Combined aerobic and resistance training reduces blood pressure in adults with hypertension

They identified five RCTs involving 182 total participants. Four studies with 154 participants showed that combined exercise reduced systolic blood pressure (the top number) by an average of 8.26 mmHg compared to control groups, a statistically significant finding. Five studies with 182 participants demonstrated a reduction in diastolic blood pressure (the bottom number) of 5.87 mmHg. However, when researchers examined mean arterial pressure across three studies, no significant difference emerged between exercise and control groups. The evidence quality was strengthened by adherence to PRISMA guidelines and consistent results across most outcomes, though the relatively small sample sizes and modest effect sizes warrant caution in generalizing findings.

The systolic blood pressure reduction of 8.26 mmHg is clinically meaningful—reductions of 5–10 mmHg are associated with cardiovascular risk reduction in population studies. The consistency of diastolic BP improvement across all five studies (zero heterogeneity in the meta-analysis) strengthens confidence in this finding. Notably, the lack of effect on mean arterial pressure suggests the benefit may not translate uniformly to all pressure measures, hinting that aerobic and resistance components may work through different mechanisms or that timing and intensity matter more than total volume. Prior observational work has suggested combined training may improve vessel compliance better than either modality alone, but these RCTs did not report mechanisms. The modest sample sizes (the largest reported n was not specified individually) and moderate heterogeneity in systolic outcomes (I² = 54.8%) indicate high-quality large trials are still needed to confirm optimal exercise prescription (duration, intensity, frequency, ratio of aerobic to resistance).