Optimal dosage of exercise interventions for enhancing inhibitory control in overweight and obese children and adolescents: insights from a multilevel meta-analysis

Abstract

Abstract

Background Overweight and obesity in children and adolescents are frequently associated with impairments in inhibitory control. Exercise interventions have been proposed as an effective means to enhance inhibitory control in this population. This study employs a three-level meta-analysis to assess the effects of exercise interventions on inhibitory control in overweight and obese children and adolescents, and further explores the dose–response relationship to identify the optimal intervention dosage. Methods Systematic searches were conducted in the PubMed, Web of Science, Embase, Cochrane Library, and CNKI databases to identify relevant studies. Hedges’ g was used as the measure of effect size, and a three-level random-effects model was implemented using the metafor package in R to address the dependency of multiple effect sizes within individual studies. Results A total of 11 studies from four countries, involving 787 overweight and obese children and adolescents (average age: 8.75–14.06 years), were included. The meta-analysis revealed that exercise interventions significantly improved inhibitory control in this population, with consistent findings across both the three-level model ( g = 0.41, p = 0.002) and the traditional two-level model ( g = 0.45, p < 0.001). Nonlinear regression analysis using restricted cubic splines showed that the improvement in inhibitory control followed a nonlinear pattern within a specific dosage range, with the optimal intervention being approximately 49 exercise sessions, each lasting 48 min. Additionally, linear meta-regression revealed a significant negative linear relationship between BMI and intervention effect ( β = −0.13, p = 0.027). Conclusion Exercise interventions significantly enhance inhibitory control in overweight and obese children and adolescents. Based on current evidence, approximately 49 exercise sessions, each lasting about 48 min, may represent a potentially beneficial intervention dosage for improving inhibitory control. However, given the very low certainty of evidence, these findings should be interpreted cautiously and considered hypothesis-generating rather than definitive clinical recommendations. Systematic review registration PROSPERO , CRD420251163768.