Combined exercise and HIIT linked to significant falls in blood pressure over 24 Hours: Study

Aerobic and resistance training combined, and high intensity interval training (HIIT), are associated with significant reductions in blood pressure over 24 hours, finds a pooled data analysis of the available evidence for several different types of structured exercise, and published online in the British Journal of Sports Medicine.

Aerobic training is the form of exercise most consistently linked to significant falls in blood pressure at any time, while the evidence for resistance training alone, isometric exercise, and yoga, pilates, and recreational sports is more limited, the analysis indicates.

Exercise is recommended for the prevention and treatment of high blood pressure, defined by the European Society of Cardiology as regular readings above 140/90 mg Hg or current use of drugs to lower it.

And ambulatory blood pressure—readings that capture fluctuations in blood pressure during routine activities of daily living, rather than during a doctor’s visit—are a more reliable indicator of future serious cardiovascular ill health and death, explain the researchers.

While different forms of exercise are known to lower blood pressure, aerobic training is, to date, the only method proven to reduce 24-hour ambulatory blood pressure.

To find out, the researchers scoured research databases from November 2024 to August 2025 for relevant comparative clinical trials looking at the impact of structured exercise training lasting at least 4 weeks.

These included a range of exercise types: aerobic exercise, such as brisk walking, running, and cycling; resistance training, using the body or weights; isometric exercise, such as planks or wall sits; HIIT; yoga/pilates; and recreational sports, such as football, beach tennis and handball.

The results of 31 randomised controlled trials, involving more than 1345 people and 67 different types of exercise, were pooled in a network meta-analysis, which integrates both direct and indirect evidence.

This showed that combined exercise and HIIT reduced blood pressure over 24 hours while aerobic exercise showed the most consistent reductions in ambulatory blood pressure–day and night.

Compared with no exercise, combined exercise training was associated with an average reduction of 6.18 mm Hg, while aerobic exercise was associated with a reduction of 4.73 mm Hg, and HIIT with a reduction of 5.71 mm Hg in systolic (the higher of the 2 numbers) blood pressure over 24 hours.

Average reductions in diastolic (the lower of the 2 numbers) blood pressure were observed with combined training (3.94 mm Hg), aerobic exercise (2.76 mm Hg), HIIT (4.64 mm Hg) and pilates (4.18 mm Hg) over 24 hours.

Pilates, yoga, and recreational sports were not without benefit, the findings indicated, but large scale clinical trials would be needed to confirm the findings before they could be used to inform clinical practice, say the researchers.

Previous research has highlighted isometric exercise as the most effective exercise for lowering high blood pressure, note the researchers.

But “the improvements in endothelial [cell lining] function and the reduction in total peripheral resistance resulting from sustained vasodilation, driven by increased shear stress during exercise, are more closely attributed to aerobic than resistance training,” they explain.

“Furthermore, resistance training may induce transient arterial stiffness due to high-pressure loads. These mechanistic differences may explain the divergent findings observed between our [network meta analysis] and previous reports.”

Their findings prompt the researchers to suggest that resistance exercise should therefore be viewed as a complementary rather than a firstline strategy to lower high blood pressure.

The researchers acknowledge various limitations to their findings. For example, to maximise the available evidence, they included trials with small numbers of participants; side effects were often under reported; data on how well participants stuck to their exercise programmes were often missing; and exercise formats were often classified differently.

But they conclude: “While [aerobic exercise] consistently demonstrated robust results across high-quality trials, the findings for [combined exercise] and HIIT remain promising, but require confirmation through adequately powered, standardised [randomised controlled trials] to enhance the certainty of evidence for clinical practice.”

They add: “Current recommendations should include aerobic (continuous or interval training) or combined training as primary evidence-based interventions for reducing 24-hour ambulatory blood pressure in adults with hypertension.”

Reference:

Mallmann Schneider V, Klarmann Ziegelmann P, Muniz Pereira D, et alEffects of different exercise training modalities on 24-hour ambulatory blood pressure in adults with hypertension: a network meta-analysis of randomised controlled trialsBritish Journal of Sports Medicine Published Online First: 12 May 2026. doi: 10.1136/bjsports-2025-111474