Every exercise modality lowers blood pressure — circuit training led at 13.5 mmHg
In short
A Bayesian network meta-analysis of 159 randomised controlled trials (n=10,821) in adults aged 45 and over found every exercise modality significantly reduced systolic and diastolic blood pressure versus control. Circuit-based training showed the largest estimated systolic reduction (−13.52 mmHg; 95% credible interval −18.59 to −8.44), followed by combined training. Higher baseline systolic pressure predicted greater reductions (−2.49 mmHg per 10 mmHg increase), and the dose–response was nonlinear, peaking around 1200 METs-min per week.
Exercise is an established non-pharmacological strategy for lowering blood pressure. What remained unclear was which modality, and how much of it. This study addressed both questions in middle-aged and older adults, aged 45 and over.
Randomised controlled trials were gathered from six databases through May 2025, yielding 159 trials with 10,821 participants. A Bayesian random-effects network meta-analysis compared modalities, and model-based dose–response analysis examined the relationship between dose — expressed as METs-minutes per week — and systolic reduction.
Which modality worked best?
The headline result first: all exercise modalities were associated with significant reductions in both systolic and diastolic blood pressure compared with control. The ranking is a secondary question.
The largest estimated reduction came from circuit-based training, at −13.52 mmHg systolic (95% credible interval −18.59 to −8.44). It was followed by combined training, then high-intensity interval training, moderate-intensity continuous training, dynamic resistance training and isometric exercise.
Circuit-based and combined training generally remained among the highest-ranked modalities across sensitivity analyses, supporting the potential value of integrated aerobic–resistance training.
How much is enough?
The dose–response was nonlinear — more is not indefinitely better. The largest model-estimated systolic reduction occurred around 1200 METs-min per week, corresponding to the upper range of World Health Organization physical activity recommendations.
Circuit training's curve is the interesting one. It reached its model-estimated peak effect at approximately 580 METs-min per week — close to the lower range of the WHO recommendations, which makes it a potentially time-efficient option.
One other consistent pattern concerns the starting point. Higher baseline systolic pressure was associated with greater reductions — 2.49 mmHg more per 10 mmHg of baseline (95% credible interval −3.73 to −1.24). The higher your blood pressure, the more exercise has to give you.
The authors' caution, stated plainly: no network comparison was rated high confidence, and many included studies had some concerns or high risk of bias. Circuit training's apparent superiority over combined training should be interpreted cautiously given the limited circuit-specific evidence. The rankings should not be treated as definitive evidence of superiority. If you take blood pressure medication, set your exercise plan with a clinician.
How this relates to your strength score
There is good news for lifters here: the top-ranked approaches all include resistance training. Circuit training is strength work cycled with short rests, and combined training pairs aerobic work with resistance work. If you already lift, you are halfway there.
The tension is worth naming honestly, though. Training that raises a strength score demands full rest between sets, while circuit training is defined by cutting rest short. Cram both into one session and you get a mediocre version of each. The practical arrangement is to keep heavy Big 3 sessions where they are and add circuits or aerobic work on separate days. Past 40, where a masters correction applies, that trade is especially worth making — see also B12 after 50.
Frequently asked questions
Which exercise is best for lowering blood pressure?
In a network meta-analysis of 159 randomised trials, circuit-based training showed the largest estimated systolic reduction at −13.52 mmHg, followed by combined training. All modalities produced significant reductions, and the authors state the rankings should not be read as definitive.
Does strength training lower blood pressure?
Yes. Every modality in the analysis, including dynamic resistance training and isometric exercise, significantly reduced systolic and diastolic pressure versus control. The two top-ranked approaches, circuit and combined training, both include resistance work.
How much exercise is needed?
The dose–response was nonlinear, with the largest model-estimated systolic reduction around 1200 METs-min per week — the upper range of WHO physical activity recommendations. Circuit training reached its peak estimated effect at approximately 580 METs-min per week.
Does higher blood pressure mean a bigger benefit?
Yes. Reductions were greater with higher baseline systolic pressure, by 2.49 mmHg for every 10 mmHg of baseline.
How reliable are these findings?
The authors note that no network comparison was rated high confidence and that many included studies had bias concerns. The direction is consistent, but the rankings between modalities should not be treated as definitive evidence of superiority.
Source: PubMed