The aim of this meta-analysis was to evaluate the effectiveness of heat acclimatization (HA) on time trial (TT) performance, maximum oxygen uptake (VO_2max), exercise heart rate (HR_E), time trials heart rate (HR_TT), maximal heart rate (HR_M), core temperature (T_C), mean skin temperature (T_S), thermal comfort (T_Comf), plasma volume (PV), blood lactate concentration and rate of perceived exertion (RPE). Cochrane-CENTRAL, EMBASE, CINAHL and PubMed databases and reference lists of included studies were searched for randomized controlled trials that investigated the efficacy of HA in athletes. Data were then extracted from the entered studies for analyses. A total of 11 randomised controlled trials (215 participants; mean age, 26.09 years; 91% men) were included after screening of 508 titles and abstracts and 19 full-text articles. The pooled standard mean difference (SMD) between the HA and non-HA groups were 0.50 (95% CI: 0.03 to 0.97, p = 0.04) for TT performance and 1 (95% CI: 1 to 2, p = 0.007) for HR_TT. The pooled mean difference (MD) between the HA and non-HA groups were -7 (95% CI: -13 to -1, p = 0.03) for HR_M. The changes in T_Comf and RPE were too small to be meaningful. There were no significant differences between the HA and non-HA groups for VO_2max, HR_E, T_C, T_S, PV and blood lactate concentration (all p > 0.05). This meta-analysis implies that HA may improve tolerance to discomfort during heat exposure, but may not necessarily improve the associated physiological markers of improved performance.

• The primary finding of this analysis is that athletic performance is improved with heat acclimatization training

• Our analysis was unable to determine the physiological variable(s) that are associated with improved performance

• After heat acclimatization training athletes may be able to tolerate greater levels of thermal stress but our analysis was unable to determine physiological markers of adaption