Effects of Isometric Exercise on Cardiovascular and Metabolic Outcomes in Patients with Coronary Artery Disease: a Systematic Review

Introduction. Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Although exercise-based interventions are a cornerstone of cardiac rehabilitation, existing evidence has predominantly focused on aerobic and dynamic resistance training. In contrast, the potential role of isometric exercise in patients with CAD remains insufficiently characterized, with limited and heterogeneous evidence regarding study designs, intervention protocols, and outcome measures, despite emerging findings suggesting favorable cardiovascular and metabolic adaptations when implemented through controlled protocols. Objective. To synthesize and critically appraise the available evidence on the effects of isometric exercise training on cardiovascular and metabolic outcomes in individuals with CAD. Method. A systematic search was conducted to identify randomized controlled trials (RCTs) published up to March 2026 in English, Portuguese, or Spanish. The databases searched included Scopus, Web of Science, PubMed, and Embase. Two independent reviewers performed the search, study selection, and data extraction. Methodological quality and risk of bias were assessed using the PEDro scale and the Cochrane Risk of Bias 2 (RoB 2) tool, respectively. Results. A total of 136 records were identified, of which thirteen met the eligibility criteria. The included studies reported both chronic and acute effects. Positive chronic adaptations were observed in cardiac structure, blood pressure, and coronary perfusion, whereas acute effects during isometric exercise included increased coronary collateral flow, reduced time and medication requirements for stress echocardiography, significant post-exercise hypotension, and metabolic responses characterized by a predominant reliance on carbohydrates as the primary energy substrate. The methodological quality of the included studies ranged from fair to good, while the RoB 2 assessment indicated risks of bias ranging from low to high. Conclusion. Isometric exercise (IE) was well tolerated and demonstrated both chronic and acute benefits, supporting its potential to improve cardiovascular health and enhance the efficiency of diagnostic procedures in patients with CAD.