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Exercise modality and cerebral hemodynamics in older adults: A systematic review and network meta-analysis
Zhijian Wu1, Jinhao Zhang1, Mengyao Guo1
1School of Sport Sciences, Nanjing Normal University, Nanjing, China.
Objectives:
To synthesize evidence on how acute and long-term (chronic) exercise interventions affect cerebral hemodynamics, with an emphasis on outcomes relevant to older adults, including mean arterial pressure (MAP), heart rate (HR), middle cerebral artery velocity (MCAv), and end-tidal CO₂ (PetCO₂).
Methods:
A systematic review and meta-analysis were conducted in accordance with PRISMA. We searched PubMed/MEDLINE, Web of Science Core Collection, and ScienceDirect from inception to August 1, 2025. Eligible studies evaluated acute exercise (single bout) or chronic exercise training (≥4 weeks) and reported cerebral and/or systemic hemodynamic outcomes. Pairwise meta-analyses and network meta-analyses were performed in Stata 17.0 to compare exercise modalities; ranking probabilities (SUCRA) were interpreted as exploratory.
Results:
Sixty studies were included (39 acute; 21 chronic). Pairwise meta-analyses indicate that acute exercise is associated with increases in MAP and HR, whereas evidence for acute changes in MCAv and PetCO₂ is less consistent across analyses. In network meta-analyses, most between-modality comparisons are not statistically significant and are often imprecise; accordingly, SUCRA rankings suggest probabilistic ordering rather than superiority. For chronic exercise, the most consistent finding is a reduction in resting HR. Evidence for chronic effects on resting MCAv and MAP remains uncertain, with limited significant between-modality differences.
Conclusions:
Acute exercise is most consistently associated with increased MAP and HR, and chronic exercise training with reduced resting HR. However, evidence for modality-specific superiority on MCAv and PetCO₂ is uncertain because network comparisons are frequently non-significant and imprecise. Ranking results should be viewed as hypothesis-generating. Future adequately powered trials with standardized cerebrovascular endpoints are needed to clarify optimal prescriptions, particularly in older adults.
