Aerobic, Resistance, and Isometric Exercise to Reduce Blood Pressure Variability: A Network Meta-Analysis of 15 Clinical Trials

Elevated blood pressure variability (BPV) is an emerging independent risk factor for increased cardiovascular diseases (CVD). Many studies are exploring the impacts of regular physical exercise on reducing BPV. This study aimed to investigate whether exercise can be an intervention to control for the short-term and long-term BPV. A literature search was conducted on MEDLINE, Embase, and PsycINFO on February 10, 2025. The clinical trials and other observational studies that investigated the effects of exercise on systolic and diastolic BPV were included. There were no limitations on age, blood pressure (BP) category, or the use of antihypertensive medication. Mean differences and standard deviations (SDs) of the BPV measurements were extracted to derive standardized mean differences (SMD) with a 95% confidence interval (CI). The heterogeneity was assessed by I^2, and random-effect models were performed. Our search identified 8359 studies, of which 25 studies reported BPV outcomes. Fifteen clinical trials compared the short-term BPV among participants with or without exercise. Exercise interventions can significantly reduce both systolic BPV (SMD [95% CI] = −0.37[−0.61 to −0.12]) and diastolic BPV (−0.48 [−0.72 to −0.23]). The benefits are stronger for those with hypertension. Different types of exercise were compared in the network meta-analyses, and aerobic exercise showed more benefits than other types of exercise to improve BPV, especially on the diastolic BPV when it was compared with no exercise (−2.52 [−4.05 to −0.99]). No evidence was observed for the long-term BPV. Exercise interventions effectively reduce the variability of both systolic and diastolic blood pressure (DBP). Aerobic exercise is shown to be more effective in reducing diastolic BPV versus no exercise.