This systematic review and meta-analysis aimed to quantify the effect of exercise interventions on blood pressure (BP) among children and adolescents with overweight or obesity. A systematic search of five databases was conducted from inception to July 26, 2024, to identify relevant randomized controlled trials (RCTs). Study quality was assessed using the revised Cochrane Risk of Bias Tool for randomized controlled trials. A random-effects model was performed, and subgroup analyses were further conducted. A total of 19 RCTs were included. All reported changes of systolic blood pressure (SBP), while 18 reported that of diastolic blood pressure (DBP). Exercise interventions significantly reduced SBP (standardized mean difference [SMD] = -0.71
95% confidence interval [CI], -1.06 to -0.36
P<
.001) and DBP (SMD= -0.67
95% CI, -1.00 to -0.34
P<
.001). Subgroup analyses indicated greater reductions in BP levels among girls and obese children and adolescents, or when the program was HIIT, or with a total time of at least 3000 minutes. Early exercise interventions may help to prevent or delay the onset of hypertension in this population.