Issue 24-5, 2025

Review

https://doi.org/10.38025/2078-1962-2025-24-5-8-26

Effectiveness of Physical Exercise in Arterial Hypertension: a Systematic Review and Network Meta-Analysis

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ORCIDAlexander V. Meshtel1,*, ORCIDAlexandr B. Miroshnikov1, ORCIDPolina D. Rybakova2, ORCIDAndrei V. Smolensky1

1 Russian University of Sports "GTSOLIFK", Moscow, Russia
2 Moscow Center of Advanced Sport Technologies, Moscow, Russia


ABSTRACT

Резюме (EN):

INTRODUCTION.  Cardiovascular diseases, especially coronary heart disease and strokes, are the leading cause of death (31 % of cases), with hypertension being a key risk factor. Physical exercise, including moderate continuous training and high-intensity interval training, has been proven to reduce blood pressure, but the optimal protocol remains a matter of debate.

AIM.  To compare the effectiveness of different physical activity regimens in reducing blood pressure and improving cardiorespiratory fitness in patients with arterial hypertension.

MATERIALS AND METHODS.  The search was conducted in PubMed, eLIBRARY.RU, Google Scholar, and other databases using standardized PICOS criteria, including only RCTs with an intervention duration of ≥ 2 weeks. The analysis was performed with an assessment of the risk of bias (Rob 2), reliability of evidence (GRADE), and statistical models (SUCRA, node-splitting), including meta-regression to account for covariates. The results are presented as mean differences (MD) with 95 % CI.

RESULTS AND DISCUSSION.  Of the 9,462 publications, 67 studies (4,466 participants) remained after elimination of duplicates and screening. Seven physical training protocols were analyzed (high volume high intensity interval training (HV-HIIT), Low volume HIIT (LV-HIIT), moderate continuous training (MICT), combined MICT + strength training (MICT + RT), Strength training (RT), Circuit training and control group (CON)). Among all the interventions, HV-HIIT demonstrated the greatest effectiveness in reducing office systolic blood pressure (SBP) (–6.85 mmHg (–9.20; –4.50); high level of evidence), whereas MICT + RT proved to be the most effective for lowering diastolic blood pressure (DBP) (–4.80 mmHg (–6.74; –2.84); moderate level of evidence). The central pulse wave velocity (CPWV) decreased most significantly with HV-HIIT (–1.33 m/s (–1.58; –1.08); moderate evidence), and maximum oxygen consumption (VO2max) increased with the same protocol (+6.38 ml/kg/min (4.91; 7.84); high evidence). Circuit training and resistance training (RT) showed the least effectiveness in reducing blood pressure and improving cardiorespiratory parameters.

CONCLUSION.  The study demonstrates that HV-HIIT is the most effective method for reducing systolic blood pressure (SBP) and improving cardiorespiratory endurance (VO2max), while MICT + RT reduces DBP better. However, data on DBP needs to be clarified due to the heterogeneity of power programs. Long-term studies are needed to clarify the effects of different HIIT protocols on hypertension and to classify training regimens in more detail.

REGISTRATION:   PROSPERO identifier No. CRD420250655946, registered 22.02.2025.


KEYWORDS: hypertension, high blood pressure, exercise, rehabilitation, cardiorespiratory fitness

FOR CITATION:

Meshtel A.V., Miroshnikov A.B., Rybakova P.D., Smolensky A.V. Effectiveness of Physical Exercise in Arterial Hypertension: a Systematic Review and Network Meta-Analysis. Bulletin of Rehabilitation Medicine. 2025; 24(5):8–26. https://doi.org/10.38025/2078-1962-2025-24-5-8-26 (In Russ.). 

FOR CORRESPONDENCE:

Alexander V. Meshtel, Е-mail: meshtel.author@yandex.ru


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