Adverse childhood experiences (ACEs) are early-life psychosocial stressors that are associated with poorer mental health and increased cardiovascular disease (CVD) risk in a dose-dependent manner. We examined the feasibility of an 8-wk combined aerobic and resistance exercise training program to improve systolic (SBP) and diastolic blood pressure (DBP), serum endothelin-1 (ET-1), resilience, hope agency, and hope pathways in young women with ACEs. Forty-two healthy women (21 ± 3 yr) with ≥4 (ACE+; n = 28) or 0 ACEs (ACE−; n = 14) participated in this study. Women with ACEs were randomly assigned to an exercise (ACE+ EXT ; n = 14) or nonexercise control (ACE+ CON ; n = 14) group, whereas all ACE− participants were assigned to a nonexercise control ( n = 14) group. Hope agency and DBP did not change in any group ( P ≥ 0.43), but hope pathways improved only in ACE+ EXT (means ± SE change; +1.6 ± 0.74 au, P = 0.032, Hedges’ g = 0.53). ET-1 decreased in ACE+ EXT only (−0.31 ± 0.15 pg/mL, P = 0.043, g = 0.46). Although the interactions for resilience and SBP did not reach significance ( P = 0.05–0.06), forced post hoc analyses indicated that resilience improved (+4.9 ± 1.9 au, P = 0.012, g = 0.64) and SBP tended to improve (−4.0 ± 2.0 mmHg, P = 0.053, g = 0.51) in ACE+ EXT only. There were significant associations between changes in hope pathways and SBP (ρ = −0.43, P = 0.023) and ET-1 (ρ = −0.53, P = 0.005), and between changes in SBP and ET-1 (ρ = 0.49; P = 0.012) in the ACE+ group. In summary, structured exercise training reduces serum ET-1 levels, improves positive psychological coping, and may improve SBP in young women with ACEs. The relationships among the changes in hope pathways, SBP, and ET-1 suggest a cardiovascular psychophysiological relationship in young women with ACEs. NEW & NOTEWORTHY This randomized controlled pilot trial shows, for the first time, that 8 wk of structured, progressive exercise training lowers serum endothelin-1 (ET-1) and improves positive psychological coping in young women with significant early-life psychosocial stress. Furthermore, the observed associations among changes in psychological attributes, ET-1, and systolic blood pressure signify a potential interplay between positive psychology and cardiovascular disease risk among women with adverse childhood experiences.