Effects of football training on patients with hypertension: a systematic review and meta-analysis

BACKGROUND: Hypertension and metabolic disorders remain major global health burdens, yet the specific benefits of football training for adults with these conditions are not fully characterized. This study aimed to systematically evaluate the effects of recreational football on cardiovascular, metabolic, and fitness outcomes, addressing current gaps in evidence. METHODS: We systematically reviewed randomized and matched controlled trials published in English and Chinese, including 20 studies and 1,225 adult participants. Primary outcomes were blood pressure, heart rate, body composition, peak oxygen uptake (VO₂max), muscle strength, and cardiometabolic biomarkers. Random-effects models were used for pooled analyses, with subgroup and sensitivity analyses. This systematic review and meta-analysis were registered in the PROSPERO international prospective register of systematic reviews (CRD420251143230). RESULTS: Football training significantly reduced systolic blood pressure (MD = - 6.67 mmHg, 95% CI: - 8.95 to - 4.39; p < 0.00001), resting heart rate (SMD = - 2.26, 95% CI: - 3.71 to - 0.81; p = 0.002), and diastolic pressure in both normotensive (SMD = - 2.44, 95% CI: - 3.41 to - 1.47) and hypertensive groups (SMD = - 0.92, 95% CI: - 1.40 to - 0.43). VO₂max improved (SMD = 3.96, 95% CI: 1.62 to 6.31; p = 0.0009), as did ejection fraction, E/A ratio, and LV mass. Benefits were observed for LDL (SMD = - 1.64), triglycerides (SMD = - 3.42), total cholesterol (SMD = - 2.44), and HDL (SMD = 2.91). Body fat mass declined in males (SMD = - 0.74), muscle strength increased (SMD = 2.14), and insulin, HbA1c, and FGF-21 improved significantly. CONCLUSION: Recreational football is an effective intervention for improving cardiovascular and metabolic health in adults, particularly those with hypertension. These findings highlight football training as a practical adjunct to conventional exercise therapy.