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

This systematic review and network meta-analysis asked which types of exercise training most improve resting blood pressure. Researchers pooled 270 randomised controlled trials with 15,827 participants total, comparing aerobic exercise, dynamic resistance training, combined training, high-intensity interval training (HIIT) and isometric exercise (holding a static muscle contraction, like a wall squat) against non-exercise control groups. All five exercise modes produced statistically significant reductions in systolic and diastolic blood pressure compared to control, ranging from about -4 to -8 mmHg systolic. Network analysis ranked isometric exercise as most effective for lowering systolic blood pressure, followed by combined training, resistance training, aerobic exercise and HIIT.

Isometric wall squats and running emerged as the top specific exercises for systolic and diastolic reductions respectively. As with any network meta-analysis, indirect comparisons across many trial designs carry more uncertainty than direct head-to-head trials, and the abstract does not report on heterogeneity or risk of bias across the included studies.

This large research review looked at whether different kinds of exercise can lower blood pressure when people are resting. The researchers combined results from 270 separate clinical trials involving 15,827 participants in total, comparing people who exercised against those who did not. They found that several types of exercise, including regular cardio (aerobic exercise), weight training, a mix of both, high-intensity interval training, and isometric exercises (where you hold a muscle contraction still, like a wall squat), were all linked to statistically significant drops in resting blood pressure.

Isometric exercise showed the largest average reductions, with wall squats standing out for lowering the top blood pressure number and running for the bottom number. Because this analysis combined many different studies using indirect comparisons between exercise types, some of these rankings carry more uncertainty than a single head-to-head trial would. The study did not report on how consistent the results were across studies or on the quality of the original trials, so these findings should be seen as an overall pattern rather than a precise, individual prediction.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This network meta-analysis pooled 270 RCTs (n=15,827) examining aerobic, dynamic resistance, combined, HIIT and isometric training against non-exercise controls for resting blood pressure. Pairwise analyses showed statistically significant reductions across all modes, with isometric training producing the largest effect sizes (-8.24/-4.00 mmHg) and combined training the largest among traditional modes (-6.04/-2.54 mmHg). SUCRA rankings from the network meta-analysis placed isometric training first (98.3%) for systolic blood pressure, followed by combined training, resistance training, aerobic training and HIIT, with isometric wall squats and running identified as the top submodes for systolic and diastolic reductions respectively.

These rankings are based on indirect comparisons across a heterogeneous set of trials and interventions, which inherently carries more uncertainty than direct comparisons. The abstract does not report heterogeneity statistics, risk-of-bias assessment, or certainty ratings for the pooled estimates, so the strength of evidence underlying these rankings cannot be fully appraised from the data given. The large sample size and study count support the overall direction of effect across exercise modes, but the relative superiority of isometric training warrants cautious interpretation given the network meta-analysis methodology and unreported study quality.