This systematic review and network meta-analysis evaluated the effectiveness of various exercise modalities in prediabetes, focusing on glycemic control, weight loss, and cardiovascular health. Twenty-four studies involving 1946 participants were included, with seven exercise intervention models analyzed. The results showed that moderate-intensity aerobic exercise combined with low-to-moderate-load resistance training was most effective in improving glycated 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 most effective in improving fasting blood glucose (FBG), while vigorous-intensity aerobic exercise showed the most significant improvements in 2-hour post-meal blood glucose (2hPG) and systolic blood pressure (SBP). Moderate-intensity aerobic exercise showed the most significant improvements in diastolic blood pressure (DBP). The study found that moderate-intensity aerobic exercise combined with low-to-moderate-load resistance training had the best overall effects on glycemic control, weight loss, and cardiovascular health in prediabetes. These findings provide valuable guidance for rehabilitation clinicians and patients to follow. The study also identified that older patients (>60 years) showed greater improvements in fasting blood glucose, and longer training durations led to better improvements in HbA1c, TC, and BMI. However, the optimal intensity and type of exercise remained moderate-intensity aerobic exercise combined with low-to-moderate-intensity resistance training. The study had several strengths, including a systematic and exhaustive review with a large sample size and the inclusion of only randomized controlled trials (RCTs), which are the gold standard for assessing intervention effectiveness. However, the study also had limitations, such as variability in study populations and the lack of follow-up data to determine the duration of exercise effects. Additionally, the study did not include all possible exercise interventions, and the results should be interpreted with caution due to the lack of direct evidence for some interventions. The findings suggest that moderate-intensity aerobic exercise combined with low-to-moderate-load resistance training is the most effective exercise modality for improving glycemic control, weight loss, and cardiovascular health in prediabetes. These results provide new insights for glycemic control and offer a basis for future research on different types of prediabetes and exercise interventions. The study also highlights the importance of considering individual factors such as age, gender, and exercise duration when designing exercise prescriptions for patients with prediabetes.This systematic review and network meta-analysis evaluated the effectiveness of various exercise modalities in prediabetes, focusing on glycemic control, weight loss, and cardiovascular health. Twenty-four studies involving 1946 participants were included, with seven exercise intervention models analyzed. The results showed that moderate-intensity aerobic exercise combined with low-to-moderate-load resistance training was most effective in improving glycated 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 most effective in improving fasting blood glucose (FBG), while vigorous-intensity aerobic exercise showed the most significant improvements in 2-hour post-meal blood glucose (2hPG) and systolic blood pressure (SBP). Moderate-intensity aerobic exercise showed the most significant improvements in diastolic blood pressure (DBP). The study found that moderate-intensity aerobic exercise combined with low-to-moderate-load resistance training had the best overall effects on glycemic control, weight loss, and cardiovascular health in prediabetes. These findings provide valuable guidance for rehabilitation clinicians and patients to follow. The study also identified that older patients (>60 years) showed greater improvements in fasting blood glucose, and longer training durations led to better improvements in HbA1c, TC, and BMI. However, the optimal intensity and type of exercise remained moderate-intensity aerobic exercise combined with low-to-moderate-intensity resistance training. The study had several strengths, including a systematic and exhaustive review with a large sample size and the inclusion of only randomized controlled trials (RCTs), which are the gold standard for assessing intervention effectiveness. However, the study also had limitations, such as variability in study populations and the lack of follow-up data to determine the duration of exercise effects. Additionally, the study did not include all possible exercise interventions, and the results should be interpreted with caution due to the lack of direct evidence for some interventions. The findings suggest that moderate-intensity aerobic exercise combined with low-to-moderate-load resistance training is the most effective exercise modality for improving glycemic control, weight loss, and cardiovascular health in prediabetes. These results provide new insights for glycemic control and offer a basis for future research on different types of prediabetes and exercise interventions. The study also highlights the importance of considering individual factors such as age, gender, and exercise duration when designing exercise prescriptions for patients with prediabetes.