Comparative effectiveness of various exercise interventions on cardiorespiratory fitness in adults living with overweight or obesity: A systematic review and Bayesian network meta-analysis.

This study evaluated how different exercise interventions affect maximal oxygen uptake (VO_2max) in adults with overweight or obesity. We systematically searched five databases from inception to February 2025 to identify relevant randomized controlled trials (RCTs). We used the Cochrane risk of bias tool. A Bayesian network meta-analysis with a random-effects model was conducted. A total of 93 RCTs involving 4,446 participants were included. The network meta-analysis showed high-intensity interval training (HIIT) ranked highest (Surface Under the Cumulative Ranking Curve [SUCRA]: 82.5%; Standardized Mean Difference [SMD]: 4.85; 95%Credible Interval [CrI]: 3.90, 5.80), followed by high-intensity aerobic training (HAT) (SUCRA: 76.7%; SMD: 4.72; 95%CrI: 3.78, 5.68), and combined aerobic and resistance training (CT) (SUCRA: 69.1%; SMD: 4.52; 95%CrI: 3.48, 5.60), with resistance training (RT) least effective (SUCRA: 18.3%; SMD: 2.57; 95%CrI: 1.32, 3.86). All six interventions effectively improved VO2max in overweight or obese adults. Among them, HIIT was most beneficial. Coaches and fitness professionals should consider these findings to help adults with overweight or obesity achieve optimal outcomes.