Relative effectiveness of different exercise interventions on cardiovascular events in individuals with prediabetes: a systematic review and network meta-analysis

BACKGROUND: Prediabetes significantly increases the risk of cardiovascular disease (CVD), including myocardial infarction, stroke, and cardiovascular death. However, the relative effectiveness of different types of exercise interventions in reducing CVD risk in this population is unclear. The aim of this systematic evaluation and network meta-analysis (NMA) was to compare the effectiveness of aerobic exercise (AE), resistance training (RT), mind-body training (MBT), and combined aerobic and resistance training (AE + RT) interventions on CVD events and their associated risk factors. METHODS: Randomized controlled trials (RCTs) published up to May 2025 were systematically searched in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database. Studies were required to report the effect of exercise interventions on cardiovascular event metrics such as Framingham score, 10-year CVD risk, and ICVD score. Two investigators independently completed screening, data extraction, and quality assessment. Network meta-analysis was performed using Stata 17.0, and intervention effects were ranked based on Surface Under the Cumulative Ranking (SUCRA) values. RESULTS: A total of 6 RCTs involving 1,265 subjects were included. The results showed that RT was the most effective in reducing cardiovascular risk, showing the lowest SUCRA values for Framingham score, ICVD score, and insulin resistance (HOMA2-IR). This effect was statistically significant. AE + RT had the most significant advantage in reducing glycated hemoglobin (HbA1c, SUCRA = 26.7%, 95% CI [0.02, 0.89]) and triglycerides (TG, SUCRA = 9.1%). MBT had the optimal effect in improving lipids, as evidenced by higher High-Density Lipoprotein Cholesterol (SUCRA = 85.3%, 95% CI [4.05, 56.83]) and lower Low-Density Lipoprotein Cholesterol, both of which were statistically significant. No significant publication bias or consistency issues were identified in this study. CONCLUSION: Different types of exercise interventions have differentiated advantages on cardiovascular risk and metabolic outcomes in prediabetic populations. RT is more suitable for controlling blood glucose and insulin resistance, AE + RT has the best effect on improving dual indexes of blood glucose and blood lipids, and MBT has a prominent role in lipid regulation. Compared with the traditional Meta-analysis, this study is the first to evaluate the relative effects of multiple exercise interventions through a network meta-analysis, which can provide a scientific basis for developing individualized and risk-oriented exercise prescriptions.