Effects of Caloric Restriction Combined With Exercise on Lipid Metabolism and Blood Pressure: A Systematic Review and Network Meta-Analysis

CONTEXT: Caloric restriction (CR) combined with exercise has been shown to significantly improve cardiovascular health; however, the synergistic effects of different exercise modalities with CR remain unclear. OBJECTIVE: In this network meta-analysis we aimed to compare the effects of resistance (RE), aerobic (AE), and mixed (MIX) exercise combined with CR on lipid metabolism and blood pressure to identify the most effective intervention strategy and provide evidence-based recommendations for cardiovascular health improvement. DATA SOURCES: We systematically searched relevant studies published January 2007 to September 2024 in PubMed, Web of Science, Embase, and the Cochrane Library. DATA EXTRACTION: Randomized controlled trials (RCTs) examining CR combined with different exercise types were included in this analysis. Data were extracted on study characteristics, intervention details, and outcome indicators. The Cochrane Collaboration risk of bias tool was used to evaluate methodological quality. DATA ANALYSIS: Standardized mean differences (SMDs) with 95% CIs were calculated using a random-effects model. Subgroup analyses were performed based on study characteristics, methodological factors, and intervention duration. CONCLUSIONS: When the intervention duration is ≤16 weeks, mixed exercise combined with CR exhibits the highest probability of yielding optimal improvements in blood lipids, cholesterol, and blood pressure. For interventions exceeding 16 weeks, aerobic exercise with CR is most likely to produce the greatest improvements in blood lipids and cholesterol. For improving blood pressure, mixed exercise combined with CR consistently shows a higher probability of being the most effective intervention compared to other approaches. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. [CRD42025632306].