The Effect of Neuromuscular Exercise Interventions on Athletic Performance Across Different Levels: A Multilevel Meta-Analysis

Background: Neuromuscular exercise interventions include diverse modalities, yet their performance effects remain inconsistent, particularly across athlete levels. Purpose: This review examined the effects of neuromuscular exercise interventions on athletic performance in trained, highly trained, and elite athletes, and explored moderating variables by analyzing intervention protocol variables (eg, weekly intervention frequency, session duration, number of sets, repetitions, duration per set, and intervention formats [warm-up or training]), athletic performance (balance, jumping, sprinting, and change of direction times), and study design. Methods: Systematic searches were conducted up to September 21, 2025. Pooled effects were calculated using standardized mean difference (Hedges g) through a 3-level meta-analysis model. Subgroup and regression analyses were used to explore potential moderators. Results: The systematic search identified 25,251 articles, of which 42 studies (1690 athletes, PEDro score 6.1) met the inclusion criteria. Compared to the control group, neuromuscular exercise interventions significantly improved performance in trained (g = 0.51 medium) and highly trained athletes (g = 0.62, medium). While not statistically significant for elite athletes, the effect size was positive (g =1.26, large). Subgroup analysis indicated that intervention format, performance outcome, and study design significantly moderated effects. Regression analysis showed that session duration was linearly related to improvements in trained and highly trained athletes, while weekly frequency, sets, and repetitions were not. Conclusion: The effectiveness of neuromuscular exercise interventions varies by performance outcome and athlete level and is influenced by intervention format and study design, highlighting the need for tailored neuromuscular programs across different levels of athletes.