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This systematic review and network meta-analysis evaluated the effects of various exercise training modes on resting blood pressure, analyzing 270 randomized controlled trials with over 15,000 participants. The findings indicated that isometric exercise training was the most effective in reducing both systolic and diastolic blood pressure, followed by combined training and dynamic resistance training. These results aim to inform updated exercise guideline recommendations for managing arterial hypertension.

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0% found this document useful (0 votes)

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Uploaded by

Andre Louw

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Systematic review

Exercise training and resting blood pressure: a large-

scale pairwise and network meta-analysis of

Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies.
► Additional supplemental ABSTRACT
material is published online Objective To perform a large-scale pairwise and WHAT IS ALREADY KNOWN?
only. To view, please visit the ⇒ The role of exercise training as an effective non-
journal online (http://d x.doi. network meta-analysis on the effects of all relevant
org/1 0.1136/b jsports-2022- exercise training modes on resting blood pressure to pharmacological antihypertensive intervention
106503). establish optimal antihypertensive exercise prescription is generally well-established.
practices. ⇒ Traditional aerobic exercise training remains the
1
School of Psychology and Life primarily recommended exercise approach for
Design Systematic review and network meta-analysis.
Sciences, Canterbury Christ
Church University, Canterbury, Data sources PubMed (Medline), the Cochrane library the management of high blood pressure.
Kent, UK and Web of Science were systematically searched. ⇒ Current exercise guidelines for blood pressure
2
Department of Health Sciences, Eligibility criteria Randomised controlled trials control are largely based on older data,
University of Leicester, Leicester, published between 1990 and February 2023. All relevant requiring an updated analysis with the inclusion
UK of more novel exercise modes, including high-
work reporting reductions in systolic blood pressure
(SBP) and/or diastolic blood pressure (DBP) following an intensity interval training and isometric exercise
Correspondence to
Dr Jamie M O’Driscoll, exercise intervention of ≥2 weeks, with an eligible non- training.
Canterbury Christ Church intervention control group, were included. WHAT ARE THE NEW FINDINGS?
University, Canterbury, UK; Results 270 randomised controlled trials were
j amie.odriscoll@c anterbury. ultimately included in the final analysis, with a pooled ⇒ This large-scale systematic review and network
ac.u k meta-analysis of 270 randomised controlled
sample size of 15 827 participants. Pairwise analyses
demonstrated significant reductions in resting SBP trials demonstrates the optimal exercise
Accepted 16 June 2023
Published Online First and DBP following aerobic exercise training (−4.49/– prescription practices in the management of
25 July 2023 2.53 mm Hg, p<0.001), dynamic resistance training resting blood pressure.
(–4.55/–3.04 mm Hg, p<0.001), combined training ⇒ Aerobic exercise training, dynamic resistance
(–6.04/–2.54 mm Hg, p<0.001), high-intensity interval training, combined training, high-intensity
training (–4.08/–2.50 mm Hg, p<0.001) and isometric interval training and isometric exercise training
exercise training (–8.24/–4.00 mm Hg, p<0.001). As are all significantly effective in reducing resting
shown in the network meta-analysis, the rank order of systolic and diastolic blood pressure. Overall,
effectiveness based on the surface under the cumulative isometric exercise training is the most effective
ranking curve (SUCRA) values for SBP were isometric mode in reducing both systolic and diastolic
exercise training (SUCRA: 98.3%), combined training blood pressure.
(75.7%), dynamic resistance training (46.1%), aerobic ⇒ These findings provide a comprehensive data-
exercise training (40.5%) and high-intensity interval driven framework to support the development
training (39.4%). Secondary network meta-analyses of new exercise guideline recommendations
revealed isometric wall squat and running as the most for the prevention and treatment of arterial
effective submodes for reducing SBP (90.4%) and DBP hypertension.
(91.3%), respectively.
Conclusion Various exercise training modes improve
an effective means of reducing blood pressure9;
resting blood pressure, particularly isometric exercise.
however, poor adherence,10–12 adverse side effects13
The results of this analysis should inform future exercise
and economic expenditure14 are important limita-
guideline recommendations for the prevention and
tions. As such, non- pharmacological approaches
treatment of arterial hypertension.
are favoured.15 16 Exercise elicits conclusive cardio-
vascular health benefits and improves long- term
survival, with a longitudinal association between
INTRODUCTION physical activity and reduced mortality well
© Author(s) (or their Hypertension is a leading modifiable risk factor documented.17–20
employer(s)) 2023. No
commercial re-use. See rights for morbidity and mortality.1–3 While differences Previous large-scale analyses have reported signif-
and permissions. Published in diagnostic cut-off points exist in guidelines,4 5 icant systolic and diastolic blood pressure (SBP and
by BMJ. blood pressure above optimal levels is lineally asso- DBP) reductions from varying exercise modes.21–26
ciated with an escalated risk of cardiovascular Based on previous work, traditional aerobic exer-
To cite: Edwards JJ,
Deenmamode AHP, disease.6 With the prevalence of hypertension cise training (AET) remains the primarily recom-
Griffiths M, et al. increasing,7 particularly in low- and middle-income mended exercise approach for the management
Br J Sports Med countries,8 research into effective antihypertensive of resting blood pressure.4 5 However, the current
2023;57:1317–1326. interventions remains critical. Medical therapy is exercise guideline recommendations are largely

Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503 1 of 11

Systematic review
based on older data, with recent investigations demonstrating we did not unnecessarily exclude any potentially valuable data.
a growing interest in more novel exercise modes, such as high- Considering the intervention, comparator and outcome of this
intensity interval training (HIIT)27 and isometric exercise training work, trials were determined eligible if they were appropriately

Br J Sports Med: first published as 10.1136/bjsports-2022-106503 on 25 July 2023. Downloaded from http://bjsm.bmj.com/ on August 13, 2025 by guest.
(IET),24 as well as a plethora of new data on the role of indepen- randomised, and reported pre- and postintervention SBP and/or
dent dynamic resistance training (RT)28 and combined RT and DBP in both the exercise and non-intervention control group. To
AET.29 30 As a consequence, the optimal exercise intervention minimise confounding, any considerable dietary, counselling or
for the management of resting blood pressure is unknown, with exercise influence in the non-intervention control group resulted
existing guidelines probably outdated. in exclusion. Similarly, studies containing concurrent co-inter-
Therefore, this work aimed to provide an updated large- ventions to exercise (such as supplementation or medication
scale systematic review and network meta-analysis (NMA) of changes) were excluded. Only trials published in peer-reviewed
randomised controlled trials (RCTs) on the effects of exercise journals were considered and thus dissertation theses were not

Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies.
training on resting SBP and DBP. We aimed to perform indepen- eligible. Studies that might appear eligible but were excluded are
dent pairwise meta-analyses for each exercise mode with subse- available on request from the corresponding author (with the
quent comparative Bayesian NMAs. We also aimed to perform reason for exclusion).
separate baseline blood pressure-stratified analyses to determine For consistency, the exercise protocol/intensity of each
the effects of each exercise mode in those of differing blood included paper was screened against the Exercise Prescription
pressure classifications. in Everyday Practice and Rehabilitative Training (EXPERT)
tool34 to be defined and categorised. All protocols were then
METHODOLOGY stratified into one of the following primary exercise mode cate-
Search strategy gories: ‘aerobic exercise training’ (AET), ‘dynamic resistance
This review was performed in accordance with the Preferred training’ (RT), ‘combined training’ (CT), ‘high-intensity interval
Reporting Items for Systematic Reviews and Meta- Analyses training’ (HIIT) and ’isometric exercise training’ (IET). Each
(PRISMA) guidelines,31 32 with PROSPERO registration category was then further explored for appropriate subgroups,
(CRD42022326565). A comprehensive electronic database allowing for the analysis of walking, running and cycling as AET
search strategy was constructed to identify RCTs reporting the subgroups, sprint interval training (SIT) and aerobic interval
effects of an exercise training intervention on resting blood training (AIT) as HIIT subgroups, and isometric handgrip (IHG),
pressure. The systematic search was performed in PubMed isometric leg extension (ILE) and isometric wall squat (IWS) as
(Medline), the Cochrane library and Web of Science using a IET subgroups. IET programmes commonly employ protocols
combination of relevant medical subject heading (MeSH) terms of 4×2 min contractions, separated by 1–4 min rest intervals,
and text words including exercise, physical activity, blood pres- performed three times a week. IHG is often prescribed at 30%
sure and hypertension, with the Boolean search terms ‘OR’ and maximum voluntary contraction, while IWS and ILE protocols
‘AND’ (online supplemental appendix A). No search filters or are typically performed at 95% of the peak heart rate achieved
limits were applied. Separately, the reference lists of previous during a laboratory-based maximal incremental isometric exer-
systematic reviews and meta-analyses were hand searched for cise test. The IWS may also be prescribed using a self-selected
additional reports not identified in the initial search. Trials wall squat, with a knee joint angle that would elicit a rate of
published between 1990 and February 2023 were considered perceived exertion (RPE) of 3.5–4.5/10 for bout 1; RPE 5–6/10
eligible. for bout 2; RPE of 6.5–7.5/10 for bout 3 and RPE of 8–9/10
for bout 4. This review defines HIIT as ‘episodic short bouts of
Screening and study eligibility high-intensity exercise separated by short periods of recovery
Following the systematic search, two authors (AD and OA) inde- at a lower intensity’.35 As subgroups of HIIT, SIT was defined
pendently screened all papers for eligibility. Studies were initially as an ‘all-out’ maximal, low-volume protocol, whereas aerobic
screened by title and abstract, and subsequently by full text if interval training AIT consisted of 4×4 min protocols of a lower
they met the predetermined inclusion criteria. Any inconsis- intensity.
tency and disagreements were discussed by the researchers and For baseline blood pressure stratified analyses, all included
a consensus was reached with the opinion of a fourth researcher studies were categorised as normotension, prehypertension or
(JE), if necessary. Following study recruitment, the respective hypertension based on the baseline SBP and DBP of both the
data of all included studies were extracted via Microsoft Excel. intervention and control group. In accordance with the Euro-
A third reviewer (MG) independently assessed and verified all pean Society of Hypertension/European Society of Cardiology
data extraction. Baseline and postintervention mean (SD) SBP (ESC/ESH) guidelines,5 the SBP and DBP status subgroups were
and DBP data were initially extracted owing to the common categorised as normotension, prehypertension or hypertension,
absence of change data being reported in exercise training and with values equal to <130/85 mm Hg, 130–139/85–89 mm Hg
blood pressure RCTs. As required for NMAs, we acquired mean or >140/90 mm Hg, respectively. Studies in which the interven-
change from the baseline and postintervention values. Following tion and control groups differed in baseline blood pressure cate-
the Cochrane Handbook for Systematic Reviews of Interventions gories were excluded from this analysis.
(Chapter 6),33 we aimed to calculate SD change from standard
errors, 95% CIs, p values or t statistics where available. When
studies did not report any such data, SD change was calculated Study quality
using a correlation coefficient of 0.8 as previously tested and Risk of bias and methodological rigour were evaluated using
validated in a similar dataset.22 the TESTEX scale.36 TESTEX is a 15- point (12 item) tool
Following the participants, interventions, comparators, designed for the assessment of exercise training trials. As previ-
outcomes PICO) framework, the population included adult ously demonstrated in such large-scale reviews,22 a random 10%
humans with no predetermined limitations on health or disease sample of trials from each exercise mode was selected for risk
state in representation of the general population, which ensured of bias assessment. Two reviewers (AD and JE) independently

2 of 11 Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503

Systematic review
scored all selected articles. Any disputes in quality analyses were uses R packages ‘gemtc’ and ‘BUGSnet’ for Bayesian statistical
resolved by consensus. calculations. This analysis runs Markov chain Monte Carlo
simulations with four chains and a total of 25 000 iterations

Br J Sports Med: first published as 10.1136/bjsports-2022-106503 on 25 July 2023. Downloaded from http://bjsm.bmj.com/ on August 13, 2025 by guest.
Statistical analysis (burn-in period of 5000). Convergence of the model was tested
The pairwise meta-analyses were performed using Comprehen- via the Gelman- Rubin convergence assessment.40 Based on
sive Meta-Analysis, version 3 (Biostat, Englewood, New Jersey, pre-established interstudy heterogeneity, random-effects anal-
USA). A pooled analysis was separately performed for each of yses of WMD were selected. Inconsistency between direct and
the primary (AET, RT, CT, HIIT, IET) and secondary (walking, indirect effect size comparisons were assessed via node-splitting
cycling, running, SIT, AIT, IHG, IWS and ILE) exercise mode models41 with corresponding Bayesian P values. Residual devi-
groups to establish the weighted mean difference (WMD) in SBP ance plots for the NMA with consistency models and unrelated
and DBP between the exercise group and the non-intervention mean effect inconsistency models were produced. For any

Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies.
controls. Parallel pooled analyses were also performed in only studies with large residual deviance (>2), further exploration
those studies free from any cardiovascular or other disease. Each was planned and exclusion in a sensitivity analysis. To assess the
primary exercise mode group was then further dichotomised by moderator effect of baseline SBP and DBP, Bayesian NMA meta-
categorisation of baseline blood pressure and separately anal- regression analyses were separately performed using WinBUGS
ysed. Meta-regression analyses were performed to ascertain if version 1.4.42
any study-level moderator variables influenced blood pressure Separate NMAs were run by primary exercise mode categori-
change and explain any of the observed interstudy variance in sation (AET, RT, CT, HIIT and IET), and then via secondary
outcomes. The selected moderators to be run independently exercise subgroup categorisation (walking, running, cycling, RT,
were intervention duration (in weeks), training frequency CT, SIT, AIT, IHG, ILE, IWS). As there was no pre-established
(sessions per week) and training compliance (mean percentage secondary exercise mode categorisation for RT and CT, these
of prescribed sessions attended). Statistical heterogeneity was were included in both analyses. Network diagrams were
always tested alongside the pooled analysis and reported as produced to visualise the direct and indirect comparisons across
the I² statistic. A significance threshold of 40% was applied to different exercise modes. NMA data are reported as mean effect
the I² statistic.37 Once past this threshold, post hoc tests such with 95% credible intervals. Ranking probability analyses were
as Egger’s regression test (1997) was systematically planned performed, with surface under the cumulative ranking curve
to assess the presence of funnel plot asymmetry to account for (SUCRA) values generated for each exercise mode and submode,
potential publication bias.38 The selection of fixed or random and displayed as litmus rank-o-gram SUCRA plots.43
effects approaches were dependent on the presence of hetero-
geneity, with random effects analysis applied when interstudy
variability was confirmed through significant heterogeneity. The Equity, diversity, and inclusion statement
results of the pooled analysis were considered significant with a Our study included all identified randomised controlled trials
p value of <0.05 and a Z-value of >2. of exercise training for the management of blood pressure,
To facilitate the comparison of exercise modes that have not inclusive of all genders, race/ethnicities and socioeconomic
been directly compared in RCT’s and enhance the precision of levels. Our author team consisted of two women and five men
comparative effect estimates (via the inclusion of both direct from different disciplines (medical research, sport and exercise
and indirect data), we performed NMAs. Bayesian NMAs were science, population health), including three authors considered
performed via the MetaInsight tool (version V4.0.2).39 MetaIn- junior scholars. Our research methods were not altered based on
sight is an interactive web-based tool powered by Rshiny which regional, educational or socioeconomic differences.

Figure 1 PRISMA systematic review and meta-analysis flow chart. RCT, randomised controlled trial.

Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503 3 of 11

Systematic review

RESULTS Z=8.8, prandom<0.001), 2.85 mm Hg for walking, 6.88 mm Hg

Figure 1 shows the PRISMA systematic review flow chart. The for cycling and 6.83 mm Hg for running. The post hoc Egger’s
initial systematic search identified 14 553 trials, with an addi- test was significant for overall AET SBP publication bias (online
tional 138 trials discovered through screening of previous supplemental figure S1). There were significant reductions in
meta-analyses and their respective reference lists. Following all SBP following RT by 4.55 mm Hg (95% CI 3.2 to 5.9, Z=6.6,
exclusions, 270 exercise training RCTs were ultimately included, prandom<0.001), and CT by 6.04 mm Hg (95% CI 3.2 to 8.9,
constituting an analysed sample of 15 827 (7632 controls) partic- Z=4.1, prandom<0.001). While there were significant SBP reduc-
ipants. The analysis involved 358 effect sizes, including 182 AET tions following overall HIIT by 4.08 mm Hg (95% CI 2.6 to 5.5,
(89 walking, 28 cycling, 21 running and 44 ‘0ther’ AET), 57 RT, Z=5.5, prandom<0.001) and SIT by 5.26 mm Hg, AIT did not
46 CT, 49 HIIT (of which 7 are SIT and 13 are AIT) and 24 IET significantly change. All IET modes produced significant reduc-
(17 IHG, 4 IWS, 3 ILE). tions in SBP, with an overall reduction of 8.24 mm Hg (95% CI
The full TESTEX risk of bias assessment scoring can be 6.5 to 10.0, Z=9.0, prandom<0.001), 7.10 mm Hg for IHG,
found in online supplemental table S1. The TESTEX assess- 10.05 mm Hg ILE and 10.47 mm Hg for IWS.
ment demonstrated several consistent limitations throughout Figure 3 displays the overall DBP reductions following each
the exercise training literature. In particular, most trials failed exercise mode compared with the control group. There was
to monitor control group activity or perform intention-to-treat a significant reduction in DBP following all modes of AET,
analysis when appropriate. Study and training characteristics with an overall reduction of 2.53 mm Hg (95% CI 1.8 to 3.2,
of all 270 trials are presented in online supplemental table S2. Z=7.3, prandom<0.001), 1.44 mm Hg for walking, 3.20 mm Hg
For sensitivity and comparative purposes, we also ran parallel for cycling and 5.67 mm Hg for running. The post hoc Egger’s
primary analyses excluding all diseases (such as type 2 diabetes). test was significant for overall AET DBP publication bias (online
Importantly, the inclusion/exclusion of such diseases does not supplemental figure S2). There were significant reductions in
meaningfully influence the overall results, instead often gener- DBP following RT by 3.04 mm Hg (95% CI 2.2 to 3.9, Z=6.9,
ating wider CIs following the omission of useful data (see online prandom<0.001), and CT by 2.54 mm Hg (95% CI 1.1 to 4.0,
supplemental table S4). Heterogeneity results for each analysis Z=3.4, prandom=0.001). While there were significant DBP reduc-
can be found within the respective figures. Sensitivity analysis tions following overall HIIT by 2.50 mm Hg (95% CI 1.2 to
was performed for the primary outcomes using the in- built 3.8, Z=3.8, prandom<0.001) and SIT by 3.29 mm Hg (95% CI
Comprehensive Meta- Analysis ‘one-study removed’ analysis 0.1 to 6.5, Z=2.0, prandom=0.043), AIT did not significantly
method, which did not significantly influence any of the overall change. All IET modes produced significant reductions in DBP,
effect sizes. with an overall reduction of 4.0 (95% CI 2.7 to 5.3, Z=6.0,
prandom<0.001), 3.46 mm Hg for IHG, 4.23 ILE and 5.33 for
Pairwise analyses IWS. The post hoc Egger’s test was significant for overall IET
Figure 2 displays the overall SBP reductions following each DBP publication bias (online supplemental figure S3).
exercise mode compared with the control group. There was Figure 4 shows the SBP reductions for each exercise mode
a significant reduction in SBP following all modes of AET, stratified by baseline blood pressure status. All analyses were
with an overall reduction of 4.49 mm Hg (95% CI 3.5 to 5.5, statistically significant except the prehypertension group analysis

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for CT and HIIT. While all exercise modes demonstrated statis- As shown in online supplemental table S3, there was a signif-
tically significant reductions in SBP in normal blood pressure icant SBP moderator interaction for AET, with a lower training
cohorts, all reductions were substantially larger in those with frequency associated with a greater blood pressure reduction
hypertension. Such baseline category stratified analysis was not (B=−1.0596, p=0.019). There was no significant moderator
feasible in DBP due to limited data.

Figure 4 Forest plot depicting overall effects of each primary exercise mode on systolic blood pressure (SBP) stratified via baseline blood pressure
category.

Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503 5 of 11

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effect of intervention duration, training frequency or training S5, S6, S11 and S12), inconsistency tests with node-splitting
compliance for any of the other exercise modes. models (online supplemental tables S7, S8, S13 and S14) and
the deviance report plots (online supplemental figures S4, S5,
Network meta-analyses S8 and S9) can be found in the supplementary file. There was
Figure 5 depicts the network diagrams with corresponding no evidence of inconsistency in the primary or secondary NMA.
Bayesian ranking panel plots, while tables 1 and 2, online supple- The primary exercise mode SBP NMA included 305 two-arm
mental tables S9 and S10 detail the comparative NMA findings studies, 24 multiarm trials and 11 direct comparisons. As seen in
for the primary and secondary exercise SBP and DBP mode anal- table 1 and the Bayesian treatment ranking (figure 5 and Table
yses, respectively. Advanced analysis results, including the tables S5), the order of effectiveness based on SUCRA values were IET
of rank probabilities with SUCRA (online supplemental tables (SUCRA: 98.3%), CT (75.7%), RT (46.1%), AET (40.53%)

Table 1 Comparative network meta-analysis for the systolic blood pressure primary exercise modes
AET Control CT HIIT IET RT
AET AET 4.37 (3.45, 5.28) −1.55 (−3.53, 0.43) 0.1 (−1.84, 2.03) −3.86 (−6.54,–1.19) −0.18 (−1.96, 1.6)
Control −4.37 (−5.28,–3.45) Control −5.92 (−7.71,–4.11) −4.27 (−6.02,–2.52) −8.24 (−10.74,–5.72) −4.54 (−6.16,–2.93)
CT 1.55 (−0.43, 3.53) 5.92 (4.11, 7.71) CT 1.65 (−0.85, 4.12) −2.31 (−5.42, 0.77) 1.37 (−1, 3.72)
HIIT −0.1 (−2.03, 1.84) 4.27 (2.52, 6.02) −1.65 (−4.12, 0.85) HIIT −3.95 (−7.03,–0.93) −0.28 (−2.64, 2.09)
IET 3.86 (1.19, 6.54) 8.24 (5.72, 10.74) 2.31 (−0.77, 5.42) 3.95 (0.93, 7.03) IET 3.68 (0.71, 6.66)
RT 0.18 (−1.6, 1.96) 4.54 (2.93, 6.16) −1.37 (−3.72, 1) 0.28 (−2.09, 2.64) −3.68 (−6.66,–0.71) RT
AET, aerobic exercise training; CT, combined training; HIIT, high-intensity interval training; IET, isometric exercise training; RT, dynamic resistance training.

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Table 2 Comparative network meta-analysis for the systolic blood pressure secondary exercise modes
AIT Control CT Cycling IHG ILE IWS Other aerobic RT Running SIT Walking
AIT AIT 2.53 (−0.9, −3.39 (−7.22, −4.36 (−8.51,– −4.75 (−9.34,– −7.32 (−14.99, −8 (−14.74,–1.22) −2.2 (−6.03, 1.65) −2.08 (−5.85, 1.7) −4.07 (−8.4, 0.26) −2.28 (−8.1, 3.55) −0.29 (−3.98,
5.99) 0.49) 0.18) 0.18) 0.29) 3.39)
Control −2.53 (−5.99, Control −5.91 (−7.72,– −6.88 (−9.22,– −7.29 (−10.33,– −9.84 (−16.72,– −10.52 (−16.3,– −4.73 (−6.55,– −4.61 (−6.23,– −6.61 (−9.21,– −4.81 (−9.49,– −2.82 (−4.13,–
0.9) 4.1) 4.51) 4.21) 3.03) 4.7) 2.92) 2.98) 3.97) 0.15) 1.5)
CT 3.39 (−0.49, 5.91 (4.1, CT −0.97 (−3.9, 1.99) −1.37 (−4.91, 2.2) −3.92 (−11.03, −4.6 (−10.66, 1.5) 1.19 (−1.3, 3.65) 1.31 (−1.06, 3.65) −0.69 (−3.86, 1.11 (−3.93, 6.11) 3.1 (0.86, 5.29)
7.22) 7.72) 3.13) 2.51)
Cycling 4.36 (0.18, 6.88 (4.51, 0.97 (−1.99, 3.9) Cycling −0.39 (−4.24, 3.46) −2.95 (−10.29, −3.65 (−9.92, 2.68) 2.15 (−0.85, 5.12) 2.28 (−0.57, 5.09) 0.28 (−3.26, 3.82) 2.08 (−3.19, 7.29) 4.06 (1.36, 6.74)
8.51) 9.22) 4.28)
IHG 4.75 (0.18, 7.29 (4.21, 1.37 (−2.2, 4.91) 0.39 (−3.46, 4.24) IHG −2.57 (−10.09, −3.24 (−9.83, 3.38) 2.56 (−1.04, 6.11) 2.67 (−0.78, 6.15) 0.67 (−3.35, 4.72) 2.49 (−3.15, 8.02) 4.46 (1.13, 7.79)
9.34) 10.33) 4.96)
ILE 7.32 (−0.29, 9.84 (3.03, 3.92 (−3.13, 2.95 (−4.28, 2.57 (−4.96, 10.09) ILE −0.68 (−9.69, 8.3) 5.11 (−1.96, 5.21 (−1.77, 3.23 (−4.09, 5.04 (−3.19, 7.01 (0.04, 14.05)
14.99) 16.72) 11.03) 10.29) 12.21) 12.31) 10.58) 13.34)

Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503

IWS 8 (1.22, 14.74) 10.52 (4.7, 4.6 (−1.5, 10.66) 3.65 (−2.68, 9.92) 3.24 (−3.38, 9.83) 0.68 (−8.3, 9.69) IWS 5.79 (−0.33, 5.9 (−0.13, 11.96) 3.92 (−2.5, 10.31) 5.71 (−1.71, 7.7 (1.69, 13.67)
16.3) 11.87) 13.18)
Other 2.2 (−1.65, 4.73 (2.92, −1.19 (−3.65, −2.15 (−5.12, −2.56 (−6.11, 1.04) −5.11 (−12.21, −5.79 (−11.87, Other aerobic 0.12 (−2.23, 2.48) −1.87 (−5.05, −0.08 (−5.08, 1.91 (−0.32, 4.16)
aerobic 6.03) 6.55) 1.3) 0.85) 1.96) 0.33) 1.32) 4.94)
RT 2.08 (−1.7, 4.61 (2.98, −1.31 (−3.65, −2.28 (−5.09, −2.67 (−6.15, 0.78) −5.21 (−12.31, −5.9 (−11.96, 0.13) −0.12 (−2.48, RT −2 (−5, 1.03) −0.19 (−5.16, 1.79 (−0.28, 3.84)
5.85) 6.23) 1.06) 0.57) 1.77) 2.23) 4.73)
Running 4.07 (−0.26, 6.61 (3.97, 0.69 (−2.51, −0.28 (−3.82, −0.67 (−4.72, 3.35) −3.23 (−10.58, −3.92 (−10.31, 2.5) 1.87 (−1.32, 5.05) 2 (−1.03, 5) Running 1.79 (−3.6, 7.08) 3.79 (0.83, 6.72)
8.4) 9.21) 3.86) 3.26) 4.09)
SIT 2.28 (−3.55, 4.81 (0.15, −1.11 (−6.11, −2.08 (−7.29, −2.49 (−8.02, 3.15) −5.04 (−13.34, −5.71 (−13.18, 0.08 (−4.94, 5.08) 0.19 (−4.73, 5.16) −1.79 (−7.08, 3.6) SIT 1.98 (−2.84, 6.83)
8.1) 9.49) 3.93) 3.19) 3.19) 1.71)
Walking 0.29 (−3.39, 2.82 (1.5, −3.1 (−5.29,– −4.06 (−6.74,– −4.46 (−7.79,– −7.01 (−14.05,– −7.7 (−13.67,– −1.91 (−4.16, −1.79 (−3.84, −3.79 (−6.72,– −1.98 (−6.83, Walking
3.98) 4.13) 0.86) 1.36) 1.13) 0.04) 1.69) 0.32) 0.28) 0.83) 2.84)
AIT, aerobic interval training; CT, combined training; IHG, isometric handgrip; ILE, isometric leg extension; IWS, isometric wall squat; RT, dynamic resistance training; SIT, sSprint interval training.
Systematic review

7 of 11
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Systematic review
and HIIT (39.44%). Comparatively, IET was significantly more values for SBP were IET ranked highest followed by CT, RT,
effective at reducing SBP than AET (WMD: −3.86 mm Hg, 95% AET and HIIT. IET was also highest ranked in the DBP NMA,
CI 1.19 to 6.54), HIIT (WMD: −3.95 mm Hg, 95% CI 0.93 to followed by RT, HIIT, CT and AET. NMA of the secondary

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7.03) and RT (WMD: −3.68 mm Hg, 95% CI 0.71 to 6.66). exercise submodes for SBP found IWS to be the most effective,
There were no other significant differences between primary followed by ILE, IHG, cycling, running, CT, SIT, other aerobic,
exercise modes for SBP. In agreement with the pairwise meta- RT, AIT and finally, walking. The DBP secondary NMA found
analysis, the NMA meta-regression demonstrated a significant running to be the most effective submode, followed by IWS,
moderator effect of baseline SBP across the exercise modes. IHG, ILE, cycling, SIT, RT, AIT, other aerobic, CT and walking.
Specifically, a single unit increase in mean baseline control group To our knowledge, only two previous large-scale meta-analyses
SBP increased the mean intervention change by 0.10 mm Hg of similar proportion have been performed.21 22 However, the
(95% CI 0.05 to 0.15). A sensitivity analysis was run excluding a present study is the first to incorporate HIIT as a novel exercise

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total of three trials with a residual deviance >2 (Figure S10). The mode, as well as provide advanced submode analyses of walking,
effect size of CT was lower in the sensitivity analysis, thereby cycling, running, SIT, AIT, IHG, ILE and IWS for the purpose
lowering its place in the Bayesian rankings compared with the of exercise prescription optimisation. Cornelissen et al21 simi-
primary analysis. larly reported IET to be the most effective exercise mode, but
The secondary exercise mode SBP NMA included 282 two- largely differed in magnitude for all other mode analyses, which
arm studies, 21 multiarm trials and 21 direct comparisons. The is probably attributable to the substantial number of newer trials
order of effectiveness based on SUCRA values were IET IWS included in the present analysis. This is supported by the more
(90.4%), ILE (84.7%), IHG (73.1%), cycling (69.9%), running recent Naci et al22 NMA, which did not assess DBP, but showed
(66.1%), CT (57.6%), SIT (43.3%), other aerobic (40.1%), RT more homogeneous AET, RT and CT SBP changes than in the
(38.2%), AIT (18.3%) and walking (17.4%). Comparatively, present work. Given the emphasis placed on the Cornelissen
IWS, ILE, IHG, CT, cycling and running were all significantly and Smart21 study in both the ESC/ESH5 and American College
more effective than walking. IWS, IHG and cycling were also of Cardiology/American Heart Association (ACC/AHA)4 blood
significantly more effective than AIT. There were no other signif- pressure management guidelines, the findings of the present
icant SBP differences between secondary exercise modes. study, combined with that of Naci et al,22 suggest the need for an
The primary exercise mode DBP NMA included 296 two- exercise recommendation guideline update.
arm studies, 24 multiarm trials and 11 direct comparisons. A previous meta- review from Hanssen et al44 sought to
The order of effectiveness based on SUCRA values (Figure S6) identify optimal personalised exercise prescription practices
were IET (89.0%), RT (67.6%), HIIT (51.5%), CT (46.7%) in the prevention and treatment of hypertension by indirectly
and AET (45.1%). Comparatively, there were no statistically comparing meta- analysis data from varying exercise modes.
significant differences between the primary exercise modes for Differentially, our work applied a more direct approach in statis-
DBP. In agreement with the pairwise meta-analysis, the NMA tically comparing all individual RCTs. As such, our differences
meta-regression demonstrated a significant moderator effect of in findings, particularly for IET, may be in part attributed to
baseline DBP across the exercise modes. Specifically, a single the inevitable reliance of Hanssen et al44 on older meta-analysis
unit increase in mean baseline control group DBP increased data to summarise the current effectiveness of IET,45–47 as well as
the mean intervention change by 0.06 mm Hg (95% CI 0.01 the inherent limitations of indirect meta-analytic comparisons.
to 0.12). A sensitivity analysis was run excluding a total of five In particular, this previous umbrella review showed the inequi-
trials with a residual deviance>2 (Figure S11). The effect size of table over-representation of AET and RT meta-analysis research,
CT improved while HIIT decreased in the sensitivity analysis, concurrent with the under-representation of IET, CT and HIIT
thereby increasing the place of CT and lowering HIIT in the meta- analysis work, resulting in dependence on inadequately
Bayesian rankings compared with the primary analysis. powered and dated systematic review and meta-analysis data to
The secondary exercise mode DBP NMA included 274 two- draw comparative conclusions.44 As our analysis sourced the data
arm studies, 21 multiarm trials and 21 direct comparisons. The directly from each RCT, this limiting gap between the dissemina-
order of effectiveness based on SUCRA values (Figure S7) were tion of RCT data and its eventual transfer into published meta-
running (91.3%), IWS (86.1%), IHG (57.1%), ILE (56.2%), analysis research was not present in our work.
cycling (54.3%), SIT (54.2%), RT (52.1%), AIT (48.1%), other Importantly, this updated analysis now provides large-scale
aerobic (46.9%), CT (38.0%) and walking (14.7%). Compar- data establishing CT as an effective exercise mode in reducing
atively, IWS, RT, running, cycling and other aerobic were all blood pressure, a mode which was previously considered incon-
significantly more effective than walking. Running was also clusive due to insufficient evidence.21 Naci et al22 previously
significantly more effective than CT, cycling, other aerobic and reported similar SBP changes, but without any DBP data to
RT. There were no other significant DBP differences between support, while Hanssen et al44 also provided support for CT but
secondary exercise modes. could only make limited comparative inferences on the basis of
a single meta-analysis.48 While the reductions observed from CT
ostensibly appear somewhat comparable to those of IET, our
DISCUSSION novel analysis demonstrates that this magnitude of SBP reduc-
In this systematic review and NMA, we analysed all relevant tion following CT is predominantly moderated by the greater
RCT data, involving 270 trials and 15 827 participants, to estab- prevalence of hypertensive populations included within the
lish optimal exercise prescription practices in the management analysis. Indeed, the magnitude of change is underwhelming
of resting arterial blood pressure (see figure 6). Pairwise anal- in those studies of normal blood pressure and prehypertensive
yses demonstrated a significant reduction in resting SBP and cohorts, and the NMA SBP sensitivity analysis revealed the
DBP following all exercise modes except AIT. All modes demon- fragile nature of this body of data. Separately, and conversely
strated substantially larger reductions in hypertensive cohorts to previous reports,21 RT now appears comparable to AET in
than those with normal baseline blood pressure. As shown by the reducing resting blood pressure. However, it should be noted
primary NMA, the rank order of effectiveness based on SUCRA that the effectiveness of AET seems dependent on the submode

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Systematic review

Figure 6 Central illustration. AET, aerobic exercise training; CT, combined training; HIIT, high-intensity interval training; IET, isometric exercise
training; RT, dynamic resistance training.

performed, with cycling and running significantly more effective but may provide loose support for the application of AET at a
than walking AET. Our meta-regression analyses also reported lower (eg, 3 times per week) frequency as opposed to extensive
the tendency for a greater SBP reduction with lower weekly weekly volumes (≥5 times per week).
training frequency in AET. Considering the interstudy differ- As a novel intervention, HIIT produced clinically relevant
ences in research protocols, the reason for this finding is unclear, reductions in both SBP and DBP but ranked as the least effective

Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503 9 of 11

Systematic review
among all primary modes for SBP. Secondary submode analyses assessing a compliance moderator effect among those individuals
(both pairwise and NMA) reveal the overarching SBP reductions who are already adhering.
to be primarily driven by SIT (low volume, maximal intensity

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intervals), while AIT (4×4 min intervals) failed to reach statis-
tical significance for either SBP or DBP. This finding, combined Conclusion
with the comparative inferiority of walking against running and Aerobic exercise training, dynamic resistance training, combined
cycling AET, appears to highlight the need for higher intensity training, high-intensity interval training and isometric exercise
training to produce the greatest blood pressure reductions. training are all significantly effective in reducing resting SBP
Similarly to IET, HIIT has recently generated substan- and DBP. Comparatively, isometric exercise training remains the
tial research interest due to its time-efficient and convenient most effective mode. The findings of this analysis should inform
nature, suggesting, although not without some disagreement,49 future guideline recommendations.

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the potential for increased adoption and adherence, with both
modes having promising future clinical utility.50–54 However, Correction notice This article has been corrected since it published Online First.
The article type has been changed to systematic review.
the outcomes of this analysis support our previous work,24
which concluded that IET was the superior antihypertensive Twitter Jamie J Edwards @EdwardsJ361 and Jamie M O'Driscoll @JODriscoll9
exercise mode. While IET may still require larger-scale longi- Contributors JE and JO contributed to the conception and design of the study:
tudinal RCTs,51 55 its clinical implementation as the primary 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
recommended exercise mode in managing blood pressure in
performed the data analysis. JE and JO were the principal writers of the manuscript.
normotensive, prehypertensive and hypertensive individuals is All authors contributed to the drafting and revision of the final article. All authors
supported by the present results. Importantly, the previous work approved the final submitted version of the manuscript.
of Cornelissen and Smart21 included only four IET trials in 2013. Funding No sources of funding were used to assist in the preparation of this
Since then, a number of IET trials and subsequent meta-analyses article. NJC is supported by the National Institute for Health and Care Research
over the previous decade have been published,24 45 56–58 with the (NIHR) Complex Reviews Support Unit (project number 14/178/29) and NIHR
present study including 19 RCTs. Subsequently, the confidence 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
interval of this finding has substantially narrowed,59 providing Health and Social Care.
more accurate SBP and DBP effect sizes of 8.2 and 4.0 mm Hg,
Competing interests None declared.
respectively, which is comparable to standard-dose antihyperten-
Patient consent for publication Not applicable.
sive monotherapy.60 61
Of interest, the NMA findings highlight the IWS as more effec- Provenance and peer review Not commissioned; externally peer reviewed.
tive than the traditionally employed IHG. Despite the support of Supplemental material This content has been supplied by the author(s). It
this analysis for IET, a degree of caution when interpreting these 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
findings is advised given the current disparity in the quantity
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
of trials analysed.56 As seen in figure 5, the NMA included no responsibility arising from any reliance placed on the content. Where the content
direct comparative IET data. Previous trials that did not meet the includes any translated material, BMJ does not warrant the accuracy and reliability
inclusion criteria of this analysis have indeed shown conflicting of the translations (including but not limited to local regulations, clinical guidelines,
results regarding the comparative effectiveness of IET against terminology, drug names and drug dosages), and is not responsible for any error
and/or omissions arising from translation and adaptation or otherwise.
current exercise guidelines,62 63 which requires consideration
when interpreting these findings. ORCID iDs
Jamie J Edwards http://orcid.org/0000-0001-7963-2550
Jamie M O’Driscoll http://orcid.org/0000-0002-5923-4798
Limitations
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36 Smart NA, Waldron M, Ismail H, et al. Validation of a new tool for the assessment 63 Goessler KF, Buys R, VanderTrappen D, et al. A randomized controlled trial comparing
of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based home-based Isometric Handgrip exercise versus endurance training for blood pressure
Healthc 2015;13:9–18. management. J Am Soc Hypertens 2018;12:285–93.

Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503 11 of 11

BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) Br J Sports Med

Exercise training and resting blood pressure: a large-scale pairwise and network meta-
analysis of RCTs

Edwards, J.J1., Deenmamode, A.H.P1., Griffiths, M1., Arnold, O1., Cooper, N.J., Wiles, J.D.,
& O’Driscoll, J.M1.

1
School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1
1QU
2
Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH

Correspondence to Dr Jamie O’Driscoll, School of Psychology and Life Sciences, Canterbury

Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU. Email:
[email protected]; Telephone: 01227782711.

Supplementary File

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Appendix S1. Search Strategy

All searches were originally performed on 02/10/21 and subsequently updated on 03/02/2023.
PubMed:
10,051 results
Set 1: ("exercise"[MeSH Terms] OR "exercise training"[Text Word])
Set 2: ("blood pressure"[MeSH Terms] OR "arterial pressure"[Text Word])
Search Performed: #1 AND #2

Cochrane:
2,169 results
ID Search Hits
#1 MeSH descriptor: [Exercise] explode all trees
#2 MeSH descriptor: [High-Intensity Interval Training] explode all trees
#3 MeSH descriptor: [Walking] explode all trees
#4 MeSH descriptor: [Jogging] explode all trees
#5 MeSH descriptor: [Resistance Training] explode all trees
#6 #1 OR #2 OR #3 OR #4 OR #5
#7 MeSH descriptor: [Blood Pressure] explode all trees
#8 MeSH descriptor: [Arterial Pressure] explode all trees
#9 MeSH descriptor: [Hypertension] explode all trees
#10 #7 OR #8 OR #9
#11 #6 AND #10 2169

Web of Science:
2333 results (Web of Science Core Collection)
Set 1: TS=("exercise training")
Set 2: TS=("blood pressure") OR TS=("arterial pressure")
Search Performed: #1 AND #2

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Table S1. Risk of bias TESTEX scoring.

Outcome
measures Between
assessed group Activity Relative Exercise
Eligibility Groups >85% Intention statistical Point monitoring exercise volume &
criteria Randomisati Allocation similar at Assessors of to treat comparisons estimates in control intensity energy Overall
Study name specified on specified concealment baseline blinded participants analysis reported reported group review expended TESTEX

Albright et
al., 1991 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Aoike et al.,
2015 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Brandon &
Elliot-
Lloyd., 2006 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Brenner et
al., 2019 YES NO NO YES NO YES (3) NO YES (2) YES NO YES YES 10

Sohn et al.,
2007 YES NO NO YES NO YES (2) NO YES (2) YES NO NO NO 7

Wallis et al.,
2016 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Goldberg et
al., 2012 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Magalhães et
al., 2019 YES YES NO YES YES YES (2) NO YES (2) YES NO YES YES 11

Mora-
Rodriguez et
al., 2017 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Foulds et al.,
2014 YES NO NO YES NO YES (2) NO YES (2) YES NO NO NO 7

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Tsai et al.,
2004 YES NO NO YES NO YES (2) NO YES (2) YES NO NO YES 8

Blumenthal
et al., 1991 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Fenkci et al.,
2006 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Guimaraes et
al., 2010 YES YES NO YES YES YES (2) NO YES (2) YES NO YES YES 11

Yavari et al.,
2012 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Beltran Valls
et al., 2013 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Conceicao et
al., 2013

YES NO NO YES NO YES (1) NO YES (2) YES NO YES YES 8

DeVallance
et al., 2016 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Olson et al.,
2006 YES YES NO YES NO YES (2) NO YES (2) YES NO YES YES 10

Venojarvi et
al., 2013 YES NO NO YES NO YES (1) NO YES (2) YES NO YES YES 8

Figueroa et
al., 2011 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Seo et al.,
2010 YES NO NO YES NO YES NO YES (2) YES NO YES YES 8

Park et al.,
2020 YES YES NO YES NO YES (2) NO YES (2) YES NO YES YES 10

Shiotsu et
al., 2018 YES NO NO YES NO YES (2) NO YES (2) YES NO YES YES 9

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Taylor
(2018) YES NO NO YES NO YES (1) NO YES (2) YES NO YES NO 7

Yamagata et
al (2020) YES YES NO YES NO YES (2) NO YES (2) YES NO YES NO 9

O’Driscoll
(2018) YES NO NO YES YES YES (1) NO YES (2) YES NO NO YES 8

Edwards et
al (2020) YES NO NO YES NO YES (2) NO YES (2) YES NO NO YES 8

Sandstad et
al (2015) YES YES NO YES NO NO NO YES (2) YES NO YES YES 8

May (2018) YES NO YES YES NO YES (1) NO YES (2) YES NO NO YES 8

Note: Black= Walking trials, Gold= Cycling, Dark Blue= Running, Orange= ‘Other’ Aerobic, Purple= Resistance Training, Green= Combined
Training, Red= Isometric Exercise Training, Light Blue= High intensity Interval Training

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Table S2. Study and Training Characteristics.

Study Country Population Mode Intensity Duration Freq p/w
weeks
Walking
Albright et al., 1991 USA Healthy Walking 65-77% Peak Hr from Baseline Test 24 5
Aoike et al., 2015 BRAZIL Chronic Kidney Disease Walking 40-60% Minimum Vo2 12 3
Araiza et al., 2006 USA T2D Walking Nr 6 5
Arca et al., 2014 BRAZIL Hypertensive Postmenopausal Walking 50-60%Hrr 12 3
Arija et al., 2017 SPAIN Primary Care Walking 396Mets/Min/Week 36 2
Arora et al., 2009 INDIA Type 2 Diabetes Walking Nr 8 3
Asikainen et al., 2003 FINLAND Postmenopausal Women Walking Up To 65% Max Aerobic Power 10 5
Baker et al., 2008 UK Healthy Walking 12 To 14 On Borg Scale 12 5
Baross et al., 2017 UK Healthy Walking 6.5Km/H 6 4
Bell et al., 2010 CANADA Healthy Walking 5600-10000 Steps Per Day 24 7
Braith et al., 1994 USA Normotensives Walking 50-70% Hrr or 50-85% Hrr 26 3
Brandon & Elliot-Lloyd., 2006 USA Sedentary Women Walking Nr 18 3
Brenner et al., 2019 CANADA Peripheral Artery Disease Walking <40% Hrr 12 5
Brixius et al., 2008 GERMANY Overweight Men 50-60 Y/O Walking 2-4 Mmol/L Lactate 24 3
Brown et al., 2014 UK Healthy Walking Nr 8 2
Chiang et al., 2019 TAIWAN Obese Walking 12000 Steps/Day, 103Steps/Min^-1 8 5
Coghill et al., 2008 UK Hypercholesterolemia Men Walking 12000 Steps Per Day 12 5
Cooper et al., 2000 UK Hypertension Walking 150-200Kcal Daily 6 5
Dalleck et al., 2009 USA Post-Menopausal Women Walking 50% Vo2R 12 5
Duncan et al., 1991 USA Sed Premenopausal Walking 8Kmh 24 5
Foulds et al., 2014 GERMANY Active Participants Walking Nr 13 1-3
Fritz et al., 2013 SWEDEN T2D Walking Pace That Caused Slight Shortness of 16 Nr
Breath
Goldie et al., 2012 CANADA Hypertensives Walking Less Than 40%Hrr 12 7

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Gradidge & Golele., 2018 SOUTH AFRICA Healthy Women Walking Nr 12 3

Hamdorf et al., 1999 AUSTRALIA Elderly Women Walking 40-60%Hrr 24 2
He et al., 2018 CHINA Elderly Essential Hypertension Walking 40-50 Vo2Max 12 3
Headley et al., 2017 USA Chronic Kidney Disease Walking 50-60% Vo2 Peak 16 3
Herzig et al., 2014 FINLAND Pre-Diabetes Walking 3-4Kmh 12 3
Higashi et al., 1999 JAPAN Hypertension Walking Around 50% Vo2Max 12 5-7
Hur et al., 2014 KOREA Type D Personality Walking 60-70% Hr Max 40 3
Khalid et al., 2013 LYBIA Postmenopausal Walking 60-75%Hrmax 8 3
Koh et al., 2010 AUSTRALIA Hemodialysis Patients Walking 12-13 Borg Scale 24 3
Kucio et al., 2017 POLAND Hypertensive Walking 40-70 Maximum Hr 4 5
Kurban et al., 2011 TURKEY T2D Walking Nr 12 3
Latosik et al., 2014 POLAND Hypertensive Postmenopausal Walking 40-70% 8 nr
Lee et al., 2007 TAIWAN Hypertensives Walking Nr 24 nr
Lim et al., 2015 SOUTH KOREA Night Shift Workers Walking 60-79% Maximal Hr 10 3
Murphy et al., 1998 IRELAND Sed Walking 70-80%Hrmax 10 5
Murphy et al., 2006 UK Sedentary Civil Servants Walking Nr 8 2
Murtagh et al., 2005 UK Healthy Walking Self-Reported Rpe 12 3
Myslivecek et al., 2002 CANADA Premenopausal Women Walking 13 Borg Scale Rpe 12 5
Nemoto et al., 2007 JAPAN Older Adults Walking 50%Vo2Peak 20 >4
Neumann et al., 2006 USA Silent Myocardial Ischemia Walking 70%Hrr 24 3
Palmer et al., 1995 USA Healthy Walking 60-70%Hrmax 8 Nr
Pospieszna et al., 2017 POLAND Postmenopausal Walking 90% Ventilators Threshold 12 3
Punia et al., 2022 INDIA Pre-Hypertensives and Hypertensives Walking 60-70% Target Hr 8 3
Ready et al., 1996 CANADA Postmenopausal Walking 70-80%Hrmax or 60%Vo2Peak 24 3-5
Ruangthai & Phoemsapthawee., THAILAND Hypertensives Walking 60-70%Hrmax 12 3
2019
Saptharishi et al., 2009 INDIA Prehypertensive And Hypertensives Walking Nr 8 4
Serwe et al., 2011 USA Healthy Walking 60-70%Hrr 8 5-7

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Shenoy et al., 2010 INDIA T2D Walking 60-70%Hrr or 50-70%Hrmax 8 5

Simons et al., 2006 USA Elderly Adults Walking Nr 16 2
Sohn et al., 2007 USA Hypertensive Walking Nr 26 5-7
Stutzman et al., 2010 CANADA Pregnant Walking 11-13 Rpe 16 5
Tudor-Locke et al., 2004 CANADA T2D Walking Nr 12 4
Tully et al., 2005 IRELAND Healthy Sed Walking Slightly Breathless 12 5
Tully et al., 2007 UK Healthy Sed Walking Self-Paced 12 3-5
Tully et al., 2011 UK University Students Walking 15% Vo2 Max 6 7
Venojarvi et al., 2013 FINLAND Men with Impaired Glucose Walking 55-75% Hr Reserve 12 3
Regulation
Venturelli et al., 2011 ITALY Alzheimers Walking As Fast As Possible 24 4
Wallis et al., 2016 AUSTRALIA Osteoarthritis, Increased Walking 3 Rate of Perceived Exertion Scale 12 2
Cardiovascular Risk
Wing et al., 1998 USA Overweight Walking 60%Vo2Peak or Up To 1500Kcal Per 24 5
Week
Cycling
Abrahin et al., 2022 BRAZIL Hypertension Cycling 60-75% Hrmax 12 3
Bouaziz et al., 2019 FRANCE Old Sed Cycling 40% Of Pre-Intervention Vt1 Workload 9.5 2
Brixius et al., 2008 GERMANY Overweight Men 50-60 Y/O Cycling 2-4 Mmol/L Lactate 24 3
Connolly et al., 2017 UK Premenopausal Women Cycling Nr 12 3
Davoodi et al., 2022 IRAN Type 2 Diabetes Cycling 70% Hrmax 12 3
Eguchi et al., 2012 JAPAN 20-65Y/O Healthy Adults Cycling 50% Vo2Max 12 3
Fairey et al., 2005 CANADA Post-Menopausal Women Cancer Cycling 70-75% 15 3
Survivors
Finucane et al., 2010 UK Healthy Older People Cycling 50-70 W Max 12 3
Fujie et al., 2014 JAPAN Increasing Plasma Apelin Level Cycling 40 % Peak O2 Uptake 8 3
Georgiades et al., 2000 USA Stage 1 Or 2 Hypertension Cycling 70-85% Heart Rate Reserve 24 3
Goldberg et al., 2012 AUSTRALIA Family History of Hypertension Cycling 65% Of Subjects Pre-Determined Load 4 3
Jabbour et al., 2017 CANADA Obese Adults Cycling 40-50% 6 3

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Lamina et al., 2013 NIGERIA Mild Hypertension Cycling 60-79% Hr Max 8 nr

Lamina., 2011 NIGERIA Hypertensive Cycling 60-79% Hr Max Reserve 8 3
Li et al., 2022 China Type 2 Diabetes Cycling 50-70% Hrmax 12 5
Maeda et al., 2004 JAPAN Elderly Women Cycling 85% Age Predicated Hr 12 5
Magalhães et al., 2019 PORTUGAL Type 2 Diabetes Cycling 40-60% Hrr 52 3
Mora-Rodriguez et al., 2017 SPAIN Metabolic Syndrome Cycling 70% Mhr- 90%Mhr 24 3
Oue et al., 2019 JAPAN Young Healthy Cycling 60%Hrr 8 3
Pereira Jorge et al., 2011 BRAZIL Type 2 Diabetes Cycling Nr 12 3
Pitsavos et al., 2011 GREECE Mild Hypertension Cycling 60-80%Hrmax 16 3
Poptempa et al., 1995 Hemiparetic Stroke Cycling 30-50% Max Effort 10 3
Sakai et al., 1998 JAPAN Mild Hypertensive Cycling 40-60% Maximum Oxygen Consumption 4 3
Sandberg et al., 2021 SWEDEN Stroke Cycling 60% Hrmax 3 5
Sikiru., 2013 NIGERIA Mild To Moderate Hypertension Cycling 60-79% 8 3
Van Craenenbroeck et al., 2015 BELGIUM CKD Stage 3-4 Cycling >90% Max Hr For 10 Mins in a Session 12 4
Yoshizama et al., 2008 JAPAN Women Cycling 60-70% Vo2Max 12 2
Running
Abdelaal & Mohamad, 2015 EGYPT Diabetic Hypertensives Running 12-14 Borg Scale 12 3
Amin-Shokravi et al., 2011 USA 45-55Y/O Iranian Women With CVD/ Running 70-80% Hrmax 12 3
Risk Factors
Anderssen et al., 1995 NORWAY Mild Hypertension Running 60-80%Hrpeak 52 3
Anshel., 1996 AUSTRALIA Healthy Running 170Bpm 10 3
Boeno et al., 2020 BRAZIL Hypertensives Running 60-80%Hrr 12 3
Chung et al., 2017 KOREA Middle Aged Obese Women Running 85 Mhr 12 3
Ezema et al., 2014 NIGERIA HIV Running 60-79% Hrr 8 3
Foulds et al., 2014 GERMANY Active Participants Running Nr 13 3
Krustrup et al., 2009 DENMARK Healthy Men Running 82% Mhr 12 2
Krustrup et al., 2010 DENMARK Premenopausal Running 80-84% 16 2
Nybo et al., 2010 DENMARK Untrained Men Running 65% Vo Max 12 2.5

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Pascoalino et al., 2015 BRAZIL Heart Transplant Running 69%Vo2Max 12 3

Patterson et al., 2017 UK Untrained Premenopausal Women Running 75% Max Hr 8 3
Ramos et al., 2018 BRAZIL Hypertensive Overweight Running 60%Hrmax 12 3
Ribeiro et al., 2012 PORTUGAL Acute Myocardial Infarction Running 60-75%Hrmax 8 3
Richter et al., 2009 BRAZIL Hyper-Reactive Individuals Running Nr 8 3
Roberson et al., 2018 CANADA Older Adults Running 55%Hrr 12 3
Suter et al., 1990 SWITZERLAND Sed Men Running 85%Hrmax 16 2-6
Tsai et al., 2002 TAIWAN Mild Hypertension Running 6-7 Mets 12 3
Tsai et al., 2002 TAIWAN White Coat Hypertension Running 6-7 Mets 12 3
Tsai et al., 2004 TAIWAN Hypertension Running 6-7 Mets 10 3
‘Other Aerobic’
Amaro-Gahete et al., 2019 SPAIN Sedentary Adults Other 60-65% Hr Reserve 12 3
Aerobic
Amozadeh et al., 2018 IRAN Overweight And Obese Females Other 40-50% Target Hr 8 3
Aerobic
Ballesta-García et al., 2020 SPAIN Middle Aged - Older Women with Other Nr 18 2
Controlled Hypertension Aerobic
Beck et al., 2013 USA Young Pre-Hypertensive Other 60-85% Perceived Max Hr 8 3
Aerobic
Blumenthal et al., 1991 USA Mild Hypertension Other 70%Hrpeak 16 3
Aerobic
Calders et al., 2011 BELGIUM Intellectual Disability Other 90% Voluntary Anabolic Threshold 20 2
Aerobic
Dureja et al., 2014 INDIA Healthy Other 5-10Kmh, 1-6% Incline 4 6
Aerobic
Eriksson et al., 1998 USA Impaired Glucose Tolerance Other 60%Hrmax 24 3
Aerobic
Faulkner et al., 2014 UK Transient Ischemic Attack Other Nr 8 2
Aerobic
Fenkci et al., 2006 TURKEY Obese Women with Severe Eating Other 50-80% Max Hr 12 3
Disorders Aerobic

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Guimaraes et al., 2010 BRAZIL Treated Hypertension Other 60% Hr Reserve 16 3

Aerobic
Hanssen et al., 2017 GERMANY Migraine Other 70%Hrmax 12 2
Aerobic
Headley et al., 2014 USA CKD Stage 3 Other 50-60% Vo2 Peak 16 3
Aerobic
Hellénius et al., 1993 SWEDEN CV Risk Factors Other 60-80% Hrmax 24 3
Aerobic
Hinderliter et al., 2002 USA Overweight Other 75%-85% Max Heart Rate Reserve 24 3-4
Aerobic
Hofgaard et al., 2019 FAROE ISLANDS Older Adults Other Nr 6 2
Aerobic
Irving et al., 2008 USA Women With Metabolic Syndrome Other Nr 16 5
Aerobic
Kadoglou et al., 2007 GREECE Type 2 Diabetes Other 50-75% Vo2 Max 24 4
Aerobic
Kim et al., 2012 KOREA Obese Postmenopausal Women Other 55%-80% Hr Max 16 3
Aerobic
King et al., 1991 USA Healthy Other 73-88% Hrpeak 52 3
Aerobic
Lopes et al., 2021 PORTUGAL Resistant Hypertension Other 50-70%Vo2Max 12 3
Aerobic
Mouodi et al., 2019 IRAN Healthy Other Nr 16 nr
Aerobic
Saremi et al., 2010 IRAN Overweight/Obese Males Other 60-65% Max Hr 12 5
Aerobic
Schroeder et al., 2019 USA Elevated Blood Pressure/ Other 40-70% Max Hr 8 3
Hypertension Aerobic
Seo et al., 2010 KOREA Middle Aged Women Other 60-80% Max Hr 12 3
Aerobic
Sigla et al., 2007 CANADA Type 2 Diabetes Other 60-75% Max HR 4 3
Aerobic
Skow et al., 2021 CANADA Gestational Hypertension Other 50-70% Heart Rate Reserve 36 3
Aerobic

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Sousa et al., 2013 PORTUGAL Older Men Other Less Than 80% Hrmax 32 3
Aerobic
Staffileno et al., 2001 USA Hypertensive Postmenopausal Women Other 50-60% Vo2 Max 8 5
Aerobic
Stefanick et al., 1998 USA Postmenopausal Men Other Nr 52 3
Aerobic
Swift et al., 2012 USA Obese Postmenopausal Women Other At Least 50% Baseline Vo2 24 3-4
Aerobic
Tanaka et al., 1997 USA Stage 1 And 2 Hypertensive Other 60% Maximal Hr Reserve 10 3
Aerobic
Wanderley et al., 2013 PORTUGAL Older Adults Other 50-80% Hr Reserve 32 3
Aerobic
Watkins et al., 2003 USA Cardiac Risk Factors Other 70-85% Heart Rate Reserve 26 4
Aerobic
Westhoff et al., 2008 GERMANY Hypertensive Other Cycling Rate Of 80-90 Cycles P/ Min 12 3
Aerobic
Williamson et al., 2022 UK Young Adults Other 60-80% peakHR 16 3
Aerobic
Wong et al., 2018 USA Menopausal Hypertension Other 11-13 Rpe 12 4
Aerobic
Wong et al., 2019 SOUTH KOREA Stage 2 Hypertensives Other 60%Hrmax 20 3-4
Aerobic
Yavari et al., 2010 IRAN Type 2 Diabetes Other 50-70% Max Hr 16 3
Aerobic
Yavari et al., 2012 IRAN Type 2 Diabetes Other 60-75% Max Hr 52 3
Aerobic
Resistance Training
Abrahin et al., 2022 BRAZIL Hypertension Resistance ACSM Guidelines increasing 2-10% upon 12 3
Training 10 repetition completion
Abdelaal & Mohamad, 2015 EGYPT Diabetic Hypertensives Resistance 75%1Rm 12 3
Training
Arora et al., 2009 INDIA Type 2 Diabetes Resistance 60% - 100% 1Rm 8 2
Training

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Beck et al., 2013 USA Young Pre-Hypertensive Resistance 60-85% Perceived Max Hr 8 3
Training
Beltran Valls et al., 2013 ITALY Older People Resistance > 85% Max Hr 12 nr
Training
Boeno et al., 2020 BRAZIL Hypertensives Resistance Nr 12 3
Training
Castaneda et al., 2002 USA Type 2 Diabetes Resistance 70.2%1Rm 16 3
Training
Choi et al., 2020 SOUTH KOREA Healthy Resistance 12-14 Rpe 12 3
Training
Conceicao et al., 2013 BRAZIL Postmenopausal Women Resistance 10 Rep Max 16 3
Training
Dantas et al., 2016 BRAZIL Hypertensives Resistance 5-7 On the Omni Scale 10 2
Training
Dantas et al., 2023 BRAZIL >60 Years of Age Resistance 50-70% 1Rm or 70-85% 1Rm 12 2
Training
DeVallance et al., 2016 USA Metabolic Syndrome and A Normal Resistance 60-85% 1 Rm 8 3
Group Training
Elliot et al., 2002 UK Postmenopausal Women Resistance 80% 10 Rep Max 8 nr
Training
Fenkci et al., 2006 TURKEY Obese Women with Severe Eating Resistance 40-80%1Rm 12 3
Disorders Training
Franklin et al., 2015 USA Obese Premenopausal Women Resistance 80-90%10Rm 8 2
Training
Gelecek et al., 2012 TURKEY Postmenopausal Women Resistance 60% Of 1 Rm 12 3
Training
Gerage et al., 2013 BRAZIL Elderly Postmenopausal Women Resistance Nr 12 3
Training
Heffernan et al., 2012 USA Prehypertension/Hypertension Resistance 40-60% 1Rm 12 3
Training
Hsieh et al., 2018 TAIWAN T2DM Resistance 50-70%1Rm 12 3
Training
Hu et al., 2009 FINLAND Healthy Men Resistance 75% 1Rm 10 2-3
Training

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Jaime et al., 2019 USA Postmenopausal Women Resistance 40%1Rm 12 nr

Training
Kanegusuku et al., 2011 BRAZIL Elderly Resistance 70-90%1Rm 16 2
Training
Kawano et al., 2006 USA Healthy Men Resistance 50-80% 1Rm 16 3
Training
Lin et al., 2022 TAIWAN Middle-Age to Older Hypertensives Resistance 50% 1Rm or 80% 1Rm 24 2
Training
Lovell et al., 2009 AUSTRALIA Healthy Resistance 70-90% 1Rm 16 3
Training
Miyachi et al., 2004 JAPAN Healthy Resistance 80% 1Rm 16 2
Training
Nybo et al., 2010 DENMARK Untrained Men Resistance 12-15 Rep Max 12 2
Training
Okamoto et al., 2006 JAPAN Healthy Women Resistance 80-100% 1Rm 8 3
Training
Okamoto et al., 2008 JAPAN Sedentary Healthy Males Resistance 80-100% 1Rm 8 3
Training
Olson et al., 2006 USA Overweight Women Resistance Nr 52 2
Training
Park et al., 2011 SOUTH KOREA Hypertensives Resistance ‘Red Resistance Band’ 12 2
Training
Plotnikoff et al., 2010 AUSTRALIA Obese Adults with Type 2 Diabetes Resistance 50-80% 1Rm 16 3
Training
Polito et al, 2020 BRAZIL Hypertensives Resistance 5-7 On the Omni Scale 12 3
Training
Queiroz et al., 2011 BRAZIL Normotensive Older Adults Resistance 30-50% 1Rm or 70-90% 1Rm 16 2
Training
Ruangthai & Phoemsapthawee., THAILAND Hypertensives Resistance 50-80%1Rm 12 3
2019 Training
Schroeder et al., 2019 USA Elevated Blood Pressure/ Resistance Nr 8 3
Hypertension Training
Sigla et al., 2007 CANADA T2D Resistance 60-75%Hrmax 4 3
Training

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Simons et al., 2006 USA Elderly Adults Resistance 75% 1 Rm 16 2

Training
Stensvold et al., 2010 NORWAY Metabolic Syndrome Resistance 70-95% Peak Hr And > 80% 1 Rm 12 3
Training
Tomeleri et al, 2017 BRAZIL Older Women Resistance Nr 12 3
Training
Van Hoof et al., 1996 BELGIUM Sedentary Men Resistance 70-90%1Rm 16 3
Training
Venojarvi et al., 2013 FINLAND Men with Impaired Glucose Resistance 50-85% Rm 12 3
Regulation Training
Vincent et al., 2003 USA Older Adults Resistance 50%1Rm or 80%1Rm 24 3
Training
Wanderley et al., 2013 PORTUGAL Older Adults Resistance 50-60% Up To 80% 1Rm 32 3
Training
Werner et al., 2021 USA Healthy Inactive Males Resistance 50-70%1RM or 80-90% 1RM 12 3-5
Training
Yavari et al., 2012 IRAN Type 2 Diabetes Resistance 60-80% 1Rm 52 3
Training
Yoshizama et al., 2008 JAPAN Women Resistance 60%1Rm 12 2
Training
Zanetti et al, 2017 BRAZIL HIV Resistance Nr 12 3
Training
Combined Training
Badicci et al., 2012 ITALY Overweight w/ T2Dm Combined Nr 48 2
Training
Calders et al., 2011 BELGIUM Intellectual Disability Combined 90% Voluntary Anabolic Threshold 20 2
Training
Do Amaral et al., 2022 BRAZIL Patients Previously Hospitalized due Combined 14-17 RPE for Resistance Training and 12 5-7
to COVID-19 Training 11-13 for Aerobic Training
Dos Santos et al., 2014 BRAZIL Hypertensive Combined 100-120% 10Rep Max And 65-75% 16 3
Training Target Hr Or 70% Of 10 Rep Max And
65-75% Target Hr
Ehlken et al., 2015 GERMANY PAH, Chronic Thromboembolic, Combined Nr 12 5-7
Hypertension Training

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Figueroa et al., 2011 SOUTH KOREA Postmenopausal Women Combined 60% 1Rm & 60% Hrmax 12 3
Training
Frih et al., 2017 TUNISA Chronic Kidney Disease Combined 50% Initial 1Rm 16 4
Training
Garnaes et al., 2016 NORWAY Obese Pregnant Combined 80% Max Capacity, 12-15 Borg Scale ~24 3
Training
Greenwood et al., 2015 UK CKD Combined 80% 1Rm 52 3
Training
Jeon et al., 2020 KOREA Postmenopausal Diabetic Combined 11-15 Rpe Scale And 70% 1Rm 12 3
Training
Jones et al., 2020 NEW ZEALAND Breast Cancer Survivors Combined 60% 1Rm 12 2
Training
Jung et al., 2022 SOUTH KOREA Elderly Obese Women with Combined 60-80%Hrr 12 3
Sarcopenia Training
Kagioglou et al., 2021 GREECE Pulmonary Hypertension Combined 60-80% Hr 24 3
Training
Karelis et al., 2016 CANADA Post Kidney Transplant Combined 80% 1Rm 16 3
Training
Kawano et al., 2006 USA Healthy Men Combined 60% Max Hr 16 3
Training
Martins et al., 2011 PORTUGAL Sedentary Combined 40-85% Hr Reserve 16 3
Training
Masroor et al., 2018 INDIA Sedentary Hypertensive Women Combined 50-80% Hrmax, 50-80% 1Rm 4 3
Training
McGavock et al., 2004 CANADA Type 2 Diabetes Combined 65-75% Hr Reserve And 50-65% 1 Rm 10 3
Training
McGuigan et al., 2001 AUSTRALIA Peripheral Arterial Disease Combined 100% 10 Rep Max 24 3
Training
Miura et al., 2015 JAPAN Hypertensives Combined Nr 12 nr
Training
Ohkubo et al,. 2001 JAPAN Older Adults Combined Started At 50-60Rpm At Less Than 25% 25 3
Training Hrr, Made Way Up To 60% Hrr by The
End

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Okamoto et al., 2007 JAPAN Healthy Combined 80% Rep Max And 60 % Target Hr 8 2
Training
Park & Park, 2017 SOUTH KOREA Sarcopenic Obesity Combined 13-17Rpe 24 5
Training
Park & Park., 2017 SOUTH KOREA Overweight Obese Women Combined 5 To 6 Out Of 10Rpe 24 5
Training
Park et al., 2020 S KOREA Obese Older Men Combined 6–7 On the Omni-Resistance Exercise 12 3
Training Scale of Perceived Exertion, 60-70%
1Rm & 60-70% Hrmax
Ruangthai & Phoemsapthawee., THAILAND Hypertensives Combined 50-80%1Rm, 60-70% Hrmax 12 3
2019 Training
Saghebjoo et al., 2021 IRAN Hypertensive Men Combined 60-80%1Rm, 40-60%Hrr 10 4
Training
Sardeli et al., 2022 BRAZIL Hypertensive Older Adults Combined 63% VO2max 16 3
Training
Schroeder et al., 2019 USA Elevated Blood Pressure/ Combined 40-70% Hrmax, Resistance Intensity Nr 8 3
Hypertension Training
Seo et al., 2010 KOREA Middle Aged Women Combined 60-80% Max Hr And 50-70% 1 Rm 12 3
Training
Seo et al., 2011 USA Obese Middle Age Women Combined 60-70% Hr Reserve And 10 Rep Max 12 3
Training
Shiotsu et al., 2018 JAPAN Older Men Combined 60% Hrr, 70-80%1Rm 10 2
Training
Sigla et al., 2007 CANADA T2D Combined 60-75%Hrmax 4 3
Training
Siu et al., 2021 HONG KONG Obese Combined Nr 12 3
Training
Son et al., 2017 KOREA Postmenopausal With Hypertension Combined 40-70% Hr Reserve 12 3
Training
Songcharern et al., 2022 THAILAND Prehypertensive Males Combined 50-80%1Rm, 60-70%Hrr 8 3
Training
Sousa et al., 2013 PORTUGAL Older Men Combined Less Than 80% Hrmax, Between 65-75% 32 3
Training 1Rm

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Stensvold et al., 2010 NORWAY Metabolic Syndrome Combined 6--80% 1 Rm 12 3

Training
Stewart et al., 2005 USA Untreated Hypertension Combined 50% 1 Rm And 60--90% Max Hr Reserve 26 3
Training
Tan et al., 2012 AUSTRALIA Elderly T2D Combined 55-75% Max Hr And 50-70% 1Rm 24 3
Training
Yavari et al., 2012 IRAN Type 2 Diabetes Combined 60-75% Max Hr And 60-80% 1Rm 52 3
Training
Yen et al., 2019 TAIWAN Neck Cancer Combined 60-70% Hrpeak, RPE Scale Of Between 8 3
Training Somewhat Heavy To Heavy
High Intensity Interval Training
Allen et al., 2017 AUSTRALIA Sedentary Adults HIIT Maximal Sprint 9 3
Alvarez et al., 2016 CHILE Type 2 Diabetes HIIT 90-100% Age Predicted Heart Rate 16 3
Reserve
Atan & Karavelioglu., 2020 TURKEY Adult Women with Fibromyalgia HIIT 80-95% Peak Hr 6 5
Atashak et al., 2021 IRAN Obese Men HIIT 85-95% Hrmax 12 3
Bahmanbeglou et al., 2019 IRAN Stage 1 Hypertensive Adults HIIT 75-90% Vo2Max Or 80-100% Vo2Max 8 3
Blackwell et al., 2020 UK Patients Before Surgery with HIIT 100-115% Max Watts 4 3-4
Urological Cancer
Boutcher et al., 2019 AUSTRALIA Postmenopausal HIIT 80-85%Hrmax 8 3
Cassidy et al., 2015 UK T2D HIIT Rpe 16-17 12 3
Cassidy et al., 2019 UK Adults With Type 2 Diabetes HIIT 16-17 Rpe 12 3
Chidnok et al., 2020 THAILAND Sed HIIT 80%Hrmax 6 3
Chin. et al., 2020 HONG KONG Obese / Overweight Men HIIT 90% Hrr 8 1-3
Connolly et al., 2017 UK Premenopausal Women HIIT 90 Maximum Effort 12 3
Connolly et al., 2020 UK Inactive Premenopausal HIIT Low/Moderate/High 12 3
Davoodi et al., 2022 IRAN Type 2 Diabetes HIIT 85-90% Hrmax 12 3
Edwards et al., 2021 UK Healthy HIIT 7.5% Bw Maximal Effort 2 3
Engel et al., 2019 GERMANY Healthy HIIT Nr 8 4
Garcia-Suarez et al., 2020 MEXICO College Students HIIT 100% Vo2 Peak 4 3

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Ghardashi Afousi et al., 2018 IRAN Coronary Bypass Graft Recipients HIIT 70%Hrmax 6 3
Gjellesvik et al., 2020 NORWAY Previous Stroke HIIT 85-95%Hrpeak 8 3
Hallsworth et al., 2015 UK Fatty Liver Disease HIIT Rpe 16-17 12 3
Hanssen et al., 2017 GERMANY Episodic Migraine HIIT 90-95%Hrmax 12 2
Heydari et al., 2013 AUSTRALIA Healthy Adult Males HIIT 80-90% Age Predicted Max Hr 12 3
Ho et al., 2019 AUSTRALIA Post-Menopausal Women HIIT Maximal Effort 8 3
Karstoft et al., 2013 DENMARK T2D HIIT 70%Peak Expenditure 16 5
Kiel et al., 2018 NORWAY Healthy HIIT 85-95%Hrmax 10 3
Lee et al., 2020 AUSTRALIA Overweight Or Obese Adults with HIIT 85-95% Hrpeak 12 3
Type 1 Diabetes
Li et al., 2022 China Type 2 Diabetes HIIT 80-95% Hrmax 12 5
Madssen et al., 2014 NORWAY Individuals After Cardiac Rehab HIIT 85-95% Hrmax 52 3
May et al., 2018 USA Healthy HIIT 90%Hrmax 4 3
Mohr et al., 2014 EXETER/FAROE Mildly Hypertensive Women HIIT Maximal 15 3
ISLANDS
Nytroen et al., 2012 NORWAY Heart Transplant HIIT 85-95% Hrmax 24 3
O'Driscoll et al., 2018 UK Sedentary Males HIIT 7.5% Bw Maximal Effort 2 3
Rentería et al., 2019 MEXICO Healthy Adult Women HIIT 80% Map 4 3
Romain et al., 2019 CANADA Overweight Adults With Psychotic HIIT 80-90% Max Hr 26 2
Disorders
Rustad et al., 2012 NORWAY Heart Transplant HIIT 85-95%Hrpeak 8 3
Sandstad et al., 2015 NORWAY Rheumatic Disease HIIT 85-95%Hrmax 10 2
Soltani et al., 2019 IRAN Hypertensives HIIT 75-90%Vo2Peak Or 80-90%Vo2Peak 8 3
Stensvold et al., 2010 NORWAY Metabolic Syndrome HIIT 90-95%Hrpeak 12 3
Streese et al., 2019 SWITZERLAND Adults At Risk Of Cardiovascular HIIT 75-90% Hrmax 12 3
Disease
Tambrus et al., 2018 BRASIL Coronary Artery Disease Patients HIIT 100-110 Of Power Output Reached at 16 3
VAT
Tew et al., 2019 UK Adults With Crohns Disease HIIT 90% Wpeak 12 3

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Tjonna et al., 2008 NORWAY Metabolic Syndrome HIIT 90% Hf Max 16 3

Winding et al., 2018 DENMARK Type 2 Diabetes HIIT 95% Wpeak 11 3
Isometric Exercise Training
Baddeley-White et al., 2019 UK Healthy IET 4 X 2 Min, 1 Min Rest Interval, 4 3
30%MVC.
Badrov et al., 2013a CANADA Normotensive Women IET 4 X 2 Min, 4 Min Rest Intervals, 30% 8 3-5
MVC.
Badrov et al., 2013b CANADA Hypertensives IET 4 X 2 Min Bilateral, 1 Min Rest Interval, 10 3
30% MVC.
Baross et al., 2012 UK Middle Aged Men IET 4 X 2 Min, 2 Min Rest Intervals, 8 3
14%Mvc, 85%Hrpeak, 75%Hrpeak.
Baross et al., 2013 UK Sedentary Older Men IET 4 X 2 Min, 2 Min Rest Intervals, 8 3
85%Hrpeak.
Cahu Rodrigues et al., 2019 BRAZIL Hypertensives IET 4 X 2 Min, 1 Min Rest Interval, 12 3
30%MVC.

Correia et al., 2020 BRAZIL Peripheral Artery Disease IET 4 X 2 Min, 4 Min Rest Intervals, 8 3
30%MVC.
Decaux et al., 2021 UK Healthy IET 4 X 2 Min, 2 Min Rest Intervals, 95% 4 3
Hrpeak.
Farah et al., 2018 BRAZIL Hypertensives IET 4 X 2 Min, 1 Min Rest Interval, 12 3
30%MVC.
Gordan et al., 2018 USA Hypertensives IET 4 X 2 Min, 1 Min Rest Interval, 12 2
30%MVC.
Nemoto et al., 2021 JAPAN Hypertensives IET 4 X 2 Min, 1 Min Rest Intervals, 30% 8 3
MVC
O’Driscoll et al., 2022 UK Healthy Prehypertensive IET 4 X 2 Min, 2 Min Rest Intervals, 95% 52 3
Hrpeak.
Okamoto et al., 2020 JAPAN Middle Aged and Older Adults IET 4 X 2 Min, 1 Min Rest Interval, 30% 8 3
MVC.
Punia et al., 2019 INDIA Hypertensives IET 4 X 2 Min, 4 Min Rest Intervals, 8 3
30%MVC.

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Taylor et al., 2003 CANADA Hypertensives IET 4 X 2 Min, 1 Min Rest Intervals, 10 3
30%MVC.
Taylor et al., 2018 UK Hypertensives IET 4 X 2 Min, 2 Min Rest Intervals, 95% 4 3
Hrpeak.
Wiles et al., 2009 UK Healthy IET 4 X 2 Min, 2 Min Rest Intervals, Hi- 8 3
95%Hrpeak.
Wiles et al., 2016 UK Healthy Young Males IET 4 X 2 Min, 1 Min Rest Interval, 4 3
95%Hrpeak).
Yamagata et al., 2020 JAPAN Young Women IET 4 X 2 Min, 3 Min Rest Intervals, 25% 8 3
MVC Handgrip.
Note: Multi-intervention trials are duplicated in different categories based on exercise mode.

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Figure S1. Aerobic Exercise Training sBP Significant Publication Bias Funnel Plot.

Funnel Plot of Standard Error by Difference in means

6
Standard Error

-50 -40 -30 -20 -10 0 10 20 30 40 50

Difference in means

Figure S2. Aerobic Exercise Training dBP Significant Publication Bias Funnel Plot.

Funnel Plot of Standard Error by Difference in means

4
Standard Error

-20 -10 0 10 20

Difference in means

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Figure S3. Isometric Exercise Training dBP Significant Publication Bias Funnel Plot.

Funnel Plot of Standard Error by Difference in means

2
Standard Error

-9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9

Difference in means

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S3. Moderator Analysis Results

Mode Intervention Duration Training Frequency Training Compliance %

2 2
Aerobic Exercise Training B= -0.0898, R = 0, B= -1.0596, R = 0.05, B= 0.0764, R2= 0.02,
p=0.0774 p=0.0193 p=0.3257
Dynamic Resistance B= 0.0886, R2= 0, B= -0.7858, R2= 0, B= 0.0750, R2= 0,
Training p=0.3026 p=0.5743 p=0.5503
Combined Training B= 0.0288, R2= 0, B= -0.5001, R2= 0, B= 0.3482, R2= 0,
p=0.8412 p=0.8490 p=0.3160
High Intensity Interval B= -0.1617, R2= 0, B= -0.5124, R2= 0, B= 0.0715, R2= 0.09,
Training p=0.1071 p=0.6537 p=0.4251
Isometric Exercise Training B= -0.0176, R2= 0, B= 0.1787, R2= 0, B= 0.1068, R2= 0,
p=0.8447 p=0.9296 p=0.2337

Note: Minus indicates a higher sBP reduction with a decreasing duration/frequency (i.e.
There was a significant moderator interaction on sBP for Aerobic Training, with a lower
training frequency associated with a greater BP reduction).

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S4. Full Statistical Outcome Data (Including Disease-Free Analyses)

Analysis Full Statistical Outcome (Including Disease-Free Analysis)

Overall Aerobic Exercise sBP:

Training Primary Analysis 182 effect sizes/measured groups,
WMD= 4.492, CI Lower= 3.496, CI Upper=5.488, I2=91.453, Z= 8.843, p<0.001.
WMD Eggers p-value: <0.001
Disease Free Analysis: ES:137, WMD= 4.603, CI Lower= 3.481, CI Upper=5.725, I2=91.759, Z= 8.042, p<0.001.
dBP:
176 effect sizes/measured groups,
WMD= 2.525, CI Lower= 1.846, CI Upper=3.204, I2=91.538, Z= 7.288, p<0.001.
WMD Eggers p-value: <0.001
Disease Free Analysis: ES:129, WMD= 2.617, CI Lower= 1.810, CI Upper= 3.423, I2=92.558, Z= 6.360, p<0.001.
Walking Primary Analysis sBP:
89 effect sizes/measured groups,
WMD= 2.851, CI Lower= 1.629, CI Upper=4.073, I2=77.387, Z= 4.573, p<0.001.
WMD Eggers p-value: 0.20242
Disease Free Analysis: ES:70, WMD= 3.174, CI Lower= 1.849, CI Upper=4.498, I2=76.931, Z= 4.697, p<0.001.
dBP:
83 effect sizes/measured groups,
WMD= 1.436, CI Lower= 0.663, CI Upper=2.209, I2=74.118, Z= 3.640, p<0.001.
WMD Eggers p-value: 0.53502
Disease Free Analysis: ES:64, WMD= 1.690, CI Lower= 0.837, CI Upper=2.543, I2=73.139, Z= 3.883, p<0.001.
Cycling Primary Analysis sBP:
28 effect sizes/measured groups,
WMD= 6.876, CI Lower= 3.908, CI Upper=9.845, I2=92.092, Z= 4.540, p<0.001.
WMD Eggers p-value: 0.61227
Disease Free Analysis: ES:19, WMD= 8.622, CI Lower= 4.896, CI Upper=12.349, I2=94.343, Z= 4.535, p<0.001.
dBP:

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

28 effect sizes/measured groups,

WMD= 3.196, CI Lower= 1.750, CI Upper=4.641, I2=91.392, Z= 4.333, p<0.001.
WMD Eggers p-value: 0.92794
Disease Free Analysis: ES:19, WMD= 3.747, CI Lower= 1.961, CI Upper=5.532, I2=93.961, Z= 4.113, p<0.001.
Running Primary Analysis sBP:
21 effect sizes/measured groups,
WMD= 6.830, CI Lower= 3.958, CI Upper= 9.701, I2= 88.366, Z= 4.662, p<0.001.
WMD Eggers p-value: 0.93655
Disease Free Analysis: ES:15, WMD= 6.083, CI Lower= 4.582, CI Upper=7.585, I2=34.776, Z= 7.940, p<0.001.
dBP:
21 effect sizes/measured groups,
WMD= 5.670, CI Lower= 3.880, CI Upper= 7.459, I2= 82.829, Z= 6.209, p<0.001.
WMD Eggers p-value: 0.65089
Disease Free Analysis: ES:15, WMD= 5.038, CI Lower= 2.339, CI Upper=7.736, I2=82.678, Z= 3.659, p<0.001
Resistance Training Primary sBP:
Analysis 57 effect sizes/measured groups,
WMD= 4.551, CI Lower= 3.202, CI Upper= 5.899, I2= 58.378, Z= 6.613, p<0.001.
WMD Eggers p-value: 0.35677
Disease Free Analysis: ES:45, WMD= 4.485, CI Lower= 2.807, CI Upper=6.162, I2=62.597, Z= 5.240, p<0.001.
dBP:
57 effect sizes/measured groups,
WMD= 3.036, CI Lower= 2.174, CI Upper= 3.897, I2= 66.609, Z= 6.905, p<0.001.
WMD Eggers p-value: 0.14719
Disease Free Analysis: ES:45, WMD= 3.318, CI Lower= 2.216, CI Upper=4.421, I2=67.243, Z= 5.899, p<0.001.
Combined Training Primary sBP:
Analysis 46 effect sizes/measured groups,
WMD= 6.035, CI Lower= 3.157, CI Upper= 8.914, I2= 92.834, Z= 4.110, p<0.001.
WMD Eggers p-value: 0.89051
Disease Free Analysis: ES:27, WMD= 6.552, CI Lower= 2.527, CI Upper=10.576, I2=95.096, Z= 3.191, p=0.001.
dBP:
45 effect sizes/measured groups,
WMD= 2.540, CI Lower= 1.071, CI Upper= 4.008, I2= 85.452, Z= 3.390, p=0.001.

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

WMD Eggers p-value: 0.24258

Disease Free Analysis: ES:27, WMD= 3.424, CI Lower= 1.378, CI Upper=5.469, I2=89.465, Z= 3.280, p=0.001.
Overall HIIT Primary Analysis sBP:
49 effect sizes/measured groups,
WMD= 4.079, CI Lower= 2.625, CI Upper= 5.534, I2= 82.420, Z= 5.497, p<0.001.
WMD Eggers p-value: 0.16285
Disease Free Analysis: ES:26, WMD= 5.818, CI Lower= 3.602, CI Upper=8.033, I2=88.331, Z= 5.147, p<0.001.
dBP:
47 effect sizes/measured groups,
WMD= 2.496, CI Lower= 1.218, CI Upper= 3.775, I2= 91.113, Z= 3.827, p<0.001.
WMD Eggers p-value: 0.37732
Disease Free Analysis: ES:24, WMD= 3.745, CI Lower= 1.927, CI Upper=5.563, I2=92.397, Z= 4.038, p<0.001.
SIT Primary Analysis sBP:
7 effect sizes/measured groups,
WMD= 5.261, CI Lower=3.937, CI Upper= 6.584, I2=0, Z= 7.791, p<0.001.
WMD Eggers p-value: 0.66940
Disease Free Analysis: ES:6, WMD= 5.127, CI Lower= 3.772, CI Upper=6.482, I2=3.005, Z= 7.415, p<0.001.
dBP:
7 effect sizes/measured groups,
WMD= 3.291, CI Lower= 0.108, CI Upper= 6.474, I2= 66.616, Z= 2.026, p=0.043.
WMD Eggers p-value: 0.90345
Disease Free Analysis: ES:6, WMD= 1.818, CI Lower= -0.298, CI Upper=3.934, I2=13.342, Z= 1.684, p=0.092.
AIT Primary Analysis sBP:
13 effect sizes/measured groups,
WMD= 1.972, CI Lower= -1.226, CI Upper= 5.170, I2= 66.901, Z= 1.208, p=0.227.
WMD Eggers p-value: 0.59221
Disease Free Analysis: ES:4, WMD= 6.415, CI Lower= 0.433, CI Upper=12.397, I2=65.302, Z= 2.102, p<0.001.
dBP:
12 effect sizes/measured groups,
WMD= 2.597, CI Lower= -0.542, CI Upper= 5.737, I2= 83.923, Z= 1.621, p=0.105.
WMD Eggers p-value: 0.55983
Disease Free Analysis: ES:3, WMD= 6.371, CI Lower= -5.165, CI Upper=17.906, I2=93.368, Z= 1.082, p=0.279.

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

IET Primary Analysis sBP:

24 effect sizes/measured groups,
WMD= 8.235, CI Lower= 6.450, CI Upper= 10.019, I2= 68.795, Z= 9.045, p<0.001.
WMD Eggers p-value: 0.14434
Disease Free Analysis: ES:23, WMD= 8.431, CI Lower= 6.628, CI Upper=10.234, I2=68.741, Z= 9.166, p<0.001.
dBP:
24 effect sizes/measured groups,
WMD= 3.977, CI Lower= 2.673, CI Upper= 5.280, I2= 63.674, Z= 5.980, p<0.001.
WMD Eggers p-value: <0.001
Disease Free Analysis: ES:23, WMD= 4.030, CI Lower= 2.683, CI Upper= 5.377, I2=63.565, Z= 5.864, p<0.001.
IHG IET Primary Analysis sBP:
17 effect sizes/measured groups,
WMD= 7.104, CI Lower= 4.694, CI Upper= 9.515, I2= 68.795, Z= 5.777, p<0.001.
WMD Eggers p-value: 0.18292
Disease Free Analysis: ES:16, WMD= 7.357, CI Lower= 4.874, CI Upper= 9.839, I2=69.206, Z= 5.809, p<0.001.
dBP:
17 effect sizes/measured groups,
WMD= 3.464, CI Lower= 1.715, CI Upper= 5.214, I2= 71.305, Z= 3.881, p<0.001.
WMD Eggers p-value: <0.001
Disease Free Analysis: ES:16, WMD= 3.489, CI Lower= 1.641, CI Upper= 5.337, I2=71.433, Z= 3.700, p<0.001.
IWS IET Primary Analysis sBP:
4 effect sizes/measured groups,
WMD= 10.469, CI Lower= 6.315, CI Upper= 14.623, I2= 81.030, Z= 4.940, p<0.001.
WMD Eggers p-value:0.77376
Disease Free Analysis: Identical results (no disease groups were analysed)
dBP:
4 effect sizes/measured groups,
WMD= 5.326, CI Lower= 3.605, CI Upper= 7.048, I2= 23.470, Z= 6.065, p<0.001.
WMD Eggers p-value:0.62065
Disease Free Analysis: Identical results (no disease groups were analysed)
ILE IET Primary Analysis sBP:

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

3 effect sizes/measured groups,

WMD= 10.047, CI Lower= 7.297, CI Upper= 12.798, I2= 0, Z= 7.159, p<0.001.
WMD Eggers p-value: 0.51599
Disease Free Analysis: Identical results (no disease groups were analysed)
dBP:
3 effect sizes/measured groups,
WMD= 4.226, CI Lower= 1.409, CI Upper= 7.042, I2= 0, Z= 2.941, p=0.003.
WMD Eggers p-value: 0.32533
Disease Free Analysis: Identical results (no disease groups were analysed)

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Systolic Blood Pressure Network Meta-Analysis – Supplementary Information

Table S5. Systolic Blood Pressure Primary Exercise Mode Bayesian Table of Rank Probabilities and Surface Under the Cumulative Ranking
Curve.

Treatment Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 SUCRA

AET 0.0002750 0.0270500 0.2583500 0.4277750 0.2865500 0.0000000 40.5345000

Control 0.0000000 0.0000000 0.0000000 0.0000000 0.0000125 0.9999875 0.0002500

CT 0.0683125 0.7335125 0.1325750 0.0456250 0.0199750 0.0000000 75.6912500

HIIT 0.0020125 0.0726500 0.2481375 0.2497625 0.4274250 0.0000125 39.4405000

IET 0.9261500 0.0646625 0.0067750 0.0017750 0.0006375 0.0000000 98.2782500

RT 0.0032500 0.1021250 0.3541625 0.2750625 0.2654000 0.0000000 46.0552500

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Table S6. Systolic Blood Pressure Secondary Exercise Mode Bayesian Table of Rank Probabilities and Surface Under the Cumulative Ranking
Curve.

Treatment Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 Rank 7 Rank 8 Rank 9 Rank 10 Rank 11 Rank 12 SUCRA

AIT 0.00005 0.00090 0.00283 0.00623 0.01253 0.02270 0.03776 0.06344 0.12476 0.23379 0.42119 0.07384 18.31148

Control 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00194 0.09565 0.90241 0.90477

CT 0.00168 0.01666 0.06571 0.14463 0.22651 0.25514 0.16794 0.08314 0.03260 0.00545 0.00055 0.00000 57.55784

Cycling 0.01816 0.10236 0.22913 0.24143 0.18555 0.11698 0.06179 0.02933 0.01224 0.00274 0.00031 0.00000 69.87614

IHG 0.04454 0.17390 0.27053 0.18538 0.13128 0.08730 0.05249 0.03073 0.01720 0.00553 0.00115 0.00000 73.07727

ILE 0.40224 0.28600 0.08865 0.05535 0.04129 0.03136 0.02468 0.02255 0.02031 0.01480 0.01024 0.00254 84.69818

IWS 0.50605 0.29054 0.07588 0.04205 0.02780 0.01889 0.01341 0.01018 0.00773 0.00441 0.00278 0.00030 90.37875

Other 0.00004 0.00121 0.00709 0.02304 0.05953 0.12681 0.22314 0.27306 0.20971 0.06449 0.01189 0.00000 40.14648
Aerobic
RT 0.00001 0.00039 0.00244 0.01259 0.04005 0.10434 0.22003 0.30034 0.24156 0.06833 0.00994 0.00000 38.23432

Running 0.01498 0.08549 0.18305 0.21066 0.19005 0.14255 0.08763 0.05048 0.02625 0.00740 0.00148 0.00000 66.11864

SIT 0.01226 0.04255 0.07471 0.07865 0.08538 0.09321 0.10573 0.10738 0.14478 0.12169 0.11278 0.02090 43.34091

Walking 0.00000 0.00000 0.00000 0.00001 0.00005 0.00073 0.00543 0.02940 0.16286 0.46945 0.33206 0.00001 17.35523

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S7. Systolic Blood Pressure Primary Exercise Mode Inconsistency Test with Node-
splitting Model.

Comparison P-value CrI

d.AET.CT 0.458775 NA
-> direct NA -3.0 (-7.9, 2.0)
-> indirect NA -0.92 (-3.1, 1.3)
-> network NA -1.5 (-3.5, 0.44)
d.AET.HIIT 0.733925 NA

-> direct NA -0.96 (-7.1, 5.1)

-> indirect NA 0.16 (-1.9, 2.2)
-> network NA 0.096 (-1.9, 2.0)
d.AET.RT 0.6983 NA
-> direct NA -0.60 (-3.9, 2.7)
-> indirect NA 0.19 (-2.0, 2.4)

-> network NA -0.18 (-2.0, 1.6)

d.CT.HIIT 0.560575 NA
-> direct NA -2.3 (-16., 11.)
-> indirect NA 1.8 (-0.74, 4.3)
-> network NA 1.6 (-0.87, 4.1)
d.CT.RT 0.4762 NA

-> direct NA -0.33 (-5.5, 4.9)

-> indirect NA 1.8 (-0.86, 4.4)
-> network NA 1.4 (-0.97, 3.7)
d.HIIT.RT 0.629575 NA
-> direct NA 3.1 (-11., 17.)
-> indirect NA -0.40 (-2.8, 2.0)

-> network NA -0.28 (-2.7, 2.1)

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S8. Systolic Blood Pressure Secondary Exercise Mode Inconsistency Test with
Notesplitting Model.

Comparison p-value CrI

d.AIT.CT 0.3839 NA
-> direct NA 2.4 (-11., 16.)
-> indirect NA -4.0 (-8.0, 0.056)
-> network NA -3.4 (-7.2, 0.45)
d.AIT.Other_Aerobic 0.377575 NA
-> direct NA 3.3 (-9.2, 16.)
-> indirect NA -2.6 (-6.7, 1.5)
-> network NA -2.2 (-6.0, 1.6)
d.AIT.RT 0.439425 NA
-> direct NA 3.0 (-11., 17.)
-> indirect NA -2.6 (-6.6, 1.4)
-> network NA -2.1 (-5.9, 1.7)
d.CT.Other_Aerobic 0.4613 NA
-> direct NA 2.9 (-2.4, 8.3)
-> indirect NA 0.67 (-2.1, 3.5)
-> network NA 1.2 (-1.3, 3.7)
d.CT.RT 0.5001 NA
-> direct NA -0.30 (-5.6, 4.9)
-> indirect NA 1.7 (-0.92, 4.4)
-> network NA 1.3 (-1.1, 3.7)
d.CT.Walking 0.999675 NA
-> direct NA 3.0 (-10., 16.)
-> indirect NA 3.0 (0.77, 5.3)
-> network NA 3.1 (0.88, 5.3)
d.Cycling.RT 0.59955 NA
-> direct NA -0.22 (-10., 9.7)
-> indirect NA 2.5 (-0.44, 5.5)
-> network NA 2.3 (-0.54, 5.1)
d.Other_Aerobic.RT 0.457825 NA
-> direct NA -1.6 (-6.7, 3.5)
-> indirect NA 0.59 (-2.1, 3.3)
-> network NA 0.12 (-2.2, 2.5)
d.RT.Running 0.663025 NA
-> direct NA -0.47 (-7.7, 6.7)
-> indirect NA -2.3 (-5.6, 1.2)
-> network NA -2.0 (-5.0, 1.0)
d.RT.Walking 0.576075 NA
-> direct NA 0.075 (-6.3, 6.4)
-> indirect NA 2.0 (-0.22, 4.2)
-> network NA 1.8 (-0.26, 3.8)

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Diastolic Blood Pressure Network Meta-Analysis – Supplementary Information

Table S9. Diastolic Blood Pressure Comparative Network Meta-Analysis for the Primary Exercise Modes.

AET Control CT HIIT IET RT

AET AET 2.47 (1.88, 3.06) 0.01 (-1.27, 1.3) -0.1 (-1.37, 1.18) -1.23 (-3, 0.52) -0.44 (-1.59, 0.7)

Control -2.47 (-3.06, -1.88) Control -2.46 (-3.63, -1.29) -2.57 (-3.71, -1.42) -3.7 (-5.36, -2.04) -2.91 (-3.95, -1.89)

CT -0.01 (-1.3, 1.27) 2.46 (1.29, 3.63) CT -0.11 (-1.72, 1.52) -1.24 (-3.27, 0.78) -0.45 (-1.97, 1.05)

HIIT 0.1 (-1.18, 1.37) 2.57 (1.42, 3.71) 0.11 (-1.52, 1.72) HIIT -1.13 (-3.14, 0.88) -0.35 (-1.88, 1.19)

IET 1.23 (-0.52, 3) 3.7 (2.04, 5.36) 1.24 (-0.78, 3.27) 1.13 (-0.88, 3.14) IET 0.79 (-1.16, 2.75)

RT 0.44 (-0.7, 1.59) 2.91 (1.89, 3.95) 0.45 (-1.05, 1.97) 0.35 (-1.19, 1.88) -0.79 (-2.75, 1.16) RT

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S10. Diastolic Blood Pressure Comparative Network Meta-Analysis for the Secondary Exercise Modes.

AIT Control CT Cycling IHG ILE IWS Other_Aerobic RT Running SIT Walking
AIT AIT 2.85 0.37 (- -0.24 (- -0.4 (- -0.58 (- -2.69 (- 0.04 (-2.37, -0.14 (- -2.58 (- -0.32 (- 1.48 (-
(0.67, 2.08, 2.84, 3.32, 5.87, 7.02, 2.47) 2.53, 5.33, 4.08, 0.86, 3.84)
5.06) 2.83) 2.39) 2.52) 4.76) 1.62) 2.26) 0.19) 3.44)
Control -2.85 (- Control -2.48 (- -3.09 (- -3.25 (- -3.43 (- -5.54 (- -2.81 (-3.94, - -2.99 (- -5.43 (- -3.19 (- -1.37 (-
5.06, - 3.63, - 4.53, - 5.18, - 8.3, 9.3, - 1.68) 4.01, - 7.1, - 6.28, - 2.21, -
0.67) 1.33) 1.66) 1.33) 1.45) 1.84) 1.98) 3.75) 0.1) 0.54)
CT -0.37 (- 2.48 CT -0.61 (- -0.77 (- -0.95 (- -3.05 (- -0.33 (-1.89, -0.51 (- -2.95 (- -0.7 (-4, 1.11 (-0.3,
2.83, (1.33, 2.46, 3.01, 5.97, 6.97, 1.23) 1.99, 4.97, - 2.61) 2.53)
2.08) 3.63) 1.23) 1.48) 4.08) 0.84) 0.97) 0.92)
Cycling 0.24 (- 3.09 0.61 (- Cycling -0.16 (- -0.33 (- -2.45 (- 0.29 (-1.54, 0.1 (- -2.34 (- -0.08 (- 1.72 (0.06,
2.39, (1.66, 1.23, 2.55, 5.4, 6.47, 2.1) 1.63, 4.55, - 3.51, 3.39)
2.84) 4.53) 2.46) 2.23) 4.75) 1.54) 1.84) 0.14) 3.31)
IHG 0.4 (- 3.25 0.77 (- 0.16 (- IHG -0.17 (- -2.29 (- 0.44 (-1.79, 0.26 (- -2.18 (- 0.07 (- 1.88 (-
2.52, (1.33, 1.48, 2.23, 5.42, 6.53, 2.68) 1.9, 4.73, 3.57, 0.22, 3.98)
3.32) 5.18) 3.01) 2.55) 5.04) 1.89) 2.45) 0.38) 3.67)
ILE 0.58 (- 3.43 (- 0.95 (- 0.33 (- 0.17 (- ILE -2.12 (- 0.62 (-4.36, 0.44 (- -2.01 (- 0.24 (- 2.06 (-
4.76, 1.45, 4.08, 4.75, 5.04, 8.23, 5.61) 4.56, 7.18, 5.49, 2.89, 7)
5.87) 8.3) 5.97) 5.4) 5.42) 4.05) 5.4) 3.17) 5.97)
IWS 2.69 (- 5.54 3.05 (- 2.45 (- 2.29 (- 2.12 (- IWS 2.72 (-1.13, 2.54 (- 0.1 (- 2.35 (- 4.16 (0.37,
1.62, (1.84, 0.84, 1.54, 1.89, 4.05, 6.64) 1.3, 3.96, 2.48, 8.02)
7.02) 9.3) 6.97) 6.47) 6.53) 8.23) 6.44) 4.24) 7.21)
Other_Aerobic -0.04 (- 2.81 0.33 (- -0.29 (- -0.44 (- -0.62 (- -2.72 (- Other_Aerobic -0.18 (- -2.62 (- -0.38 (- 1.44 (0.03,
2.47, (1.68, 1.23, 2.1, 2.68, 5.61, 6.64, 1.65, 4.64, - 3.65, 2.84)
2.37) 3.94) 1.89) 1.54) 1.79) 4.36) 1.13) 1.28) 0.6) 2.91)
RT 0.14 (- 2.99 0.51 (- -0.1 (- -0.26 (- -0.44 (- -2.54 (- 0.18 (-1.28, RT -2.44 (- -0.19 (- 1.62 (0.33,
2.26, (1.98, 0.97, 1.84, 2.45, 5.4, 6.44, 1.65) 4.33, - 3.44, 2.91)
2.53) 4.01) 1.99) 1.63) 1.9) 4.56) 1.3) 0.53) 3.05)

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Running 2.58 (- 5.43 2.95 2.34 2.18 (- 2.01 (- -0.1 (- 2.62 (0.6, 2.44 Running 2.24 (- 4.06 (2.19,
0.19, (3.75, (0.92, (0.14, 0.38, 3.17, 4.24, 4.64) (0.53, 1.24, 5.93)
5.33) 7.1) 4.97) 4.55) 4.73) 7.18) 3.96) 4.33) 5.77)
SIT 0.32 (- 3.19 0.7 (- 0.08 (- -0.07 (- -0.24 (- -2.35 (- 0.38 (-2.91, 0.19 (- -2.24 (- SIT 1.81 (-
3.44, (0.1, 2.61, 4) 3.31, 3.67, 5.97, 7.21, 3.65) 3.05, 5.77, 1.39, 4.99)
4.08) 6.28) 3.51) 3.57) 5.49) 2.48) 3.44) 1.24)
Walking -1.48 (- 1.37 -1.11 (- -1.72 (- -1.88 (- -2.06 (-7, -4.16 (- -1.44 (-2.84, - -1.62 (- -4.06 (- -1.81 (- Walking
3.84, (0.54, 2.53, 3.39, - 3.98, 2.89) 8.02, - 0.03) 2.91, - 5.93, - 4.99,
0.86) 2.21) 0.3) 0.06) 0.22) 0.37) 0.33) 2.19) 1.39)

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Figure S6. Diastolic Blood Pressure Primary Exercise Mode Analysis Bayesian Ranking
Panel: Litmus Rank-O-Gram Surface Under the Cumulative Ranking Curve Plot.

Figure S7. Diastolic Blood Pressure Secondary Exercise Mode Analysis Bayesian Ranking
Panel: Litmus Rank-O-Gram Surface Under the Cumulative Ranking Curve Plot.

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S11. Diastolic Blood Pressure Primary Exercise Mode Bayesian Table of Rank Probabilities and Surface Under the Cumulative Ranking
Curve.

Treatment Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 SUCRA

AET 0.0125375 0.0999000 0.2692625 0.3677375 0.2505625 0.0000000 45.1222500

Control 0.0000000 0.0000000 0.0000000 0.0000000 0.0000125 0.9999875 0.0002500

CT 0.0498375 0.1638875 0.2079500 0.2271375 0.3511750 0.0000125 46.6807500

HIIT 0.0683875 0.2088625 0.2267125 0.2219875 0.2740500 0.0000000 51.5110000

IET 0.7137875 0.1409875 0.0663625 0.0412875 0.0375750 0.0000000 89.0425000

RT 0.1554500 0.3863625 0.2297125 0.1418500 0.0866250 0.0000000 67.6432500

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S12. Diastolic Blood Pressure Secondary Exercise Mode Bayesian Table of Rank Probabilities and Surface Under the Cumulative
Ranking Curve.

Treatment Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 Rank 7 Rank 8 Rank 9 Rank 10 Rank 11 Rank 12 SUCRA

AIT 0.00783 0.035912 0.094062 0.121125 0.114062 0.101425 0.101750 0.110400 0.121125 0.117850 0.069537 0.004912 48.06227
75 5 5 0 5 0 0 0 0 0 5 5 27
Control 0.00000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.002600 0.108162 0.889237 1.030568
00 0 0 0 0 0 0 0 0 0 5 5 2
CT 0.00002 0.001637 0.012487 0.036625 0.070937 0.109850 0.155287 0.202625 0.220950 0.157575 0.031987 0.000012 37.95113
50 5 5 0 5 0 5 0 0 0 5 5 64
Cycling 0.00233 0.022100 0.094937 0.157162 0.166150 0.155525 0.134275 0.117537 0.089450 0.050587 0.009937 0.000000 54.32397
75 0 5 5 0 0 0 5 0 5 5 0 73
IHG 0.01056 0.052912 0.146137 0.171900 0.141100 0.114987 0.099400 0.093825 0.084875 0.061000 0.022837 0.000462 57.13761
25 5 5 0 0 5 0 0 0 0 5 5 36
ILE 0.14180 0.125237 0.133150 0.083162 0.057175 0.044762 0.042425 0.045750 0.059675 0.079137 0.105062 0.082662 56.20102
00 5 0 5 0 5 0 0 0 5 5 5 27
IWS 0.44512 0.235137 0.122487 0.060725 0.034412 0.024375 0.019075 0.016662 0.016537 0.014387 0.009325 0.001750 86.11647
50 5 5 0 5 0 0 5 5 5 0 0 73
Other 0.00025 0.005412 0.033650 0.081562 0.135900 0.170287 0.184375 0.176075 0.136387 0.067112 0.008987 0.000000 46.94363
Aerobic 00 5 0 5 0 5 0 0 5 5 5 0 64
RT 0.00035 0.006975 0.048375 0.118100 0.180575 0.200562 0.186425 0.140425 0.084825 0.031062 0.002325 0.000000 52.12659
00 0 0 0 0 5 0 0 0 5 0 0 09
Running 0.35128 0.423675 0.166625 0.041225 0.011525 0.003237 0.001425 0.000750 0.000162 0.000087 0.000000 0.000000 91.28386
75 0 0 0 0 5 0 0 5 5 0 0 36
SIT 0.04042 0.091000 0.148087 0.128375 0.087925 0.073775 0.069912 0.073225 0.088825 0.097050 0.081100 0.020300 54.15204
50 0 5 0 0 0 5 0 0 0 0 0 55
Walking 0.00000 0.000000 0.000000 0.000037 0.000237 0.001212 0.005650 0.022725 0.097187 0.321550 0.550737 0.000662 14.67079
00 0 0 5 5 5 0 0 5 0 5 5 55

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S13. Diastolic Blood Pressure Primary Exercise Mode Inconsistency Test with
Notesplitting Model.

Comparison P-value CrI

d.AET.CT 0.365925 NA
-> direct NA -1.4 (-4.7, 2.0)
-> indirect NA 0.33 (-1.1, 1.8)
-> network NA 0.0077 (-1.3, 1.3)
d.AET.HIIT 0.663325 NA
-> direct NA 0.71 (-3.2, 4.6)
-> indirect NA -0.20 (-1.6, 1.1)
-> network NA -0.10 (-1.4, 1.2)
d.AET.RT 0.889375 NA
-> direct NA -0.29 (-2.4, 1.8)
-> indirect NA -0.47 (-1.9, 0.95)
-> network NA -0.44 (-1.6, 0.70)
d.CT.HIIT 0.246975 NA
-> direct NA -4.8 (-13., 3.3)
-> indirect NA 0.10 (-1.6, 1.8)
-> network NA -0.11 (-1.7, 1.5)
d.CT.RT 0.779825 NA
-> direct NA -0.84 (-4.1, 2.4)
-> indirect NA -0.31 (-2.0, 1.4)
-> network NA -0.45 (-2.0, 1.1)
d.HIIT.RT 0.5527 NA
-> direct NA 2.2 (-6.5, 11.)
-> indirect NA -0.44 (-2.0, 1.1)
-> network NA -0.34 (-1.9, 1.2)

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S14. Diastolic Blood Pressure Secondary Exercise Mode Inconsistency Test with
Notesplitting Model.

Comparison P-value CrI

d.AIT.CT 0.2482 NA
-> direct NA 4.8 (-3.1, 13.)
-> indirect NA -0.089 (-2.7, 2.5)
-> network NA 0.36 (-2.1, 2.8)
d.AIT.Other_Aerobic 0.648475 NA
-> direct NA -1.6 (-9.2, 6.0)
-> indirect NA 0.26 (-2.3, 2.9)
-> network NA 0.036 (-2.4, 2.5)
d.AIT.RT 0.552525 NA
-> direct NA 2.2 (-6.2, 11.)
-> indirect NA -0.48 (-3.0, 2.0)
-> network NA -0.14 (-2.5, 2.3)
d.CT.Other_Aerobic 0.490925 NA
-> direct NA 0.81 (-2.8, 4.4)
-> indirect NA -0.59 (-2.4, 1.2)
-> network NA -0.33 (-1.9, 1.2)
d.CT.RT 0.8048 NA
-> direct NA -0.85 (-4.1, 2.4)
-> indirect NA -0.40 (-2.1, 1.3)
-> network NA -0.51 (-2.0, 0.97)
d.CT.Walking 0.4723 NA
-> direct NA 4.0 (-4.1, 12.)
-> indirect NA 1.0 (-0.46, 2.4)
-> network NA 1.1 (-0.30, 2.5)
d.Cycling.RT 0.96225 NA
-> direct NA -0.015 (-6.5, 6.5)
-> indirect NA 0.15 (-1.7, 2.0)
-> network NA 0.10 (-1.6, 1.8)
d.Other_Aerobic.RT 0.592525 NA
-> direct NA 0.55 (-2.6, 3.7)
-> indirect NA -0.42 (-2.1, 1.3)
-> network NA -0.17 (-1.6, 1.3)
d.RT.Running 0.321075 NA
-> direct NA -0.36 (-4.9, 4.2)
-> indirect NA -2.9 (-5.0, -0.70)
-> network NA -2.4 (-4.3, -0.53)
d.RT.Walking 0.995175 NA
-> direct NA 1.6 (-2.2, 5.4)
-> indirect NA 1.6 (0.25, 3.0)
-> network NA 1.6 (0.32, 2.9)
d.AIT.CT 0.2482 NA
-> direct NA 4.8 (-3.1, 13.)
-> indirect NA -0.089 (-2.7, 2.5)
-> network NA 0.36 (-2.1, 2.8)

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Network Meta-Analysis Sensitivity Analysis – Supplementary Information

Figure S10. Systolic Blood Pressure Primary Exercise Mode Sensitivity Analysis Bayesian
Ranking Panel: Litmus Rank-O-Gram Surface Under the Cumulative Ranking Curve Plot.

Figure S11. Diastolic Blood Pressure Primary Exercise Mode Sensitivity Analysis Bayesian
Ranking Panel: Litmus Rank-O-Gram Surface Under the Cumulative Ranking Curve Plot.

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

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Systematic review

Exercise training and resting blood pressure: a large-­

Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503 1 of 11

2 of 11 Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503

Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503 3 of 11

RESULTS Z=8.8, prandom<0.001), 2.85 mm Hg for walking, 6.88 mm Hg

4 of 11 Edwards JJ, et al. Br J Sports Med 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503

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Correspondence to Dr Jamie O’Driscoll, School of Psychology and Life Sciences, Canterbury

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Appendix S1. Search Strategy

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S1. Risk of bias TESTEX scoring.

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

YES NO NO YES NO YES (1) NO YES (2) YES NO YES YES 8

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S2. Study and Training Characteristics.

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Gradidge & Golele., 2018 SOUTH AFRICA Healthy Women Walking Nr 12 3

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Shenoy et al., 2010 INDIA T2D Walking 60-70%Hrr or 50-70%Hrmax 8 5

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Lamina et al., 2013 NIGERIA Mild Hypertension Cycling 60-79% Hr Max 8 nr

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Pascoalino et al., 2015 BRAZIL Heart Transplant Running 69%Vo2Max 12 3

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Guimaraes et al., 2010 BRAZIL Treated Hypertension Other 60% Hr Reserve 16 3

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Jaime et al., 2019 USA Postmenopausal Women Resistance 40%1Rm 12 nr

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Simons et al., 2006 USA Elderly Adults Resistance 75% 1 Rm 16 2

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Stensvold et al., 2010 NORWAY Metabolic Syndrome Combined 6--80% 1 Rm 12 3

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Tjonna et al., 2008 NORWAY Metabolic Syndrome HIIT 90% Hf Max 16 3

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Funnel Plot of Standard Error by Difference in means

-50 -40 -30 -20 -10 0 10 20 30 40 50

Funnel Plot of Standard Error by Difference in means

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Funnel Plot of Standard Error by Difference in means

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S3. Moderator Analysis Results

Mode Intervention Duration Training Frequency Training Compliance %

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Table S4. Full Statistical Outcome Data (Including Disease-Free Analyses)

Analysis Full Statistical Outcome (Including Disease-Free Analysis)

Overall Aerobic Exercise sBP:

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

28 effect sizes/measured groups,

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

WMD Eggers p-value: 0.24258

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

IET Primary Analysis sBP:

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

3 effect sizes/measured groups,

Edwards JJ, et al. Br J Sports Med 2023;0:1–11. doi: 10.1136/bjsports-2022-106503

Systolic Blood Pressure Network Meta-Analysis – Supplementary Information

Treatment Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 SUCRA

AET 0.0002750 0.0270500 0.2583500 0.4277750 0.2865500 0.0000000 40.5345000

Control 0.0000000 0.0000000 0.0000000 0.0000000 0.0000125 0.9999875 0.0002500

CT 0.0683125 0.7335125 0.1325750 0.0456250 0.0199750 0.0000000 75.6912500

HIIT 0.0020125 0.0726500 0.2481375 0.2497625 0.4274250 0.0000125 39.4405000

Exercise training and resting blood pressure: a large-