Abstract: OBJECTIVE: Elevated blood pressure increases the risk of cardiovascular diseases. Isometric exercise training has been shown to significantly reduce resting blood pressure, but the factors influencing its effectiveness remain unclear, and specific application guidelines are yet to be established. This study aims to evaluate the impact of isometric exercise training on resting blood pressure through meta-analysis, explore its moderating factors, and provide evidence-based recommendations based on its dose-response relationship. 
METHODS: Following the PRISMA guidelines, a systematic search was conducted in PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases using keywords “Isometric exercise training,” “Systolic blood pressure,” and “Diastolic blood pressure,” covering literature up to September 2024. Randomized controlled trials involving isometric exercise training and resting blood pressure were included. Three independent researchers performed literature screening and data extraction, assessing bias risk and quality grades using the Risk of Bias 2.0 tool and GRADE framework. Main effect pooling, publication bias assessment, subgroup, and regression analysis were conducted using R software (version 4.3.4). 
RESULTS: A total of 28 articles (comprising 32 randomized controlled trials) involving 977 participants were included. (1) Meta-analysis results indicated that isometric exercise training significantly reduced resting systolic blood pressure (MD=-8.01, 95%CI=-9.22 to -6.80, P < 0.01, I²=18.20%, low evidence grade) and diastolic blood pressure (MD=-3.46, 95%CI=-4.64 to -2.28, P < 0.01, I²=0%, moderate evidence grade) compared to no exercise. (2) Subgroup analysis results revealed significant influences of gender, health status, exercise modality, frequency, intensity, duration, sets per session, rest duration, and baseline blood pressure on the main effects for both systolic (P < 0.01) and diastolic blood pressure (P < 0.05). (3) Regression analysis results did not show any significant influencing factors, but body mass index (β=-4.11, P=0.091) showed a significant negative trend on the main effect for systolic blood pressure. (4) No significant publication bias was observed in the meta-analysis results (P > 0.05). 
CONCLUSION: (1) Isometric exercise training significantly lowers systolic (low evidence grade) and diastolic (moderate evidence grade) blood pressure with clinically meaningful thresholds. (2) Participant characteristics (gender, health status, baseline blood pressure, and body mass index) and isometric exercise training protocols (modality, frequency, intensity, duration, cycle, sets per session, and rest duration) influence its antihypertensive effects. (3) The article recommends the optimal blood pressure management prescription: three sessions per week, with four sets per session, each set lasting 2 minutes with a 2-minute rest, at an intensity of 95% HRpeak using isometric wall squat exercises; the intervention period can be adjusted around a 6-week node. Future high-quality research is urgently needed to further validate and support these conclusions.

Key words: exercise prescription, isometric exercise training, isometric exercise, blood pressure management, hypertension, resting blood pressure, meta-analysis