Effects of pre-competition conditioning strategies on acute sport performance in high-level athletes: a systematic review and network meta-analysis

Introduction This systematic review and network meta-analysis compared the effects of different pre-competition conditioning strategies on sport performance in high-level athletes and aimed to provide evidence-based guidance for optimizing competitive readiness. Methods PubMed, Web of Science, SPORTDiscus, China National Knowledge Infrastructure, Scopus, and Embase were searched from inception until 4 August 2026 to identify randomized controlled or crossover trials examining acute pre-competition conditioning strategies in high-level athletes. Frequentist random-effects network meta-analyses used standardized mean differences (SMDs) with 95% confidence intervals (CIs). Intervention rankings were evaluated using the surface under the cumulative ranking curve (SUCRA). Sensitivity analyses used assumed within-participant correlation coefficients of 0.30, 0.50, and 0.70. Results Eighty-nine publications contributing 90 independent datasets involving 1,609 high-level athletes were included. Four outcome-specific networks were constructed for explosive/jump, speed/change-of-direction, sport-specific, and endurance performance. No significant inconsistency was detected across networks. For explosive/jump performance, post-activation performance enhancement (PAPE) was superior to regular warm-up (WU) [SMD = 0.40, 95% CI 0.20–0.59] and ranked highest by SUCRA (91.5%). For speed/change-of-direction performance, foam rolling showed the largest effect versus WU [SMD = 0.66, 95% CI 0.10–1.21], followed in the rankings by dynamic stretching and PAPE. For sport-specific performance, ischemic preconditioning (IPC) was superior to sham stimulation [SMD = 0.54, 95% CI 0.16–0.92]. For endurance performance, remote ischemic preconditioning (RIPC) was superior to WU [SMD = 0.62, 95% CI 0.20–1.05] and ranked highest (95.1%). Sensitivity analyses did not materially alter the findings. Conclusions Acute pre-competition conditioning strategies exert outcome-specific effects rather than universal performance benefits in high-level athletes. PAPE may be most applicable to explosive performance; foam rolling, dynamic stretching, and PAPE to speed/change-of-direction tasks; IPC to sport-specific tasks; and RIPC to endurance performance. Confidence in Network Meta-Analysis (CINeMA) ratings ranged from high to very low across comparisons; therefore, SUCRA rankings should be interpreted alongside the certainty and amount of supporting evidence. Further high-quality randomized crossover studies are needed. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261368915 , identifier CRD420261368915.