Abstract Introduction Resistant hypertension (RHT) is a phenotype of hypertension that is challenging to manage by medications alone. While high grade evidence supports physical activity (PA) and exercise to reduce blood pressure (BP) in hypertension, it is unclear whether these are also efective for RHT. Aims To determine the quality of evidence for the efectiveness of PA and exercise and the change of magnitude of 24-hour ambulatory BP (24hABP) in adults with RHT. Methods Scopus, MEDLINE, CINHAL, Web of Science, Embase and SPORTDiscus databases were searched. Cochrane risk of bias tools, Review Manager and Grading of the Recommendation Assessment, Development and Evaluation were used to assess the methodological quality, the clinical heterogeneity and quality of the evidence. Results Four studies comprising 178 individuals in total were included. A meta-analysis with random efects showed decreased 24hABP. The experimental group demonstrated grater mean diferences for 24hABP following the PA and exercise programmes (systolic − 9.88 mmHg, 95% CI: − 17.62, − 2.14, I 2 = 72%, p = 0.01; diastolic − 6.24 mmHg, 95% CI: − 12.65, 0.17, I 2 = 93%,p = 0.06); and aerobic exercise (systolic − 12.06 mmHg, 95% CI: − 21.14, − 2.96, I 2 = 77%, p = 0.009, diastolic − 8.19 mmHg, 95% CI: − 14.83, − 1.55, I 2 = 92% ,p = 0.02). In the included studies, indirectness and publication bias were ‘moderate’ while inconsistency and imprecision were rated as ‘low’. Thus, the overall quality of the evidence was considered to be ‘low’. Conclusions Low certainty evidence suggests that PA and aerobic exercise added to usual care may be more efective in 24hABP reduction in RHT than usual care alone