Effects of six traditional Chinese mind-body exercise therapies on vascular health and cardiac function in middle-aged and elderly hypertensive patients: A network meta-analysis of 48 randomized controlled trials

BACKGROUND: Hypertension is a significant risk factor for cardiovascular disease on a global scale, particularly among middle-aged and elderly individuals. Hypertension is not only associated with cardiovascular disease, including heart disease and stroke, but also leads to vascular endothelial dysfunction and decreased cardiac function. Among non-pharmacological intervention modalities, traditional Chinese mind-body exercise therapy can regulate blood pressure, induce psychological relaxation and improve cardiovascular health through gentle exercise with respiratory regulation. However, further verification is required to confirm the specific effects of this therapy. METHODS: Relevant randomized controlled trials (RCTs) published after 2000 were searched and screened in Chinese and English databases. A systematic review and frequency network meta-analysis (NMA) were used to assess the effects of six traditional Chinese mind-body exercise therapies, Taichi, Baduanjin, Liuzijue, Shuxinpingxuegong, Qigong, and Daoyinyangshengshu, on blood pressure (systolic blood pressure, diastolic blood pressure), vascular endothelial function secretion factors (nitric oxide, endothelin-1) and cardiac function (heart rate, cardiac output, stroke volume, cardiac index, ejection fraction). The risk of bias was independently assessed using the RoB tool, and the quality of evidence for outcome indicators was evaluated using the Confidence in Network Meta-Analysis (CINeMA) online tool. RESULTS: A total of 48 RCTs (4184 patients) were included in this study, of which 77.6 % were assessed as having a low risk of bias. Of the various exercise interventions, Taichi was the most commonly used, accounting for 51.02 % of cases, while Baduanjin was the second most prevalent, representing 26.53 % of cases. The mean duration of a single exercise session for patients was 48.8 min, with most intervention cycles exceeding 12 weeks and an average frequency of 3.9 sessions per week. The NMA results revealed that Taichi was most effective in reducing systolic blood pressure (SMD = -1.10, 95 % CI -1.23, -0.98), improving cardiac output (SMD = 1.31, 95 % CI 0.42, 2.20), and enhancing cardiac index (SMD = 0.43, 95 % CI 0.02, 0.84) among middle-aged and elderly patients. Baduanjin exercise was found to be the most effective in reducing heart rate (SMD = -1.60, 95 % CI -2.01, -1.18), increasing nitric oxide levels (SMD = 0.96, 95 % CI 0.58, 1.33), and decreasing endothelin-1 concentrations (SMD = -0.91, 95 % CI -1.29, -0.52). Daoyinyangshengshu was the most effective in improving diastolic blood pressure (SMD = -1.26, 95 % CI -1.65, -0.87) and elevating stroke volume (SMD = 0.93, 95 % CI 0.47, 1.38). Liuzijue was the most effective in improving ejection fraction (SMD = 3.30, 95 % CI 1.73, 4.88). CONCLUSION: Taichi, Baduanjin and Daoyinyangshengshu are the most suitable exercise therapies for middle-aged and older patients with high blood pressure. These therapies significantly lower blood pressure and effectively improve vasodilatory function and heart work efficiency. It is recommended that the exercise be performed for a period of 60 min, 3-5 times per week, for a minimum of 12 weeks.