Effects of different exercise training modalities on 24-hour ambulatory blood pressure in adults with hypertension: a network meta-analysis of randomised controlled trials

Objective To compare the effects of exercise training modalities on 24-hour ambulatory blood pressure in adults with hypertension. Design Systematic review and network meta-analysis. Data sources MEDLINE, Embase, Cochrane Central and Regional Portal of the Virtual Health Library were systematically searched from November 2024 to August 2025. Eligibility criteria for selecting studies Randomised controlled trials evaluating the effects of exercise training (intervention duration ≥4 weeks) compared with a non-exercise control condition or another exercise modality on 24-hour systolic and diastolic blood pressure were included. Results 31 trials were included, with 67 arms and 1345 participants. In the network meta-analysis, compared with the control, combined training (mean difference (MD) −6.18 mm Hg, 95% credible interval (CrI) −11.45 to −1.21), aerobic training (MD −4.73 mm Hg, 95% CrI −7.53 to −2.01), and high-intensity interval training (MD −5.71 mm Hg, 95% CrI −11.31 to −0.002) reduced 24-hour systolic blood pressure. Reductions in 24-hour diastolic blood pressure were observed with combined training (MD −3.94, 95% CrI −6.47 to −1.34), aerobic training (MD −2.76, 95% CrI −4.21 to −1.34), high-intensity interval training (MD −4.64, 95% CrI −8.21 to −0.72) and pilates (MD −4.18, 95% CrI −7.18 to −1.17). Exercise-versus-exercise comparisons were inconclusive with respect to superiority between modalities. Conclusion Aerobic training (continuous and interval) and combined training significantly reduced 24-hour blood pressure. Evidence for dynamic and isometric resistance training remains uncertain. Data on non-conventional exercise modalities such as pilates and recreational sports are limited and imprecise for the management of ambulatory blood pressure.