Network meta-analysis shows exercise modalities reduce blood pressure in adults with prehypertension or hypertension

Exercise interventions can effectively reduce blood pressure (BP), but the optimal exercise modality and dose remain unclear. This study aimed to compare the effects of different exercise modalities and doses on systolic and diastolic BP using Bayesian network meta-analysis and dose-response modeling. Randomized controlled trials published up to April 2025 were searched, and a total of 105 randomized controlled trials were included. A random-effects model was applied to conduct both the network meta-analysis and dose-response analysis. Combined training and high-intensity interval training produced the most significant reductions in BP. Combined training reduced systolic BP by -12.05 mm Hg (95% CrI, -15.08 to -9.05) and diastolic BP by -6.20 mm Hg (95% CrI, -7.79 to -4.62), while high-intensity interval training reduced systolic BP by -10.97 mm Hg (95% CrI, -14.97 to -6.95) and diasatolic BP by -6.42 mm Hg (95% CrI, -8.68 to -4.16). Yoga and tai chi had moderate effects, whereas aerobic exercise, isometric exercise training, and resistance training showed relatively weaker effects. Dose-response analysis revealed a nonlinear U-shaped relationship, with the greatest benefit observed at ≈830 metabolic equivalents/min per wk, and the optimal doses varied by exercise modality. All exercise modalities can significantly reduce BP levels in individuals with prehypertension and established hypertension, and there is a nonlinear dose-response relationship between exercise volume and BP levels.