The effect of different modes of physical exercise on hemodynamic response in middle-aged and older adults with multimorbidity: a systematic review and meta-analysis

Objectives: To verify the effect of different exercise modes on hemodynamic response in middle-aged and older adults with multimorbidity. Methods: A systematic review of randomized controlled trials (RCTs) was performed under the 2020 PRISMA guidelines. Data was extracted from CENTRAL, MEDLINE, EMBASE, and CINAHL sources from 1990 to September 2024. The RCTs eligibility criteria were defined on PICO’s framework as investigating the effect of several exercise modes compared to no exercise intervention in people with hypertension plus one of the following conditions: diabetes mellitus II, chronic obstructive pulmonary disease, knee or hip osteoarthritis, obesity and dyslipidemia. The quality of evidence was measured by Cochrane RoB 2.0 and the GRADE assessment. Results: Twenty-six RCTs (35 comparisons with 2199 participants) testing different modes of physical exercise showed that systolic blood pressure decreased with aerobic exercise (Mean Difference (MD) − 6.98; CI: − 10.07 to − 3.88), resistance exercise (MD − 4.69; CI: − 7.99 to − 1.22), combined exercise (MD − 6.97; CI: − 12.68 to − 1.26). A similar trend was found for diastolic blood pressure after aerobic exercise (MD − 3.91; CI: − 5.92 to − 1.91), resistance exercise (MD − 1.81; CI: − 2.95 to − 0.68) and combined exercise (MD − 4.21; CI: − 7.43 to − 1.00). The overall quality of the evidence was moderate due to inconsistencies found in some categories. Conclusions: Although having a moderate quality, the included studies showed that aerobic, resistance and combined exercise modes seem to be beneficial for blood pressure in middle-aged and older adults with multimorbidity, while alternative interventions seem not to have the same effect.