Background <p>Pulmonary hypertension (PH) is a progressive disease associated with reduced exercise tolerance and quality of life, despite advances in pharmacologic therapy. Exercise training has recently emerged as a potential non-pharmacological intervention, with growing evidence supporting its clinical benefits. However, optimal training modalities remain uncertain. This study aimed to synthesize current evidence and determine the overall efficacy and safety of exercise training in patients with PH.</p> Methods <p>This systematic review and meta-analysis evaluated the effects of structured exercise training programs in adults with Group 1 or 4 PH. PubMed and Cochrane Library were searched to identify randomized controlled trials and non-randomized interventional studies. Key outcomes included exercise capacity [Peak oxygen-uptake (VO_2peak), 6-minute walk distance (6MWD)], quality of life, and safety. Data was pooled using a random-effects model, and study quality was assessed with validated risk of bias tools.</p> Results <p>Thirteen studies, approximately 700 participants, were included. Exercise interventions significantly improved 6MWD (+ 52.5&#xa0;m, 95%CI: 38.33–66.69, <i>p</i> &lt; 0.001) and VO_2peak (+ 1.65 mL/kg/min, 95%CI: 0.67–2.62, <i>p</i> &lt; 0.001). Considerable heterogeneity was observed. Changes in quality-of-life scores were not statistically significant but trended positively. A reduction in pulmonary artery systolic pressure was noted [standardized mean difference (SMD) = − 0.21, 95%CI: −0.33 to − 0.10, <i>p</i> &lt; 0.001], while resting heart rate remained unchanged (SMD = − 0.17, 95%CI: −0.55 to 0.21, <i>p</i> = 0.27). Across all studies, exercise training was consistently well-tolerated, with no serious adverse events directly linked to the interventions.</p> Conclusion <p>Exercise training appears to be effective and safe for individuals with PH, improving functional capacity and cardiorespiratory fitness. These findings support its integration into multidisciplinary care.</p>