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The purpose of this study is to conduct a systematic review and meta -analysis of exercise interventions designed to improve cardiovascular responses in individuals with DS. A search for relevant articles was conducted on seven electronic databases: PubMed, PEDro, Google Scholar, Scopus, WOS, MEDLINE, and SPORT Discus. An electronic search was conducted on October 15, 2022, without applying any year constraints. The studies were chosen based on a predetermined set of inclusion and exclusion criteria. The methodology of the study was evaluated using the PEDro scale, and data analyses were conducted using the CMA v3 random effects model. In total, 625 articles were reviewed, and data from 10 randomized controlled trials (RCTs) involving DS were used in this meta -analysis. The results showed that exercise programs were effective in increasing VO 2peak (ml. kg -1 min -1 ) (ES: 0.69; 95 % confidence interval [CI], 0.27-1.12; P : 0.001), time to exhaustion (ES: 0.83; CI, 0.31-1.35, P : 0.001), and VE peak (ES: 0.76; CI, 0.32-1.20; P: 0.001). No changes were found for HR peak (ES: 0.3; CI, -0.02-0.63, P : 0.07), VO 2peak (ml·min -1 ) (ES: 0.45; CI, -0.01-0.92; P : 0.06), or RER (ES: 0.45; CI, -0.09-0.98, P : 0.10). No adverse effects were reported in any of the studies. In this meta -analysis and comprehensive review, exercise interventions may improve cardiovascular responses in DS; however, the association wasn't consistent across trials. RCTs with precise intervention criteria, large sample sizes, and long-term follow-up are needed in the future to demonstrate the benefits of exercise on cardiovascular responses in people with DS., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)