Aerobic exercise has been confirmed to improve endothelial function (EF). However, the effect of resistance exercise (RE) on EF remains controversial. We conducted this systematic review and meta-analysis on randomized controlled trials (RCTs) to determine the effect of RE and its intensities on EF. We searched Web of Science, PubMed/Medline, Scopus, and Wiley Online Library, and included 15 articles (17 trials) for the synthesis. Overall, RE intervention significantly improved flow-mediated dilatation (FMD) in brachial artery (SMD 0.76; 95% CI 0.47 to 1.05; p < 0.00001), which represents improved EF. Meta-regression showed that the RE intensity was correlated with changes in FMD (coef -0.274, T = -2.18, p = 0.045). We found both intensities of RE improved FMD, but the effect size for the low- to moderate-intensity (30 to 70% 1RM) was bigger (SMD 1.02; 95% CI 0.60 to 1.43; p < 0.0001) than for the high-intensity (>= 70% 1RM; SMD 0.48; 95% CI 0.21 to 0.74; p = 0.005). We further noticed that RE had a beneficial effect (SMD 0.61; 95% CI 0.13 to 1.09; p = 0.01) on the brachial artery baseline diameter at rest (BADrest), and the age variable was correlated with the changes in BADrest after RE (coef -0.032, T = -2.33, p = 0.038). Young individuals (< 40 years) presented with a bigger effect size for BADrest (SMD 1.23; 95% CI 0.30 to 2.15; p = 0.009), while middle-aged to elderly (>= 40 years) were not responsive to RE (SMD 0.07; 95% CI -0.28 to 0.42; p = 0.70). Based on our findings, we conclude that RE intervention can improve the EF, and low- to moderate-intensity is more effective than high-intensity.

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