Comparative effectiveness of exercise modalities and doses on carotid-femoral pulse wave velocity in adults: a systematic review and network meta-analysis of randomized controlled trials.

PURPOSE: To compare the effects of exercise modalities and exercise dose on carotid-femoral pulse wave velocity (cfPWV) in adults using pairwise meta-analysis, network meta-analysis, and dose-response analysis. METHODS: PubMed/MEDLINE, Cochrane Library, Web of Science, EBSCO, Embase, and Scopus were searched from inception to 28 January 2026 for parallel-group randomized controlled trials in adults reporting cfPWV. Trials evaluating seven exercise modalities were included. Pairwise meta-analysis, frequentist network meta-analysis, and Bayesian dose-response analysis were performed. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Sixty-nine studies involving 3,422 participants were included. Overall, exercise reduced cfPWV vs. control (WMD = -0.74 m/s, 95% CI -1.02 to -0.46), although heterogeneity was considerable. In the network meta-analysis, aerobic training, combined training, and interval training reduced cfPWV vs. non-exercise control, but no active modality was statistically superior to another. Certainty of evidence was moderate for combined training, low for aerobic training, and very low for interval training vs. control. Bayesian dose-response modelling suggested a nonlinear, model-derived association, with greater uncertainty at the extremes of the dose distribution. CONCLUSION: Exercise training was associated with lower cfPWV in adults, with the most consistent certainty supporting combined training. Comparative rankings and dose-response estimates should be interpreted as exploratory because of heterogeneity, initial network inconsistency, prediction intervals crossing the null, and model-dependent dose estimation. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261355633, PROSPERO identifier CRD420261355633.