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Study-level age patterns in cardiometabolic response to high-intensity interval training among adults with overweight or obesity: a systematic review and meta-analysis of randomized controlled trials
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DOI：10.3389/fphys.2026.1833719.png)
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Abstract
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BackgroundHIIT is a time-efficient exercise strategy for adults with overweight or obesity; but trial findings are heterogeneous and whether age independently modifies cardiometabolic response remains uncertain.MethodsPubMed; Embase; the Cochrane Library; and Web of Science were searched from inception to December 2025. Random-effects meta-analyses estimated weighted mean differences for SBP and DBP in mmHg and standardized mean differences for lipid and anthropometric outcomes; with 95% confidence intervals and prediction intervals where available. Additional Stata analyses included funnel plots; Egger tests for all six outcomes; trim-and-fill analysis for BW and BMI; exploratory study-level meta-regression using continuous mean age and intervention duration; and GRADE assessment.ResultsNineteen trials involving 570 participants were included. HIIT was associated with reductions in SBP; DBP; TG; BW; and BMI and an increase in HDL-C; overall heterogeneity was moderate to substantial (I² range; 46.77%–87.07%). Egger tests suggested small-study effects for BW and BMI; but not SBP; DBP; HDL-C and TG. Trim-and-fill imputed no studies for BW and BMI. Mean age was associated with TG effects and duration was associated with HDL-C effects in univariable models. Certainty of evidence was low for SBP and very low for the remaining outcomes.ConclusionHIIT was associated with favorable average cardiometabolic changes in adults with overweight or obesity; but substantial heterogeneity; low-to-very-low certainty and possible small-study effects findings require cautious interpretation. The available evidence supports the hypothesis that trial-level mean age may be associated with differential responses; rather than proving age as a definitive individual-level effect modifier.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/; identifier CRD420261279689.
Keywords:
systematic review
age
adults
overweight or obesity
cardiometabolic response
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