The effects of aquatic exercise therapy on blood pressure in elderly people with hypertension: a systematic review and meta-analysis
Abstract
Hypertension remains one of the most common controllable risk factors for cardiovascular disease morbidity and mortality in the elderly. Aquatic exercise therapy (AET), as a safe and low-impact form of exercise, has attracted considerable attention due to its potential cardiovascular benefits; however, its impact on blood pressure control in elderly patients with hypertension remains unclear. This systematic review and meta-analysis aimed to investigate the effects of AET on blood pressure and heart rate in elderly patients with hypertension. A comprehensive search of PubMed, Embase, Web of Science, the Cochrane Library, and CINAHL was conducted from inception to July 2026. Randomized controlled trials (RCTs) evaluating the effects of AET compared with control interventions in older adults with hypertension were included. The primary outcomes were systolic blood pressure (SBP) and diastolic blood pressure (DBP), while HR was considered a secondary outcome. Random-effects models were applied for meta-analysis, and subgroup analyses were performed based on the type of control intervention. Four RCTs involving 123 participants were included in this meta-analysis. Compared with control conditions, aquatic exercise therapy (AET) significantly reduced systolic blood pressure (SBP) (MD −10.98 mmHg, 95% CI −17.41 to −4.56, P = 0.001; I² = 29%), diastolic blood pressure (DBP) (MD −5.97 mmHg, 95% CI −6.57 to −5.36, P = 0.001; I² = 0%), and heart rate (HR) (MD −5.91 beats/min, 95% CI −6.70 to −5.12, P = 0.001; I² = 0%). According to the GRADE assessment, the certainty of evidence for the main outcomes was rated as moderate. AET may be an effective non-pharmacological intervention for improving blood pressure control and reducing heart rate in older adults with hypertension. However, further well-designed RCTs with larger sample sizes are needed to confirm its long-term clinical effects. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261462262 , PROSPERO: CRD420261462262.