Can resistance training alone or resistance training combined with aerobic training improve arterial stiffness, endothelial function, and other vascular function indicators in adults with hypertension or overweight/obesity-related vascular risk? A systematic review and meta-analysis of randomized controlled trials

Objective This systematic review and meta-analysis synthesized evidence from randomized controlled trials to examine the overall effects of resistance training alone or in combination with aerobic training on arterial stiffness, endothelial function, and other vascular function indices in adults with hypertension or overweight/obesity-related vascular risk. Methods Following PRISMA guidelines, PubMed, Embase, Web of Science, the Cochrane Library, Ovid, CNKI, Wanfang Data, VIP, and CBM were searched from inception to January 2026 for randomized controlled trials examining resistance training alone or combined with aerobic training on vascular function in adults with hypertension or overweight/obesity-related vascular risk. Random-effects meta-analyses were performed using Hedge's g with 95% confidence intervals (CIs), and heterogeneity was assessed using the I 2 statistic. Prespecified subgroup analyses and meta-regression were conducted as exploratory analyses to identify possible sources of heterogeneity, rather than to establish definitive moderator effects or optimal exercise-prescription thresholds. Results Twenty randomized controlled trials were included. Resistance training-based interventions performed alone or combined with aerobic training significantly reduced arterial stiffness ( g = −0.18, 95% CI −0.33 to −0.04; p = 0.01) and improved FMD ( g = 0.70, 95% CI 0.41–0.99; p < 0.0001) in adults with hypertension or overweight/obesity-related vascular risk. However, the FMD finding should be interpreted cautiously because potential publication bias or small-study effects were detected and the evidence base was limited. Exploratory subgroup patterns were not supported by significant linear associations in meta-regression. No significant effect was observed for wave reflection indices, and evidence for peripheral haemodynamic outcomes remained insufficient. Conclusions Resistance training-based interventions may improve selected vascular function outcomes in adults with hypertension or overweight/obesity-related vascular risk, particularly FMD. However, the FMD finding should be interpreted cautiously because of potential publication bias or small-study effects and the limited evidence base. Evidence for arterial stiffness was less robust after sensitivity analyses, no consistent benefit was observed for wave reflection indices, and evidence for peripheral haemodynamics remained insufficient. Current evidence does not support the superiority of resistance training-based interventions performed alone over combined aerobic–resistance training, and exploratory subgroup findings should not be used to infer optimal training prescriptions. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335684