Comparative effects of hypoxic exercise training modalities on cardiometabolic health: A systematic review and network meta-analysis

While the benefits of various training modalities on cardiometabolic health and body composition are well-established under normoxic conditions, their efficacy in hypoxic environments remains unclear. We conducted a frequentist network meta-analysis (NMA) using random-effects models to evaluate the efficacy of hypoxic exercise modalities in individuals with excess body weight or obesity. Analysis revealed that combined hypoxic aerobic and resistance training is the most effective modality for improving body mass index, fat mass, and several cardiometabolic markers (e.g., low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure). Hypoxic aerobic training is most beneficial for reducing triglycerides, while hypoxic high-intensity interval training is best for improving maximal oxygen consumption. This first NMA of hypoxic exercise establishes a hierarchy of modality-specific effects, enabling personalized prescription for individuals with excess body weight and obesity.