Objective:

To evaluate the comparative modulatory efficacy of various exercise modalities on endothelial function and arterial stiffness in older adults.

Approach:

• Search Methodology: Systematically searched eight electronic databases for RCTs evaluating seven exercise modalities in older adults aged 60 years or older.
• Eligibility Criteria: Included supervised, standardized training programs with a minimum duration of 4 weeks and continuous monitoring of exercise intensity.
• Analysis Method: Performed a frequentist network meta-analysis to integrate direct and indirect trial evidence.
• Evidence Assessment: Quality of evidence assessed using Cochrane RoB 2.0 and CINeMA frameworks.

Key Findings:

• Whole-body vibration and resistance training ranked highest for enhancing endothelial function.
• Aerobic training and walking were associated with greater improvements in attenuating arterial stiffness.
• Stretching exercise showed a higher probability of reducing systolic blood pressure.
• Combined training ranked among the leading modalities for lowering diastolic blood pressure.
• Reductions in systolic blood pressure exceeding 10 mmHg are clinically relevant.

Interpretation:

Exercise-induced vascular adaptations in older adults are likely modality-specific, with different modalities offering distinct benefits for endothelial function and arterial stiffness.

Limitations:

• Extensive confidence interval overlap precluded definitive claims of clinical superiority.
• Head-to-head differences generally lacked statistical significance.
• Study heterogeneity and reliance on indirect network comparisons may affect results.

Conclusion:

Exercise monitoring tailored to specific phenotypic characteristics may refine clinical prescriptions, though caution is warranted due to potential risks of bias.

Sources:

• Systematic Review Registration