.69 to −0.75, P = 0.01), whereas neither showed notable change in the CART vs. AE subgroup. Total cholesterol and triglycerides showed no notable change in any subgroup. The GRADE evidence quality assessment showed that fasting insulin, SBP, and DBP in the CART vs. CON subgroup, as well as fasting insulin and HOMA-IR in the CART vs. AE subgroup, were of moderate quality, while the remaining indicators were of low or very low quality. Conclusion Current evidence indicates that CART demonstrates statistically significant improvements in fasting insulin, SBP, DBP, and adiponectin levels in adolescents with overweight or obesity; however, due to limitations including high variability in intervention protocols, absence of blinding, and regional concentration of included studies, the overall quality of evidence is low, and the actual clinical meaningfulness still requires cautious interpretation. All conclusions must be interpreted based on the classification of control group activity status. Future research urgently needs to adopt standardized combined training protocols, establish consistent comparator definitions, and conduct large-sample RCTs with longer follow-up periods for confirmation.