This systematic review and network meta-analysis evaluates the effectiveness of different exercise training modalities in prediabetes. The study included 24 studies involving 1,946 patients and seven exercise intervention models. The meta-analysis found that any type of exercise was more effective than no exercise in improving glycemic control, but the changes were moderate. Specifically, moderate-intensity aerobic exercise combined with low-to-moderate load resistance training showed the most significant improvements in glycosylated hemoglobin (HbA1c), body mass index (BMI), body weight (BW), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL). Low-to-moderate load resistance training was more effective in improving fasting blood glucose (FBG). Vigorous-intensity aerobic exercise showed the most significant improvements in 2-hour post-meal blood glucose (2hPG) and systolic blood pressure (SBP), while moderate-intensity aerobic exercise improved diastolic blood pressure (DBP). Subgroup analysis revealed that FBG reduction was more significant in patients over 60 years old, and improvements in HbA1c, TC, and BMI increased with training duration. The study concludes that moderate-intensity aerobic exercise, low-to-moderate load resistance training, and their combination have beneficial effects on glycemic control, weight loss, and cardiovascular health in prediabetes patients. These findings provide valuable guidance for clinicians and patients.This systematic review and network meta-analysis evaluates the effectiveness of different exercise training modalities in prediabetes. The study included 24 studies involving 1,946 patients and seven exercise intervention models. The meta-analysis found that any type of exercise was more effective than no exercise in improving glycemic control, but the changes were moderate. Specifically, moderate-intensity aerobic exercise combined with low-to-moderate load resistance training showed the most significant improvements in glycosylated hemoglobin (HbA1c), body mass index (BMI), body weight (BW), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL). Low-to-moderate load resistance training was more effective in improving fasting blood glucose (FBG). Vigorous-intensity aerobic exercise showed the most significant improvements in 2-hour post-meal blood glucose (2hPG) and systolic blood pressure (SBP), while moderate-intensity aerobic exercise improved diastolic blood pressure (DBP). Subgroup analysis revealed that FBG reduction was more significant in patients over 60 years old, and improvements in HbA1c, TC, and BMI increased with training duration. The study concludes that moderate-intensity aerobic exercise, low-to-moderate load resistance training, and their combination have beneficial effects on glycemic control, weight loss, and cardiovascular health in prediabetes patients. These findings provide valuable guidance for clinicians and patients.