Optimal Exercise Type and Dose for Blood Pressure Improvement in Middle-Aged and Older Adults with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis

Objective: This study assessed the blood-pressure effects of various exercise regimens in middle-aged and older adults with type 2 diabetes, considering baseline levels, to clarify dose–response relationships for personalized exercise guidance. Methods: We conducted a dose–response network meta-analysis. Systematic searches were performed in Web of Science, EMBASE, PubMed and Cochrane Library. Baseline blood pressure was modelled as an explanatory variable via meta-regression. Thirty-six eligible RCTs of physical-activity interventions in older adults with type 2 diabetes reporting blood-pressure outcomes were included. Results: In stage 1–2 hypertension, mind–body activities were associated with the greatest systolic blood-pressure reduction and appear to be the most effective intervention based on available evidence. For diastolic blood pressure, combined aerobic-resistance training was effective in stage 1 hypertension. Dose–response analysis indicated that clinically meaningful reductions occur at modest volumes (668 and 657 MET-min/week for systolic and diastolic pressures, respectively), aligning with the lower end of international activity guidelines. Conclusions: Individualized exercise prescription based on baseline blood pressure may offer a useful non-pharmacological strategy for hypertension management in older adults with type 2 diabetes. By quantifying the required activity dose, this work provides an evidence base for integrating structured exercise into precision care for this high-risk population.