(2018) conducted an SR and meta-analysis to estimate the pooled effects of community-based, recreational-level group sports on cardiometabolic risk factors and fitness parameters in adults.[114] Included trials compared group sports interventions against exercise and/or non-exercise controls; the majority used soccer as the group sports intervention. Intervention groups averaged 134 min/week of physical activity; the average intervention duration was roughly six months. Statistically significant differences favored recreational group sports for both SBP (MD -5.7 mm Hg) and DBP (MD -3.4 mm Hg). Improvements in total cholesterol, low-density lipoprotein (LDL) cholesterol, and BMI were also seen with intervention groups; statistically significant differences favored recreational group sports. An SR by Reichert et al. (2018) examined the blood pressure effects of aquatic-based exercise versus land training or non-exercise controls in adults and elderly individuals.[115] Aquatic interventions included aerobic, resistance, or combined aerobic/resistance training, but were limited to exercise performed in an upright position due to potentially beneficial physiological changes associated with hydrostatic pressure from immersion. Improvements in blood pressure for aquatic-based exercise versus control reached statistical significance only with sensitivity analyses for individuals with HTN (SBP and DBP) or for individuals with prehypertension (DBP only). Evidence reviewed did not suggest meaningful differences between higher and lower intensities of exercise or digital interventions to reduce sedentary time versus control. The strength of evidence reviewed for yoga and traditional Chinese exercise was rated low or very low quality and showed either no benefit for intervention versus control or inconsistent findings for critical outcomes.[116-119] As this is a Reviewed, Amended recommendation, the Work Group systematically reviewed evidence related to this recommendation identified in the evidence review conducted as part of this guideline update.[111-119] Quality of the evidence reviewed was affected by the inherent difficulty of blinding participants to exercise interventions. 