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com
This section features a recent systematic review which is indexed
on PEDro, the Physiotherapy Evidence Database (http://www.pedro.
org.au). PEDro is a free, web-based database of evidence relevant to
physiotherapy.
The effects of warm-up
on physical performance
are not clear
Fradkin AJ, Tsharni RZ, Smoliga JM. J Strength Cond Res 2010;24:1408.
BACKGROUND
Warm-up is commonly used as part of an exercise programme.
Previous reviews have cast doubts on the benecial effects
long thought to be associated with warm-up.1 2 However,
recent evidence indicates that warm-up prevents sports-
related injuries. 35 Warm-up in the form of stretching has a
small effect in reducing muscle soreness following exercise3
and leads to an increase in joint range of motion, but magni-
tude of the increase is small. Thus, it has an uncertain clinical
importance.6 7
In addition to preventing muscle soreness and injury,
another possible benet of warm-up is enhanced physical per-
formance. Only one previous review has examined the effects
of warm-up on performance, 2 but found limited evidence.
Hence, the effects of warm-up on performance during sport or
physical activity are not clear.
AIM
The aim of the systematic review was to investigate the effects
of warm-up on performance of physical activity.
SEARCHES AND INCLUSION CRITERIA
The search was done in three databases (Medline, SPORTDiscus
and PubMed) from 1966 to April 2008 and in reference lists of
reviews and retrieved studies. The search terms consisted of
variations of the terms warm-up or exercise combined with
variations of the term performance improvement. Studies
had to include human subjects, report sport or physical activity
performance as an outcome measure and incorporate at least
two components of warm-up (low-intensity aerobic exercise,
stretching or sport-specic exercise). There was no restriction
on study design, however, non-English language studies and
studies with a methodological quality lower than 6/10 on the
PEDro scale were excluded.
INTERVENTIONS
The warm-up interventions of the 32 included studies var-
ied in the type (aerobic exercise with or without stretching
vs sport-specic exercise with or without stretching) and the
duration (ranging from 1 to 15 min) of warm-up. The review
did not make it clear what the comparison interventions were
in estimating the effects of warm-up.
MAIN OUTCOME MEASURES
Studies had to measure sport or physical activity performance
in order to be included, but the review did not give examples of
the outcome measures used in the studies. No other outcome
measure was used.
Br J Sports Med May 2011 Vol 45 No 6
PEDro systematic review update
STATISTICAL METHODS
From the included studies, the review authors recalculated the
changes in performance due to warm-up as percentage changes.
The method for this is unclear as the paper suggests that pre and
post within-group comparisons were used but at least some of
the data seem to be from between-group comparisons.
RESULTS
Of the 2355 studies identied in the search, 32 studies ful-
lled the inclusion criteria. These studies ranged from 6.5 to
9 out of 10 on the PEDro scale. The majority of the included
studies were crossover studies (n = 26). Two studies provided
only pre- and post comparisons. The sample size of included
studies ranged from 10 to 166, but more than two-thirds of the
studies had fewer than 50 participants.
The review authors reported that the majority of the stud-
ies showed improvement in physical performance due to
warm-up. A forest plot was presented; however, it was not
well annotated making interpretation difcult. No pooled
results were reported.
LIMITATIONS/CONSIDERATIONS
This review contains an up-to-date collection of studies exam-
ining the effects of warm-up on physical performance, but has
several methodological issues limiting the interpretation of the
results. Although the review found that warm-up improved
physical performance, it was not clear what warm-up was
being compared to. Results of the review have been derived
from vote counting rather than a meta-analysis and no raw
data were given, hence it is not possible to assess whether
the reported improvement in physical performance is clini-
cally worthwhile. An added consideration is that due to sport
specicity, the effects of warm-up on physical performance
may vary depending on the type (eg, sport-specic vs generic
warm-up), intensity or duration of warm-up. The issue of
specicity or dose is not examined in the present review but is
an interesting area to explore in future research.
This review did not report or was unclear on some impor-
tant steps of a systematic review.8 The search strategy does
not appear to be comprehensive. Only three databases were
searched, the search terms were limited and there was a lan-
guage restriction to English. Most included studies were not
randomised controlled trials but crossover studies, and it was
not clear whether data were extracted from all or only some of
the intervention periods in the crossover studies. The PEDro
scale was used to indicate methodological quality of the
included studies. However, it was unclear why half scores were
reported as the PEDro scale does not contain half scores.9
CLINICAL IMPLICATIONS
A limitation of this systematic review is that it does not pro-
vide robust evidence on whether warm-up improves physical
performance.
Paula R Beckenkamp, C Christine Lin
Musculoskeletal Division, The George Institute for Global Health, Sydney,
New South Wales, Australia
Correspondence to Paula R Beckenkamp, Musculoskeletal Division, The George
Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW 2050,
Australia; pbeckenkamp@georgeinstitute.org.au
Contributors PRB and CCL selected the systematic review. PRB wrote the first
draft of the manuscript. PRB and CCL contributed to interpretation of the data and
revision of the final manuscript and are guarantors.
525
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PEDro systematic review update

Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
Accepted 10 March 2011
Br J Sports Med 2011;45:525526. doi:10.1136/bjsports-2011-090022
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The effects of warm-up on physical

performance are not clear
Paula R Beckenkamp and C Christine Lin

Br J Sports Med 2011 45: 525-526

doi: 10.1136/bjsports-2011-090022

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