Impact of Physical Activity on Targeted Fat Deposits in Children

Overview

This review summarizes evidence that moderate-to-vigorous aerobic and combined aerobic-resistance exercise effectively reduce visceral, subcutaneous, hepatic, and intermuscular fat in children and adolescents with obesity. Data on pancreatic and bone marrow fat are limited but suggest potential benefits, while research on epicardial fat is scarce.

Background

Physical inactivity is prevalent among children globally and is closely linked to excess adiposity and obesity, which increases risk for cardiometabolic diseases and certain cancers. While overall adiposity has been widely studied, fat accumulation in specific depots such as visceral, subcutaneous, hepatic, and ectopic fat is increasingly recognized for its distinct health implications. Exercise is a key lifestyle intervention for childhood obesity, but its effects on these specific fat depots require further elucidation.

Data Highlights

Evidence from randomized controlled trials and meta-analyses indicates that moderate-to-vigorous aerobic or combined aerobic and resistance training reduces visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), hepatic fat, and intermuscular adipose tissue (IMAT) in pediatric populations with overweight or obesity. Limited studies suggest exercise may also reduce pancreatic and bone marrow fat, though data are sparse. Research on epicardial adipose tissue (EAT) in children is virtually absent.

Key Findings

• Moderate-to-vigorous aerobic and combined aerobic-resistance exercise effectively reduce visceral fat in children and adolescents with obesity.
• Exercise interventions also decrease subcutaneous, hepatic, and intermuscular fat depots, which are linked to cardiometabolic risk.
• Limited evidence suggests potential benefits of exercise on pancreatic and bone marrow fat, but findings are preliminary.
• Research on the impact of exercise on epicardial fat in pediatric populations is lacking.
• Most studies do not adequately report exercise dose parameters, limiting understanding of dose-response relationships.
• Adding supervised exercise to lifestyle interventions enhances reductions in multiple fat depots compared to lifestyle changes alone.

Clinical Implications

Clinicians should consider incorporating moderate-to-vigorous aerobic or combined aerobic and resistance exercise into treatment plans for children and adolescents with obesity to target harmful fat depots beyond overall adiposity. Detailed exercise prescriptions regarding modality, frequency, duration, and intensity are needed to optimize fat depot-specific benefits. Further research is warranted to establish evidence-based exercise guidelines for reducing ectopic fat in pediatric populations.

Conclusion

Exercise is a promising strategy to reduce specific fat depots associated with cardiometabolic risk in children and adolescents with obesity. However, more research is needed to define optimal exercise modalities and doses for targeting distinct fat depots.

References

1. World Health Organization 2020 -- Global Guidelines on Physical Activity
2. EFIGRO Project -- Effects of Exercise on Ectopic Fat in Children
3. Systematic Reviews and Meta-Analyses -- Exercise and Visceral Fat Reduction