Chronotype-aligned exercise timing in middle-aged adults at cardiometabolic risk: a randomised controlled trial

Clinical Snapshot

Key Findings

• P Value: p=0.002 for systolic BP group difference; p=0.005 for group×time interaction

• Effect Size: Large effect size for systolic BP (η²=0.095 indicates 9.5% of variance explained by intervention)

• Primary Outcome: Systolic BP reduction: CAE group -10.8 mmHg vs CME group -5.5 mmHg (difference 5.3 mmHg)

• Nnt Or Sensitivity: Not calculable from available data - would require threshold definitions for clinical response

• Confidence Interval: Not reported

Clinical Application

Moderate feasibility - requires chronotype assessment and flexible scheduling but uses standard exercise protocols Relevant to Australian practice given similar cardiovascular disease burden; aligns with RACGP guidelines for lifestyle modification in cardiovascular prevention; no specific PBS implications as intervention is non-pharmacological Middle-aged adults (40-60 years) with cardiovascular risk factors who are sedentary and suitable for moderate-intensity exercise

Abstract

OBJECTIVE: To investigate whether aligning exercise timing with chronotype enhances cardiometabolic and sleep-related benefits in sedentary adults with cardiovascular risk factors. METHODS: In this 12-week randomised controlled trial conducted in Lahore, Pakistan (January-June 2025), 150 sedentary adults (aged 40-60) with at least one cardiovascular risk factor were recruited and categorised as morning-type or evening-type using the Morningness-Eveningness Questionnaire and validated by 48 hour core body temperature monitoring. Participants were randomised into a chronotype-aligned exercise (CAE) group exercising at their preferred time, or a chronotype-misaligned exercise (CME) group exercising at their non-preferred time. Moderate-intensity aerobic training (5 sessions/week, 40 min/session) was supervised. Primary outcomes included systolic and diastolic blood pressure (BP) and heart rate variability (RMSSD); secondary outcomes included peak oxygen consumption (VO₂ peak), low density lipoprotein (LDL), fasting glucose and sleep quality (PSQI), assessed pre- and post-intervention. RESULTS: Of 150 randomised participants, 134 completed the study (CAE: n=64; CME: n=70). CAE led to significantly greater improvements in systolic BP (-10.8 vs -5.5 mm Hg, p=0.002), diastolic BP, RMSSD, VO₂ peak, LDL, fasting glucose and PSQI scores compared with CME. Repeated measures analysis of variance (ANOVA) revealed significant group×time interactions across all outcomes (eg, systolic BP: η²=0.095, p=0.005). The reduction in systolic BP in the CAE group was substantial and significantly greater than in the CME group. CONCLUSION: Aligning exercise timing with individual chronotype significantly enhances cardiometabolic and sleep-related outcomes in at-risk adults. Chronotype-based exercise prescriptions may offer a cost-effective, personalised approach to improving cardiovascular health.

References

1. 1.Tariq, A., Harris Khalid, M., & Ammar, M. (2026). Chronotype-aligned exercise timing in middle-aged adults at cardiometabolic risk: a randomised controlled trial. Open Heart, 13(1), e003573. https://doi.org/10.1136/openhrt-2025-003573