Comparative efficacy of exercise modalities on cardiometabolic health in older adults: A systematic review and network meta-analysis.

Purpose

To use a network meta-analysis to compare the effects of different exercise modalities on cardiometabolic risk factors in older adults.

Methods

Eight electronic databases were searched from inception to November 30, 2025, for randomized controlled trials involving participants aged ≥ 60 years. Interventions were classified as aerobic training (AT), resistance training (RT), combined training (CT), high-intensity interval training (HIIT), and traditional Chinese training (TCT), an umbrella category encompassing Tai Chi and Health Qigong forms such as Baduanjin, Wuqinxi, and Yijinjing. Outcomes included lipid profiles, blood pressure, glycemic control, body mass index (BMI), and heart rate.

Results

Fifty-seven trials involving 3655 participants were included. Traditional Chinese training ranked highest for total cholesterol and low-density lipoprotein; aerobic training ranked highest for high-density lipoprotein and diastolic blood pressure; combined training ranked highest for systolic blood pressure and fasting blood glucose; resistance training ranked highest for triglycerides and body mass index; and high-intensity interval training ranked highest for glycated hemoglobin. Rankings were interpreted together with effect estimates and Confidence in Network Meta-Analysis (CINeMA) ratings because a high surface under the cumulative ranking curve (SUCRA) value alone does not establish superiority.

Conclusion

The findings indicated modality-specific patterns across cardiometabolic outcomes. Exercise selection may be tailored to the intended clinical outcome, although sparse comparisons and low or very low confidence ratings for several outcomes warrant cautious interpretation.