BJSM - 2026-07-06 - Journal Article; Network Meta-Analysis; Systematic Review
Effects of different exercise training modalities on 24-hour ambulatory blood pressure in adults with hypertension: a network meta-analysis of randomised controlled trials.
Mallmann Schneider V, Klarmann Ziegelmann P, Muniz Pereira D, Ferrari R
Topics
Key Takeaway
Combined training produced the largest reduction in 24-hour systolic BP (-6.18 mmHg) among hypertensive adults, but no exercise modality demonstrated superiority over another in head-to-head comparisons.
Summary Depth
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Summary
This network meta-analysis compared exercise training modalities on 24-hour ambulatory BP in hypertensive adults across 31 RCTs. Combined training reduced 24-hour SBP by 6.18 mmHg and DBP by 3.94 mmHg; aerobic training reduced SBP by 4.73 mmHg and DBP by 2.76 mmHg; HIIT reduced SBP by 5.71 mmHg and DBP by 4.64 mmHg versus control. Direct exercise-versus-exercise comparisons were inconclusive, and evidence for resistance training and non-conventional modalities (Pilates, recreational sports) remained imprecise.
Key Limitation
Exercise-versus-exercise comparisons were statistically inconclusive due to sparse direct evidence, preventing definitive ranking of modalities and limiting actionable guidance beyond aerobic/combined training.
Original Abstract
OBJECTIVE
To compare the effects of exercise training modalities on 24-hour ambulatory blood pressure in adults with hypertension.
DESIGN
Systematic review and network meta-analysis.
DATA SOURCES
MEDLINE, Embase, Cochrane Central and Regional Portal of the Virtual Health Library were systematically searched from November 2024 to August 2025. ELIGIBILITY
CRITERIA FOR SELECTING STUDIES
Randomised controlled trials evaluating the effects of exercise training (intervention duration ≥4 weeks) compared with a non-exercise control condition or another exercise modality on 24-hour systolic and diastolic blood pressure were included.
RESULTS
31 trials were included, with 67 arms and 1345 participants. In the network meta-analysis, compared with the control, combined training (mean difference (MD) -6.18 mm Hg, 95% credible interval (CrI) -11.45 to -1.21), aerobic training (MD -4.73 mm Hg, 95% CrI -7.53 to -2.01), and high-intensity interval training (MD -5.71 mm Hg, 95% CrI -11.31 to -0.002) reduced 24-hour systolic blood pressure. Reductions in 24-hour diastolic blood pressure were observed with combined training (MD -3.94, 95% CrI -6.47 to -1.34), aerobic training (MD -2.76, 95% CrI -4.21 to -1.34), high-intensity interval training (MD -4.64, 95% CrI -8.21 to -0.72) and pilates (MD -4.18, 95% CrI -7.18 to -1.17). Exercise-versus-exercise comparisons were inconclusive with respect to superiority between modalities.
CONCLUSION
Aerobic training (continuous and interval) and combined training significantly reduced 24-hour blood pressure. Evidence for dynamic and isometric resistance training remains uncertain. Data on non-conventional exercise modalities such as pilates and recreational sports are limited and imprecise for the management of ambulatory blood pressure.