Different exercise modalities improve health gains in vascular function in overweight or obese children and adolescents: a Bayesian meta-analysis

doi:10.12307/2026.729

Abstract

Abstract: OBJECTIVE: In recent years, exercise has been widely recognized as an effective non-pharmacological intervention for improving vascular health. This study conducted a systematic review of the effects of different exercise modalities on the prevention and improvement of cardiovascular disease in overweight or obese children and adolescents.
METHODS: Randomized controlled trials (RCTs) investigating the effects of different exercise modalities on vascular function in overweight or obese children and adolescents were retrieved from PubMed, Web of Science, Cochrane Library, and EBSCO-SPORTD. The control group continued their normal lifestyle, while the experimental group underwent continuous traditional aerobic training, resistance training, traditional interval training, or combined training. The search period ranged from the inception of each database to February 17, 2025. Two researchers independently screened the studies, assessed their quality, and extracted data. Bayesian meta-analysis was performed using RevMan 5.4 and R software to evaluate outcome measures, including pooled effect sizes, subgroup analysis, Markov chain convergence diagnostics, and funnel plot construction.
RESULTS: (1) A total of 15 randomized controlled trials that met the requirements were finally included, involving 767 subjects. The overall quality of the included literature was high. (2) Bayesian meta-analysis results revealed that compared with the control group, different exercise interventions had an improvement effect on three indices in overweight or obese children and adolescents, namely pulse wave conduction velocity [standardized mean difference (SMD)=-0.72, 95% confidence interval (CI): -1.30 to -0.15], flow-mediated dilation (SMD=0.91, 95% CI: 0.38 to 1.40) and carotid intima-media thickness (SMD=-0.28, 95% CI: -0.51 to -0.06). (3) The results of subgroup analysis further showed that compared with the control group, high-intensity interval training was effective in improving pulse wave conduction velocity (SMD=-1.13, 95% CI: -1.76 to -0.51, P < 0.05), flow-mediated dilation (SMD=0.74, 95% CI: 0.15 to 1.34, P < 0.05) and carotid intima-media thickness (SMD=-0.80, 95% CI: -1.40 to -0.20, P < 0.05); and aerobic training had a statistically significant improvement in blood flow-mediated vasodilatory function (SMD=1.37, 95% CI: 0.97 to 1.77, P < 0.05) in overweight or obese children and adolescents.
CONCLUSION: Current evidence suggests that exercise interventions have a significant beneficial effect on vascular function in overweight or obese children and adolescents. High-intensity interval training has the most prominent effect on improving functional vascular health in children and adolescents who are overweight or obese, with conventional aerobic training having the second most significant improvement. It is recommended that more research be conducted in the future to determine the optimal exercise training prescription for children and adolescents who are overweight or obese.

Key words: cardiovascular diseases, arterial pulse wave velocity, carotid intima-media thickness, high-intensity interval training, traditional aerobic training, resistance training, combined aerobic-resistance training, mixed training, Bayesian meta-analysis

CLC Number:

Xu Yang, Li Xiupeng, Yang Bing, Yang Chunbaixue, Zhao Zhongwei . Different exercise modalities improve health gains in vascular function in overweight or obese children and adolescents: a Bayesian meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(16): 4204-4218.

Figures/Tables 17

运动干预类型的可知性，导致对受试者和干预者设置盲法受阻，但仍有4篇文献对结局测量者进行设盲，提升了所取文献的可信度[33，41-42，45]。根据Rob 2.0偏倚风险评估工具对纳入文献的随机化过程、偏离预期干预措施、结果数据的缺失、报告结果的选择进行偏倚评估，1篇文献由于设备变化和退出导致试验组与对照组样本量不均衡，被评估为高风险[38]。其余文章均为中低风险文献，其中低风险文献为5篇[32，39，41-42，44]，见图3。综上所述，文章通过 PEDro 评分量表与 RoB 2.0 偏倚风险图结合进行双重评级，最终纳入文献均在 PEDro 评分上达标，并且除1篇高偏倚风险外，其余文献均为中低风险，具备较高的可信度与方法学质量，进一步验证了该研究的可靠性。 2.4 基于贝叶斯模型下运动干预对超重或肥胖儿童青少年的Meta分析2.4.1 总体分析森林图颈脉搏波传导速度：8篇文献分析了运动干预对超重或肥胖儿童青少年颈脉搏波传导速度的影响[31-38]。异质性检验(I2=93%，P < 0.000 01)显示研究间异质性较高，采用随机效应模型进行分析。由于此次研究纳入单位不一致，故采用SMD标准化均数差进行合并效应量检验。森林图中显示的不是每个研究观察的效应量，而是基于贝叶斯模型中的每个研究估计到的效应量，结果显示运动干预可以改善超重或肥胖儿童青少年的颈脉搏波传导速度[SMD=-0.72，95%CI(-1.30，-0.15)]，见图4。血流介导的血管舒张功能：6篇文献分析了运动干预对超重或肥胖儿童青少年血流介导的血管舒张功能的影响[35，41-44]。异质性检验(I2=57%，P < 0.000 01)显示研究间异质性较高，采用随机效应模型。由于此次研究纳入单位不一致，故采用SMD标准化均数差进行合并效应量检验。森林图中显示的不是每个研究观察的效应量，而是基于贝叶斯模型中的每个研究估计到的效应量，结果显示，与对照组比较，运动干预可以改善超重或肥胖儿童青少年血流介导的血管舒张功能[SMD=0.91，95%CI(0.38，1.40)]，见图5。颈动脉内膜中层厚度：7篇文献分析了运动干预对超重或肥胖儿童青少年颈动脉内膜中层厚度的影响[35，38-40，42-43，45]。异质性检验(I2=0%，P=0.792 1)显示研究间异质性较低，采用固定效应模型。由于此次研究纳入单位不一致，故采用SMD标准化均数差进行合并效应量检验，结果显示，与对照组比较，运动干预可以改善超重或肥胖儿童青少年颈动脉中层厚度[SMD=-0.28，95%CI(-0.51，-0.06)]，见图6。 2.4.2 亚组分析森林图颈脉搏波传导速度：8篇文献分析了运动干预对超重或肥胖儿童青少年颈脉搏波传导速度的影响[31-38]。异质性检验(I2=82%，P < 0.000 01)显示研究间异质性较高，采用随机效应模型。由于此次研究纳入单位不一致，故采用SMD标准化均数差进行合并效应量检验。整体合并效应量显示，"

与对照组比较，运动干预可以有效改善超重或肥胖儿童青少年脉搏波传导速度[SMD=-0.72，95%CI=(-1.19，-0.25)，P < 0.05]；亚组分析森林图显示，与对照组比较，高强度间歇训练可以有效改善超重或肥胖儿童青少年脉搏波传导速度[SMD=-1.13，95%CI(-1.76，-0.51)，P < 0.05]，联合训练[SMD=-0.61，95%CI(-1.38，0.16)，P > 0.05]、传统有氧训练[SMD=-1.23，95%CI(-2.77，0.30)，P > 0.05]、抗阻训练[SMD=-0.05，95%CI(-0.69，0.59)，P > 0.05]和混合训练[SMD=-0.30，95%CI(-0.79，0.19)，P > 0.05]未能改善超重或肥胖儿童青少年脉搏波传导速度，见图7。综上来看，高强度间歇训练对超重或肥胖儿童青少年脉搏波传导速度改善效果明显，传统有氧训练、联合训练、混合训练、阻力训练的改善效果不大，该结果可能是文章数量过少导致的。血流介导的血管舒张功能：5篇文献分析了运动干预对超重或肥胖儿童青少年肥胖血流介导的血管舒张功能的影响[35，41-44]。异质性检验(I2=59%，P=0.03)研究间异质性较高，采用随机效应模型。由于此次研究纳入单位不一致，故采用SMD标准化均数差进行合并效应量检验。整体合并效应量显示，与对照组比较，运动干预可有效改善超重或肥胖儿童青少年血流介导的血管舒张功能[SMD=0.93，95%CI(0.46，1.40)，P < 0.05]；亚组分析森林图发现，与对照组比较，高强度间歇训练[SMD=0.74，95%CI(0.15，1.34)，P < 0.05]和传统有氧训练[SMD=1.37，95%CI(0.97，1.77)，P < 0.05]可有效改善超重或肥胖儿童青少年血流介导的血管舒张功能，联合训练未能有效改善超重或肥胖儿童青少年血流介导的血管舒张功能[SMD=0.21，95%CI(-0.38，0.81)，P > 0.05]，见图8。综上来看，高强度间歇训练、传统有氧训练改善超重或肥胖儿童青少年血流介导的血管舒张功能的效果显著，而联合训练改善效果不佳，该结果可能是文章数量过少导致的。颈动脉内膜中层厚度：7篇文献分析了运动干预超重或肥胖儿童青少年颈动脉内膜中层厚度的影响[35，38-40，42-43，45]。异质性检验(I2=0%，P=0.80)显示研究间异质性较低，采用固定效应模型。由于此次研究纳入单位不一致，故采用SMD标准化均数差进行合并效应量检验。整体合并效应量显示，与对照组比较，运动干预可有效改善超重或肥胖儿童青少年颈动脉内膜中层厚度[SMD=-0.28，95%CI(-0.48，-0.07)，P < 0.05]；通过亚组分析森林图发现，与对照组比较，高强度间歇训练可有效改善超重或肥胖儿童青少年颈动脉内膜中层厚度[SMD=-0.80，95%CI(-1.40，-0.20)， P < 0.05]，传统有氧训练[SMD=-0.18，95%CI(-0.52，0.15)，P > 0.05]、联合训练[SMD=-0.25，95%CI(-0.71，0.21)，P > 0.05]、混合训练[SMD=-0.25，95%CI(-0.68，0.19)，P > 0.05]和抗阻训练[SMD=-0.14，95%CI(-0.78，0.49)，P > 0.05]均未能有效改善超重或肥胖儿童青少年颈动脉内膜中层厚度，见图9。综上来看，高强度间歇训练对超重或肥胖儿童青少年颈动脉内膜中层厚度的改善效果显著，传统有氧训练、联合训练、混合训练、抗阻训练的改善效果不大，该结果可能是文章数量过少导致的。 2.4.3 遍历均值图图10对应脉搏波传导速度、血流介导的血管舒张功能及颈动脉内膜中层厚度3个参数的收敛性分析，展示了各参数在迭代过程中的变化情况。结果显示各链的波动平稳且重叠良好，表明模型收敛性较好；迭代次数充足，参数在早期即达到稳定状态，未观察到明显的自相关性，进一步验证了模型的有效性。总体来看，遍历均值图支持模型的收敛性，结果可靠。 2.4.4 自相关图图11展示了颈脉搏波传导速度、血流介导的血管舒张功"

能、颈动脉内膜中层厚度参数在不同滞后阶数下的自相关性。结果显示，图中自相关系数在低滞后阶数(lag=1和lag=2)时迅速下降至接近零，表明马尔可夫链的混合效果较好，样本独立性较高；在滞后阶数达到10时，自相关系数已接近零，进一步支持模型的收敛性；未观察到自相关系数在高滞后阶数时显著高于零的情况，表明样本之间的相关性较低。总体来看，自相关图的结果表明模型混合效果良好，分析结果可靠。 2.4.5 Geweke诊断图 Geweke诊断图通过对比马尔可夫链早期与后期样本均值的差异来评估收敛性。图12中Z-score的分布集中在零附近且大部分落在[-1.96，1.96]的范围内，表明链的早期和后期均值无显著差异，支持模型收敛；未观察到明显的异常值或模式，进一步验证了模型的有效性。总体来看，Geweke诊断图的结果表明模型收敛性良好，分析结果可靠。 2.4.6 核密度图核密度图的作用，即通过平滑曲线展示参数后验分布形态，用于直观反映参数的不确定性及其集中趋势。图13核密度图展示了参数后验分布的平滑曲线。结果显示图中曲线呈现单峰且近似对称形态，表明参数估计具有较高的确定性；曲线的尾部较短，进一步支持参数的不确定性范围较小；与先验分布相比，后验分布更为集中，表明数据对参数估计提供了较强的信息。总体来看，核密度图的结果表明参数后验分布形态合理，分析结果可靠。 2.4.7 踪迹图踪迹图展示了马尔可夫链蒙特卡洛采样过程中参数的迭代值，用于诊断贝叶斯模型的收敛程度，当迭代次数不足时，马尔可夫链蒙特卡洛链未明显拟合，可识别出链的波动，收敛程度差，应增加迭代次数；当迭代次数达到7 000次时，各条马尔可夫链蒙特卡洛链从起始部分开始已达到稳定融合，并且在后续计算中重叠面积占链波动范围的大部分，并且不能识别单条链的波动，收敛程度满意。如图14所示，图中各链的波"

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