Comparative effectiveness of various exercise modalities on arterial stiffness and endothelial function in older adults: a systematic review and network meta-analysis of randomised controlled trials

Figure 1. Flowchart of literature search and selection process.

Figure 2. Network geometry for FMD. The diameter of each node is proportional to the total number of participants randomised to each intervention modality; The thickness of the connecting lines (edges) corresponds to the number of direct head-to-head trials between interventions.The structural matrix of the evidence base was mapped via network geometry (Figure 2A), which demonstrated comprehensive network connectivity predominantly anchored by the CON node. The presence of a closed loop among CON, AT, and WT structurally enabled both direct and indirect comparisons, thereby enhancing the statistical stability of the subsequent global consistency model. AT, aerobic training; CON, non-exercise control; CT, combined training; MBE, mind–body exercise; RT, resistance training; WBV, whole-body vibration; WT, walking training.

Figure 3. Forest plot of the network meta-analysis illustrating the relative effectiveness of six exercise intervention modalities vs. CON for the improvement of FMD. The plot presents the pooled mean differences (MDs) with 95% confidence intervals (CIs) for each intervention modality relative to the CON.

Figure 4. Network geometry for cfPWV. the diameter of each node is proportional to the total number of participants randomised to each intervention modality; the thickness of the connecting lines (edges) corresponds to the number of direct head-to-head trials between interventions. AT, aerobic training; CON, non-exercise control; CT, combined training; RT, resistance training; SE, stretching exercise; WBV, whole-body vibration; WT, walking training.

Figure 5. Forest plot of the network meta-analysis illustrating the relative effectiveness of six intervention modalities vs. CON for the reduction of cfPWV. The plot presents the SMDs with 95% CIs for each intervention modality relative to the CON.

Figure 6. Network geometry for baPWV. the diameter of each node is proportional to the total number of participants randomised to each intervention modality; the thickness of the connecting lines (edges) corresponds to the number of direct head-to-head trials between interventions. AT, aerobic training; CON, non-exercise control; CT, combined training; MBE, mind–body exercise; RT, resistance training; WBV, whole-body vibration; WT, walking training.

Figure 7. Forest plot of the network meta-analysis illustrating the relative effectiveness of six exercise intervention modalities vs. CON for the reduction of baPWV. The plot presents the SMDs with 95% CIs for each intervention modality relative to the CON.

Figure 8. Network geometry for SBP. The diameter of each node is proportional to the total number of participants randomised to each intervention modality; the thickness of the connecting lines (edges) corresponds to the number of direct head-to-head trials between interventions. AT, aerobic training; CON, non-exercise control; CT, combined training; MBE, mind–body exercise; RT, resistance training; SE, stretching exercise; WBV, whole-body vibration; WT, walking training.

Figure 9. Forest plot of the network meta-analysis illustrating the relative effectiveness of seven exercise intervention modalities vs. CON for the reduction of SBP. The plot presents the pooled MDs with 95% CIs for each intervention modality relative to the CON group.

Figure 10. Network geometry for DBP. The diameter of each node is proportional to the total number of participants randomised to each intervention modality; the thickness of the connecting lines (edges) corresponds to the number of direct head-to-head trials between interventions. AT, aerobic training; CON, non-exercise control; CT, combined training; MBE, mind–body exercise; RT, resistance training; SE, stretching exercise; WBV, whole-body vibration; WT, walking training.

Figure 11. Forest plot of the network meta-analysis illustrating the relative effectiveness of seven exercise intervention modalities vs. non-exercise controls for the reduction of DBP. The plot presents the pooled MDs with 95% CIs for each intervention modality relative to the CON.