# Effects of neuromuscular warm-up on athletes’ change-of-direction performance and knee isokinetic muscle strength: a systematic review and meta-analysis

## TL;DR

Neuromuscular warm-up improves athletes' change-of-direction performance and knee strength, with effectiveness influenced by protocol details and athlete level.

## Contribution

A systematic review and meta-analysis evaluating how neuromuscular warm-up protocols affect COD performance and knee isokinetic strength in athletes.

## Key findings

- Neuromuscular warm-up significantly improves change-of-direction performance (g = 0.46).
- Knee isokinetic muscle strength is also significantly enhanced (g = 0.72).
- Effectiveness is moderated by warm-up protocol parameters like frequency, sets, and athlete level.

## Abstract

Neuromuscular warm-up is a structured protocol containing at least three of the following exercise types: resistance, dynamic stability, core strength, plyometrics, and agility. Neuromuscular warm-up holds significant clinical value for enhancing athletic performance and reducing injury risk. However, current evidence remains limited regarding its effects on change-of-direction (COD) performance and knee isokinetic muscle strength—two physical qualities critically associated with performance outcomes and injury prevention in multidirectional sports. Furthermore, a comprehensive synthesis is lacking on how to tailor warm-up protocols to optimally improve these two interrelated domains.

This review aims to: 1) evaluate the effects of neuromuscular warm-up on COD performance and knee isokinetic muscle strength, and 2) systematically analyze moderating effects of warm-up protocols (number of exercise, frequency, sets, repetitions, duration, and metrics), athlete level, and study designs (randomized vs. non-randomized trials).

Searches were conducted in PubMed, Web of Science (Core Collection), Embase, and Scopus on 5 May 2025, and updated on 15 May 2025. Pooled effects for each outcome were summarized using standardized mean difference (Hedges’ g) through a three-level meta-analysis model, subgroup and regression analyses were used to explore moderators. The certainty of evidence was assessed using the GRADE approach.

From 25,251 records, 19 studies (n = 810) were included, with a mean PEDro score of 6.00 (high quality). Neuromuscular warm-up significantly improved COD performance (g = 0.46 [0.09, 0.82], I2-2 = 33.7%; I2-3 = 37.7%, Moderate GRADE) and knee isokinetic muscle strength (g = 0.72 [0.39, 1.04], I2-2 = 69.5%; I2-3 = 5.2%, High GRADE) versus controls (regular or dynamic warm-up). Meta-regression analysis indicated that sets in neuromuscular warm-up protocols significantly moderate COD performance. Subgroup analyses indicated that warm-up protocols (neuromuscular warm-up frequency and metrics), athlete levels, and study designs significantly influenced both COD performance and knee isokinetic muscle strength (p < 0.05).

Neuromuscular warm-up significantly enhances COD performance and knee isokinetic muscle strength compared to the control group, moderated by warm-up protocols (frequency, sets, and metrics), athlete level, and study designs.

This study is registered with ClinicalTrials.gov as CRD420251046324.

Infographic summarizes a systematic review and meta-analysis on neuromuscular warm-up effects for athletes' change-of-direction (COD) performance and knee isokinetic muscle strength, including objectives, methods, and findings. Main effects show significant improvements in COD performance and muscle strength. Methods include systematic search, bias assessment, data extraction, and statistical analysis. Key moderators for effectiveness are session frequency and number of sets. Visual elements include icons illustrating protocols, athlete movement, muscle strength measurement, and assessment scales.