Circuit training tops the table for lowering blood pressure after 45

High blood pressure is one of the biggest drivers of cardiovascular disease, and exercise is an established way to lower it without medication. What has never been settled is which type of exercise works best for middle-aged and older adults, and how much of it is actually needed. Guidelines tend to recommend activity in general terms, leaving people to guess whether running, lifting, intervals or something mixed delivers the biggest return. This review set out to rank the options and map the dose against the benefit.

The authors searched six databases for randomised controlled trials in adults aged 45 and over, ending in May 2025, and included 159 trials covering 10,821 participants. They used a Bayesian network meta-analysis to compare exercise modalities against each other and against control on resting systolic and diastolic blood pressure. Exercise dose was expressed in METs-minutes per week, a combined measure of intensity and time, and modelled against the size of the systolic reduction. They also explored what modified the effects, including participants' starting blood pressure.

All exercise modalities significantly lowered both systolic and diastolic blood pressure compared with control. Circuit-based training showed the largest estimated systolic reduction at 13.52 mmHg, ahead of combined training, high-intensity intervals, moderate continuous training, resistance training and isometric exercise. People with higher starting pressure gained more, at an extra 2.49 mmHg of reduction per 10 mmHg of baseline pressure. The dose-response curve was nonlinear, peaking around 1200 METs-minutes per week overall, while circuit training's modelled peak arrived at roughly 580 METs-minutes, near the lower end of WHO recommendations.

This is one of the largest attempts yet to rank exercise types for blood pressure in this age group, and its headline reassurance, that everything works, sits comfortably with existing guidance. The novelty is the strong showing of formats mixing aerobic and resistance work in the same programme. The authors themselves urge caution: no comparison in the network reached high confidence, many trials carried bias concerns, and the circuit-specific evidence base is thin, so the rankings should not be read as definitive.

The most useful message here is permission not to agonise over modality: every form of structured exercise studied moved blood pressure in the right direction. If your reading runs high, the data suggest you have more to gain than someone starting near normal. The strong result for circuit-style sessions is a reason to find mixed aerobic and strength formats interesting, particularly since their modelled benefit peaked at a comparatively modest weekly dose, though that specific ranking is the least certain part of the whole analysis.