Effects of different exercise training modalities on 24-hour ambulatory blood pressure in adults with hypertension: a network meta-analysis of randomised controlled trials

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.