The road to designing integrated neuromuscular training programs for children and adolescents: A systematic review and meta-analysis

Integrative neuromuscular training (INT) combines motor competence and strength development to boost athletic performance but its specific components and effects on children and adolescents are not well understood. Three pre-determined principles (INT exercise categories, INT progression modalities, and INT program effectiveness) were used to guide this review. Electronic databases SPORTDiscus, MEDLINE (Ovid), APA PsycINFO, Cochrane Library, Web of Science, and Embase were searched. Search terms related to study design, population and intervention were identified, and risk of bias was appraised using the Physiotherapy Evidence Database (PEDro) Scale. Narrative synthesis indicated “strength training” (18 out of 30 studies, 60%), particularly core strength exercises (72.2%), was the most common in INT exercise categories. Twelve out of 30 studies (40%) met at least two types of INT progression modalities (i.e., volume-based progressions, intensity-based progressions and complexity-oriented progressions). Meta-analysis reported significant improvements in countermovement jump (mean difference [MD] 3.32 cm, 95% CI [2.07, 4.38]; p=0.00), push-up (MD 3.74 repetitions, 95% CI [1.53, 5.95]; p=0.00) and sprint (standardized MD -0.18s, 95% CI [-0.26, -0.09]; p=0.00), but not in flexibility. Subgroup analysis revealed that meeting all the three progression modalities significantly enhanced sprint (standardized MD -0.76s, 95% CI [1.21, -0.31]; p=0.03) and flexibility (MD 6.38 cm, 95% CI [5.45, 7.31]; p=0.00). This review provides evidence that INT programs have a positive effect on improving children and adolescents’ physical fitness and is regarded as a promising protocol. This review and future research can inform a call to action for using INT as a novel approach for developing motor competence, strength and conditioning simultaneously during childhood and adolescence.