Acute and chronic effects of cumulative vs. continuous physical activity on cardiovascular metabolic risk biomarkers in adults: a systematic review and meta-analysis

Objective Current systematic reviews and meta-analyses comparing the effects of accumulated versus continuous exercise on cardiometabolic risk markers in adults remain scarce, and conclusions from existing primary studies are inconsistent. This study aimed to: (1) quantify the acute and chronic intervention effects of accumulated bouts of exercise versus continuous exercise on cardiometabolic risk markers in adults; (2) objectively identify between-group differences across all outcome indicators, so as to provide evidence-based references for the optimization of exercise prescription. Methods Databases were searched from inception to January 7, 2026, with records imported into EndNote 20. Based on the PICOS framework, two researchers independently screened literature, extracted data, and resolved discrepancies via discussion or third-party arbitration. Study quality was assessed using the PEDro and MINORS scales, and bias risk via Cochrane RoB2 and ROBINS-I tools. Stata 16.0 was used for statistical analysis with a random-effects model, supplemented by sensitivity analyses and Egger’s/Begg’s tests for publication bias. Results A total of 8,053 identified studies, 35 were included after de-duplication and full-text review. Included studies had acceptable quality and controllable bias risk; results were robust with no significant publication bias. In long-term interventions, accumulated exercise showed a small beneficial effect on weight reduction (g=-0.20, P = 0.035). For core indicators (BF, LBM, WC, blood lipids), the two modalities were equivalent. After excluding high-heterogeneity studies, their blood pressure regulatory effects were consistent. In acute interventions, accumulated exercise exerted time-dependent effects on S-SBP (advantage within 10–20 min, g=-0.61, P = 0.005) and S-DBP (reduction within 20–40 min, g=-0.61, P = 0.018), and demonstrated small-to-moderate/moderate advantages in improving S-TG-iAUC (g=0.24, P = 0.03) and S-ASI (g=-0.41, P = 0.028), with more pronounced benefits in the ΔCAVI subgroup (g=-0.56, P = 0.006). Conclusion Compared with continuous exercise, volume-matched accumulated exercise yields statistical equivalence for most long-term cardiometabolic risk biomarkers, with only trivial statistically significant differences observed in body weight. Acute single-bout accumulated exercise merely induces transient improvements in partial blood pressure, vascular and lipid indicators without sustained long-term benefits. The evidence-based findings herein support the formulation of individualized exercise prescriptions based on participants’ time adherence and provide objective quantitative evidence to underpin accumulated exercise interventions.