Effects of different exercise types on visceral adipose tissue and glycemic parameters in adults with stage 1 cardiovascular-kidney-metabolic syndrome: a systematic review and network meta-analysis of randomized controlled trials

Background Cardiovascular-kidney-metabolic (CKM) syndrome, particularly at stage 1, is increasingly prevalent worldwide. Although exercise interventions are recognized as effective in reducing visceral adipose tissue (VAT) and improving glucose metabolism, their effects in adults with stage 1 CKM syndrome remain unclear. This study aimed to systematically analyze the effects of different exercise types on VAT, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) in adults with stage 1 CKM syndrome. Methods We searched six bibliographic databases—China National Knowledge Infrastructure (CNKI), WanFang Database, VIP Database, Web of Science, Embase, and PubMed—from inception to 15 April 2026, using the PICOS framework. A frequentist random-effects Network Meta-Analyses was conducted using STATA 18.0 software to evaluate the effects of interventions on VAT, FBG and HbA1c. The effectiveness of various exercise intervention types was ranked by calculating the surface under the cumulative ranking curve (SUCRA), and the risk of bias was evaluated using the Cochrane Risk of Bias (ROB 2.0) tool. This study protocol was registered in PROSPERO (CRD420261304633). Results Thirty-seven randomized controlled trials involving 3483 participants were included. Compared with the control group, aerobic training significantly decreased VAT [standardized mean difference = −0.44, 95% confidence interval (CI): (−0.62, −0.26)], while mind–body exercise (MBE) significantly improved FBG [mean difference (MD) = −1.16 mmol/L, 95% CI: (−1.57, −0.75)] and HbA1c [MD = −0.35%, 95% CI: (−0.62, −0.07)]. Subgroup analysis revealed that high-intensity interval training with an intervention duration of ≤ 12 weeks (SUCRA = 67%) and aerobic training with a duration of >12 weeks (SUCRA = 94.9%) had the highest probability of being the most effective intervention for reducing VAT in included studies. In addition, mind–body exercise ranked highest for FBG improvement, though with limited certainty. Conclusions These findings provide evidence that different exercise types exert distinct benefits on metabolic health in adults with stage 1 CKM syndrome. In particular, aerobic training may be more effective than other exercise types in reducing VAT, while MBE may contribute to more benefits in improving FBG and HbA1c. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261304633 , Identifier CRD420261304633.