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Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials
  1. Jamie J Edwards1,
  2. Algis H P Deenmamode1,
  3. Megan Griffiths1,
  4. Oliver Arnold1,
  5. Nicola J Cooper2,
  6. Jonathan D Wiles1,
  7. Jamie M O'Driscoll1
  1. 1School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
  2. 2Department of Health Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr Jamie M O'Driscoll, Canterbury Christ Church University, Canterbury, UK; jamie.odriscoll{at}


Objective To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices.

Design Systematic review and network meta-analysis.

Data sources PubMed (Medline), the Cochrane library and Web of Science were systematically searched.

Eligibility criteria Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included.

Results 270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (−4.49/–2.53 mm Hg, p<0.001), dynamic resistance training (–4.55/–3.04 mm Hg, p<0.001), combined training (–6.04/–2.54 mm Hg, p<0.001), high-intensity interval training (–4.08/–2.50 mm Hg, p<0.001) and isometric exercise training (–8.24/–4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively.

Conclusion Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.

  • exercise
  • exercise training
  • preventive medicine
  • sports medicine

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  • Correction notice This article has been corrected since it published Online First. The article type has been changed to systematic review.

  • Contributors JE and JO contributed to the conception and design of the study: contributed to the development of the search strategy; conducted the systematic review. JE, AD, MG and OA completed the acquisition of data. JE, NJC, and JO performed the data analysis. JE and JO were the principal writers of the manuscript. All authors contributed to the drafting and revision of the final article. All authors approved the final submitted version of the manuscript.

  • Funding No sources of funding were used to assist in the preparation of this article. NJC is supported by the National Institute for Health and Care Research (NIHR) Complex Reviews Support Unit (project number 14/178/29) and NIHR Applied Research Collaboration East Midlands (ARC EM). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.