Aerobic and Combined Training as Primary Interventions for 24-Hour Hypertensive Management

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Summary of  British Journal of Sports Medicine https://doi.org/10.1136/bjsports-2025-111474
Dr. Vinícius Mallmann Schneider et al.

Points

A network meta-analysis of 31 randomized controlled trials involving 1,345 participants identifies aerobic and combined exercise as the most effective interventions for reducing 24-hour ambulatory blood pressure.
Combined exercise training achieved the highest mean reduction in 24-hour systolic blood pressure at 6.18 mm Hg while high-intensity interval training significantly reduced diastolic blood pressure by 4.64 mm Hg.
Aerobic exercise demonstrated the most consistent blood pressure reductions across both daytime and nighttime periods due to improved endothelial function and sustained vasodilation from increased vascular shear stress.
The study suggests that resistance training should be viewed as a complementary strategy rather than a first-line treatment because high-pressure loads may induce undesirable transient arterial stiffness.
While non-conventional exercises like Pilates and yoga show promise for blood pressure management, researchers emphasize that larger standardized trials are necessary to confirm these benefits for clinical practice.

Summary

This network meta-analysis evaluated the efficacy of various exercise modalities on 24-hour ambulatory blood pressure (ABP) in adults with hypertension, pooling data from 31 randomized controlled trials involving 1,345 participants and 67 exercise types. Researchers conducted an extensive database search spanning November 2024 to August 2025 to compare aerobic training, resistance training, high-intensity interval training (HIIT), isometric exercise, and non-conventional modalities like yoga and Pilates. The primary objective was to determine which interventions most effectively mitigate 24-hour ABP fluctuations, which serve as superior prognostic indicators for cardiovascular morbidity and mortality compared to office-based readings.

The analysis demonstrated that aerobic exercise provided the most consistent reductions in both day and night ABP. Compared to sedentary controls, combined exercise training yielded the most significant mean reduction in 24-hour systolic blood pressure at 6.18 mm Hg, followed by HIIT at 5.71 mm Hg and aerobic exercise at 4.73 mm Hg. Diastolic blood pressure (DBP) reductions were also observed across multiple modalities, with HIIT leading at 4.64 mm Hg, followed by Pilates at 4.18 mm Hg, combined training at 3.94 mm Hg, and aerobic exercise at 2.76 mm Hg. While isometric exercise has been previously lauded, these findings suggest its benefits are less robust for 24-hour ambulatory profiles than for resting office measurements.

Mechanistically, the study attributes the superiority of aerobic training to enhanced endothelial function and sustained vasodilation driven by shear stress, whereas resistance training may induce transient arterial stiffness. Although Pilates, yoga, and recreational sports showed potential for DBP reduction, the evidence remains limited by small sample sizes and inconsistent reporting of participant adherence. The researchers conclude that aerobic or combined training should serve as the primary evidence-based intervention for managing hypertension, though they emphasize the need for adequately powered, standardized trials to confirm the efficacy of HIIT and non-conventional modalities in clinical practice.

Link to the article: https://bjsm.bmj.com/content/early/2026/05/03/bjsports-2025-111474

References

Mallmann Schneider, V., Klarmann Ziegelmann, P., Muniz Pereira, D., & Ferrari, R. (2026). Effects of different exercise training modalities on 24-hour ambulatory blood pressure in adults with hypertension: A network meta-analysis of randomised controlled trials. British Journal of Sports Medicine, bjsports-2025-111474. https://doi.org/10.1136/bjsports-2025-111474