Background Drop-set training (DROP) is a time-efficient resistance training method for hypertrophy and strength. Its long-term adaptations remain debated, particularly in relation to its acute physiological responses such as metabolic stress and fatigue. This meta-analysis examines both acute and chronic effects of DROP to provide a comprehensive evaluation of its efficacy. Methods A systematic search was conducted across PubMed, Web of Science, SCOPUS, and SPORTDiscus up to January 20, 2026, following PRISMA guidelines. Studies comparing DROP and traditional resistance training (TRAD) on hypertrophy, strength, metabolic stress, fatigue, and perceived exertion were included. Data extraction and risk of bias assessment were performed using the PEDro scale. Meta-analyses were conducted using a random-effects model. Results The meta-analysis, based on 12 studies (n = 274 participants), revealed significant increases in ratings of perceived exertion (SMD = 1.62, 95% CI [0.33 to 2.91]) and lactate levels (SMD = 0.67, 95% CI [0.20 to 1.14]) for DROP. A trend in favor of DROP was observed for heart rate, although this did not reach statistical significance (SMD = 0.45, 95% CI [- 0.12 to 1.02]). No significant differences were observed between DROP and TRAD for chronic hypertrophy (SMD = 0.04, 95% CI [- 0.29 to 0.36]), strength (SMD = - 0.04, 95% CI [- 0.34 to 0.26]), or muscle endurance adaptations (SMD = 0.53, 95% CI [- 0.20 to 1.26]). Conclusion DROP offers a time-efficient alternative to TRAD, yielding comparable long-term gains in muscle hypertrophy and strength. Based on current evidence, DROP acutely induces significantly higher perceived exertion and lactate responses, whereas heart rate shows no consistent differences between methods. Practitioners should consider these elevated perceptual demands and potential recovery needs when integrating DROP into long-term training periodization. Key Points - Drop-set training induces significantly higher perceived exertion, blood lactate concentrations, and neuromuscular fatigue than traditional resistance training. - Both training modalities lead to comparable long-term gains in muscle hypertrophy, strength, and muscle endurance - While drop-set training is a highly time-efficient alternative, its elevated perceptual and neuromuscular demands might necessitate strategic recovery management to maintain long-term training adherence and frequency.
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