Objective To systematically review the effects of various exercise modalities on obese children and adolescents with metabolic syndrome (MetS). MethodsChinese and English databases such as CNKI, WanFang Data, VIP, PubMed and Web of Science were selected to search for RCTs on the effects of exercise on obese children and adolescents with MetS, and the search period was from January 2000 to November 2024 And two researchers independently screened the literature, extracted data and evaluated the risk of bias of the included studies, and net meta−analysis was performed using Stata 17.0 and RevMan 5.4 software. Results A total of 15 RCT trials involving 968 obese children and adolescents with MetS were included. The results of reticulated meta−analysis showed that compared with the non−exercise intervention group, aerobic exercise was effective in improving the patients' body mass index (BMI) (SMD=−1.21, 95% CI −2.31 to −0.11, P=0.031), total cholesterol (TC) (SMD=−0.44, 95% CI −0.82 to −0.05, P=0.028), triglyceride (TG) (SMD=−1.10, 95% CI −1.98 to −0.22, P=0.014), fasting blood glucose (FBG) (SMD=−0.70, 95% CI −1.34 to −0.07, P=0.030), systolic blood pressure (SBP) (SMD=−1.10, 95% CI −1.83 to −0.38, P=0.003), diastolic blood pressure (DBP) (SMD=−0.93, 95% CI −1.49 to −0.37, P=0.001); Resistance exercise can effectively improve the HDL cholesterol (SMD=0.55, 95% CI 0.09 to 1.02, P=0.020) and SBP (SMD=−1.16, 95% CI −2.18 to −0.14, P=0.025); aerobic combined with resistance exercise can effectively improve waist circumference (WC) (SMD=−1.09, 95% CI −1.74 to −0.44, P=0.001), BMI (SMD=−1.22, 95% CI −2.32 to −0.12, P=0.030), HDL (SMD=0.56, 95% CI 0.13 to 1.00, P=0.011), and FBG (SMD=−0.57, 95% CI −1.13 to −0.02, P=0.044). The results of cumulative probability ranking showed that aerobic exercise was the most effective in improving TG, TC, FBG and DBP; resistance exercise was the most effective in improving SBP; and aerobic combined with resistance exercise was the most effective in improving WC, BMI and HDL. ConclusionDifferent exercise modes have different improvement effects on various body indexes in obese children and adolescents with MetS. Due to the limitation of the number and quality of included studies, more high−quality studies are needed to verify the above conclusions.