Comparative dose–response effects of exercise modalities on blood pressure in post-menopausal women: a systematic review with dose–response network meta-analyses

AIMS: While physical exercise is widely recognized as a lifestyle treatment for managing blood pressure, direct comparisons between exercise modalities performed at different weekly exercise doses remain limited. In the meantime, post-menopausal women are at increased risk of hypertension due to the compounded negative effects of aging and dramatic hormone changes during the menopausal transition. Therefore, this study aims to comprehensively evaluate the dose-response effects of exercise modalities on blood pressure in post-menopausal women. METHODS AND RESULTS: A systematic search for randomized controlled trials was conducted across seven databases, encompassing data from inception to December 2024. Dose-response network meta-analyses were conducted to compare the effects of exercise modalities performed at various weekly exercise doses on blood pressure. The primary outcome was the within-group change of systolic (SBP) and diastolic (DBP) blood pressure. Results were reported as mean difference (MD) and 95% credible intervals (CrI), expressed in mmHg. Certainty of evidence was evaluated using Confidence in Network Meta-Analysis (CINeMA) tool. A total of 79 studies, involving 3,628 post-menopausal women, were included in this analysis. Dose-response network meta-analysis identified that multi-component exercises performed at the dose of 900 metabolic equivalent of tasks-min/week (METs-min/week) provided the most consistent benefits in lowering both SBP (MD=-11.94 mmHg; 95% CrI [-16.72, -7.16]) and DBP (MD=-8.60 mmHg; 95% CrI [-11.55, -5.60]). CONCLUSION: This review represents the most comprehensive integration of evidence to date on the comparative dose-response effectiveness of exercise modalities on reducing blood pressure in post-menopausal women, with multi-component exercise at 900 METs-min/week offering the most consistent and beneficial effects.