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

Figures

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  Figure 1. Flow diagram of literature selection.

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  Figure 2. Risk of bias results.

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  Figure 3. Forest plot for arterial stiffness. Forest plot of the effects of resistance training alone or resistance training combined with aerobic training on arterial stiffness in adults with hypertension or overweight/obesity-related vascular risk, compared with non-exercise/usual-care controls; , squares represent study-specific effect estimates, with square area proportional to study weight; , horizontal lines indicate 95% confidence intervals; , the diamond represents the pooled effect estimate, and its width indicates the 95% CI. Positive values favour exercise for arterial stiffness.

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  Figure 4. Meta-regression analysis based on meta-analysis results of arterial stiffness. Meta-regression bubble plot for age, repetitions, sets, frequency, time, duration. Bubble plots for meta-regression analyses of continuous variables. Each bubble denotes an individual effect size, and bubble size is proportional to its weight in the pooled analysis. β, represents the meta-regression coefficient, indicating the estimated change in Hedge's g for each 1-unit increase in the moderator. The black line represents the fitted regression line, the dark gray area the 95% confidence interval, and the light gray area the 95% prediction interval.

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  Figure 5. Forest plot for FMD. Forest plot of the effects of resistance training alone or resistance training combined with aerobic training on FMD in adults with hypertension or overweight/obesity-related vascular risk, compared with non-exercise/usual-care controls; , squares represent study-specific effect estimates, with square area proportional to study weight; , horizontal lines indicate 95% confidence intervals; , the diamond represents the pooled effect estimate, and its width indicates the 95% CI. Positive values favour exercise for FMD.

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  Figure 6. Meta-regression analysis based on meta-analysis results of FMD. Meta-regression bubble plot for age, repetitions, sets, frequency, time, duration. Bubble plots for meta-regression analyses of continuous variables. Each bubble denotes an individual effect size, and bubble size is proportional to its weight in the pooled analysis. β, represents the meta-regression coefficient, indicating the estimated change in Hedge's g for each 1-unit increase in the moderator. The black line represents the fitted regression line, the dark gray area the 95% confidence interval, and the light gray area the 95% prediction interval.

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  Figure 7. Forest plot for wave reflection indices. Forest plot of the effects of resistance training alone or resistance training combined with aerobic training on wave reflection indices in adults with hypertension or overweight/obesity-related vascular risk, compared with non-exercise/usual-care controls; , squares represent study-specific effect estimates, with square area proportional to study weight; , horizontal lines indicate 95% confidence intervals; , the diamond represents the pooled effect estimate, and its width indicates the 95% CI. Positive values favour exercise for wave reflection indices.

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  Figure 8. Publication bias. Funnel plots for arterial stiffness, FMD, wave reflection indices. Each dot represents an individual study effect size. The x-axis indicates Hedge's g, and the y-axis indicates the standard error. The vertical line represents the pooled effect estimate, and the diagonal lines indicate the pseudo 95% confidence limits.

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  Figure 9. GRADE level of evidence for this study's findings. Randomised controlled trials start as high-certainty evidence. Certainty was downgraded by one level for each domain judged as serious and by two levels for any domain judged as very serious.