Effects of exercise on cognitive function in children and adolescents with overweight or obesity: A systematic review and meta-analysis of randomized controlled trials

Shi Li¹Mengyan Wu²Jie Hu³Jingfeng Chen⁴Bichen Xiong⁵Deyu Jiao⁶Pengbo Ren⁷Hongwei Liu^8,9*Haixia Fan^10*

• ¹Wuxi City College of Vocational Technology, Wuxi, China
• ²Suzhou City University, Suzhou, China
• ³Guangzhou Sport University, Guangzhou, China
• ⁴The Education University of Hong Kong, Hong Kong, Hong Kong, SAR China
• ⁵Zhejiang Police College, Hangzhou, China
• ⁶High School Affiliated to Nanjing Normal University, Nanjing, China
• ⁷Changzhou University Huaide College, Jing jiang, China
• ⁸Taiyuan City Central Hospital, Tai Yuan, China
• ⁹The Ninth Clinical Medical College of Shanxi Medical University, Tai Yuan, China
• ¹⁰First Hospital of Shanxi Medical University, Taiyuan, China

Background Exercise is a non-pharmacological strategy for enhancing cognitive function among various populations. The aim of our systematic review was to synthesise evidence of the effects of exercise on cognitive function in children and adolescents with overweight or obesity. Methods A comprehensive search of four databases (Web of Science, PubMed, Scopus, EMBASE was conducted from each database inception through 1 April, 2025. This review investigates the impact of exercise intervention on the cognitive function of children and adolescents with overweight or obesity through randomized controlled trials (RCTs). The quality of the included studies was evaluated using the Cochrane Risk of Bias Tool 2, and the treatment effects were analyzed through random-effects or fixed-effects models, with Hedges' g serving as the metric for effect size estimation. Results The meta-analysis of 15 RCTs, including 1210 children and adolescents with overweight or obesity revealed that exercise significantly improved executive function (g=0.39, 95% CI:0.12 to 0.66, p=0.0043). No significant effects were observed for other aspects of attention and memory (p> 0.05). Subgroup analysis identified that exercise with a frequency of >3 sessions per week (g=0.39, p=0.0257), moderate-to-vigorous intensity (g=0.50, p=0.0132), exercise interventions ≥10 weeks (g=0.41, p=0.0184), single session duration >30 minutes (g=0.41, p=0.0139) ,and weekly exercise volume>120mins (g=0.28, p=0.00236) had higher effect sizes in improving executive function in children and adolescents with overweight or obesity. Subgroup analyses revealed that exercise frequencies <5 sessions/week (g = 0.98), single-session durations ≥40 mins (g = 0.60), weekly volumes ≥120 mins (g = 0.60), and intervention periods >15 weeks (g = 0.98) significantly enhanced attention (p < 0.05). Conclusions This study demonstrates that exercise interventions significantly improve executive function and attention in children and adolescents with overweight or obesity. In particular, moderate-intensity aerobic exercise performed more than three times per week, for over 30 minutes per session, and sustained for at least 10 weeks appears to represent the optimal training parameters for improving executive function. These findings support the use of exercise as a cognitive enhancement strategy. However, larger-scale studies are needed to confirm its effects on other cognitive domains.