Effects of different exercise modalities and doses on arterial stiffness in individuals with overweight and obesity: a systematic review and Bayesian dose–response meta-analysis

OBJECTIVE: Arterial stiffness (AS), an independent cardiovascular risk factor, is elevated in individuals with overweight or obesity. Exercise is a key non-pharmacological intervention, yet the comparative efficacy and optimal dose across modalities remain unclear. This study aimed to evaluate the effects of different exercise types and doses on AS in overweight and obese populations. METHODS: A systematic search of PubMed, Web of Science, EBSCO, Cochrane Library, and Embase identified randomized controlled trials (RCTs) published up to August 2025. Bayesian network meta-analysis and dose-response analysis were conducted using Stata 17.0 and R software. RESULTS: 40 RCTs (n = 2,064) were included, covering five exercise modalities: aerobic exercise (AE), resistance training (RT), combined AE and RT (CT), high-intensity interval training (HIIT), and HIIT + RT. Compared with controls, AE (SMD = - 0.81), RT (-0.48), HIIT (-0.87), and HIIT + RT (-0.95) significantly reduced arterial stiffness, whereas CT showed a borderline reduction (SMD = - 0.39, 95% CI: - 0.79 to 0.00). HIIT + RT ranked highest in efficacy, followed by HIIT, AE, and RT, with CT ranked lowest. Bayesian dose-response analysis demonstrated a nonlinear L-shaped association, with a minimum effective dose of 92 MET-min/week and the overall benefit approaching a plateau at approximately 670 MET-min/week. Modality-specific plateau ranges were approximately 720 MET-min/week for AE, 390 MET-min/week for HIIT, and 550 MET-min/week for HIIT + RT. No significant dose-response relationship was identified for RT or CT. CONCLUSIONS: Exercise improves arterial stiffness in individuals with overweight or obesity. AE, HIIT, and HIIT + RT showed favorable effects, although the apparent superiority of HIIT + RT should be interpreted cautiously because the available evidence remains limited. The findings support the use of modality-specific dose ranges, rather than a single overall dose estimate, to inform individualized exercise prescription. Further large-scale direct randomized controlled trials are needed to confirm these findings.