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Visceral Fat and Exercise: What a Review of 84 Trials Found

11 min read

Visceral fat is fat stored deep inside the abdomen, around the organs. It is different from the fat under the skin, which the 2024 review measured separately. That review pooled 84 randomised trials in 4,836 people with overweight or obesity and found that aerobic exercise of at least moderate intensity, resistance training, the two combined, and high-intensity interval training (HIIT) all reduced visceral fat, though resistance training was the least effective.

The 2013 review in this guide measured visceral fat on CT or MRI scans, and the 2024 review reported visceral fat alongside body measures such as weight and waist size. Neither measured whether exercise-driven fat loss prevents heart disease or diabetes.

84
Randomised trials in people with overweight or obesity, pooled in one review of exercise and visceral fat
Chen et al. 2024, 4,836 people
30+ sq cm
Fall in visceral fat area on one scan slice in women, the authors' cautious estimate for exercise with no diet
Vissers et al. 2013, 5 controlled studies
55%
Higher relative risk of heart and circulatory disease with a high against a low visceral adiposity index
Wang et al. 2025, 17 cohort studies
Under half
Waist under half your height: the NHS (National Health Service) home check if your BMI (body mass index) is under 35
NHS overweight and obesity page
Sources: Chen et al. 2024, Obesity Reviews. Vissers et al. 2013, PLOS ONE. Wang et al. 2025, Nutrition, Metabolism and Cardiovascular Diseases. NHS.

Why visceral fat matters

In the background section of their 2013 review, citing earlier studies, Dirk Vissers and colleagues write that there seems to be a strong association between visceral fat and a higher risk of diseases such as heart disease, type 2 diabetes and non-alcoholic fatty liver disease.

A 2025 review by Rui Wang and colleagues pooled 17 cohort studies with 824,268 people. It looked at the visceral adiposity index, a marker used to estimate visceral fat rather than a direct scan measure. Compared with the lowest index group, people in the highest group had a 55% higher relative risk of heart and circulatory disease, a 45% higher relative risk of stroke and a 38% higher relative risk of death from heart and circulatory causes. These are relative figures, and the abstract does not give absolute risk. They come from observational studies, so they show an association, not cause and effect, and they do not show that exercise lowers that risk.

If your BMI is under 35, the NHS suggests using your waist to height ratio to check whether you carry too much fat around your tummy, and advises keeping your waist below half your height. The NHS also notes that BMI does not tell muscle from fat, so a muscular person might score as overweight without much body fat.

What the review of 84 trials found

Xiaoke Chen and colleagues published a network meta-analysis in 2024, a method that compares several exercise types at once, including pairs not tested head to head. It included 84 randomised controlled trials, studies that assign people to groups at random, with 4,836 people with overweight or obesity. The abstract does not report their ages, health conditions or how long the programmes lasted, and the full paper was not available to us.

Aerobic exercise of at least moderate intensity, aerobic and resistance training combined, and HIIT all reduced visceral fat. Resistance training on its own also reduced visceral fat overall. In a subgroup analysis, that benefit showed in men and in people under 40% body fat, but not in women or in people at 40% body fat or more. In the ranking analysis, vigorous aerobic exercise and HIIT had the highest probability of being the best option. The ranking shows which type was most likely to come top, not how much more fat it removed, and the abstract does not give the size of the gap between types. The authors conclude that resistance training is the least effective of the options for visceral fat.

What an earlier review measured

The 2013 Vissers review pooled 15 studies with 852 people in the exercise groups, in studies of adults with overweight or obesity whose average ages ranged from about 30 to 73. None used a calorie-restricted diet. Every study measured visceral fat with a CT (computed tomography) or MRI (magnetic resonance imaging) scan. Nine studies had a control group and six did not. Two-thirds of the programmes ran 3 to 5 sessions a week, most often of 45 to 90 minutes each.

Exercise reduced visceral fat overall. Aerobic training reduced it clearly. Strength training also reduced it, but the result only narrowly reached statistical significance, meaning it was barely clear of chance, and it rested on two studies. The two studies of combined training did not show a significant fall. Among aerobic studies, moderate and high intensity training reduced visceral fat, while low intensity, tested in only two studies, showed no clear effect. The authors defined low intensity as under 60% of maximum heart rate, moderate as 60% to 70% and high as 70% or more. The length of the programme, which ranged from 10 weeks to 12 months, was not linked to the size of the fall.

Estimated fall in visceral fat area with exercise alone Square centimetres on a CT or MRI scan slice, controlled studies, no diet Men 46.5 sq cm Women 37.1 sq cm 0 30 60
Source: Vissers et al. 2013, PLOS ONE. Estimated fall on one scan slice, converted from a pooled effect in the 5 controlled studies, 569 adults, that reported square centimetres. The authors note these 5 studies slightly overestimate the effect and settle on more than 30 in women and more than 40 in men. The review did not test whether men and women differ.

To make the results easier to picture, the authors converted the pooled effect from the 5 controlled studies that reported area in square centimetres. That came to an estimated fall of about 37 square centimetres in women and about 47 in men on one scan slice. The authors note these 5 studies slightly overestimate the effect compared with all 9 controlled studies, so they settle on more than 30 in women and more than 40 in men. For scale, starting areas in several of the included studies were between about 110 and 200 square centimetres.

What the evidence does not show

Neither review measured heart attacks, strokes or diabetes. The 2025 study linking the visceral adiposity index with heart disease was observational, so it does not show that lowering visceral fat with exercise lowers that risk. The 2013 review mixed studies with and without control groups, and its findings on strength and combined training each rest on two studies.

The 2024 review included people with overweight or obesity and the 2013 review included adults with overweight or obesity, so the results apply most directly to that group. A CT or MRI scan is the only direct measure of visceral fat.

Who should take care

The NHS advises seeing a GP (general practitioner) if your BMI is in the overweight or obese range and you also want help to lose weight, have a waist more than half your height, or have pre-diabetes, diabetes, high blood pressure, joint pain, high cholesterol, sleep apnoea or heart disease. In our view, speak to your GP before vigorous sessions or HIIT if you have a heart condition, take medicine for diabetes or blood pressure, or have been inactive for a long time.

The NHS advises calling 999 if you get sudden chest pain or discomfort that does not go away, pain that spreads to your arm, neck, jaw, stomach or back, or chest pain with sweating, sickness, light-headedness or shortness of breath. In our view, stop exercising at once if you feel chest pain, faintness or unusual breathlessness.

How to fit this into your week

The NHS advises adults aged 19 to 64 to do at least 150 minutes of moderate activity or 75 minutes of vigorous activity a week, plus strength activities on at least 2 days. In the 2013 review, two-thirds of the programmes ran 3 to 5 sessions a week, most often of 45 to 90 minutes each, which is often more than that minimum. If you are 65 or over, the NHS advises activities that improve strength, balance and flexibility on at least 2 days a week, and suggests 75 minutes of vigorous activity only if you are already active. The steps below are ours, built from the two reviews. They are not a tested programme.

1
Reach moderate effort
Low-intensity aerobic training showed no clear fall in visceral fat in the 2013 review. The NHS says moderate effort means you can still talk, but not sing, as in brisk walking or cycling.
2
Add vigorous work gradually
Read the section above first. Vigorous effort, in the NHS description, means you are unable to say more than a few words without pausing for breath. In our view, add one such session a week only after 4 to 8 weeks of regular moderate exercise.
3
Pair strength with aerobic work
In a subgroup analysis of the 2024 review, resistance training on its own did not show a clear fall in visceral fat in women or in people at 40% body fat or more, so pair it with aerobic work. The NHS still advises strength activities on at least 2 days a week.
4
Track your waist
Compare your waist with half your height, as the NHS suggests if your BMI is under 35. A tape measure tracks waist size, not visceral fat, so a slow change does not mean the exercise has failed. In our view, measure every 4 weeks at the same time of day.

Frequently asked questions

Do I need to diet to lose visceral fat?
The 2013 review included only studies without a calorie-restricted diet, and exercise still reduced visceral fat. The NHS notes that losing a small amount of weight, 5 to 10% of your body weight, can improve your health.
Is HIIT better than steady cardio for visceral fat?
In the 2024 review, vigorous aerobic exercise and HIIT were most likely to rank top, but the abstract does not say how big the difference was. Both moderate and high-intensity aerobic training reduced visceral fat in the 2013 review.
Does strength training help?
In the 2024 review, resistance training on its own reduced visceral fat overall, and the authors call it the least effective option. In a subgroup analysis, the benefit showed in men and in people under 40% body fat, but not in women or in people at 40% body fat or more. In the 2013 review, its effect barely reached significance.
How long before I see a change?
The studies in the 2013 review ran from 10 weeks to 12 months, and programme length was not linked to the size of the fall. The authors suggest exercise without a diet has the potential to reduce visceral fat by more than 30 square centimetres in women and more than 40 in men, with aerobic programmes as short as 12 weeks.
How do I check my visceral fat at home?
Only a scan measures visceral fat directly. The NHS suggests keeping your waist below half your height as a home check for fat around your tummy if your BMI is under 35.

The bottom line

A 2024 review of 84 randomised trials in 4,836 people with overweight or obesity found that aerobic exercise of at least moderate intensity, resistance training, combined training and HIIT reduced visceral fat, with vigorous aerobic exercise and HIIT most likely to rank top. Resistance training on its own also helped overall, though in a subgroup analysis the benefit showed in men and leaner people but not in women or people with more body fat. A 2013 review estimated that exercise without a diet has the potential to reduce visceral fat by more than 30 square centimetres in women and more than 40 in men on a scan slice, and among aerobic studies only moderate or higher intensity worked. A high visceral adiposity index, a marker of visceral fat, is linked with heart and circulatory disease in observational studies. In our view, regular moderate to vigorous aerobic exercise with strength work twice a week, tracked with your waist to height ratio, is the practical takeaway.

Build a plan to reduce visceral fat
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Sources

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