PURPOSE: This study was based on the PICO framework to systematically evaluate the effects of aerobic exercise on key health management indicators such as blood pressure, heart rate and cardiorespiratory fitness in older hypertensive patients. PATIENTS AND METHODS: A systematic search of randomized controlled trials from four English language databases, Web of Science, PubMed, Cochrane, and Embase, and four Chinese language databases, CNKI, VIP, Wanfang, and Sinomed, was performed (April 2014 to April 2024). StataCorp Stata v.18.0 was used for data analysis. In a random-effects meta-analysis, continuous variables were represented by the mean difference, and each effect size was represented by a 95% confidence interval. RESULTS: Nine randomized controlled trials with 484 participants were included. The meta-analysis revealed that compared with the control group, participants engaging in aerobic exercise significantly reduced systolic blood pressure (SMD -0.93, 95% CI -1.48 to -0.39, p = 0.001), diastolic blood pressure (SMD -0.48, 95% CI -0.75 to -0.21, p = 0.001), and heart rate (SMD -1.78, 95% CI -3.31 to -0.24, p = 0.024), and improved cardiorespiratory health (SMD 0.71, 95% CI 0.24 to 1.18, p = 0.003). CONCLUSION: Older patients with hypertension aged 60 years should engage in 120 to 150 minutes of low- to moderate-intensity aerobic exercise per week, maintaining 40 to 75% maximum HR or 40 to 60% VO2max (20 to 30 minutes per day, 5 days per week, or 75 to 150 minutes of exercise only once or twice a week. However, it is crucial that individuals assess their own health conditions, make appropriate time adjustments, and gradually increase the duration and intensity of exercise. And central randomization with blinded assessment should be used in future randomized controlled trials to reduce implementation bias and measurement bias.

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