Effects of isometric training based on the entire population on blood pressure regulation: systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Although numerous studies have investigated the influence of isometric exercise on the management of resting blood pressure, consistent conclusions have not been reached. This study aims to assess the effect of isometric exercise on resting blood pressure regulation and to identify the key parameters of an effective training protocol through subgroup analysis, thereby providing a scientific foundation for individualized exercise prescriptions. Methods: Following the PRISMA guidelines, a systematic search was conducted across the PubMed, Web of Science, EBSCO, Cochrane, and Scopus databases. The search cutoff date was set for September 7, 2025. Emphasis was placed on randomized controlled trials published in the past decade. Results: A total of 40 randomized controlled trials were included. Meta-analysis results demonstrated that isometric training significantly reduced SBP (WMD, −6.72; 95% CI, −8.21 to −5.23, p < 0.0001, I2 = 74%) and DBP (WMD, −2.72; 95% CI, −3.57 to −1.87, p < 0.0001, I2 = 48%). Regression analysis revealed no significant influencing factors. Subgroup analyses suggested that, within the analyzed studies, larger reductions in blood pressure were observed in trials implementing wall squat exercises three times per week for a duration exceeding 8 weeks, particularly among males and hypertensive populations. The intensity associated with the largest effect size differed between systolic (85% HR peak) and diastolic (95% HR peak) blood pressure. Conclusion: Isometric exercise, particularly wall squats performed three times weekly for over 8 weeks, is associated with significant reductions in resting blood pressure. The greatest benefits were observed in males and hypertensive individuals. While higher intensities (e.g., 85–95% HR peak) are effective, the preferable intensity may differ between systolic and diastolic blood pressure and should be individualized. This training represents a valuable adjunctive therapeutic strategy. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251171800, Identifier CRD 420251171800.