Obesity has been considered the driving force for culminating in a significant increase in direct and indirect healthcare costs (Jensen et al., 2013). It is, therefore, important to develop cost-effective strategies for the treatment of obesity in order to reduce the prevalence of obesity-related hypertension (Landsberg et al., 2013 ; Piepoli et al., 2016). One benefit of losing body mass is the concomitant reduction in blood pressure (BP), (Landsberg et al., 2013 ; Jensen et al., 2013 ;Mancia et al., 2013) especially in individuals taking antihypertensive medication (Mancia et al., 2013). Hypertension (HTN), also known as elevated blood pressure (BP), is a disease that occurs when blood vessels are constantly strained by high pressure(WHO, 2020). Studies reported that 5%–10% of patients with hypertension suffer from other diseases, a condition called secondary hypertension (Bruce & Miskulin, 2015). Numerous studies reported that high BP increases the risk of developing common chronic diseases, such as heart, brain, and kidney diseases, as well as the occurrence of cerebrovascular accidents and coronary heart disease (Wenger et al., 2018; Lu et al., 2018; Ettehad et al., 2016) argued that lowering BP can effectively prevent CVDs and death. Therefore, the occurrence and development of hypertension must be prevented and controlled to reduce the risk of CVDs and cerebrovascular diseases. Overweight and obesity are important risk factors affecting the incidence of hypertension (Rhee etal., 2018). Obesity is reported to account for 60–70% of incident hypertension, and individuals with obesity are 3.5 times more likely to have hypertension than normal-weight individuals (Mokdad et al., 2003; Must et al., 1999) .

Hypertension contributes significantly to the global burden of disease, with a ~ 40% prevalence in adults worldwide and accounts for ~ 7.5 million deaths annually, largely due to stroke and coronary artery disease (WHO, 2019). Contemporary evidence revealed that the worldwide prevalence of overweight / obesity among children and adolescents were 13.5% (Berman et al., 2011). In Africa, overweight/obesity is noticeably high with a prevalence of 8.5% in 2010 and predicted to be 12.7% by 2020(Berman et al., 2011). Currently estimates show that in some settings in Africa more than 40% of adults have hypertension (Vijver et al., 2013 ; WHO, 2013).

The combined pooled prevalence of overweight and obesity among children and adolescents in Ethiopia was 11.30% (95% CI: 8.71, 13.88%). Also, the separate pooled prevalence of overweight and obesity were 8.92 and 2.39%, respectively and in Addis Ababa, 11.94 (95% CI: 9.39, 14.50) (Desalew et al., 2017; Gali et al., 2017). The survey also indicated that overweight/obesity in Addis Ababa has increased from 12.4% to 19.6% among men in the same year (EDHS, 2016 ; Moges, 2016). Hypertension is one risk factor for Non-Communicable Diseases in Ethiopia. A meta-analysis on the prevalence of HTN in Ethiopia found that it is increasing with an estimated prevalence of 19.6% (Kibret et al., 2018).

So, using antihypertensive medications are very effective and play an essential role in the management of hypertension in the elderly population, but therapeutic approaches for hypertension per se may not be entirely effective or sufficient for adults with comorbid obesity. In addition to that long-term use of these medications can place significant strain on the kidneys and liver and may lead to dependency and side effects (Wang et al., 2021; Landsberg et al., 2013). As a result, the pursuit of non-pharmacological methods for alleviating and treating hypertension has become a key objective, exercise need as an additional therapeutic management. However, the distinct role of exercise in patients with obesity and hypertension is unclear. Non-pharmacologic strategies, i.e., exercise and weight loss in obese hypertensive adults, alone or in combination with antihypertensive medications, have been used successfully in patients with mild to moderate (grades I and II) hypertension (WHO, 2021).

You et al., showed that even 10 min of vigorous physical activity every week can help reduce the prevalence of hypertension. Several studies have examined the relationship between physical activity and hypertension(You et al., 2018;Bakker et al., 2018). Physical activity is usually recommended as an important lifestyle modification that may help in prevention and treatment of hypertension (Piepoli et al., 2016; Diaz & M., 2013; WHO, 2013; Chobanian et al., 2003 ). It has been shown that active subjects have a lower risk of becoming hypertensive than do sedentary subjects (Fagard, 2006).

People with hypertension are less physically active than those without hypertension and there is strong evidence supporting the blood pressure–lowering ability of regular exercise, especially in hypertensive individuals (Churilla, 2010). Physical inactivity is responsible for around 10% of all deaths, and physical inactivity costs global healthcare systems billions of dollars each year (Berman, 2011). In 2019, out-of-pocket expenditure as a share of current health expenditure for Ethiopia was 37.9% (Gizaw et al., 2015).

Among its many established benefits, acute and regular exercise has a transient and sustained antihypertensive effect, respectively (Cornelissen, 2013), and guidelines exist for its safe prescription in adults with established hypertension (Sharman et al., 2019; Pescatello et al., 2004). Indeed, a review concluded that “evidence is inadequate to recommend exercise training as a non-pharmacological therapy in hypertension” (Seals & Hangberg, 1984). Accordingly, management strategies for obesity-related hypertension are more complicated than for either condition alone.

Currently, no research has determined the effects of different exercise modality and combined with life style counseling in obese, sedentary adults diagnosed with hypertension. Therefore, the aim of this study was to determine changes in BP, body composition, and lipid profile following different (moderate aerobic Vs aerobic-anaerobic or combined intervention) exercise programs performed for 16-weeks.

Following baseline data collection, participants were randomly allocated to one of the three groups, aerobic group, combined (aerobic –anaerobic training) group and control group with life style counseling for two session before the intervention began. The intervention was follow ACSM guidelines (Albrightet al., 2000), exercisers were scheduled to attend four sessions /week which included resistance and aerobic components. The prescribed number of sessions was 64hrs (4-days per week for 16 weeks). All participants were asked to continue with their normal physical activity patterns outside of the study protocol. However, in addition to treatment for the hypo-caloric diet, the control group received the standard guidelines for physical activity recommendations in order to comply with ethical procedures regarding health (Mancia et al., 2013).

The heart rate (HR) of each subject was monitored using a wearable polar device (Electro, Oy, Kempele, Finland) during the entire training session so as to maintain the correct training intensity (Jeffrey et al., 2000; Hagberg et al., 1989). All participants were asked to continue with their normal physical activity patterns outside of the study protocol.

Each session included a 5-minute warm-up and a 5-minute cool-down. The core part of each training session consisted of a range of aerobic exercises group, walking or jogging on the treadmill and pedaling bicycles exercise. The Moderate Aerobic (60–70 Max-HR) performed for 45 minutes.

Participants progressed from 25 to 30 minutes per session at 60% of the maximum heart rate to 45 minutes per session at 70% of the Max-HR (Robergs & Landwehr, 2002) as determined by using a maximal treadmill, and cycling exercise test for 4-times per a week for 16 weeks(Saris et al., 2003; Sigal, 2010).

Participants in this group trained, using CRA for 16 weeks, 4 days per week, 60 minutes each day. This CRA program was divided into warm-up (5-minutes), the main exercise (Participants progressed from 15 to 20min /session at 50% Max-HR to 25min session at 70% Max-HR determined by using walking or jogging on treadmill and pedaling-cycling exercise that maximum heart rate is calculated, Max HR = 220-Age. Plus resistance training at 50% − 70% Max-HR, & 1RM performed 10 different exercises Chest flay, Triceps extension, Lower back ( back extension), leg raise, squatting, dumbbell supine, leg extension, dumbbell curl and trunk flexion and vertical bench press on weight machines), and cool-down (5 minutes).

The warm-up and cool-down included static stretching. Strength intervention progressing to 2 to 3 sets of each exercise at the maximum weight that could be lifted 10 to 12 times.

Weeks 1–9, 50% − 60% of 1RM used for 5–9 repetitions. In weeks 10–12, 60%-70% 1RM were used for 13–16 repetitions for 20-25min. Each session the aerobic and combined exercise totally lasted for 30–45 min (Sigal et al., 2007; Dobrosielski et al., 2012;Whyte et al., 2013). All of the sessions were fully supervised by the researchers.

Control groups were instructed not to change their usual lifestyle, including physical activity. Only life style nutritional council was given the same like other groups. A Hypo-caloric and controlled sodium diet (1,500mg/day) was prescribed for each participant in accordance with the recommendations of the American Diabetes Association and the Spanish Society for the Study of Obesity (Whelton et al., 2012).

The research involved 30 male subjects in the program. No significant variations were in the variables before the program began. Furthermore, a normality test, used by the Shapiro-Wilk test, observed that the data followed a normal distribution among the groups. The intervention started from September/ 2023 and end on January/2024, because it is enough to see a change.

Table 1: Descriptive statistics show that the aerobic group, combined group, and control group participant’s age scores were mean values (M = 52.1, SD = 6.48876; M = 52.3, SD = 6.13242; and M = 52.8, SD = 6.23476), respectively. And their number of years with disease after being medically checked was (M = 5.41, SD = 2.33620, M = 4.63, SD = 2.72641, and M = 4.273, SD = 2.23591), respectively. As the ANOVA table reveals, there is no significant difference between groups before the interventions started by age and years of life time with the disease (F (2, 27) = .036, with p = .895 and F (2, 27) = .051, with respectively (p = .821) level.

The descriptive statistics reveal that the participants mean age and duration of disease after medical diagnosis in the aerobic group were 51.2 years (4.6 years), the combined group was 52.3 years (4.2 years), and the control group was 52.8 years (4.9 years) respectively. The SD indicates that the distribution of age in each group was very small, ranging from 6.1 to 6.5 years, and the distribution of disease after medical diagnosis ranges from 4.3 to 5.4 years.

The study used dependent paired sample t-test, to compare intra group changes in weight, BMI, SBP, and DBP as the primary outcome and TC, LDL, HDL, TG, and WC as the secondary outcome. The results indicated that for all intervention groups, there was a statistically significant difference (P < .001) between the pre- and post-tests, but not for the control group.

Both AG and ARG show very large effect sizes (d > 0.8) across nearly all metabolic and cardiovascular parameters — indicating substantial and clinically meaningful improvements. The control group (COG) shows very small or negligible effects, suggesting little or no natural improvement without intervention. Between intervention groups, ARG often has slightly higher d values, implying that combining interventions produced the greatest effect.

From Table 2 & 3; The t-test reveals that there was a statistical significance differences between pre-test and post-test in aerobic group on weight (W) t(9) = 10.403, P < .001, BMI t(9) = 9.4, p < .001, SBP t (9) = 8.188, P < .001, DBP t(9) = 5.805, P < .001, TC t (9) = 14.853, P < .001, LDL, t (9) = 38.534, P < .001, HDL t (9) = -9.642, p < .001, TG t(9) = 34.552, P < .001, and WC t(9) = 15.653, P < .001 and the combined training group showed a significance statistical differences on Weight (W) t(9) = 15.743, p < .001, BMI t(9) = 14.653, P < .001, SBP t(9) = 21.755, p < .001, DBP t(9) = 5.332, TC t(9) = 22.131, P < .001, LDL t(9) = 8.532, P < .001, HDL t (9) = -5.87,p < .001, TG t(9) = 42.521, P < .001, and WC t(9) = 24.765, P < .001 after intervention. Generally, there was a statistically significant difference between the pretest and post-test of all measured variables in all two different intervention training protocols at (p < 0.001).

The ANOVA and Post-hoc test, Table 4: after a 16weeks the two types of intervention training differed significantly from the control group on weight (W) F (2, 27) = 5.275, P < 0.05), BMI (F (2, 27) = 22.453, P < 0 .001), SBP F( 2,27) = 89.272, P < .001), DBP ( F= (2,27) 37.134, P < .001) TC (F= (2,27) 70.835, P < .001), LDL F ( 2, 27) = 52.110, p < .001, HDL F (2,27) = 36.113, P < .001), TG F (2, 27) = 695.234, P < .001). WC F (2, 27) =. 282.1).

Table 5; presents multiple group pairwise comparisons of the post-hoc mean differences between the two interventions and a control group for Weight, BMI, TC, LDL, HDL, TG, and WC. A significance difference and decrease in those variables has been observed except HDL increase in both of the intervention training groups.

From the Post-hock result, Aerobic intervention group vs. Control group showed significant differences (p < 0.05) with reductions in Weight (MD = -11.00, p < 0.001), BMI (MD = -5.08, P < .001), SBP (MD = -13.3, p < 0.001), DBP (MD = -8.3, p < 0.001), TC (MD = -22.8, p < 0.001), LDL (MD = -49.9, p < 0.001), TG (MD = -70.1, p < 0.001), WC (MD = 14.5, p < 0.001), increase HDL( MD = 5.2, p > 0.05).

From the post-hoc result, the combined intervention group vs. control group showed significant differences (p < 0.001) with reductions in weight (MD = 8, p < 0.001), BMI (MD = -4.78, P < .001), TC (MD = -29.1, P < 0.001), LDL (MD = -46.8, P < 0.001), TG (MD = -80.4, P < 0.001), WC (MD = -17.1, P < 0.001), and increased HDL (MD = 7.3, p < .001).

When we see the combined vs. aerobic group, the combined group shows a statistically significant improvement in SBP (M = -3.8, p < .05) and HDL (MD = 5.4, p < .001), more compared to the aerobic group. The aerobic group decreased more on DBP (MD = 5.4, P < .05), TG (MD = 10.3, P < .05), and WC (MD = 4.5, P < .001) compared with the combined group, but there was no significant difference between the aerobic and combined groups in WC, BMI, TC, and LDL (p > 0.05).

Using the Structured Physical Exercise Program, the study investigated the impact of both aerobic and combined exercise modalities on obese patients with hypertension. Our results indicate that both types of moderate, aerobic and combined exercise performed over a 16-weeks period 4-times a week in the form of supervised, have a great and significant effect on improving body composition, lipid profile, and BP in patients. The study involved 30 male subjects, assigned to the aerobic group (AG = 10), combined (CARG = 10) and control group (COG = 10).

The study reveals that there was a statistically significant difference or change in weight, BMI, blood pressure (SBP and DBP), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and waist circumference (WC) in the aerobic and combined groups, but there was no statistical change in the control group between the pretest and post. The descriptive statistics reveal that the participants mean age and duration of disease after medical diagnosis in the aerobic group were 51.2 years (4.6 years), the combined group was 52.3 years (4.2 years), and the control group was 52.8 years (4.9 years) respectively.

The SD indicates that the distribution of age in each group was very small, ranging from 6.1 to 6.5 years, and the distribution of disease after medical diagnosis ranges from 4.3 to 5.4 years. That means the majority of the participants in each group were similar in age and duration of disease after medical diagnosis, as confounding factors were likely minimized, which strengthens the validity of the result. Significant and substantial improvements were observed in HbA1c, blood pressure, lipid profile, and anthropometric measures in both intervention groups (AG and ARG), with effect sizes ranging from large to extremely large (d = 1.68–12.0). In contrast, the control group (COG) showed only trivial changes (d < 0.4) across all variables. These findings indicate that the interventions produced profound and clinically meaningful benefits in metabolic health.

Evidence from earlier investigations suggests that aging brings about physiological changes resembling those found in people who are inactive or obese. These changes involve increased body and abdominal fat (Kohrt & Obert, 1992; Ryan, 1999), and a noticeable decline in the physical fitness required for regular physical activity(Gregg et al., 2000; Kalyani et al., 2010).

Older adults commonly exhibit increased abdominal adiposity, along with higher rates of obesity and sedentary behavior. These factors are known to elevate the risk of morbidity and mortality within this population (Gregg et al., 2000; Kalyani et al., 2010).

Changes in body mass index, lipid profile, and blood pressure indicate that both aerobic and combined exercise produce beneficial effect on hypertension, weight control, and various metabolic health markers. These outcomes align with previous findings demonstrating that aerobic and combined exercise contribute to reductions in body weight and cardiovascular risk (Slentz et al., 2004). Research further supports that exercise interventions can decrease body fat levels, lower blood pressure, and improve lipid profiles, ultimately helping to reduce the likelihood of cardiovascular disease (Woudberg et al., 2018; Ohta et al., 2005).

Research has shown that aerobic training and dietary modification, whether implemented independently or together, are effective behavior-change strategies for producing favorable improvements in cardiovascular disease risk factors among individuals with obesity (Sandouk, 2017). Current scientific health guidelines also indicate that aerobic and combined exercise programs enhance cardiac function, increase metabolic rate, support weight reduction, lower blood pressure, raise HDL (“good”) cholesterol levels, and improve overall mood and well-being (ADA, 2024).

Consistently with the current result, a study investigating the combined training intervention used both aerobic (45-min walking with cycling) and resistance training (2–3 sets of 7 exercises with 7–9 repetitions). Participants completed a double dose of exercise and observed significant decreases in body weight, body BMI, and abdominal subcutaneous fat in the aerobic and resistance groups compared to control (Sigal et al., 2007).

Comparable findings have been documented regarding the effects of aerobic, resistance, and combined exercise programs performed at moderate intensity for 30 minutes, five days a week over a 12-week period. Studies have shown that individuals participating in combined training experienced significant reductions in body weight, BMI or body fat percentage, and abdominal fat when compared with both control and resistance-only groups (Suleen et al., 2012)

A meta-analysis by Taoli et al., (2018) reported that there was a significant reduction in the BMI in the combined exercise group compared to the non-exercise group (P < 0.05). A randomized controlled design was employed in which forty-seven patients were allocated to either an aerobic training group (n = 27) or an aerobic plus resistance training group (n = 20), both combined with a dietary counseling intervention. After 21 days of high-frequency exercise training, both groups demonstrated a significant reduction in body weight, primarily attributable to losses in fat mass, while fat-free mass was maintained—particularly in the aerobic plus resistance group. In line with the reductions in body weight, both waist and hip circumferences showed comparable decreases across the two treatment conditions (Pietro et al., 2011).

Furthermore, our results indicate that reductions in total cholesterol (TC) were greater in the combined exercise group than in the aerobic-only group, although the difference was not statistically significant. This suggests that combined exercise interventions may have a stronger effect on lipid profiles, which play a key role in the prevention and management of cardiovascular complications.

Our study demonstrated a significant reduction in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the aerobic and combined exercise intervention groups compared with the control group. These findings are consistent with previous meta-analyses, which reported that aerobic exercise interventions can reduce the risk of developing hypertension and effectively lower both SBP and DBP in hypertensive patients(Wang, 2021; Cornelissen, 2013; Whelton et al., 2018).

Similarly, Studies showed that there was a significant decrease in systolic and diastolic blood pressure after moderate-intensity aerobic exercise such as a treadmill performed 3–5 times a week with duration of 30–60 minutes for each exercise (Dimeo et al., 2012; Shaphe et al., 2013).

Meta-analytic evidence indicates that aerobic exercise training can reduce blood pressure by 5 to 7 mmHg, while dynamic resistance exercise has been shown to lower blood pressure by 2 to 3 mmHg in patients with hypertension.( Cornelissen, 2005; Cornelissen, 2013). A study investigating obesity and hypertension reported significant reductions in blood pressure after 12 weeks of exercise interventions. Participants who engaged in moderate-intensity aerobic training three times per week experienced decreases in SBP and DBP of − 4.8 ± 1.69% and − 6.02 ± 1.06%, respectively, while those in a circuit-based resistance training program showed reductions of − 3.09 ± 0.69% (SBP) and − 2.98 ± 1.07% (DBP), compared with minimal changes in the control group (0.3 ± 4.3% SBP; 0.23 ± 0.58% DBP). The study included 59 adults with obesity and mild essential hypertension (Albright et al., 2000).

A meta-analysis evaluating the effects of combined exercise on blood pressure reported a significant reduction in systolic blood pressure (SBP) of 5.47 mmHg (P < 0.05) and in diastolic blood pressure (DBP) of 2.75 mmHg (P < 0.05) compared with a non-exercise control group (Loimaala et al., 2008). Similarly, a 12-week combined exercise intervention demonstrated a greater decrease in SBP, consistent with our findings, although the reduction in DBP differed when compared with aerobic or resistance training alone (Corso et al., 2016).

The study demonstrated that participants in the combined exercise group achieved a significantly larger reduction in systolic blood pressure (MD = − 3.8, P < .05) compared with those in the aerobic-only group, indicating a stronger impact on lowering blood pressure. Consistent with our findings, the combined exercise group demonstrated statistically significant improvements in both systolic blood pressure (SBP) and HDL cholesterol levels compared with the aerobic-only group. Evidence also suggests that substantial volumes of high-intensity exercise may be required to effectively enhance HDL cholesterol efflux capacity in individuals with obesity (Sarzynski et al., 2018). Argani et al., (2014) suggested that even 30 min of exercise per day is sufficient to boost HDL-C levels in obese patients.

On the other hand, our study found that the aerobic exercise group experienced greater reductions in body weight, diastolic blood pressure (DBP), triglycerides (TG), and waist circumference (WC) compared with the combined exercise group, highlighting its effectiveness in promoting weight loss, improving blood pressure, and reducing cardiovascular risk factors (Minyu et al., 2021). Our findings, supported by previous studies, indicate that the combined intervention group experienced significant reductions in systolic blood pressure (SBP), while reductions in diastolic blood pressure (DBP) were observed in comparison to aerobic training alone (Schroeder et al., 2019). Similarly, another study reported that combined training led to a greater reduction in systolic blood pressure (SBP) compared with aerobic training alone. In contrast to our findings, that study also observed a reduction in diastolic blood pressure (DBP) with combined exercise interventions compared to aerobic training (Corso et al., 2016;Sousa et al., 2013). Combined exercise has recently been shown to be an effective intervention for patients with hypertension. Consistently, Ruangthai et al., (2019), reported that following a period of self-supervised training, only the combined training group achieved reductions in both systolic and diastolic blood pressure (SBP and DBP).

Both the aerobic and combined training groups demonstrated significant improvements in total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and waist circumference (WC), reflecting positive effects on lipid profiles that are important for cardiovascular health. In our study, no significant differences were observed between the aerobic and combined exercise groups for TC and LDL. Regular physical activity, particularly aerobic exercise, has consistently been shown to reduce TG and LDL-C levels and modestly increase HDL-C in individuals with obesity and hypertension.

These effects are thought to occur through mechanisms such as enhanced mitochondrial oxidation efficiency, contraction-induced pathways, adrenal stimulation affecting non-esterified fatty acid levels, increased expression of lipases and fatty acid transporters, and promotion of mitochondrial biogenesis (Sakamoto, 1985 ; Van Hall G, 2015).

Previous studies have shown that exercise training positively influences blood lipid profiles by reducing triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C), increasing high-density lipoprotein cholesterol (HDL-C), and enhancing insulin sensitivity as well as the activity of lipoprotein lipase(Trejo-Gutierrez et al., 2013; Wang, 2021; Mann & Beedie, 2014).

Aerobic exercise has been shown to positively affect blood lipid metabolism by increasing high-density lipoprotein cholesterol (HDL-C) through enhanced concentration and activity of lipoprotein lipase (LPL) in skeletal muscle (Sluik et al., 2012). Additionally, aerobic activity accelerates lipid transport, breakdown, and excretion, contributing to reductions in fasting and postprandial lipid levels (Virani et al., 2021; Rothenbacher & Koenig, 2006).

Apart from the aforementioned changes, it also lowers total cholesterol (TC) and serum low-density lipoprotein cholesterol (LDL-C) levels(Virani et al., 2021; Rothenbacher & Koenig, 2006). Intensive diet and aerobic exercise interventions have been shown to produce substantial reductions in TC and triglycerides (TG), although some studies did not include control groups (Barnard et al., 1992). Exercise stimulates lipolytic activity—resulting in decreased plasma TG—enhances the use of free fatty acids (FFA) as an energy source, and increases HDL concentrations. It has also been shown to alter both the quantity and composition of LDL particles, as well as the quality of HDL (Goldhammer et al., 2007;Romani et al., 2009). Combined exercise appears to be the most effective approach for reducing total TG levels and is the best exercise regimen for improving body weight, waist circumference (WC), diastolic blood pressure (DBP), and TC (Minyu et al., 2021).

A meta-analysis by Taoli et al., (2018), reported a significant reduction in TG levels in the combined exercise group compared with the non-exercise group (P < 0.05). Two additional studies examined the effects of combined exercise on LDL-C and HDL-C. They found a significant increase in HDL-C (P < 0.05) in the combined exercise group relative to the non-exercise group. However, the results for LDL-C differed, showing no significant difference between the combined exercise and non-exercise groups (P = 0.22).

A study by (Ha & So, 2012) reported combining 30 min of aerobic exercise at 60–80% of the maximal heart rate − heart at rest (HR reserve) with 30 min of resistance training at 12–15 repetitions maximum in 16 participants aged 20–26 years for 12 weeks. The intervention significantly reduced the participants’ waist circumference and body fat percentage compared with those of non-exercising controls.

A 22-week study evaluating the effects of aerobic training, resistance training, and combined training on percentage body fat in 304 overweight and obese adolescents showed that significant changes in waist circumference (WC) occurred in the aerobic and combined training groups compared with the control group (p < .05) (Sigal et al., 2014). A meta-analysis by Taoli et al., (2018) reported that two studies were included to assess the effect of exercise on WC, and a significant decrease in WC was found in the combined exercise group compared with the non-exercise group (P < 0.05). Another study also demonstrated changes in WC before and after exercise (Church et al., 2010), reporting a 2.8 cm reduction in the combined exercise group, which was the greatest reduction among all groups and significantly different from the non-exercise group.

A meta-analysis and review by Minyu et al., (2021) reported a contrary result: the aerobic exercise group has no statistically significant result observed on weight and waist circumference among the moderate aerobic combined and strength exercise groups, but there was a significant difference in high-intensity aerobic exercise. Exercise has been suggested as a non-pharmacological treatment to improve cardiovascular function in both young and older individuals (Figueroa et al., 2011;Weinstein et al., 2004), aerobic exercise improves cardiovascular health in obese adolescent girls (Pietro et al., 2011). Previous studies reported that increased Nitrogen Oxide bioavailability promotes a decrease in vascular resistance and eventually results in a decrease in blood pressure (Park et al., 2016).

Some limitations of the present study have to be acknowledged. First of all, we are aware of the relatively small group of participants. In addition to that participants medical therapy (medicine they used), nutrition they follow could be a cofounder factors which influence the present study result. The generalization might be difference if the result were included female participants because of the difference variations in vascular function, hormonal response, and baseline blood pressure levels between sexes. Further future research is needed to explore the long-term effects of these interventions with different FITT( frequency, intensity, type and time)of exercise on large participants of men and women too to determine the most effective approach for optimizing health outcomes in individuals with obesity and hypertension.

The findings suggest that aerobic and combined interventions can have a synergistic effect on improving health outcomes like weight management, waist circumference, reducing the risk of various chronic conditions, cardiovascular disease (hypertension).

In addition to that, lower levels of LDL and TG can reduce the risk of atherosclerosis, while higher levels of HDL cholesterol are associated with a lower risk of heart disease. The combined approach may be more effective in improving blood pressure and HDL cholesterol levels, while aerobic exercise may be more beneficial for weight management, reducing TG levels, and improving waist circumference.

The present study provides some insight into the specific changes in health and body composition in response to the proposed aerobic and combined training protocol for obese diabetic hypertensive patients. These findings highlight the importance of individualized treatment plans that may combine different interventions to address the specific needs of individuals with obesity and hypertensive. Further research is needed to explore the long-term effects of these interventions on men and female too to determine the most effective approach for optimizing health outcomes in individuals with hypertensive.

Authors’ contributions TA drafted the manuscript; AK and AT edited and revised the manuscript. All authors have read and approved the final version of the manuscript, and agree with the order of presentation of the authors.