Network Meta-Analysis Ranks Exercise Types for Blood Pressure Reduction, With Tai Chi Showing Moderate Benefit

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High blood pressure and prehypertension are major cardiovascular risk factors, and exercise is widely recommended as a non-pharmacological management strategy. However, it has remained unclear which type of exercise works best and at what dose. This large network meta-analysis set out to compare multiple exercise modalities — including combined training, high-intensity interval training, aerobic exercise, resistance training, isometric exercise training, yoga, and tai chi — in adults with prehypertension or established hypertension.

Researchers searched for randomised controlled trials published up to April 2025 and identified 105 eligible studies. Using Bayesian network meta-analysis and dose-response modelling, they assessed the effects of each exercise type on both systolic and diastolic blood pressure. A dose-response analysis was also conducted to explore the relationship between exercise volume and blood pressure reduction.

Combined training and high-intensity interval training produced the greatest reductions in blood pressure overall. Yoga and tai chi demonstrated moderate effects, sitting in the middle of the ranking. Aerobic exercise, isometric exercise training, and resistance training showed comparatively weaker effects. Importantly, dose-response modelling revealed a nonlinear, inverted U-shaped relationship, with the greatest benefit occurring at approximately 830 metabolic equivalents per minute per week, and optimal dosing differing across exercise types.

Conclusion: Tai chi appears to offer a moderate level of blood pressure reduction for people with prehypertension or hypertension, representing a viable option particularly for those who may not tolerate more intensive exercise modalities.

Source: Xin X, Guo Y, Wang M et al. Journal of the American Heart Association (2026). View on PubMed (PMID 42132182) · doi:10.1161/JAHA.125.044003

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