Synergistic Effects of Concurrent Aerobic and Strength Training on Fitness in Children and Adolescents: A Multivariate and Network Meta-Analysis.

The decline in fitness levels among children and adolescents underscores the urgent need for effective exercise interventions. Aerobic endurance training (ET) and resistance training (RT) are vital for physical development in this demographic. This study employs multivariate and network meta-analysis (NMA) to assess the impact of concurrent training (CT), which integrates both ET and RT, on youth physical fitness. The objective is to identify the distinct advantages of CT over either ET or RT alone, emphasizing demographic and training-specific variables. A systematic literature review of publications from 1980 onward was conducted through ISI Web of Science, PubMed/MEDLINE, and SPORTDiscus databases, adhering to the PICOS criteria for study selection. Data were analyzed using univariate, multivariate, and network meta-analyses in Stata 17.0, focusing on cardiorespiratory fitness and muscular strength. The methodological quality and risk of bias were evaluated using the PEDro scale and Egger's test, along with sensitivity analyses and meta-regression to explore heterogeneity and publication bias. This analysis included 36 studies with 2658 participants (mean age: 14.32 ± 2.29 years) from an initial 11 074 publications, indicating low bias risk (PEDro scores ≥ 6). Univariate meta-analysis showed no significant differences in maximal oxygen uptake (VOmax) between CT and ET (standardized mean difference [SMD] = 0.01; 95% confidence interval [CI]: -0.23 to 0.25; p = 0.93). In contrast, CT significantly improved countermovement jump (CMJ) compared to RT alone (SMD = 0.19; 95% CI: 0.01-0.36; p = 0.04). Multivariate analysis confirmed notable enhancements in endurance and explosiveness for CT compared to ET or RT. NMA indicated significant improvements in lower limb strength, CMJ, and VOmax across interventions compared to controls, with the consecutive resistance training followed by ET (CRE) group yielding the most significant CMJ improvement (SMD = 0.27; 95% CI: 0.07-0.47). Isolated RT showed the highest lower limb strength improvement (SUCRA score 80.1%), while CRE excelled in CMJ advancements (SUCRA score 93.4%), and the CRED group (alternating ET and RT) led in VOmax improvements (SUCRA score 81.6%). Furthermore, high-intensity interval training (HIIT) significantly enhanced VOmax compared to team sports. This meta-analysis emphasizes the effectiveness of CT in improving muscle power and VOmax in children and adolescents, surpassing isolated ET or RT, and advocates for integrating ET and RT to optimize physical performance. Future research should explore the mechanisms underlying these enhancements. Trial Registration: PROSPERO registration number CRD42022368452.