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

Apr 14, 2026Open heart

Exercise timed to body clock in middle-aged adults with heart and metabolism risks

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Abstract

Aligning exercise timing with chronotype resulted in a 10.8 mm Hg reduction in systolic blood pressure for participants in the chronotype-aligned exercise group.

Chronotype-aligned exercise (CAE) produced significantly greater improvements in systolic blood pressure compared to chronotype-misaligned exercise (CME).
Participants in the CAE group experienced greater reductions in diastolic blood pressure and enhancements in heart rate variability.
Improvements in peak oxygen consumption and low-density lipoprotein levels were also greater in the CAE group compared to the CME group.
Fasting glucose levels and sleep quality scores showed more significant improvements in those exercising at their preferred times.
Statistical analysis indicated significant interactions between group and time across all measured outcomes.

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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.

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

Abstract

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