By 2050, the population aged 60 and older worldwide is projected to double, reaching 22% of the global population in the world (Kanasi et al., 2016). The aging process is accompanied by elevated blood pressure and increased arterial stiffness, along with unfavorable changes in body composition (Steen, 1988; Wu et al., 2019). Along with insufficient physical activity, these factors exacerbate chronic health conditions such as hypertension, and cardiovascular disease (Merchant et al., 2021).

Hypertension in the older population is primarily attributed to a decline in arterial wall elasticity, characterized by increased SBP and decreased DBP in older adults (Westhoff et al., 2007). As large arteries progressively stiffen, DBP continues to decline, further elevating SBP and contributing to isolated systolic hypertension (ISH), the most prevalent subtype among the elderly (Asmar, 2003).

Pulse wave velocity (PWV) is widely recognized as the gold standard for assessing arterial stiffness (Laurent et al., 2006). It also serves as an independent indicator of cardiovascular disease in both individuals with existing conditions and in healthy ones (Blacher et al., 1999; Mattace-Raso et al., 2006). Given its strong association with cardiovascular events, PWV has become a key focus in chronic disease prevention among the elderly.

According to the report, 80%–92% of the elderly have at least one chronic illness, while 50%–77% experience multiple chronic conditions (Chiaranai et al., 2018). Additionally, more than 66% of adults aged 65 and older suffered from hypertension (Chobanian et al., 2003). Furthermore, chronic diseases have a significant impact on life expectancy. Eliminating deaths from major cardiovascular diseases could extend life expectancy by approximately 5.5 years (Arias et al., 2013), and alleviate significant burden on the medical system and on relevant departments (Control and Prevention, 2003). Moreover, after the age of 30 in women and 40 in men, bone mineral density begins to decline and continues to decrease throughout life (Santos et al., 2017). With aging, the progressive loss of bone mass and reduced bone strength make the skeleton increasingly susceptible to osteoporosis, thereby raising the risk of fragility fractures (Demontiero et al., 2012). The BMD of femoral neck measured by DXA is a strong predictive indicator of hip fractures (Johnell et al., 2005), which are associated with more than a threefold increase in 1-year motality risk (Klop et al., 2017). Bone mineral content (BMC) refers to the total mass of mineral content within the bone as measured by DXA, expressed in grams (g). BMD, on the other hand, indicates the mineral density per unit area, with the widely used unit being g/cm². From a clinical perspective, however, T-scores and Z-scores, which are derived from raw BMD values, are more commonly used. The T-score is primarily applied to older individuals and represents the number of SDs a person’s BMD deviates from the mean BMD of a healthy young adult population. Defined by the WHO, the T-score is considered the gold standard for diagnosing osteoporosis: a T-score ≥ −1 SD is considered normal, between −1 and −2.5 SDs indicates osteopenia, and ≤−2.5 SDs indicates osteoporosis. The Z-score, in contrast, reflects how much a person’s BMD deviates from the average BMD of individuals of the same age and sex, and is used to evaluate whether a person’s BMD is lower than expected for their age group (Dimai, 2017).

Substantial evidence suggests that exercise, as non-pharmacological interventions, can effectively benefit older adults on their cardiovascular fitness and body composition (Blair, 1996; Ryan et al., 1998; Chodzko-Zajko et al., 2009), enabling them to maintain independence, actively participate in their families and communities, and sustain overall health (Koopman and Van Loon, 2009). The chronic effect of traditional RT on blood pressure management has been widely recognized. However, traditional RT generally show limited improvement on arterial stiffness (Miyachi, 2013; Ashor et al., 2014; Ceciliato et al., 2020; Lopes et al., 2021). Therefore, comprehensive exercise interventions need to be further explored. CBRT is a time-efficient training model that integrates elements of both resistance and aerobic training (Gotshalk et al., 2004; Kolahdouzi et al., 2019). Consequently, CBRT offers various benefits, including enhanced cardiovascular fitness, decreased body fat, improved lean body mass (Gotshalk et al., 2004; Brentano et al., 2008; Camargo et al., 2008; Kolahdouzi et al., 2019). These lower training intensity can minimize muscle soreness and reduce rate of perceived exertion, thereby enhancing compliance and safety among aged individuals (Sparling et al., 1990; Waller et al., 2011).

Community-dwelling older adults, who maintain greater physical independence than hospitalized counterparts, can be well-suited for exercise interventions. However, previous meta-analyses overlooked the effects of CBRT on blood pressure, arterial stiffness. To address this research gap, our systematic review with meta-analysis will evaluate the intervention effects of CBRT on those overlooked outcomes. Additionally, we will evaluate the effects of CBRT on key health indicators across participants with different BMI ranges, as BMI is the most widely used anthropometric measure in clinical practice and research, associating with cardiovascular disease-related mortality (Nuttall, 2015). By systematically evaluating the effects of CBRT on cardiovascular health and body composition in community-dwelling older adults, this study aims to fill the gap in existing knowledge with respect to the effects of this specific form of resistance training in older populations.

To the best of our knowledge, this is the first meta-analysis systematically evaluating the effects of CBRT on blood pressure, arterial stiffness, and bone health in community-dwelling older adults.

Our findings suggest that CBRT can be safely applied to improve cardiovascular health and body composition in older populations. Notably, seven studies included participants aged 70 years or more, yet still demonstrated beneficial effects. Among the 14 studies included in this meta-analysis, 11 focused on the effects of exercise interventions on cardiovascular health and body composition. The intervention period for these studies was uniformly 12 weeks, except for Simms et al. (2024), which lasted 8 weeks. In contrast, studies targeting bone health typically required longer intervention durations of 12, 24, or 52 weeks (Rhodes et al., 2000; Romero-Arenas et al., 2013; Camacho-Cardenosa et al., 2022). Therefore, discussions regarding the improvements in cardiovascular function are based solely on short-to medium-term interventions. CBRT, as an “optimal combination” of training modalities, led to a significant reduction in SBP (−6.10 mmHg), DBP (−2.88 mmHg), and baPWV (−101.81 cm s⁻¹). This may be due to the nature of CBRT, where lighter weights are lifted with shorter recovery time between sets and result in greater cardiovascular stimulation (Gotshalk et al., 2004).

Our meta-analysis demonstrated that CBRT significantly improves both blood pressure and arterial stiffness at the same time. In consistent with ours, a meta-analysis reported that low-intensity short-rest resistance training significantly reduces baPWV by improving endothelial function (Okamoto et al., 2011). Moreover, resistance training, regardless of intensity, has been shown to effectively improve blood pressure, including both peripheral and central blood pressure (Figueroa et al., 2019). In contrast, traditional resistance training with heavy weights has no significant effect on arterial stiffness in middle-aged and older adults (Miyachi, 2013; Ashor et al., 2014; Lopes et al., 2021). One potential mechanism potentially interpreting the effect of CBRT is that the CBRT-induced muscle hypoxia stimulates nitric oxide (NO) production, enhances endothelial function, and subsequently reduces arterial stiffness, whereas high-intensity resistance training with longer recovery periods does not improve this function (Okamoto et al., 2009). It is suggested that lower-intensity resistance training with shorter rest intervals may be more effective in simultaneously improving baPWV and blood pressure. In terms of training organization, CBRT inherently possesses these characteristics.

It is reported that 10 mmHg reduction in SBP or SBP decrease to lower than 130 mmHg can greatly lower the risk of major cardiovascular disease and coronary heart disease (Ettehad et al., 2016). Additionally, a meta-analysis stated that every 1 m/s increase in baPWV can compound the risk of developing cardiovascular increases by 12% (Vlachopoulos et al., 2012). In this meta-analysis, CBRT significantly lower the baPWV by around 1 m/s, which can be interpreted as a significant lowered risk of cardiovascular disease. However, Since the included studies in this meta-analysis reported blood pressure-related outcomes only lasted 8–12 weeks, the long-term sustainable effect of CBRT-induced cardiovascular fitness improvements in community-dwelling older adults remains unclear. Furthermore, the significant reduction in baPWV observed in this study were restricted to suggest that CBRT may improve peripheral arterial elasticity, while its effects on central aortic compliance remain to be elucidated. Future studies should incorporate carotid-femoral pulse wave velocity (cfPWV) assessments to further investigate the effect of CBRT on lowering central arterial stiffness.

Body composition primarily includes fat, muscle, bone, and water. These components together constitute the total body mass. The relative proportion of body composition can reflect the physiological status and overall health of an individual (Heymsfield et al., 2005). The present meta-analysis indicates that CBRT has positive effects in reducing body fat and improving LBM. This effect may be attributed to the CBRT model, which enhances glucose uptake by skeletal muscle, reduces fat storage in adipose tissue, and helps maintain or increase basal metabolic rate (Donnelly et al., 2009).

Although the meta-analysis revealed a significant improvement in BMC_FN, no significant change was observed in BMD_FN. The increase in BMC_FN suggests a potential enhancement in bone quality at the femoral neck; however, due to the absence of clinically diagnostic indicators such as T-scores, this finding can only be interpreted as evidence of the physiological potential of CBRT to improve bone mineral content. Its clinical relevance in terms of osteoporosis prevention or treatment remains unclear. This is in line with previous findings suggesting that low-impact resistance training may not produce significant changes in BMD_FN or BMD at lumber spine in older adults (Marques et al., 2012). In contrast, a 6-month high-intensity resistance training intervention has shown that BMD_FN could be improved significantly (Vincent and Braith, 2002). This may be attributed to the relatively light weights used in CBRT, which may not impose the mechanical stress to stimulate BMD increases, thereby limiting the potential for BMD improvement.

Although this study provides important evidence. Some limitations in the present meta-analysis also need to be acknowledged.

Firstly, the included studies showed overall low quality with quite a few unclear or unreported risk of bias, which may have compromised the robustness of our findings and limited the generalizability of the results. Secondly, only a few studies reported on several outcomes variables, such as baPWV, which restricted our ability to conduct more comprehensive subgroup analyses. Another potential limitation of this meta-analysis is the inability to assess publication bias due to the small number of included studies. Future studies with sufficient number of included study could confirm the robustness of these findings and further evaluate possible publication bias.

This meta-analysis suggests that CBRT is a safe and effective intervention in community-dwelling older adults, which can significantly improve elevated blood pressure, stiffened arteries, and exacerbated body composition with age. An 8–12-week CBRT program can effectively improve systolic and diastolic blood pressure, as well as body fat percentage and lean body mass in community-dwelling older adults. A higher training frequency (three sessions per week) appears to exert a more pronounced effect on blood pressure management in this population. Exercise prescriptions based on the modality of CBRT can be designed for community-dwelling older adults to promote public health in communities.