Effect of aquatic exercise on blood pressure and related physiological indicators in hypertensive patients: a systematic meta-analysis of randomized controlled trials

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• Picked for Physiology (medical) (top studies of the week, 2 August 2026).

Abstract

BACKGROUND: Hypertension remains one of the most prevalent health risks globally. Aquatic exercise is considered an important non-pharmacological intervention for hypertension; however, its effectiveness in managing blood pressure in hypertensive patients remains controversial. The aim of this study was to systematically evaluate and conduct a meta-analysis to assess the effects of aquatic exercise on blood pressure and related parameters in individuals with hypertension. METHODS: This study followed the PRISMA and Cochrane methodological guidelines. A systematic search was conducted across PubMed, Embase, Web of Science, and Cochrane Library databases. Statistical analyses and funnel plots were generated using R software for the included studies. A total of nine randomized controlled trials (RCTs), contributing up to 12 intervention-control comparisons, were included in the final analysis. Random-effects models were applied to pool effect sizes, and publication bias was assessed. RESULTS: Nine RCTs involving 421 participants were included, contributing up to 12 intervention-control comparisons to the quantitative synthesis. Aquatic exercise significantly reduced systolic blood pressure (MD = -10.68 mmHg, 95% CI: -13.81, -7.54, P < 0.0001; I² = 17.0%) and diastolic blood pressure (MD = -5.85 mmHg, 95% CI: -8.00, -3.69, P < 0.0001; I² = 0%). However, no statistically significant improvements were found in heart rate (MD = -1.99 bpm, 95% CI: -6.47, 2.48, P = 0.3824; I² = 38.8%) or pulse wave velocity (MD = -0.68 m/s, 95% CI: -2.22 to 0.87, P = 0.3913; I² = 65.5%) (P > 0.05). Thus, aquatic exercise did not significantly improve arterial stiffness in hypertensive patients. CONCLUSION: Aquatic exercise significantly reduces systolic and diastolic blood pressure in hypertensive individuals. However, its effects on heart rate and pulse wave velocity are not statistically significant, indicating that it does not have a substantial impact on arterial stiffness in hypertensive patients. Further high-quality research is needed to confirm these findings.

Abstract as published, via PubMed.