Effects of Aquatic Exercise Training on Cardiovascular Functions and Cardiometabolic Risk Factors in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Excess adiposity increases cardiovascular and cardiometabolic risks, while aquatic exercise may reduce mechanical barriers to participation. This systematic review and meta-analysis examined aquatic exercise training in individuals with overweight or obesity. PubMed, Web of Science, and the Cochrane Library were searched through to June 2026. Eight randomized controlled trials involving 295 participants were included. Random-effects meta-analyses showed increased VO2 max (MD 3.70 mL·kg−1·min−1, 95% CI 2.49–4.90; p < 0.001) and lower resting heart rate (MD −1.47 beats/min, 95% CI −2.73 to −0.21), systolic blood pressure (MD −4.50 mmHg, 95% CI −7.05 to −1.94), diastolic blood pressure (MD −2.17 mmHg, 95% CI −4.11 to −0.22), triglycerides (MD −15.75 mg/dL, 95% CI −23.12 to −8.39), and fasting glucose (MD −7.82 mg/dL, 95% CI −12.48 to −3.16). No significant pooled effects were observed for total cholesterol, HDL cholesterol, LDL cholesterol, BMI, or body fat percentage. Evidence certainty ranged from low to very low. Aquatic exercise may improve selected cardiovascular and metabolic outcomes, although small samples and heterogeneity limit confidence. Future research must focus on high-quality RCTs to further confirm these findings. PROSPERO: CRD420261340445.