Comparative Efficacy of Exercise Type on Visceral Adipose Tissue in Patients With Prediabetes and Type 2 Diabetes Mellitus: A Systematic Review With Pairwise and Network Meta-Analyses.

The aim of this systematic review with pairwise and network meta-analyses was to examine the effects of different exercise types on visceral adipose tissue (VAT) in patients with prediabetes and type 2 diabetes mellitus (T2DM). A comprehensive search was conducted in PubMed, Web of Science, and Scopus using four main keywords including "exercise training," "visceral fat," "diabetes," and "randomization" from inception to April 2025. Thirty-three randomized controlled trials or clinical trials with parallel groups were included (1740 patients), in which exercise training was compared with either nonexercise or other types of exercise training. Combined training (n = 5) (-0.63 [95% CI -0.95 to -0.30], p = 0.001), high-intensity interval training (n = 11) (-0.53 [95% CI -0.86 to -0.19], p = 0.001), and aerobic training (n = 24) (-0.38 [95% CI -0.59 to -0.18], p = 0.001), but not resistance training (n = 8) (-0.25 [95% CI -0.54 to 0.03], p = 0.08) were more effective for reducing VAT as compared with controls. Subgroup analyses based on age, health status, body mass index, or intervention duration confirmed that combined training, high-intensity interval training, aerobic training, but not resistance training, induced advantageous alterations in VAT compared to the control group. The main findings show that the P-score-based ranking of interventions reported the highest probability ranking for CT (0.89), followed by HIIT (0.76), AT (0.52), and RT (0.32). These findings provide compelling evidence to support the use of exercise training as a noninvasive and cost-effective nonpharmacological intervention for the reduction of VAT in patients with prediabetes and T2DM. PROSPERO REGISTRATION NUMBER: CRD42024598045.