The Effects of Flywheel Resistance Training on Athletic Performance: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The Effects of Flywheel Resistance Training on Athletic Performance: A Systematic Review and Meta-analysis of Randomized Controlled Trials | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effects of Flywheel Resistance Training on Athletic Performance: A Systematic Review and Meta-analysis of Randomized Controlled Trials Junxin Zhang, Jianxiu Liu, Ruidong Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7868842/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background In contemporary elite sport, escalating physical demands require time-efficient strategies that transfer to competition. Flywheel resistance training (FRT)—an iso-inertial modality delivering eccentric overload—may elicit superior neuromuscular adaptations versus gravity-dependent methods. This systematic review and meta-analysis compared the effects of FRT versus non-flywheel comparators (e.g., traditional resistance training) on athletes’ physical performance. Methods Six databases (MEDLINE, PubMed, Scopus, SPORTDiscus, Web of Science, and Academic Search Ultimate) were searched through August 26, 2025. Randomized controlled trials (RCTs) were pooled using random-effects (REML) meta-analysis. Outcomes were synthesized as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study-level risk of bias and certainty of evidence were appraised with the revised Cochrane tool (RoB 2) and GRADE, respectively. Publication bias was examined where k ≥ 10. Results Thirty-four RCTs including 879 athletes met the criteria. One study showed low risk of bias, two high risk, and thirty-one some concerns. Compared with controls, FRT significantly improved strength (SMD = 0.57, 95% CI 0.37–0.76, p < 0.001, I²=50%), explosive power (SMD = 0.56, 0.45–0.68, p < 0.001, I²=31%), speed (SMD = − 0.48, − 0.71 to − 0.25, p < 0.001, I²=42%), agility (SMD = − 0.80, − 1.05 to − 0.55, p < 0.001, I²=60%), endurance (SMD = 0.55, 0.29–0.81, p < 0.001, I²=38%), balance (SMD = 0.85, 0.38–1.32, p = 0.003, I²=52%), and sport-specific performance (SMD = 0.57, 0.32–0.82, p < 0.001, I²=10%). Conclusion FRT is an effective and comprehensive modality to enhance multiple dimensions of athletic performance. Future trials should refine dose–response prescriptions, evaluate long-term adaptations, and examine injury-risk outcomes across diverse athlete populations. Flywheel resistance training Iso-inertial training Traditional resistance training Athletic performance Athletes Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction In contemporary elite sport, escalating match intensity and rapid offensive–defensive transitions impose stringent demands on physical capacities [ 1 , 2 ]. Core neuromuscular qualities—strength, explosive power, speed, and agility—govern initial acceleration, deceleration, change-of-direction (COD), and jumping performance [ 3 , 4 ]. With competition calendars increasingly congested and preparation windows constrained, coaches and performance staff need time-efficient strategies that transfer to competition [ 5 , 6 ]. Traditional, gravity-dependent resistance training (TRT) is foundational, yet it affords limited, independent control of concentric versus eccentric loading [ 7 ]. In practice, to avoid technique breakdown near failure, the eccentric stimulus is often underdosed despite approaches such as eccentric-emphasis prescriptions, tempo control, or dedicated devices [ 8 , 9 ]. Because robust eccentric braking capacity underpins stretch–shortening cycle (SSC) function, explosive output, and rapid deceleration–reacceleration, augmenting eccentric adaptations may also contribute to mitigating non-contact injury risk [ 10 , 11 ]. Flywheel resistance training (FRT) uses an iso-inertial device that stores kinetic energy during the concentric phase and requires active braking during the subsequent eccentric phase; the external load therefore self-adjusts to instantaneous force output [ 12 , 13 ]. With appropriate inertia selection, explicit braking intent, and sound technique, FRT provides a relative eccentric advantage and, under certain configurations, can achieve eccentric overload [ 14 ]. These characteristics may preferentially target braking torque and rate of force development (RFD), support SSC behavior and intermuscular coordination, and deliver high-intensity eccentric stimuli while preserving movement quality [ 15 – 17 ]. FRT program design is flexible: practitioners can manipulate inertia, joint angles and ranges of motion, braking/tempo strategies, and—where available—encoder-derived real-time feedback for velocity–power monitoring and set-density management to align training with sport-specific biomechanics and recovery constraints [ 12 , 13 , 18 , 19 ]. In this article, FRT refers specifically to iso-inertial, flywheel-based resistance training and is distinguished from variable-resistance, isokinetic, or isolated supramaximal eccentric approaches. Comparative studies suggest that, relative to TRT, FRT can enhance several key actions (e.g., vertical jump, short-distance acceleration) [ 14 , 20 ]. However, randomized controlled trials (RCTs) report mixed effects across broader performance domains, with some observing clear benefits (jumping, sprinting, COD) [ 14 , 21 ] and others finding unclear or null effects in agility, balance, or endurance—and occasional unfavorable changes in isolated outcomes [ 22 ]. Differences in training dose, inertia prescription, athlete characteristics, and test subtype likely contribute to this inconsistency. Accordingly, we conducted an RCT-only systematic review and meta-analysis in athlete populations to compare FRT with non-flywheel comparators (CG) across seven performance domains (strength, explosive power, speed, agility, endurance, balance, and sport-specific performance). We also explored whether effects varied by study-level characteristics. We hypothesized larger effects for strength-/power-related outcomes and more variable effects for endurance and balance. Methods This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines[ 23 , 24 ], ensuring methodological rigor, transparency, and reproducibility. Additionally, the study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration ID: CRD420251134531). Data Sources and Search Strategy A comprehensive literature search was performed on August 26, 2025, using six electronic databases: MEDLINE, PubMed, Scopus, SPORTDiscus, Web of Science, and Academic Search Ultimate. The search was limited to peer-reviewed, full-text articles published in English and involving human participants. The complete search strategy for each database, including all Boolean operators and search fields, is presented in Table S1 . All search results were imported into EndNote (Clarivate Analytics), and duplicate records were removed in accordance with PRISMA 2020 guidelines. Title, abstract, and full-text screening were conducted independently by two reviewers (JZ and RL) without the use of automated or semi-automated approaches (e.g., machine learning-based tools). Discrepancies were resolved through discussion or, when necessary, consultation with a third independent reviewer (JL). To ensure comprehensive coverage, we also performed a manual search of the reference lists of all included studies. In addition, the reference lists of relevant narrative reviews, systematic reviews, and meta-analyses were screened to identify any potentially eligible studies not captured by the database search. Eligibility criteria Two authors (JZ and RL) independently screened all retrieved records based on the following pre-defined eligibility criteria: (1) Participants: Competitive athletes (youth or adult; team or individual sports), free from musculoskeletal injury at baseline (no injury requiring time-loss or medical care within the previous 3–6 months). (2) Interventions: Iso-inertial FRT delivered as a multi-session program (i.e., a training intervention, not an acute single-bout study), using disc or conic-pulley devices. (3) Comparators: Non-flywheel training conditions such as traditional/conventional, gravity-dependent resistance training, plyometrics, or usual sport-specific training aimed at improving physical performance; co-interventions were matched between groups, and comparators contained no flywheel exposure. (4) Outcomes: Physical performance outcomes within seven domains—strength, explosive power, speed, agility, endurance, balance, and sport-specific performance (e.g., sport-specific velocity/accuracy/timed tasks). When multiple time points were reported, we extracted the post-intervention assessment closest to program end. (5) Study design: RCTs or randomized crossover trials. Exclusion criteria were as follows: (1) Not an athlete population or presence of relevant injury/clinical condition; (2) Interventions not meeting FRT definition (e.g., isokinetic, variable-resistance, supramaximal-only eccentric) or mixed protocols without isolatable FRT effects; (3) No appropriate non-flywheel comparator; (4) Acute, single-session studies; (5) Insufficient data for quantitative synthesis; and (6) Non-eligible publication types (letters, editorials, protocols, conference abstracts, books, or narrative reviews). Data extraction The data extraction procedures followed the guidelines outlined in the Cochrane Collaboration Handbook [ 25 ]. Data extraction was performed independently by two reviewers (JZ and RL). The characteristics of the included studies are summarized in Table S2 . The extracted information included: (i) first author’s name and year of publication; (ii) participant characteristics (health status, sample size, age, sex); (iii) study design; (iv) study duration; (v) training frequency; (vi) description of the intervention group; (vii) description of the control group; (viii) outcome measurement methods; and (ix) main findings. For both the FRT and control groups, physical performance-related outcomes were recorded as means and standard deviations, and were screened and extracted independently by the two reviewers (JZ and RL). Any discrepancies during the extraction process were resolved through discussion or, if necessary, by consultation with a third independent reviewer (JL). Quality assessment Two reviewers (JZ and RL) used the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess the risk of bias in each included study [ 26 ]. The assessment covered five domains: the randomization process, deviations from the intended interventions, missing outcome data, measurement of the outcome, and selection of the reported results. In each domain, the two reviewers rated the studies as “high risk,” “some concerns,” or “low risk,” based on the signaling questions provided by the tool. Any disagreements between the two reviewers (JZ and RL) were resolved through discussion with a third reviewer (JL). Certainty of Evidence The certainty of evidence for each outcome was assessed by two authors (JZ and RL) using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, based solely on RCTs included in the review. This method classifies the overall confidence in effect estimates as high, moderate, low, or very low [ 27 ]. Evaluations were based on five key domains: risk of bias, inconsistency, indirectness, imprecision, and potential publication bias [ 27 , 28 ]. Discrepancies were resolved by discussion to achieve consensus. This structured evaluation provided a transparent summary of evidence strength specific to RCT-derived outcome estimates. Synthesis Methods and Statistical Analysis All statistical analyses were conducted in R (4.3.1) using the metafor package (version 7.0–0) [ 29 , 30 ]. This study compared the intervention effects between the FRT group and the CG. The meta-analysis was based on changes in variables (i.e., pre- and post-intervention values). When change scores were not directly reported, the standard deviation of change (ΔSD) was calculated based on the pre- and post-intervention standard deviations, assuming a correlation coefficient of R = 0.5 [ 31 ], as previously recommended ( \(\:\varDelta\:SD=\surd\:({SD}_{pre}^{2}+{SD}_{post}^{2}-2\times\:R\times\:S{D}_{pre}\times\:S{D}_{post})\) ) [ 25 ]. Data synthesis was conducted using a random-effects model (Restricted Maximum Likelihood). Statistical significance was set at p < 0.05. Publication bias was assessed using Egger’s linear regression test [ 32 ]. When at least 10 studies were included in a meta-analysis, a funnel plot was generated to visually inspect publication bias [ 31 ]. In addition, the trim-and-fill method was applied to adjust for potential bias. To examine covariates that may modulate the effects of FRT, we conducted subgroup analyses by age (≥ 18 years vs. <18 years), sex (female, male, mixed-sex cohorts), competitive level (elite vs. amateur), intervention duration (≥ 8 weeks vs. <8 weeks), and training frequency (three sessions per week, two sessions per week, or one session per week). To enhance the robustness of the findings, we performed a series of sensitivity analyses to evaluate the influence of individual studies—including those at high risk of bias or identified as outliers—on the pooled results. Outliers were defined as studies whose effect sizes markedly deviated from the overall distribution and had the potential to distort the combined estimates. Sensitivity analyses employed a leave-one-out approach, whereby each study was removed in turn to assess its impact on the meta-analytic conclusions. Sensitivity analyses were conducted using a leave-one-out approach, systematically omitting each study in turn to assess its influence on the overall results. Statistical heterogeneity was quantified using the I² statistic and classified as low (0–25%), moderate (26–50%), substantial (51–75%), or high (> 75%) [ 25 ]. The magnitude of standardized effect sizes was interpreted according to Hopkins’s criteria [ 33 ], with values of 0.0–0.19 considered trivial, 0.2–0.59 small, 0.6–1.19 moderate, 1.2–2.0 large, and > 2.0 very large. Results Study Selection A total of 896 records were identified through the predefined search strategy (896 from databases). After removing 308 duplicate records before screening, 588 unique records remained for title and abstract screening. Of these, 514 were excluded for not meeting the eligibility criteria. The full texts of 74 reports were sought for retrieval, of which one report could not be obtained. The remaining 73 reports from databases/registers were assessed for eligibility, and 40 were excluded for the following primary reasons: absence of a true FRT intervention (n = 19), absence of a control group (n = 12), lack of performance outcome measures (n = 7), and inclusion of participants with injuries (n = 2). One additional report identified through citation searching met the eligibility criteria. Ultimately, 34 studies fulfilled the inclusion criteria and were included in the meta-analysis [ 20 , 34 – 66 ]. The detailed results of the literature search are presented in the PRISMA flow diagram (Fig. 1 ). Characteristics of Included Studies Table S2 provides a qualitative description of the included studies. In total, 34 RCTs involving 879 participants were included in the analysis. The duration of training interventions ranged from 4 weeks to 6 months. The participants were young athletes from various sporting backgrounds. Specifically, ten studies included soccer players, four included basketball players[ 20 , 38 , 46 – 48 , 51 , 53 , 54 , 58 , 61 ], four included handball players[ 39 , 40 , 55 , 63 ], three involved volleyball players[ 35 , 37 , 60 ], three involved tennis players[ 50 , 62 , 64 ], and two included runners[ 44 , 45 ]. In addition, individual studies investigated athletes from badminton[ 34 ], water polo[ 42 ], rugby, track and field[ 36 ], and swimming[ 59 ]. One study included both soccer and basketball players[ 41 ], while another included both volleyball and basketball players[ 49 ]. With respect to training frequency, six studies implemented one session per week [ 20 , 40 , 48 , 49 , 56 , 58 ], twenty-two studies applied two sessions per week [ 34 – 36 , 38 , 39 , 41 – 43 , 46 , 47 , 50 – 54 , 57 , 60 – 62 , 64 – 66 ], five studies conducted three sessions per week [ 37 , 44 , 45 , 55 , 63 ], and one study adopted a four-session-per-week protocol[ 59 ]. Risk of Bias in Studies The risk of bias of the included studies was assessed using the RoB 2 tool, and the overall judgments across the five bias domains are presented in Table 3. Among the included studies, two were rated as having a high risk of bias [ 46 , 49 ], one as having a low risk of bias [ 65 ], and the remaining 31 were judged as raising some concerns. It is noteworthy that all included studies were conducted in the form of RCTs. However, in most cases, the reporting of the randomization process lacked sufficient detail. Only one study provided a complete and detailed description of both the randomization method and allocation concealment. Likewise, only one study explicitly stated that participants remained blinded until arriving at the laboratory to complete the trials. The studies rated as having a high risk of bias included one that primarily adopted team-based allocation rather than individual randomization, without implementing random sequence generation or allocation concealment, thereby introducing a clear risk of selection bias. The other study, although described as randomized, analyzed only those participants with ≥ 80% adherence, with a relatively high dropout rate that was concentrated in the intervention group, which may have led to systematic bias in the estimation of outcomes. The remaining studies were judged as raising “some concerns,” mainly due to insufficient reporting of the randomization process and the potential for deviations from intended interventions or measurement bias arising from contextual factors during the trials. Certainty of Evidence The overall certainty of evidence was evaluated using the GRADE framework, and the results are presented in Table S4. The certainty of evidence for agility, speed, and balance was rated as low, indicating limited confidence in the effect estimates, primarily due to concerns regarding allocation concealment, high heterogeneity, and small sample sizes. In contrast, the certainty of evidence for endurance, sport-specific performance, strength, and power was rated as moderate, suggesting a moderate level of confidence in the effect estimates, although further research may still influence these conclusions. Results of Data Synthesis Strength A total of 18 RCTs assessed maximal strength performance using various methods, including one-repetition maximum squat (1RM squat) [ 37 , 40 , 43 , 45 , 48 , 54 , 55 , 57 ], isometric mid-thigh pull (IMTP)[ 34 ], maximal voluntary contraction (MVC) [ 52 ], isokinetic strength testing of knee extension/flexion at different velocities (CON/ECC) [ 38 , 47 , 48 , 53 , 60 ], bench press[ 42 ], and peak force output in jump tasks (CMJ and SJ) [ 66 ]. The pooled results indicated that FRT significantly enhanced maximal strength compared with CG (SMD = 0.57, 95% CI 0.37 to 0.76, p < 0.001), with moderate heterogeneity (I² = 50%) (Fig. 2 ). Egger’s test suggested funnel plot asymmetry (t = 2.06, p = 0.047), indicating potential publication bias. The trim-and-fill analysis imputed eight studies, and the adjusted pooled effect size remained significant (SMD = 0.34, 95% CI 0.10 to 0.57, p = 0.006), suggesting the robustness of the results (Fig. S1 ). Power Jump performance, a core indicator of explosive power, was widely assessed across the included studies, with several RCTs incorporated into the analysis. Different jump tests were employed, including countermovement jump (CMJ)[ 20 , 36 – 38 , 40 – 43 , 47 – 50 , 52 , 54 – 57 , 62 , 63 , 66 ], squat jump (SJ)[ 36 , 43 , 44 , 47 – 49 , 52 , 55 , 61 , 66 ], drop jump (DJ)[ 52 , 61 ], reactive strength index (RSI)[ 52 , 66 ], single-leg jump[ 39 , 40 ], multiple Hops[ 39 , 58 , 61 ], standing long jump[ 39 ], medicine ball throw (MBT)[ 50 , 62 ], and squat jump[ 40 , 55 , 66 ]. The pooled analysis demonstrated that FRT significantly improved jump performance in athletes (SMD = 0.56, 95% CI 0.45 to 0.68, p < 0.001), although moderate heterogeneity was present (I² = 31%) (Fig. 3 ). Egger’s test suggested funnel plot asymmetry (t = 2.19, p = 0.032), indicating potential publication bias. The trim-and-fill analysis imputed 11 studies, but the adjusted pooled effect size remained significant (SMD = 0.44, 95% CI 0.31 to 0.58, p < 0.001), supporting the robustness of the findings (Fig. S2 ). Agility This meta-analysis included 16 RCTs evaluating the effect of FRT on agility performance in athletes [ 20 , 34 , 39 , 41 – 43 , 46 – 48 , 50 , 51 , 56 , 55 , 58 , 61 , 62 ]. All studies employed change-of-direction–related tests, though the specific formats varied. The pooled results revealed that FRT significantly improved agility performance compared with CG (SMD = − 0.80, 95% CI − 1.05 to − 0.55, p < 0.001), with moderate heterogeneity (I² = 60%) (Fig. 4 ). Egger’s test suggested funnel plot asymmetry (t = − 2.77, p = 0.009), indicating potential publication bias. However, after adjustment using the trim-and-fill method, the pooled effect size remained significant (SMD = − 0.60, 95% CI − 0.88 to − 0.33, p < 0.001), supporting the robustness of the findings (Fig. S3 ). Speed Sixteen RCTs were included in this meta-analysis, providing data related to sprint performance [ 20 , 36 , 40 , 42 , 43 , 46 – 48 , 50 , 54 – 56 , 58 , 61 – 63 ]. Specifically, 5 m sprints were reported in three studies [ 50 , 56 , 62 ], 10 m sprints in seven studies [ 20 , 43 , 47 , 48 , 50 , 54 , 62 ], 15 m sprints in one study [ 63 ], 20 m sprints in five studies [ 20 , 40 , 42 , 55 , 56 ], 30 m sprints in four studies [ 20 , 36 , 47 , 48 ], 40 m sprints in one study [ 58 ], and 60 m sprints in one study [ 61 ]. In addition, some studies used specific sprint-related measures such as 10 m acceleration and 20 m flying sprint [ 36 , 46 ], as well as repeated sprint tests (CS10r, CS20r) [ 38 ]. The pooled results indicated that FRT significantly improved sprint performance compared with CG (SMD = − 0.48, 95% CI − 0.71 to − 0.25, p < 0.001), with moderate heterogeneity (I² = 42%) (Fig. 5 ). Egger’s test suggested funnel plot asymmetry (t = − 2.20, p = 0.037), indicating potential publication bias. However, the trim-and-fill analysis did not impute additional studies, and the pooled effect size remained significant (SMD = − 0.48, 95% CI − 0.71 to − 0.25, p < 0.001), confirming the robustness of the results (Fig. S4). Endurance Seven RCTs assessed the effect of FRT on endurance performance in athletes [ 39 , 41 , 44 , 45 , 58 , 60 , 63 ]. Various measures were employed, including intermittent running tests such as the VIFT [ 58 ] and 20 m Shuttle-Run [ 63 ]; repeated sprint ability (RSA) tests including RCODD and RCODND [ 39 ], RE65–85% [ 44 ], best and mean RSA [ 60 ], and RSAb, RSAs, RSAm, and %Dec [ 41 ]; maximal oxygen uptake–related measures such as VO₂max, VVO₂max, VT1, VT2, and RE75% [ 45 ]; and endurance time trials including the 2 km TT and 10 km TT [ 45 ] and the 20-m ST [ 41 ]. The pooled results demonstrated that FRT significantly improved endurance performance compared with CG (SMD = 0.55, 95% CI 0.29 to 0.81, p < 0.001), with moderate heterogeneity (I² = 38%) (Fig. 6 ). Balance This meta-analysis included three RCTs with a total of ten effect sizes evaluating the impact of FRT on athletes’ balance performance. Various assessment methods were employed across studies, including the Y-Balance Test (YBT) [ 51 ], the Dynamic Postural Stability Index (DPSI) [ 34 ], and dynamic stability indicators such as CRDR and CRDI [ 35 ]. The pooled results indicated that FRT had a statistically significant positive effect on balance performance compared with the control group (SMD = 0.85, 95% CI 0.38 to 1.32, p = 0.0026), with moderate heterogeneity observed (I² = 52%) (Fig. 7 ). Sport-specific performance This meta-analysis included nine RCTs evaluating the effect of FRT on sport-specific performance [ 37 , 39 , 40 , 51 , 59 , 61 – 64 ]. The studies employed various sport-specific assessments, including hitting velocity, serve velocity, throwing velocity, sport-specific jumps, and skill performance. The pooled results indicated that FRT significantly enhanced sport-specific performance compared with CG (SMD = 0.57, 95% CI 0.32 to 0.82, p < 0.001), with low heterogeneity (I² = 10%) (Fig. 8 ). Sensitivity Analyses We conducted sensitivity analyses to evaluate the impact of potential high-risk studies and outliers on the meta-analytic results (Table S5). Overall, the findings demonstrated a high level of stability. In the analysis of agility, the pooled effect size remained significant (SMD = − 0.84 and − 0.77) even after excluding individual studies, with heterogeneity remaining similar or slightly reduced (I² decreased from 60% to 56%), indicating that the results were not unduly influenced by any single study. Similarly, for endurance, balance, maximal strength, and power, the pooled effect sizes consistently remained significant (all p < 0.01) after the removal of potential outliers, accompanied by varying degrees of reduced heterogeneity. Notably, in the analyses of sport-specific performance and sprint ability, sensitivity testing almost completely eliminated heterogeneity (I² reduced to 0%–3% and 0%, respectively), further strengthening the reliability of these findings. Taken together, the sensitivity analyses confirmed that no single study substantially altered the overall conclusions, with the direction and statistical significance of the effects remaining consistent across analyses, thereby supporting the robustness and reliability of our results. Subgroup Analyses The subgroup analyses (Tables S6–S12) revealed significant differences in certain moderators, including strength (gender), power (age, training frequency, intervention duration), agility (gender, training frequency), speed (gender), endurance (age, gender, training level), balance (training level, intervention duration), and sport-specific performance (training frequency), while no significant effects were observed in other subgroups. Discussion This study represents the first systematic review and meta-analysis to comprehensively evaluate the effects of FRT on multiple dimensions of athletic performance. The primary aim was to determine whether FRT outperforms traditional training methods in enhancing physical performance among athletes. Given the highly specialized training environments in which competitive athletes operate, the efficiency and effectiveness of training strategies are of critical importance [ 67 , 68 ]. The meta-analytic results demonstrated that FRT produced statistically significant improvements in strength, explosive power, speed, agility, endurance, balance, and sport-specific performance. Sensitivity analyses further confirmed the robustness of these findings, with the main conclusions remaining consistent even after excluding studies with high risk of bias or statistical outliers. Effect of FRT versus CG on Strength and Power Our meta-analysis demonstrated that FRT produced significant improvements in both maximal strength (p < 0.001) and explosive power (p < 0.001) compared with CG, with sensitivity analyses confirming the robustness of these findings. These benefits were consistently observed across multiple strength assessments, including isometric, isokinetic, and one-repetition maximum (1RM) tests, as well as peak force outcomes in jump tasks. The observed gains can be primarily attributed to the unique principle of eccentric overload, which differentiates FRT from traditional resistance training by imposing greater mechanical tension during the eccentric phase and thereby eliciting more pronounced neuromuscular adaptations [ 9 , 13 ]. Mechanistically, eccentric overload induces adaptations through three complementary pathways. At the neural level, it enhances motor unit recruitment and synchronization, thereby improving the efficiency of force production[ 69 ]. At the muscular and structural level, it provides a potent stimulus for hypertrophy of fast-twitch fibers and increases tendon stiffness, improving force transmission capacity [ 70 , 71 ]. In addition, FRT augments the efficiency of the SSC by enhancing spindle pre-activation and optimizing elastic energy storage and reutilization, enabling athletes to convert eccentric loading into greater concentric explosive force [ 52 ]. Together, these neural, muscular, and neuromechanical adaptations provide a strong physiological basis for the concurrent improvements in strength and power [ 13 ]. Subgroup analyses further indicated that male and elite athletes derived greater benefits, while training frequency and duration were critical moderators. Programs implemented at least twice per week for a minimum of eight weeks yielded the most substantial gains. Based on the current evidence, incorporating FRT into training regimens two to three times per week over sustained periods appears to be an effective strategy for maximizing neuromuscular adaptations and optimizing performance outcomes in strength and power. Effect of FRT versus CG on Agility and Speed Our meta-analysis indicates that FRT significantly enhances both change-of-direction ability (p < 0.001) and linear sprint speed (p < 0.001) compared with CG. These results indicate that foundational gains in strength and explosive power can be effectively transferred into complex, performance-critical athletic skills. The improvement in CoD ability is best explained by FRT’s influence on the deceleration–reacceleration cycle. The braking phase of a CoD maneuver is dominated by eccentric muscle actions and requires substantial eccentric strength to absorb impact forces [ 72 ]. The principle of eccentric overload—a hallmark of FRT—directly targets this capacity and enhances braking efficiency [ 13 ]. As a result, athletes can decelerate more effectively, shorten stopping distances, and create favorable conditions for rapid directional changes. The subsequent re-acceleration phase relies on concentric power and the acute contribution of the SSC, which facilitates the rapid transition from braking to propulsion [ 22 ]. In contrast, sprint performance depends on the repeated utilization of the SSC across successive strides. Efficient sprinting requires rapid force production combined with continuous elastic energy recycling [ 73 , 74 ]. Recent evidence provides direct support for this, demonstrating that FRT significantly enhances SSC efficiency, as reflected in improvements in the RSI [ 52 ]. These adaptations are thought to result from enhanced stretch-reflex responses and optimized muscle–tendon stiffness [ 10 ]. Together, these mechanisms facilitate more effective elastic energy storage and reutilization [ 75 ]. Therefore, the benefits of FRT for agility and sprint speed should not be regarded as independent outcomes but rather as convergent effects of systematic neuromuscular enhancement. For athletes in team sports such as soccer and basketball—where repeated sprinting and rapid CoD actions are decisive—current evidence suggests that incorporating FRT at least twice per week for eight weeks or longer is an effective strategy to maximize neuromuscular adaptations and optimize on-field performance [ 13 ]. Effect of FRT versus CG on Endurance According to our meta-analysis, FRT was associated with significant improvements in endurance performance compared with CG (p < 0.001), with moderate heterogeneity (I² = 38%). This positive effect was consistently validated across multiple outcomes, including running economy (RE), repeated-sprint ability (RSA), and maximal oxygen uptake (VO₂max), underscoring the effectiveness of FRT in optimizing metabolic efficiency and delaying fatigue. These improvements appear to result from complementary physiological adaptations: enhanced oxidative capacity of type II fibers [ 76 ], improved RE through greater neuromuscular coordination [ 77 ] and tendon stiffness [ 75 ], and increased lactate tolerance and buffering capacity, which together prolong high-intensity performance [ 78 ]. Individual trials provide further nuance to these findings. Weng et al. reported that FRT significantly improved RE in well-trained distance runners [ 44 ], whereas Festa et al. found no significant effects in recreational runners [ 45 ], suggesting a potential population-specific effect. In team sport contexts, FRT has been shown to improve RSA and maintain its effectiveness in complex, game-like scenarios [ 41 , 58 ], thereby strengthening its ecological validity. Collectively, these results indicate that FRT enhances not only strength and power but also endurance performance by improving metabolic efficiency and fatigue resistance. This dual benefit holds particular importance for endurance athletes and offers practical value for team sports that rely on repeated high-speed movements and intermittent sprints. Effect of FRT versus CG on Balance Our meta-analysis confirmed that FRT is significantly more effective than CG in improving balance performance among athletes. Based on a random-effects model incorporating 10 effect sizes, the analysis revealed a statistically significant advantage of FRT interventions (p = 0.0026), with a moderate level of heterogeneity across studies (I² = 52%). This finding suggests both statistical and practical certainty regarding the efficacy of FRT. The superiority of FRT can largely be attributed to its unique high-tension eccentric loading mechanism [ 79 ]. Unlike traditional resistance training, FRT utilizes inertial resistance to generate a marked eccentric overload where eccentric forces can exceed concentric loads, providing intensified neuromuscular stimulation as evidenced by considerable muscle activation throughout the eccentric phase of the movement [ 80 ]. This enhanced stimulus improves the integration of sensory input, postural feedback, and motor output [ 81 ]. These physiological advantages are consistent with the observed improvements in DPSI, reinforcing the role of FRT in targeting dynamic balance enhancement [ 34 ]. From a neurophysiological perspective, eccentric overload training has been shown to promote more efficient cortico-spinal-muscular activation [ 82 ], optimize motor unit recruitment strategies [ 83 ], and facilitate sensorimotor integration, thereby forming a more robust and adaptive feedback loop for postural control [ 84 ]. Additionally, FRT—as a high-strain resistance modality—has been associated with increased tendon stiffness [ 75 ] and enhanced reflex responsiveness [ 85 ], while effective balance under perturbation relies on anticipatory pre-activation [ 86 ]. These adaptations are particularly relevant for young competitive athletes, who typically exhibit heightened neurodevelopmental plasticity and responsiveness to proprioceptive stimuli. Therefore, FRT’s efficacy as a core balance strategy is grounded in its enhancement of eccentric control, deceleration capacity, and sensorimotor integration, offering a direct pathway to improved athletic stability and potentially reduced injury risk. Effect of FRT versus CG on Sport-specific Performance According to the results of our meta-analysis, we found that FRT was associated with significant enhancement in sport-specific performance compared with the CG (p < 0.001), with negligible heterogeneity across studies (I² = 0%). These positive effects were observed across multiple skill-based tasks, with particularly strong evidence in lower-limb–dominant actions such as soccer-related shooting outcomes. The advantage of FRT in enhancing sport-specific skills can be attributed to its “transfer value”—namely, the ability to efficiently convert gains in fundamental strength and power into sport-specific movements through the kinetic chain [ 13 , 87 ]. In addition to reinforcing lower-limb and core musculature, the unique eccentric overload stimulus of FRT enhances postural stability during explosive actions, thereby providing a solid platform for rapid force generation in both upper- and lower-limb tasks [ 9 , 13 ]. Research evidence further substantiates this transfer value, particularly in skills that depend on end-point outputs of the kinetic chain [ 39 , 51 ]. In sports characterized by kicking or striking, FRT not only improves output force (e.g., soccer shooting velocity) but also enhances accuracy [ 51 , 61 ]. Notably, Centorbi et al. demonstrated that FRT improved stroke precision in elite tennis players, suggesting that its benefits extend beyond force production to the fine regulation of motor skills [ 64 ]. Taken together, these findings indicate that FRT not only develops foundational physical capacities but also effectively translates them into improvements in sport-specific performance. This outcome carries important implications for skill-dependent sports and underscores the value of FRT as an efficient training modality in competitive athletics. Methodological Considerations During FRT Implementation FRT is a conceptually distinct, high-strain modality that warrants deliberate planning and close supervision. Individualize to maturation/training age, technique, and sport demands; guide load/progression by mechanical outputs; apply across sexes and in injury-prevention/rehab, supporting motivation [ 13 , 88 ]. Begin with a brief familiarization phase to standardize device handling and braking technique before formal loading; ensure appropriate fundamental technique is in place [ 13 ]. For multidomain adaptations, a pragmatic entry is 2–3 sessions per week for at least eight weeks, emphasizing eccentric and deceleration tasks with unilateral, multiplanar actions. Progress inertial load, range of motion, and set density conservatively—never at the expense of technique. Schedule sessions in step with on-field loads to manage fatigue and recovery. Monitor with balance tests (Y-Balance, DPSI), execution or velocity metrics when available, and tolerance indicators (session RPE, soreness, tendon symptoms); adjust iteratively and re-assess periodically to confirm transfer to sport tasks. Apply FRT for performance enhancement, injury-risk management, and staged rehabilitation in coordination with medical staff. During congested periods, maintain continuity through maintenance exposures and minimal-effective-dose strategies to limit detraining. Strengths and Limitations This review applied a comprehensive search strategy and prioritized higher-quality evidence by including randomized controlled trials conducted in athlete cohorts. Outcomes covered a broad spectrum of physical-performance indicators (e.g., balance and related neuromuscular measures), allowing convergent inference across domains and enhancing practical relevance Overall study quality was moderate (frequently rated as “some concerns”). Evidence of publication bias was observed; however, sensitivity analyses indicated that the principal effects were robust. Substantial intervention heterogeneity—including exercise selection, flywheel device configurations, inertia loading parameters, and progression models—as well as variability in assessment protocols may have influenced pooled estimates and warrants cautious interpretation. In addition, the limited number of trials constrained several subgroup/further analyses (e.g., by sex, competitive level, or age), and long-term follow-up was generally lacking, restricting insight into durability and transfer to competition. To strengthen inference and application, future work should: (i) conduct more high-quality RCTs, particularly on balance-related outcomes; (ii) map dose–response relationships (load, inertia, session frequency, and training-cycle duration); (iii) compare sexes, competitive levels, and age groups; (iv) perform direct head-to-head trials of FRT versus traditional resistance or mixed models; and (v) include long-term follow-up to evaluate retention and translation to competition performance. Conclusion This study concludes that FRT is an effective, comprehensive method for enhancing athletes’ performance. Although the overall certainty of evidence is moderate, the effects are robust and carry clear practical relevance for competitive sport. These findings can guide coaches and practitioners in optimizing training regimens. Future research should use standardized, sport-specific randomized trials to clarify dose–response relationships, long-term adaptations, and injury-risk outcomes. Declarations Conflict of interest statement: The authors declare that the research was conducted without any commercial or financial relationships that could be construed as potential conflicts of interest. None of the manuscript or parts of the study are being submitted to other journals while being considered for publication by your journal. This study involves no human subjects and is exempt from IRB review. The datasets generated and/or analyzed during the current study are available. Ethics approval and consent to participate Not applicable. This study is a systematic review and meta-analysis and does not involve any human participants or animals. Consent for publication Not applicable. No individual data (e.g., images, videos, personal details) are included in this manuscript. Competing interests The authors declare that they have no competing interests. Funding This research was funded by The Fundamental Research Funds for the Central Universities, grant number 2025KYPT04 and Beijing Social Science Foundation Project,24YTC035. Author Contributions JZ conducted the literature search, performed data extraction, statistical analysis, and wrote the first draft of the manuscript. RL and JL contributed to the study design, data interpretation, manuscript revision, and supervised the overall process. All authors read and approved the final version of the manuscript. Acknowledgements Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Barnes C, Archer DT, Hogg B, Bush M, Bradley PS. The evolution of physical and technical performance parameters in the English Premier League. Int J Sports Med. 2014;35(13):1095–100. https://doi.org/10.1055/s-0034-1375695 . Stølen T, Chamari K, Castagna C, Wisløff U. 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Supplementary Files Checklist.docx SupplementaryInformation.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 04 Jan, 2026 Reviewers invited by journal 19 Nov, 2025 Editor assigned by journal 17 Oct, 2025 First submitted to journal 15 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7868842","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547610432,"identity":"9550fbd7-3251-4342-ba23-738d66958541","order_by":0,"name":"Junxin Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYBACxgYgkQBGDIyPIWIJxGthNiZKCwyAlLFJE6WFeUbuMYmHO+ry+Ge3X6su+HOYgZ89x4Dh5w48DpuRl2yQeIatWOLOmbLbM9sOM0j2vDFg7D2DT0uO4YPENp7Ehhs5abd5Gw4zGNzIMWBmbMOrxeBAYptE4nyglmIeoMPsidACssUgccON9GPMPGxAWyQIael5Y2yQ2JaQuPFGDrP0zLZ0HokzzwoO9uLRYtieYyb5s60ucd6N9IefC/5Yy/G3J2988BOflgY4k8cATIKIA7g1MDDII5jsD/ApHAWjYBSMghEMAPcfU+DOYcHgAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0001-4918-5830","institution":"Tsinghua University","correspondingAuthor":true,"prefix":"","firstName":"Junxin","middleName":"","lastName":"Zhang","suffix":""},{"id":547610433,"identity":"206deef8-b232-4b04-8063-77f199e96148","order_by":1,"name":"Jianxiu Liu","email":"","orcid":"","institution":"Tsinghua 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09:06:32","extension":"xml","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":213404,"visible":true,"origin":"","legend":"","description":"","filename":"SMOAD25006770structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/46d59ef1edb1bd0b44eb44c9.xml"},{"id":96889947,"identity":"5030b3b7-4c69-44b7-aa69-520c3f583189","added_by":"auto","created_at":"2025-11-27 09:06:32","extension":"html","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":229711,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/9288c6742db80b4165bc8a2f.html"},{"id":96920539,"identity":"bc1e0318-3b35-4966-8b55-e9d4248d7d7a","added_by":"auto","created_at":"2025-11-27 14:15:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97504,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of publications included in systematic review and meta-analysis (PRISMA diagram). PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/00c67345c872c02a242d6d19.png"},{"id":96919174,"identity":"d3921e18-d7e0-410a-9636-5422ba533dd2","added_by":"auto","created_at":"2025-11-27 14:13:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":432158,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the effects of flywheel resistance training versus CG on maximal strength. SMD (standard mean difference) indicates the standard mean difference in the change values of the FRT versus the PT groups. 1RM, one-repetition maximum; IMTP, isometric mid-thigh pull; MVC, maximal voluntary contraction; CONEXT/CONFLEX, concentric knee extension/flexion; ECCEXT/ECCFLEX, eccentric knee extension/flexion; Q/H, quadriceps/hamstrings; (ec), eccentric; PPT, peak torque; NPT, normalized peak torque; CMJ_PF, peak force during countermovement jump; SJ_PF, peak force during squat jump; IST, isometric squat test; BP_50/FP_50, peak force at the prescribed 50% load (per original protocol); Hecc:Qconc, hamstrings eccentric : quadriceps concentric ratio (arbitrary units); °/s, degrees per second.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/71876302cd79e04fdd3c8e63.png"},{"id":96889932,"identity":"82c6d736-0274-4238-8504-f070c24532e9","added_by":"auto","created_at":"2025-11-27 09:06:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":955908,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the effects of flywheel resistance training versus CG on power. SMD (standard mean difference) indicates the standard mean difference in the change values of the FRT versus the PT groups. SJ, squat jump；CMJ, countermovement jump；DJ_20cm/DJ_40cm, drop jump from 20/40 cm；DJh, drop-jump height；DJct, drop-jump contact time；RSI, reactive strength index；RSI_20cm/RSI_40cm, RSI from a 20/40 cm drop jump；CPP, concentric peak power；EPP, eccentric peak power；Concentric MP/PP, mean/peak power during the concentric phase；Eccentric MP/PP, mean/peak power during the eccentric phase；CMJ_H, countermovement-jump height；CMJ_PP, countermovement-jump peak power；RVJ, running vertical jump；MBT_O/MBT_F/MBT_B, medicine-ball throw (overhead or back throw/chest-pass or forward throw/backward overhead)；3HopD/3HopND, triple-hop distance (dominant/non-dominant)；Abalakov jump, arm-swing countermovement jump；UCMJD/UCMJND, unilateral CMJ—dominant/non-dominant；UBJD/UBJND, unilateral broad-jump distance—dominant/non-dominant；SJRFD/CMJRFD, rate of force development during SJ/CMJ；EUR, eccentric utilization ratio；HT_r/HT_l, single-leg hop test (right/left)；In-water boost, swimming-specific “in-water boost” test；THs, throwing/hitting speed；CMJ_d/CMJ_nd, unilateral CMJ (dominant/non-dominant)；7-RHOPh/7-RHOPct, seven-repetition repeated-hop height/contact time；SJh, squat-jump height；PO90, power output under the “PO90” condition (per study definition)；Triple jump right/left, standing triple-jump distance (right/left take-off)；SJ_ecc/SJ_con, eccentric/concentric phase measures in the squat jump.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/51e23cec6ec9ce640d316495.png"},{"id":96920550,"identity":"a3dc5aaa-8c85-4599-8e0b-bb287547e831","added_by":"auto","created_at":"2025-11-27 14:15:15","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":429546,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the effects of flywheel resistance training versus CG on agility. SMD (standard mean difference) indicates the standard mean difference in the change values of the FRT versus the PT groups. Dribbling, dribbling time test；DD, dribbling drill；505, 5-0-5 change-of-direction test with a 180° turn；505_L/505_R, 505 test planting off the left/right limb；V-cut, V-cut agility test；Modified T-test, modified T-agility test；RSA-180b/m/s, repeated-sprint ability test with a 180° turn—best time / mean time / sum (or slowest) of sprint times；COD180D/COD180ND, 180° change-of-direction time using the dominant/non-dominant plant leg；Illinois test, Illinois agility test；In-water agility, water-based agility test；COD10D/COD10ND, 10-m change-of-direction time—dominant/non-dominant；COD10defD/COD10defND, 10-m COD deficit—dominant/non-dominant；COD20D/COD20ND, 20-m change-of-direction time—dominant/non-dominant；COD20defD/COD20defND, 20-m COD deficit—dominant/non-dominant；t_test, T-agility test；IIT, Illinois agility test；YT, Y-shaped reactive agility test；505 COD, 505 change-of-direction time；Shuttle 20+20, 20-m + 20-m shuttle sprint/agility test.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/34877c87f67b12e9fb4d3897.png"},{"id":96920873,"identity":"318a86f0-6c09-4612-b61e-901bc6fde8ab","added_by":"auto","created_at":"2025-11-27 14:15:28","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":342913,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the effects of flywheel resistance training versus CG on sprinting capacity. SMD (standard mean difference) indicates the standard mean difference in the change values of the FRT versus the PT groups. ST_5, 5-m sprint test; ST_10, 10-m sprint test; ST_15, 15-m sprint test; ST_20, 20-m sprint test; ST_30, 30-m sprint test; ST_40, 40-m sprint test; ST_60, 60-m sprint test; CS_10, 10-m curved-sprint test; CS_20, 20-m curved-sprint test.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/a2ea003a73115208a9ef0198.png"},{"id":96919919,"identity":"fcaaedef-8e65-4508-866f-11a88a2366c6","added_by":"auto","created_at":"2025-11-27 14:14:36","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":271481,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the effects of flywheel resistance training versus CG on endurance. SMD (standard mean difference) indicates the standard mean difference in the change values of the FRT versus the PT groups. VIFT, maximal running speed in the 30–15 Intermittent Fitness Test; 20-m Shuttle-Run, 20-m multistage shuttle run test; RCODD/RCODND, repeated change-of-direction test performed toward the dominant / non-dominant side; RE65%/RE75%/RE85%, running economy measured at ~65% / 75% / 85% of vVO₂max speed; Best RSSA/Mean RSSA, best and mean sprint time in a repeated sprint with change-of-direction test; VO₂max, maximal oxygen uptake; VVO₂max , running velocity at VO₂max; VT1/VT2, first and second ventilatory thresholds; 2-km TT / 10-km TT, 2-km and 10-km time-trial performance; RSAb/RSAs/RSAm, best, sum, and mean sprint time in a repeated-sprint ability test; %Dec, performance-decrement index in RSA.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/d199e051ba0117b4bc937964.png"},{"id":96889940,"identity":"65e946b3-e1be-4d6e-bc28-a81fb61e5294","added_by":"auto","created_at":"2025-11-27 09:06:31","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":151957,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the effects of flywheel resistance training versus CG on balance. SMD (standard mean difference) indicates the standard mean difference in the change values of the FRT versus the PT groups. YBT_R, Y-Balance Test composite reach score with the right limb as the stance leg; YBT_L, Y-Balance Test composite reach score with the left limb as the stance leg. DPSI_DF, Dynamic Postural Stability Index during single-leg landing on the dominant foot; DPSI_DL, Dynamic Postural Stability Index during landing on the dominant leg; DPSI_NF, DPSI during landing on the non-dominant foot; DPSI_NL, DPSI during landing on the non-dominant leg. CRDR_f / CRDR_m, dynamic stability metric “CRDR” derived from center-of-pressure/ground-reaction-force recovery following perturbation, reported for female/male subgroups; CRDL_f / CRDL_m, complementary dynamic stability metric “CRDL” from the same procedure, reported for female/male subgroups.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/b878ff2b98aeafe9cfb0c05e.png"},{"id":96889950,"identity":"4dd72204-6725-4896-8492-965d48dc2ee2","added_by":"auto","created_at":"2025-11-27 09:06:32","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":205478,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the effects of flywheel resistance training versus CG on sport-specific performance. SMD (standard mean difference) indicates the standard mean difference in the change values of the FRT versus the PT groups. SS, shooting speed; AJ_h, approach jump height; AJ_pp, approach jump peak power; SV_r/SV_l, serve velocity (right/left); SP_F/SP_B, stroke precision (forehand/backhand); PTV, penalty throwing velocity; 3_SRTV, three-step running throw velocity; JTV, jump throw velocity; HT, hitting test (spike/overhead hit); SHOT, soccer shooting accuracy test; 9_TV, 9-m throwing velocity; S100/S50, 100-m/50-m swimming time.\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/80dfb4e4e1fda7f746eebcf8.png"},{"id":97136080,"identity":"a86fe22f-37b6-43ba-9396-a6dfa3a28f79","added_by":"auto","created_at":"2025-12-01 09:55:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3164271,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/f579e3f1-242d-4492-88f2-8f0b0d6ae57a.pdf"},{"id":96889934,"identity":"d1d7b1dc-f340-4733-a277-9e4af862b15f","added_by":"auto","created_at":"2025-11-27 09:06:31","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30087,"visible":true,"origin":"","legend":"","description":"","filename":"Checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/a9b15dea04668731e4f6d149.docx"},{"id":96919867,"identity":"f028c299-1403-4915-a6f0-02b0f062eac9","added_by":"auto","created_at":"2025-11-27 14:14:34","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":412269,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-7868842/v1/63862fbc36d7eb6858d3c297.docx"}],"financialInterests":"","formattedTitle":"The Effects of Flywheel Resistance Training on Athletic Performance: A Systematic Review and Meta-analysis of Randomized Controlled Trials","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn contemporary elite sport, escalating match intensity and rapid offensive\u0026ndash;defensive transitions impose stringent demands on physical capacities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Core neuromuscular qualities\u0026mdash;strength, explosive power, speed, and agility\u0026mdash;govern initial acceleration, deceleration, change-of-direction (COD), and jumping performance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. With competition calendars increasingly congested and preparation windows constrained, coaches and performance staff need time-efficient strategies that transfer to competition [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Traditional, gravity-dependent resistance training (TRT) is foundational, yet it affords limited, independent control of concentric versus eccentric loading [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In practice, to avoid technique breakdown near failure, the eccentric stimulus is often underdosed despite approaches such as eccentric-emphasis prescriptions, tempo control, or dedicated devices [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Because robust eccentric braking capacity underpins stretch\u0026ndash;shortening cycle (SSC) function, explosive output, and rapid deceleration\u0026ndash;reacceleration, augmenting eccentric adaptations may also contribute to mitigating non-contact injury risk [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFlywheel resistance training (FRT) uses an iso-inertial device that stores kinetic energy during the concentric phase and requires active braking during the subsequent eccentric phase; the external load therefore self-adjusts to instantaneous force output [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. With appropriate inertia selection, explicit braking intent, and sound technique, FRT provides a relative eccentric advantage and, under certain configurations, can achieve eccentric overload [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These characteristics may preferentially target braking torque and rate of force development (RFD), support SSC behavior and intermuscular coordination, and deliver high-intensity eccentric stimuli while preserving movement quality [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. FRT program design is flexible: practitioners can manipulate inertia, joint angles and ranges of motion, braking/tempo strategies, and\u0026mdash;where available\u0026mdash;encoder-derived real-time feedback for velocity\u0026ndash;power monitoring and set-density management to align training with sport-specific biomechanics and recovery constraints [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In this article, FRT refers specifically to iso-inertial, flywheel-based resistance training and is distinguished from variable-resistance, isokinetic, or isolated supramaximal eccentric approaches.\u003c/p\u003e\u003cp\u003eComparative studies suggest that, relative to TRT, FRT can enhance several key actions (e.g., vertical jump, short-distance acceleration) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, randomized controlled trials (RCTs) report mixed effects across broader performance domains, with some observing clear benefits (jumping, sprinting, COD) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and others finding unclear or null effects in agility, balance, or endurance\u0026mdash;and occasional unfavorable changes in isolated outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Differences in training dose, inertia prescription, athlete characteristics, and test subtype likely contribute to this inconsistency.\u003c/p\u003e\u003cp\u003eAccordingly, we conducted an RCT-only systematic review and meta-analysis in athlete populations to compare FRT with non-flywheel comparators (CG) across seven performance domains (strength, explosive power, speed, agility, endurance, balance, and sport-specific performance). We also explored whether effects varied by study-level characteristics. We hypothesized larger effects for strength-/power-related outcomes and more variable effects for endurance and balance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], ensuring methodological rigor, transparency, and reproducibility. Additionally, the study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration ID: CRD420251134531).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Sources and Search Strategy\u003c/h2\u003e\u003cp\u003eA comprehensive literature search was performed on August 26, 2025, using six electronic databases: MEDLINE, PubMed, Scopus, SPORTDiscus, Web of Science, and Academic Search Ultimate. The search was limited to peer-reviewed, full-text articles published in English and involving human participants. The complete search strategy for each database, including all Boolean operators and search fields, is presented in Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e All search results were imported into EndNote (Clarivate Analytics), and duplicate records were removed in accordance with PRISMA 2020 guidelines. Title, abstract, and full-text screening were conducted independently by two reviewers (JZ and RL) without the use of automated or semi-automated approaches (e.g., machine learning-based tools). Discrepancies were resolved through discussion or, when necessary, consultation with a third independent reviewer (JL). To ensure comprehensive coverage, we also performed a manual search of the reference lists of all included studies. In addition, the reference lists of relevant narrative reviews, systematic reviews, and meta-analyses were screened to identify any potentially eligible studies not captured by the database search.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003eTwo authors (JZ and RL) independently screened all retrieved records based on the following pre-defined eligibility criteria: (1) Participants: Competitive athletes (youth or adult; team or individual sports), free from musculoskeletal injury at baseline (no injury requiring time-loss or medical care within the previous 3\u0026ndash;6 months). (2) Interventions: Iso-inertial FRT delivered as a multi-session program (i.e., a training intervention, not an acute single-bout study), using disc or conic-pulley devices. (3) Comparators: Non-flywheel training conditions such as traditional/conventional, gravity-dependent resistance training, plyometrics, or usual sport-specific training aimed at improving physical performance; co-interventions were matched between groups, and comparators contained no flywheel exposure. (4) Outcomes: Physical performance outcomes within seven domains\u0026mdash;strength, explosive power, speed, agility, endurance, balance, and sport-specific performance (e.g., sport-specific velocity/accuracy/timed tasks). When multiple time points were reported, we extracted the post-intervention assessment closest to program end. (5) Study design: RCTs or randomized crossover trials. Exclusion criteria were as follows: (1) Not an athlete population or presence of relevant injury/clinical condition; (2) Interventions not meeting FRT definition (e.g., isokinetic, variable-resistance, supramaximal-only eccentric) or mixed protocols without isolatable FRT effects; (3) No appropriate non-flywheel comparator; (4) Acute, single-session studies; (5) Insufficient data for quantitative synthesis; and (6) Non-eligible publication types (letters, editorials, protocols, conference abstracts, books, or narrative reviews).\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\u003cp\u003eThe data extraction procedures followed the guidelines outlined in the Cochrane Collaboration Handbook [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Data extraction was performed independently by two reviewers (JZ and RL). The characteristics of the included studies are summarized in Table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e. The extracted information included: (i) first author\u0026rsquo;s name and year of publication; (ii) participant characteristics (health status, sample size, age, sex); (iii) study design; (iv) study duration; (v) training frequency; (vi) description of the intervention group; (vii) description of the control group; (viii) outcome measurement methods; and (ix) main findings.\u003c/p\u003e\u003cp\u003eFor both the FRT and control groups, physical performance-related outcomes were recorded as means and standard deviations, and were screened and extracted independently by the two reviewers (JZ and RL). Any discrepancies during the extraction process were resolved through discussion or, if necessary, by consultation with a third independent reviewer (JL).\u003c/p\u003e\n\u003ch3\u003eQuality assessment\u003c/h3\u003e\n\u003cp\u003eTwo reviewers (JZ and RL) used the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess the risk of bias in each included study [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The assessment covered five domains: the randomization process, deviations from the intended interventions, missing outcome data, measurement of the outcome, and selection of the reported results. In each domain, the two reviewers rated the studies as \u0026ldquo;high risk,\u0026rdquo; \u0026ldquo;some concerns,\u0026rdquo; or \u0026ldquo;low risk,\u0026rdquo; based on the signaling questions provided by the tool. Any disagreements between the two reviewers (JZ and RL) were resolved through discussion with a third reviewer (JL).\u003c/p\u003e\n\u003ch3\u003eCertainty of Evidence\u003c/h3\u003e\n\u003cp\u003eThe certainty of evidence for each outcome was assessed by two authors (JZ and RL) using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, based solely on RCTs included in the review. This method classifies the overall confidence in effect estimates as high, moderate, low, or very low [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Evaluations were based on five key domains: risk of bias, inconsistency, indirectness, imprecision, and potential publication bias [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Discrepancies were resolved by discussion to achieve consensus. This structured evaluation provided a transparent summary of evidence strength specific to RCT-derived outcome estimates.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSynthesis Methods and Statistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were conducted in R (4.3.1) using the metafor package (version 7.0\u0026ndash;0) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This study compared the intervention effects between the FRT group and the CG. The meta-analysis was based on changes in variables (i.e., pre- and post-intervention values). When change scores were not directly reported, the standard deviation of change (ΔSD) was calculated based on the pre- and post-intervention standard deviations, assuming a correlation coefficient of R\u0026thinsp;=\u0026thinsp;0.5 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], as previously recommended (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varDelta\\:SD=\\surd\\:({SD}_{pre}^{2}+{SD}_{post}^{2}-2\\times\\:R\\times\\:S{D}_{pre}\\times\\:S{D}_{post})\\)\u003c/span\u003e\u003c/span\u003e) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Data synthesis was conducted using a random-effects model (Restricted Maximum Likelihood). Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Publication bias was assessed using Egger\u0026rsquo;s linear regression test [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. When at least 10 studies were included in a meta-analysis, a funnel plot was generated to visually inspect publication bias [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In addition, the trim-and-fill method was applied to adjust for potential bias.\u003c/p\u003e\u003cp\u003eTo examine covariates that may modulate the effects of FRT, we conducted subgroup analyses by age (\u0026ge;\u0026thinsp;18 years vs. \u0026lt;18 years), sex (female, male, mixed-sex cohorts), competitive level (elite vs. amateur), intervention duration (\u0026ge;\u0026thinsp;8 weeks vs. \u0026lt;8 weeks), and training frequency (three sessions per week, two sessions per week, or one session per week). To enhance the robustness of the findings, we performed a series of sensitivity analyses to evaluate the influence of individual studies\u0026mdash;including those at high risk of bias or identified as outliers\u0026mdash;on the pooled results. Outliers were defined as studies whose effect sizes markedly deviated from the overall distribution and had the potential to distort the combined estimates. Sensitivity analyses employed a leave-one-out approach, whereby each study was removed in turn to assess its impact on the meta-analytic conclusions.\u003c/p\u003e\u003cp\u003eSensitivity analyses were conducted using a leave-one-out approach, systematically omitting each study in turn to assess its influence on the overall results. Statistical heterogeneity was quantified using the I\u0026sup2; statistic and classified as low (0\u0026ndash;25%), moderate (26\u0026ndash;50%), substantial (51\u0026ndash;75%), or high (\u0026gt;\u0026thinsp;75%) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The magnitude of standardized effect sizes was interpreted according to Hopkins\u0026rsquo;s criteria [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], with values of 0.0\u0026ndash;0.19 considered trivial, 0.2\u0026ndash;0.59 small, 0.6\u0026ndash;1.19 moderate, 1.2\u0026ndash;2.0 large, and \u0026gt;\u0026thinsp;2.0 very large.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStudy Selection\u003c/h2\u003e\u003cp\u003eA total of 896 records were identified through the predefined search strategy (896 from databases). After removing 308 duplicate records before screening, 588 unique records remained for title and abstract screening. Of these, 514 were excluded for not meeting the eligibility criteria. The full texts of 74 reports were sought for retrieval, of which one report could not be obtained. The remaining 73 reports from databases/registers were assessed for eligibility, and 40 were excluded for the following primary reasons: absence of a true FRT intervention (n\u0026thinsp;=\u0026thinsp;19), absence of a control group (n\u0026thinsp;=\u0026thinsp;12), lack of performance outcome measures (n\u0026thinsp;=\u0026thinsp;7), and inclusion of participants with injuries (n\u0026thinsp;=\u0026thinsp;2). One additional report identified through citation searching met the eligibility criteria. Ultimately, 34 studies fulfilled the inclusion criteria and were included in the meta-analysis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48 CR49 CR50 CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. The detailed results of the literature search are presented in the PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of Included Studies\u003c/h2\u003e\u003cp\u003eTable \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e provides a qualitative description of the included studies.\u003c/p\u003e\u003cp\u003eIn total, 34 RCTs involving 879 participants were included in the analysis. The duration of training interventions ranged from 4 weeks to 6 months. The participants were young athletes from various sporting backgrounds. Specifically, ten studies included soccer players, four included basketball players[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], four included handball players[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e], three involved volleyball players[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], three involved tennis players[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], and two included runners[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In addition, individual studies investigated athletes from badminton[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], water polo[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], rugby, track and field[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and swimming[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. One study included both soccer and basketball players[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], while another included both volleyball and basketball players[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. With respect to training frequency, six studies implemented one session per week [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], twenty-two studies applied two sessions per week [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51 CR52 CR53\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e], five studies conducted three sessions per week [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e], and one study adopted a four-session-per-week protocol[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eRisk of Bias in Studies\u003c/h2\u003e\u003cp\u003eThe risk of bias of the included studies was assessed using the RoB 2 tool, and the overall judgments across the five bias domains are presented in Table\u0026nbsp;3. Among the included studies, two were rated as having a high risk of bias [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], one as having a low risk of bias [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e], and the remaining 31 were judged as raising some concerns. It is noteworthy that all included studies were conducted in the form of RCTs. However, in most cases, the reporting of the randomization process lacked sufficient detail. Only one study provided a complete and detailed description of both the randomization method and allocation concealment. Likewise, only one study explicitly stated that participants remained blinded until arriving at the laboratory to complete the trials.\u003c/p\u003e\u003cp\u003eThe studies rated as having a high risk of bias included one that primarily adopted team-based allocation rather than individual randomization, without implementing random sequence generation or allocation concealment, thereby introducing a clear risk of selection bias. The other study, although described as randomized, analyzed only those participants with \u0026ge;\u0026thinsp;80% adherence, with a relatively high dropout rate that was concentrated in the intervention group, which may have led to systematic bias in the estimation of outcomes. The remaining studies were judged as raising \u0026ldquo;some concerns,\u0026rdquo; mainly due to insufficient reporting of the randomization process and the potential for deviations from intended interventions or measurement bias arising from contextual factors during the trials.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCertainty of Evidence\u003c/h2\u003e\u003cp\u003eThe overall certainty of evidence was evaluated using the GRADE framework, and the results are presented in Table S4. The certainty of evidence for agility, speed, and balance was rated as low, indicating limited confidence in the effect estimates, primarily due to concerns regarding allocation concealment, high heterogeneity, and small sample sizes. In contrast, the certainty of evidence for endurance, sport-specific performance, strength, and power was rated as moderate, suggesting a moderate level of confidence in the effect estimates, although further research may still influence these conclusions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eResults of Data Synthesis\u003c/h2\u003e\u003cp\u003e\u003cem\u003eStrength\u003c/em\u003e A total of 18 RCTs assessed maximal strength performance using various methods, including one-repetition maximum squat (1RM squat) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], isometric mid-thigh pull (IMTP)[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], maximal voluntary contraction (MVC) [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], isokinetic strength testing of knee extension/flexion at different velocities (CON/ECC) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], bench press[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], and peak force output in jump tasks (CMJ and SJ) [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. The pooled results indicated that FRT significantly enhanced maximal strength compared with CG (SMD\u0026thinsp;=\u0026thinsp;0.57, 95% CI 0.37 to 0.76, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with moderate heterogeneity (I\u0026sup2; = 50%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Egger\u0026rsquo;s test suggested funnel plot asymmetry (t\u0026thinsp;=\u0026thinsp;2.06, p\u0026thinsp;=\u0026thinsp;0.047), indicating potential publication bias. The trim-and-fill analysis imputed eight studies, and the adjusted pooled effect size remained significant (SMD\u0026thinsp;=\u0026thinsp;0.34, 95% CI 0.10 to 0.57, p\u0026thinsp;=\u0026thinsp;0.006), suggesting the robustness of the results (Fig. \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePower\u003c/em\u003e Jump performance, a core indicator of explosive power, was widely assessed across the included studies, with several RCTs incorporated into the analysis. Different jump tests were employed, including countermovement jump (CMJ)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan additionalcitationids=\"CR41 CR42\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48 CR49\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan additionalcitationids=\"CR55 CR56\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e], squat jump (SJ)[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e], drop jump (DJ)[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], reactive strength index (RSI)[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e], single-leg jump[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], multiple Hops[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], standing long jump[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], medicine ball throw (MBT)[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e], and squat jump[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. The pooled analysis demonstrated that FRT significantly improved jump performance in athletes (SMD\u0026thinsp;=\u0026thinsp;0.56, 95% CI 0.45 to 0.68, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), although moderate heterogeneity was present (I\u0026sup2; = 31%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Egger\u0026rsquo;s test suggested funnel plot asymmetry (t\u0026thinsp;=\u0026thinsp;2.19, p\u0026thinsp;=\u0026thinsp;0.032), indicating potential publication bias. The trim-and-fill analysis imputed 11 studies, but the adjusted pooled effect size remained significant (SMD\u0026thinsp;=\u0026thinsp;0.44, 95% CI 0.31 to 0.58, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), supporting the robustness of the findings (Fig. \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eAgility\u003c/em\u003e This meta-analysis included 16 RCTs evaluating the effect of FRT on agility performance in athletes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. All studies employed change-of-direction\u0026ndash;related tests, though the specific formats varied. The pooled results revealed that FRT significantly improved agility performance compared with CG (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.80, 95% CI \u0026minus;\u0026thinsp;1.05 to \u0026minus;\u0026thinsp;0.55, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with moderate heterogeneity (I\u0026sup2; = 60%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Egger\u0026rsquo;s test suggested funnel plot asymmetry (t\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.77, p\u0026thinsp;=\u0026thinsp;0.009), indicating potential publication bias. However, after adjustment using the trim-and-fill method, the pooled effect size remained significant (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.60, 95% CI \u0026minus;\u0026thinsp;0.88 to \u0026minus;\u0026thinsp;0.33, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), supporting the robustness of the findings (Fig. \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003eS3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eSpeed\u003c/em\u003e Sixteen RCTs were included in this meta-analysis, providing data related to sprint performance [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan additionalcitationids=\"CR55\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan additionalcitationids=\"CR62\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Specifically, 5 m sprints were reported in three studies [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e], 10 m sprints in seven studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e], 15 m sprints in one study [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e], 20 m sprints in five studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], 30 m sprints in four studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], 40 m sprints in one study [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], and 60 m sprints in one study [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. In addition, some studies used specific sprint-related measures such as 10 m acceleration and 20 m flying sprint [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], as well as repeated sprint tests (CS10r, CS20r) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The pooled results indicated that FRT significantly improved sprint performance compared with CG (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.48, 95% CI \u0026minus;\u0026thinsp;0.71 to \u0026minus;\u0026thinsp;0.25, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with moderate heterogeneity (I\u0026sup2; = 42%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Egger\u0026rsquo;s test suggested funnel plot asymmetry (t\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.20, p\u0026thinsp;=\u0026thinsp;0.037), indicating potential publication bias. However, the trim-and-fill analysis did not impute additional studies, and the pooled effect size remained significant (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.48, 95% CI \u0026minus;\u0026thinsp;0.71 to \u0026minus;\u0026thinsp;0.25, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming the robustness of the results (Fig. S4).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eEndurance\u003c/em\u003e Seven RCTs assessed the effect of FRT on endurance performance in athletes [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Various measures were employed, including intermittent running tests such as the VIFT [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] and 20 m Shuttle-Run [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]; repeated sprint ability (RSA) tests including RCODD and RCODND [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], RE65\u0026ndash;85% [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], best and mean RSA [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], and RSAb, RSAs, RSAm, and %Dec [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]; maximal oxygen uptake\u0026ndash;related measures such as VO₂max, VVO₂max, VT1, VT2, and RE75% [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]; and endurance time trials including the 2 km TT and 10 km TT [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] and the 20-m ST [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The pooled results demonstrated that FRT significantly improved endurance performance compared with CG (SMD\u0026thinsp;=\u0026thinsp;0.55, 95% CI 0.29 to 0.81, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with moderate heterogeneity (I\u0026sup2; = 38%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eBalance\u003c/em\u003e This meta-analysis included three RCTs with a total of ten effect sizes evaluating the impact of FRT on athletes\u0026rsquo; balance performance. Various assessment methods were employed across studies, including the Y-Balance Test (YBT) [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], the Dynamic Postural Stability Index (DPSI) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and dynamic stability indicators such as CRDR and CRDI [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The pooled results indicated that FRT had a statistically significant positive effect on balance performance compared with the control group (SMD\u0026thinsp;=\u0026thinsp;0.85, 95% CI 0.38 to 1.32, p\u0026thinsp;=\u0026thinsp;0.0026), with moderate heterogeneity observed (I\u0026sup2; = 52%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eSport-specific performance\u003c/em\u003e This meta-analysis included nine RCTs evaluating the effect of FRT on sport-specific performance [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan additionalcitationids=\"CR62 CR63\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. The studies employed various sport-specific assessments, including hitting velocity, serve velocity, throwing velocity, sport-specific jumps, and skill performance. The pooled results indicated that FRT significantly enhanced sport-specific performance compared with CG (SMD\u0026thinsp;=\u0026thinsp;0.57, 95% CI 0.32 to 0.82, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with low heterogeneity (I\u0026sup2; = 10%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eSensitivity Analyses\u003c/h2\u003e\u003cp\u003eWe conducted sensitivity analyses to evaluate the impact of potential high-risk studies and outliers on the meta-analytic results (Table S5). Overall, the findings demonstrated a high level of stability. In the analysis of agility, the pooled effect size remained significant (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.84 and \u0026minus;\u0026thinsp;0.77) even after excluding individual studies, with heterogeneity remaining similar or slightly reduced (I\u0026sup2; decreased from 60% to 56%), indicating that the results were not unduly influenced by any single study. Similarly, for endurance, balance, maximal strength, and power, the pooled effect sizes consistently remained significant (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) after the removal of potential outliers, accompanied by varying degrees of reduced heterogeneity. Notably, in the analyses of sport-specific performance and sprint ability, sensitivity testing almost completely eliminated heterogeneity (I\u0026sup2; reduced to 0%\u0026ndash;3% and 0%, respectively), further strengthening the reliability of these findings. Taken together, the sensitivity analyses confirmed that no single study substantially altered the overall conclusions, with the direction and statistical significance of the effects remaining consistent across analyses, thereby supporting the robustness and reliability of our results.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSubgroup Analyses\u003c/h2\u003e\u003cp\u003eThe subgroup analyses (Tables S6\u0026ndash;S12) revealed significant differences in certain moderators, including strength (gender), power (age, training frequency, intervention duration), agility (gender, training frequency), speed (gender), endurance (age, gender, training level), balance (training level, intervention duration), and sport-specific performance (training frequency), while no significant effects were observed in other subgroups.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents the first systematic review and meta-analysis to comprehensively evaluate the effects of FRT on multiple dimensions of athletic performance. The primary aim was to determine whether FRT outperforms traditional training methods in enhancing physical performance among athletes. Given the highly specialized training environments in which competitive athletes operate, the efficiency and effectiveness of training strategies are of critical importance [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. The meta-analytic results demonstrated that FRT produced statistically significant improvements in strength, explosive power, speed, agility, endurance, balance, and sport-specific performance. Sensitivity analyses further confirmed the robustness of these findings, with the main conclusions remaining consistent even after excluding studies with high risk of bias or statistical outliers.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eEffect of FRT versus CG on Strength and Power\u003c/h2\u003e\u003cp\u003eOur meta-analysis demonstrated that FRT produced significant improvements in both maximal strength (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and explosive power (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared with CG, with sensitivity analyses confirming the robustness of these findings. These benefits were consistently observed across multiple strength assessments, including isometric, isokinetic, and one-repetition maximum (1RM) tests, as well as peak force outcomes in jump tasks. The observed gains can be primarily attributed to the unique principle of eccentric overload, which differentiates FRT from traditional resistance training by imposing greater mechanical tension during the eccentric phase and thereby eliciting more pronounced neuromuscular adaptations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMechanistically, eccentric overload induces adaptations through three complementary pathways. At the neural level, it enhances motor unit recruitment and synchronization, thereby improving the efficiency of force production[\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. At the muscular and structural level, it provides a potent stimulus for hypertrophy of fast-twitch fibers and increases tendon stiffness, improving force transmission capacity [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. In addition, FRT augments the efficiency of the SSC by enhancing spindle pre-activation and optimizing elastic energy storage and reutilization, enabling athletes to convert eccentric loading into greater concentric explosive force [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Together, these neural, muscular, and neuromechanical adaptations provide a strong physiological basis for the concurrent improvements in strength and power [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Subgroup analyses further indicated that male and elite athletes derived greater benefits, while training frequency and duration were critical moderators. Programs implemented at least twice per week for a minimum of eight weeks yielded the most substantial gains. Based on the current evidence, incorporating FRT into training regimens two to three times per week over sustained periods appears to be an effective strategy for maximizing neuromuscular adaptations and optimizing performance outcomes in strength and power.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eEffect of FRT versus CG on Agility and Speed\u003c/h2\u003e\u003cp\u003eOur meta-analysis indicates that FRT significantly enhances both change-of-direction ability (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and linear sprint speed (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared with CG. These results indicate that foundational gains in strength and explosive power can be effectively transferred into complex, performance-critical athletic skills. The improvement in CoD ability is best explained by FRT\u0026rsquo;s influence on the deceleration\u0026ndash;reacceleration cycle. The braking phase of a CoD maneuver is dominated by eccentric muscle actions and requires substantial eccentric strength to absorb impact forces [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The principle of eccentric overload\u0026mdash;a hallmark of FRT\u0026mdash;directly targets this capacity and enhances braking efficiency [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. As a result, athletes can decelerate more effectively, shorten stopping distances, and create favorable conditions for rapid directional changes. The subsequent re-acceleration phase relies on concentric power and the acute contribution of the SSC, which facilitates the rapid transition from braking to propulsion [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn contrast, sprint performance depends on the repeated utilization of the SSC across successive strides. Efficient sprinting requires rapid force production combined with continuous elastic energy recycling [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Recent evidence provides direct support for this, demonstrating that FRT significantly enhances SSC efficiency, as reflected in improvements in the RSI [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. These adaptations are thought to result from enhanced stretch-reflex responses and optimized muscle\u0026ndash;tendon stiffness [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Together, these mechanisms facilitate more effective elastic energy storage and reutilization [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. Therefore, the benefits of FRT for agility and sprint speed should not be regarded as independent outcomes but rather as convergent effects of systematic neuromuscular enhancement. For athletes in team sports such as soccer and basketball\u0026mdash;where repeated sprinting and rapid CoD actions are decisive\u0026mdash;current evidence suggests that incorporating FRT at least twice per week for eight weeks or longer is an effective strategy to maximize neuromuscular adaptations and optimize on-field performance [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eEffect of FRT versus CG on Endurance\u003c/h2\u003e\u003cp\u003eAccording to our meta-analysis, FRT was associated with significant improvements in endurance performance compared with CG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with moderate heterogeneity (I\u0026sup2; = 38%). This positive effect was consistently validated across multiple outcomes, including running economy (RE), repeated-sprint ability (RSA), and maximal oxygen uptake (VO₂max), underscoring the effectiveness of FRT in optimizing metabolic efficiency and delaying fatigue. These improvements appear to result from complementary physiological adaptations: enhanced oxidative capacity of type II fibers [\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e], improved RE through greater neuromuscular coordination [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e] and tendon stiffness [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e], and increased lactate tolerance and buffering capacity, which together prolong high-intensity performance [\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIndividual trials provide further nuance to these findings. Weng et al. reported that FRT significantly improved RE in well-trained distance runners [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], whereas Festa et al. found no significant effects in recreational runners [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], suggesting a potential population-specific effect. In team sport contexts, FRT has been shown to improve RSA and maintain its effectiveness in complex, game-like scenarios [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], thereby strengthening its ecological validity. Collectively, these results indicate that FRT enhances not only strength and power but also endurance performance by improving metabolic efficiency and fatigue resistance. This dual benefit holds particular importance for endurance athletes and offers practical value for team sports that rely on repeated high-speed movements and intermittent sprints.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eEffect of FRT versus CG on Balance\u003c/h2\u003e\u003cp\u003eOur meta-analysis confirmed that FRT is significantly more effective than CG in improving balance performance among athletes. Based on a random-effects model incorporating 10 effect sizes, the analysis revealed a statistically significant advantage of FRT interventions (p\u0026thinsp;=\u0026thinsp;0.0026), with a moderate level of heterogeneity across studies (I\u0026sup2; = 52%). This finding suggests both statistical and practical certainty regarding the efficacy of FRT. The superiority of FRT can largely be attributed to its unique high-tension eccentric loading mechanism [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e]. Unlike traditional resistance training, FRT utilizes inertial resistance to generate a marked eccentric overload where eccentric forces can exceed concentric loads, providing intensified neuromuscular stimulation as evidenced by considerable muscle activation throughout the eccentric phase of the movement [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. This enhanced stimulus improves the integration of sensory input, postural feedback, and motor output [\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e]. These physiological advantages are consistent with the observed improvements in DPSI, reinforcing the role of FRT in targeting dynamic balance enhancement [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFrom a neurophysiological perspective, eccentric overload training has been shown to promote more efficient cortico-spinal-muscular activation [\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e], optimize motor unit recruitment strategies [\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e], and facilitate sensorimotor integration, thereby forming a more robust and adaptive feedback loop for postural control [\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e]. Additionally, FRT\u0026mdash;as a high-strain resistance modality\u0026mdash;has been associated with increased tendon stiffness [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e] and enhanced reflex responsiveness [\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e], while effective balance under perturbation relies on anticipatory pre-activation [\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e]. These adaptations are particularly relevant for young competitive athletes, who typically exhibit heightened neurodevelopmental plasticity and responsiveness to proprioceptive stimuli. Therefore, FRT\u0026rsquo;s efficacy as a core balance strategy is grounded in its enhancement of eccentric control, deceleration capacity, and sensorimotor integration, offering a direct pathway to improved athletic stability and potentially reduced injury risk.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eEffect of FRT versus CG on Sport-specific Performance\u003c/h2\u003e\u003cp\u003eAccording to the results of our meta-analysis, we found that FRT was associated with significant enhancement in sport-specific performance compared with the CG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with negligible heterogeneity across studies (I\u0026sup2; = 0%). These positive effects were observed across multiple skill-based tasks, with particularly strong evidence in lower-limb\u0026ndash;dominant actions such as soccer-related shooting outcomes. The advantage of FRT in enhancing sport-specific skills can be attributed to its \u0026ldquo;transfer value\u0026rdquo;\u0026mdash;namely, the ability to efficiently convert gains in fundamental strength and power into sport-specific movements through the kinetic chain [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e]. In addition to reinforcing lower-limb and core musculature, the unique eccentric overload stimulus of FRT enhances postural stability during explosive actions, thereby providing a solid platform for rapid force generation in both upper- and lower-limb tasks [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch evidence further substantiates this transfer value, particularly in skills that depend on end-point outputs of the kinetic chain [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. In sports characterized by kicking or striking, FRT not only improves output force (e.g., soccer shooting velocity) but also enhances accuracy [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Notably, Centorbi et al. demonstrated that FRT improved stroke precision in elite tennis players, suggesting that its benefits extend beyond force production to the fine regulation of motor skills [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Taken together, these findings indicate that FRT not only develops foundational physical capacities but also effectively translates them into improvements in sport-specific performance. This outcome carries important implications for skill-dependent sports and underscores the value of FRT as an efficient training modality in competitive athletics.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eMethodological Considerations During FRT Implementation\u003c/h2\u003e\u003cp\u003eFRT is a conceptually distinct, high-strain modality that warrants deliberate planning and close supervision. Individualize to maturation/training age, technique, and sport demands; guide load/progression by mechanical outputs; apply across sexes and in injury-prevention/rehab, supporting motivation [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e]. Begin with a brief familiarization phase to standardize device handling and braking technique before formal loading; ensure appropriate fundamental technique is in place [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For multidomain adaptations, a pragmatic entry is 2\u0026ndash;3 sessions per week for at least eight weeks, emphasizing eccentric and deceleration tasks with unilateral, multiplanar actions. Progress inertial load, range of motion, and set density conservatively\u0026mdash;never at the expense of technique. Schedule sessions in step with on-field loads to manage fatigue and recovery. Monitor with balance tests (Y-Balance, DPSI), execution or velocity metrics when available, and tolerance indicators (session RPE, soreness, tendon symptoms); adjust iteratively and re-assess periodically to confirm transfer to sport tasks. Apply FRT for performance enhancement, injury-risk management, and staged rehabilitation in coordination with medical staff. During congested periods, maintain continuity through maintenance exposures and minimal-effective-dose strategies to limit detraining.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eThis review applied a comprehensive search strategy and prioritized higher-quality evidence by including randomized controlled trials conducted in athlete cohorts. Outcomes covered a broad spectrum of physical-performance indicators (e.g., balance and related neuromuscular measures), allowing convergent inference across domains and enhancing practical relevance Overall study quality was moderate (frequently rated as \u0026ldquo;some concerns\u0026rdquo;). Evidence of publication bias was observed; however, sensitivity analyses indicated that the principal effects were robust. Substantial intervention heterogeneity\u0026mdash;including exercise selection, flywheel device configurations, inertia loading parameters, and progression models\u0026mdash;as well as variability in assessment protocols may have influenced pooled estimates and warrants cautious interpretation. In addition, the limited number of trials constrained several subgroup/further analyses (e.g., by sex, competitive level, or age), and long-term follow-up was generally lacking, restricting insight into durability and transfer to competition. To strengthen inference and application, future work should: (i) conduct more high-quality RCTs, particularly on balance-related outcomes; (ii) map dose\u0026ndash;response relationships (load, inertia, session frequency, and training-cycle duration); (iii) compare sexes, competitive levels, and age groups; (iv) perform direct head-to-head trials of FRT versus traditional resistance or mixed models; and (v) include long-term follow-up to evaluate retention and translation to competition performance.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study concludes that FRT is an effective, comprehensive method for enhancing athletes\u0026rsquo; performance. Although the overall certainty of evidence is moderate, the effects are robust and carry clear practical relevance for competitive sport. These findings can guide coaches and practitioners in optimizing training regimens. Future research should use standardized, sport-specific randomized trials to clarify dose\u0026ndash;response relationships, long-term adaptations, and injury-risk outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest statement:\u003c/h2\u003e\u003cp\u003eThe authors declare that the research was conducted without any commercial or financial relationships that could be construed as potential conflicts of interest. None of the manuscript or parts of the study are being submitted to other journals while being considered for publication by your journal. This study involves no human subjects and is exempt from IRB review. The datasets generated and/or analyzed during the current study are available.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eNot applicable. This study is a systematic review and meta-analysis and does not involve any human participants or animals.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable. No individual data (e.g., images, videos, personal details) are included in this manuscript.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by The Fundamental Research Funds for the Central Universities, grant number 2025KYPT04 and Beijing Social Science Foundation Project,24YTC035.\u003c/p\u003e\u003ch2\u003eAuthor Contributions\u003c/h2\u003e\u003cp\u003eJZ conducted the literature search, performed data extraction, statistical analysis, and wrote the first draft of the manuscript. RL and JL contributed to the study design, data interpretation, manuscript revision, and supervised the overall process. All authors read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBarnes C, Archer DT, Hogg B, Bush M, Bradley PS. The evolution of physical and technical performance parameters in the English Premier League. 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National Strength and Conditioning Association position statement on long-term athletic development. 2016;30(6):1491\u0026ndash;509.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sports-medicine-open","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"smoa","sideBox":"Learn more about [Sports Medicine-Open](http://sportsmedicine-open.springeropen.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/smoa/default.aspx","title":"Sports Medicine-Open","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Flywheel resistance training, Iso-inertial training, Traditional resistance training, Athletic performance, Athletes","lastPublishedDoi":"10.21203/rs.3.rs-7868842/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7868842/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn contemporary elite sport, escalating physical demands require time-efficient strategies that transfer to competition. Flywheel resistance training (FRT)\u0026mdash;an iso-inertial modality delivering eccentric overload\u0026mdash;may elicit superior neuromuscular adaptations versus gravity-dependent methods. This systematic review and meta-analysis compared the effects of FRT versus non-flywheel comparators (e.g., traditional resistance training) on athletes\u0026rsquo; physical performance.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eSix databases (MEDLINE, PubMed, Scopus, SPORTDiscus, Web of Science, and Academic Search Ultimate) were searched through August 26, 2025. Randomized controlled trials (RCTs) were pooled using random-effects (REML) meta-analysis. Outcomes were synthesized as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study-level risk of bias and certainty of evidence were appraised with the revised Cochrane tool (RoB 2) and GRADE, respectively. Publication bias was examined where k\u0026thinsp;\u0026ge;\u0026thinsp;10.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThirty-four RCTs including 879 athletes met the criteria. One study showed low risk of bias, two high risk, and thirty-one some concerns. Compared with controls, FRT significantly improved strength (SMD\u0026thinsp;=\u0026thinsp;0.57, 95% CI 0.37\u0026ndash;0.76, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2;=50%), explosive power (SMD\u0026thinsp;=\u0026thinsp;0.56, 0.45\u0026ndash;0.68, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2;=31%), speed (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.48, \u0026minus;\u0026thinsp;0.71 to \u0026minus;\u0026thinsp;0.25, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2;=42%), agility (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.80, \u0026minus;\u0026thinsp;1.05 to \u0026minus;\u0026thinsp;0.55, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2;=60%), endurance (SMD\u0026thinsp;=\u0026thinsp;0.55, 0.29\u0026ndash;0.81, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2;=38%), balance (SMD\u0026thinsp;=\u0026thinsp;0.85, 0.38\u0026ndash;1.32, p\u0026thinsp;=\u0026thinsp;0.003, I\u0026sup2;=52%), and sport-specific performance (SMD\u0026thinsp;=\u0026thinsp;0.57, 0.32\u0026ndash;0.82, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2;=10%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eFRT is an effective and comprehensive modality to enhance multiple dimensions of athletic performance. Future trials should refine dose\u0026ndash;response prescriptions, evaluate long-term adaptations, and examine injury-risk outcomes across diverse athlete populations.\u003c/p\u003e","manuscriptTitle":"The Effects of Flywheel Resistance Training on Athletic Performance: A Systematic Review and Meta-analysis of Randomized Controlled Trials","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-27 09:06:27","doi":"10.21203/rs.3.rs-7868842/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-01-05T01:00:38+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-19T14:49:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-17T12:49:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sports Medicine-Open","date":"2025-10-16T01:44:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sports-medicine-open","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"smoa","sideBox":"Learn more about [Sports Medicine-Open](http://sportsmedicine-open.springeropen.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/smoa/default.aspx","title":"Sports Medicine-Open","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d7669f5-5e43-4548-831b-1d9ae7043d53","owner":[],"postedDate":"November 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-27T09:06:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-27 09:06:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7868842","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7868842","identity":"rs-7868842","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}