Frontiers in Physiology · Nov 2, 2026
The Influence of Muscle Contraction Patterns on the Antihypertensive Effects of Exercise: An Umbrella Review of Isometric versus Dynamic Exercise
By RuiQi Liu, Zhiheng Li, Kaitong Hao et al.
Background: Exercise is a key non-pharmacological strategy for hypertension management. Several meta-analyses suggest that isometric exercise may lower blood pressure more than dynamic exercise (aerobic, dynamic resistance, high-intensity interval and combined training); however, these conclusions are constrained by small sample sizes and variable evidence quality. This umbrella review compared the antihypertensive effects of isometric and dynamic exercise, classified by muscle contraction type, and graded the credibility of the existing evidence. Methods: Eight databases were searched from inception to January 2026 for systematic reviews with meta-analyses of randomized controlled trials (RCTs) of exercise training and resting blood pressure in adults. Methodological quality was appraised with A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2), and small-study effects with Egger's test and trim-and-fill analysis. Contraction modes were compared using mixed-effects meta-regression with robust variance estimation, with sensitivity analyses for overlap among primary RCTs; evidence credibility was graded using the Fusar-Poli and Radua criteria. Results: Twenty-three meta-analyses (489 RCT inclusions; 20,111 participants) contributed 30 effect sizes (18 dynamic, 12 isometric). Compared with control, dynamic exercise (systolic blood pressure [SBP]: −5.73 mmHg, 95% CI −7.38 to −4.09; diastolic blood pressure [DBP]: −3.10 mmHg, 95% CI −4.13 to −2.08) and isometric exercise (SBP: −7.26 mmHg, 95% CI −9.50 to −5.02; DBP: −3.56 mmHg, 95% CI −4.11 to −3.00) reduced blood pressure. No statistically significant difference between contraction modes was detected (isometric minus dynamic, SBP: −1.53 mmHg, 95% CI −4.21 to 1.15, P = 0.245; DBP: −0.45 mmHg, 95% CI −1.57 to 0.67, P = 0.403), although the SBP difference favored isometric exercise in all sensitivity analyses and was significant in two. Class II evidence was found for three dynamic and one isometric effect size per outcome; most others were Class IV (weak). Conclusions: Both modes reduced resting blood pressure, with no statistically significant difference between them in the main analysis. This does not establish equivalence: the confidence intervals include clinically relevant differences, the SBP comparison was sensitive to modelling assumptions, and contraction mode was confounded with active muscle mass. The evidence for isometric exercise remains limited and requires confirmation in large, high-quality trials.