Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials

Objective: To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal anti-hypertensive exercise prescription practices.<br /><br />Design: Systematic review and network meta-analysis.<br /><br />Data sources: PubMed (MEDLINE), the Cochrane library and Web of Science were systematically searched.<br /><br />Eligibility criteria: Randomised controlled trials published between 1990 and February 2023. All relevant work reporting systolic blood pressure (sBP) and/or diastolic (dBP) reductions following an exercise intervention ≥2 weeks with an eligible non-intervention control group were included.<br /><br />Results: 270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15,827 participants. Pairwise analyses demonstrated significant reductions in resting sBP and dBP following aerobic exercise training (-4.49/-2.53mmHg, P<0.001), dynamic resistance training (-4.55/-3.04mmHg, P<0.001), combined training (-6.04/-2.54mmHg, P<0.001), high intensity interval training (-4.08/-2.50mmHg, P<0.001) and isometric exercise training (-8.24/-4.00mmHg, P<0.001). As evidenced in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for sBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective sub-modes for reducing sBP (90.4%) and dBP (91.3%) respectively. <br /><br />Conclusion: Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.<br />