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Background: The influence of aerobic exercise training on cardiovascular adaptations in healthy males vs. females is unclear. This systematic review and meta-analysis summarized sex-based differences in cardiac adaptations following aerobic exercise training interventions in healthy adults., Methods: Five electronic databases were searched from inception to June 2024. Cardiac adaptation data included peak oxygen uptake, heart rate, arteriovenous oxygen difference, systolic and diastolic blood pressure, stroke volume, cardiac output, left ventricular (LV) mass, LV end diastolic volume (LVEDV), LV end systolic volume (LVESV), and LV ejection fraction (LVEF). Meta-analyses were conducted in RevMan 5.4., Results: Meta-analyses were conducted on 4 outcomes: LV mass, LVEDV, LVESV, and LVEF. The meta-analysis revealed no sex differences in LV mass (standardized mean difference = -0.01, 95% confidence interval [CI]: -0.29, 0.27, P = 0.97), LVESV (mean difference [MD] = 1.85, 95% CI: -3.45, 7.10, P = 0.5), or LVEF (MD = -0.9, 95% CI: -3.26, 1.46, P = 0.45) following aerobic exercise interventions. Meta-analyses revealed a sex difference in LVEDV: males show a greater improvement in LVEDV (MD = 7.67, 95% CI: 2.75, 12.59, P = 0.002) than females after aerobic exercise training. No other sex differences were observed in any of the other outcomes. The overall risk of bias was low, and the quality of evidence was moderate., Conclusions: Aerobic exercise interventions were associated with a larger increase in LVEDV in men relative to women, yet no sex differences were found in cardiac morphology (LV mass) or functional indices (LVEF)., (Copyright © 2024 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)