No Evidence of Post-Activation Performance Enhancement on Endurance Exercises: A Comprehensive Systematic Review and Meta-analysis.

PURPOSE: Narrative reviews have suggested that post-activation induced by warm-up routines is effective to increase endurance exercise performance in real-world scenarios. However, systematic reviews with meta-analysis (SRMA) rather than narrative ones are required to provide an up-to-date summary of the evidence and provide directions for practical decisions. Therefore, we systematically reviewed peer-reviewed and gray literature to determine the certainty of evidence and the relative effects of post-activation performance enhancement (PAPE) in endurance exercises.

METHODS: The effects of PAPE on endurance performance were meta-analyzed as a standardized mean difference (SMD) from control conditions within a random-effects model considering polled data and subgroups (PAPE strategies, endurance test modalities, and VO2MAX-based endurance level).

RESULTS: Eligible studies (n = 35) showed a high risk of bias due to methodological flaws in randomization and blinding procedures. A meta-analysis including 57 comparisons (432 participants) revealed a significant, but very small PAPE effect on endurance performance (Z = 2.49; SMD = 0.15 - very small; 95% CI 0.03 to 0.28) due to exceptional effect sizes reported by two studies (SMD of 2.85 and 2.14). We also observed that neither PAPE strategies nor endurance test modalities or VO2MAX-based endurance levels influenced the PAPE effects on endurance performance. Meta-regression showed that PAPE effects were neither correlated with the time interval between conditioning routines and endurance exercise, nor with endurance exercise duration. We found a very low certainty of evidence that PAPE potentiates endurance performance.

CONCLUSIONS: Based on the analyses of bias and certainty of evidence, we found no support to recommend PAPE strategies to improve endurance exercise performance. Significant, but very small PAPE effects on endurance performance were due to two exceptional effect sizes.