Combined training reduces 24-hour systolic blood pressure by 6.18 mm Hg in adults with hypertensionDifferent types of exercise show promise for managing high blood pressure

This network meta-analysis synthesized evidence from 31 trials involving a total of 1345 participants with hypertension to evaluate the efficacy of various exercise modalities. The study specifically analyzed several forms of physical activity, including combined training, aerobic training, high-intensity interval training (HIIT), and pilates, compared against non-exercise control conditions or other exercise modalities. The primary outcome measured was 24-hour systolic and diastolic blood pressure.

Regarding the primary outcomes for systolic blood pressure, combined training demonstrated a mean difference (MD) of -6.18 mm Hg (95% CrI -11.45 to -1.21) compared to control conditions. Aerobic training resulted in an MD of -4.73 mm Hg (95% CrI -7.53 to -2.01), while high-intensity interval training showed a reduction of 5.71 mm Hg (95% CrI -11.31 to -0.002). These results indicate that all three modalities were effective in reducing systolic blood pressure compared to control groups.

For the secondary outcomes involving diastolic blood pressure, combined training showed an MD of -3.94 mm Hg (95% CrI -6.47 to -1.34) compared to controls. Aerobic training resulted in a reduction of 2.76 mm Hg (95% CrI -4.21 to -1.34). High-intensity interval training showed an MD of -4.64 mm Hg (95% CrI -8.21 to -0.72), and pilates demonstrated a reduction of 4.18 mm Hg (95% CrI -7.18 to -1.17).

Safety and tolerability data were not reported in the included studies, meaning specific adverse event rates or discontinuation rates for these exercise modalities are unknown from this analysis. The study noted that while several types of training significantly reduced blood pressure compared to controls, evidence comparing different exercise modalities against one another was inconclusive regarding which specific modality was superior.

Methodological limitations include uncertain evidence regarding dynamic and isometric resistance training. Furthermore, data concerning non-conventional exercise modalities, such as pilates and recreational sports, were noted as limited and imprecise. These gaps suggest that while the primary findings for aerobic and combined training are robust, the comparative hierarchy of all types is not fully established.

Clinically, these results suggest that aerobic training (both continuous and interval) and combined training programs can significantly reduce 24-hour blood pressure in patients with hypertension. These modalities may serve as viable non-pharmacological components in a comprehensive management plan. However, the lack of clear superiority between different exercise types means clinicians can offer various options based on patient preference without necessarily favoring one specific modality over another for systolic or diastolic reduction. Questions remain regarding the optimal duration and intensity required to achieve these specific reductions, as well as the long-term sustainability of these outcomes. Additionally, more precise data is needed for non-conventional modalities like pilates to determine their specific role in hypertension management compared to standard aerobic protocols.