Protocol of a Systematic Review with Meta-analysis: Sex differences in Blood Pressure Response to Chronic Exercise v1

Exercise has been shown to reduce blood pressure (BP) in adults; however, the influence of sex on the hypotensive effects of chronic exercise remains unclear. This study aims to evaluate sex differences in BP responses to chronic exercise. A systematic review with meta-analysis will be conducted using digital databases (EMBASE, PUBMED, LILACS, and SPORTDiscus). Eligible studies will include both randomized and non-randomized clinical trials, as well as crossover studies, involving adult participants (aged 18-65 years). These studies will have representation from both men and women, allowing for sex-based comparisons. The interventions will include chronic exercise (≥ 4 weeks) of any modality. The primary outcomes will include BP values measured pre- and post-exercise (systolic, diastolic, and/or mean BP). Two independent reviewers will evaluate studies during the screening, eligibility, inclusion, and data extraction phases. The methodological quality of the included studies will be assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise. The risk of bias will be assessed using the Joanna Briggs Institute's Critical Appraisal Tools. The overall quality of evidence for each outcome will be rated using the GRADE approach. The pooled results will be presented through forest plots. Subgroup analysis will be conducted based on population and exercise characteristics. Publication bias will be assessed using a funnel plot and Egger’s test for asymmetry.