Acute and chronic effect of exercise on muscle sympathetic nerve activity in hypertensive individuals: a systematic review

Abstract To examine the effects of exercise training and its governing mechanisms on muscle sympathetic nerve activity (MSNA) in hypertensive individuals. We conducted systematic searches in PubMed, Web of Science and Scopus from inception until June 2025. Studies included randomised controlled trials (RCTs), and non-randomised studies of interventions (NRSI) that focused on hypertensive patients with direct assessment of MSNA using microneurography. Studies participants underwent at least four weeks of aerobic, resistance, or breathing exercises. The revised Cochrane Risk of Bias tool (RoB 2) and the Risk Of Bias In Non-randomised Studies of Interventions tool (ROBINS-I) were used to assess the quality of the studies. Among the five trials included, three studies revealed a significant reduction in MSNA, while two reported no change after long term exercise training. The quality of three studies was rated as ‘high RoB’, one as ‘moderate RoB’, and one as ‘serious RoB’. Exercise training may reduce sympathetic activity among hypertensive individuals. However, significant heterogeneity in terms of the type of exercise, duration, and comparison group precluded us from conducting a meta-analysis, making it difficult to draw conclusive evidence. This highlights the need for further systematic exploration with more dose-response trials. (PROSPERO: CRD42024526625).