- Design
- Systematic review and Bayesian network meta-analysis of randomised trials
- Population
- 284 trials, 18,750 adults with prehypertension or hypertension
- Primary outcome
- Change in resting systolic and diastolic blood pressure
- Effect
- Aquatic −10.3 mmHg systolic; mind-body −4.7 mmHg diastolic
A Bayesian network meta-analysis combined 284 randomised trials of structured exercise in 18,750 adults with prehypertension or hypertension, mean age 57, comparing ten modalities.
Aquatic exercise ranked highest for systolic pressure (mean difference −10.3 mmHg, 95% credible interval −13.1 to −7.5). Mind-body exercise ranked highest for diastolic pressure (−4.7 mmHg, −6.5 to −2.9). Dose modelling suggested isometric training had its largest modelled systolic effect at about 750 MET-minutes a week.
Rankings from network meta-analyses are fragile, trials were small and mostly short, and blinding is impossible. The useful message is broader: several kinds of exercise lower pressure by amounts comparable to a single drug, which widens the choice for patients who dislike running or cannot do it.
- Offer patients a choice of exercise type; swimming, isometric handgrip or wall-sit work, and yoga all have trial support.
- Prescribe a weekly dose and recheck home blood pressure after eight to twelve weeks.
- Consider isometric training for people with limited time or joint problems.
- Keep exercise as an addition to, not a replacement for, indicated drug treatment.
Why it matters
A patient who will not run still has exercise options that lower blood pressure meaningfully.
Don't overread it
The dose estimates are model-based and the head-to-head rankings rest mostly on indirect comparisons.
The statistics, in plain English
A credible interval is the Bayesian version of a confidence interval. The ranking score shows which option is most likely best, not how much better it is, and rankings can shift with a few new trials.
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