Childhood overweight and obesity have dramatically increased worldwide, affecting tens of millions of children and adolescents and paralleling increases in type 2 diabetes, fatty liver, and cardiovascular diseases. Of particular concern is ectopic fat—lipid stored within visceral, hepatic, intramuscular, pancreatic, and perivascular tissues—which independently promotes metabolic dysfunction beyond total body fat. Exercise represents a cornerstone in the management of obesity, yet aerobic, resistance, high-intensity interval training (HIIT), combined training, and novel modalities such as yoga, mind–body, and neuromuscular stimulation uniquely activate the muscular, hormonal, and metabolic axes. Here, in this narrative review, we review the evidence from pediatric exercise trials that compare these modes of exercise for depot-specific fat loss in overweight/obese adolescents. High-intensity and aerobic exercise have shown promising effects in several pediatric trials on mobilizing visceral fat and liver fat, respectively, though they do not always surpass resistance training alone. Combined training may produce broader improvements in multiple depots when sustained for the longer term, while nontraditional modes can serve as useful adjuncts to core exercise by improving adherence or targeting less well-studied depots. Key limitations include the narrative (rather than systematic) design of this review, the overall paucity of high-quality long-term pediatric randomized controlled trials, reliance on adult and preclinical data for mechanistic insights, heterogeneity in measurement techniques, and sparse evidence for certain ectopic depots. We emphasize practical implications for the design of youth exercise programs and enumerate knowledge gaps in the extant literature, including pancreatic and pericardial fat, and age- and sex-based tailoring.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> What is Known: • Childhood and adolescent obesity is strongly associated with increased ectopic fat deposition (visceral, hepatic, and intramuscular fat), which contributes to metabolic disorders such as insulin resistance, type 2 diabetes, and cardiovascular disease. • Exercise interventions, including aerobic, resistance, and high-intensity interval training (HIIT), are effective in reducing overall adiposity, but their comparative effects on specific ectopic fat depots in pediatric populations remain incompletely understood. </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> What is New: • This narrative review synthesizes and compares evidence across multiple exercise modalities (aerobic, resistance, HIIT, combined, and mind–body approaches) specifically focusing on depot-specific ectopic fat reduction in overweight and obese children and adolescents. • It highlights that combined training may offer broader multi-depot fat reduction, while emerging modalities (e.g., yoga and neuromuscular approaches) may enhance adherence and target underexplored fat depots such as pancreatic and pericardial fat. </entry> </row> </tbody> </tgroup> </Table>

Comparative effects of exercise modalities on ectopic fat reduction in overweight and obese children and adolescents: a narrative review

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发表日期：

2026年5月31日

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Junwen Jiang,
Liwen Qin,
Yangfeng Shen

摘要

Childhood overweight and obesity have dramatically increased worldwide, affecting tens of millions of children and adolescents and paralleling increases in type 2 diabetes, fatty liver, and cardiovascular diseases. Of particular concern is ectopic fat—lipid stored within visceral, hepatic, intramuscular, pancreatic, and perivascular tissues—which independently promotes metabolic dysfunction beyond total body fat. Exercise represents a cornerstone in the management of obesity, yet aerobic, resistance, high-intensity interval training (HIIT), combined training, and novel modalities such as yoga, mind–body, and neuromuscular stimulation uniquely activate the muscular, hormonal, and metabolic axes. Here, in this narrative review, we review the evidence from pediatric exercise trials that compare these modes of exercise for depot-specific fat loss in overweight/obese adolescents. High-intensity and aerobic exercise have shown promising effects in several pediatric trials on mobilizing visceral fat and liver fat, respectively, though they do not always surpass resistance training alone. Combined training may produce broader improvements in multiple depots when sustained for the longer term, while nontraditional modes can serve as useful adjuncts to core exercise by improving adherence or targeting less well-studied depots. Key limitations include the narrative (rather than systematic) design of this review, the overall paucity of high-quality long-term pediatric randomized controlled trials, reliance on adult and preclinical data for mechanistic insights, heterogeneity in measurement techniques, and sparse evidence for certain ectopic depots. We emphasize practical implications for the design of youth exercise programs and enumerate knowledge gaps in the extant literature, including pancreatic and pericardial fat, and age- and sex-based tailoring.

What is Known:

• Childhood and adolescent obesity is strongly associated with increased ectopic fat deposition (visceral, hepatic, and intramuscular fat), which contributes to metabolic disorders such as insulin resistance, type 2 diabetes, and cardiovascular disease.

• Exercise interventions, including aerobic, resistance, and high-intensity interval training (HIIT), are effective in reducing overall adiposity, but their comparative effects on specific ectopic fat depots in pediatric populations remain incompletely understood.

What is New:

• This narrative review synthesizes and compares evidence across multiple exercise modalities (aerobic, resistance, HIIT, combined, and mind–body approaches) specifically focusing on depot-specific ectopic fat reduction in overweight and obese children and adolescents.

• It highlights that combined training may offer broader multi-depot fat reduction, while emerging modalities (e.g., yoga and neuromuscular approaches) may enhance adherence and target underexplored fat depots such as pancreatic and pericardial fat.