A systematic review comparing the effectiveness of back-squat

protocols with plyometric protocols for eliciting post-activation

potentiation (PAP) in elite athletes
Table of Contents
Abstract ................................................................................................................................ 3
Background ........................................................................................................................... 4
Objectives.............................................................................................................................. 4
Introduction .......................................................................................................................... 4
Mechanisms of PAP .......................................................................................................................4
Conditioning activities....................................................................................................................5
Trained versus untrained ...............................................................................................................6
Methodology ......................................................................................................................... 7
Literature search strategy ..............................................................................................................7
Information source ........................................................................................................................7
Eligibility criteria ............................................................................................................................8
Data extraction ..............................................................................................................................9
Quality assessment ...................................................................................................................... 11
Results ................................................................................................................................ 12
Discussion............................................................................................................................ 16
Objective (1): Identify the effect of a PAP-inducing protocol on subsequent activity ...................... 17
Objective (2): Compare the effect of back-squat and plyometric conditioning activities ................. 18
Objective (3): Determine the most appropriate protocol for elite athletes. ....................................20
Strengths of this review ............................................................................................................... 22
Limitations of this review ............................................................................................................. 22
Further research recommendations .............................................................................................. 23
Conclusion ........................................................................................................................... 24
References:.......................................................................................................................... 26
Abstract
Post-activation potentiation (PAP) involves using a conditioning activity to enhance muscular
performance during subsequent high-intensity activity.
Study aim: to compare the effectiveness of back-squat protocols with plyometric protocols for
eliciting post-activation potentiation (PAP) in elite athletes.
Study design and methods: This systematic review sourced articles from the Discover database
using the following terms and Boolean operators (see page 7, figure 1): elite, athletics, athlete,
"track and field", plyometric*, back-squat, “back squat”, “box jump”, “counter-movement jump”,
“depth jump”, potentiation, “post activation potentiation”, “postactivation potentiation”, PAP,
“potentiation postactivation”. A total of 1,554 studies were screened and excluded if: the
conditioning activity being used which was not either a back-squat or plyometric protocol, or if
these activities were combined so that comparison of protocols was made impossible, the
outcome measure was not specific to athletics, the publication date fell outside of the period
2001-2021, participants in the study were not deemed healthy, the participants used in the study
were below an elite performance level, the conditioning activity was performed >1 hour before
the outcome measure to ensure no extraneous variables significantly interfered with results, the
item was a non-academic source or was not peer reviewed, the study was not retrievable.
Results: Nine studies satisfied all inclusion/exclusion criteria. Seven studies used a plyometric
protocol, six of which achieved a significant performance enhancement (with one insignificant
result). Just two studies used back-squat protocols, and only one reported a significant
performance enhancement (one insignificant result). Results indicate superior PAP benefit from
plyometric conditioning protocols compared with back-squat protocols.
Conclusion: There is strong evidence to suggest that plyometrics successfully elicit PAP in elite
athletes when performed before a main activity, however the degree of success is highly
dependent on the specificity and intensity of the conditioning stimulus. Further research is
needed to fully explore the potential of back-squat protocols in eliciting PAP, as well as unilateral
conditioning protocols.
Background
Post-activation potentiation is a method of enhancing performance by performing maximal
strength or power exertions before a main activity (de Alcantara Borba, D. et al., 2017). Many
studies have examined PAP as the result of a single conditioning activity (CA) performed before
a subsequent trial of maximal effort (Asencio et al., 2020; Garcia et al., 2020; Lagrange et al.,
2020; de Oliveira et al., 2020; Villalon-Gasch et al., 2020; George et al., 2019). However, much
less research has compared the effectiveness of two or more conditioning protocols and the most
effective variant of PAP conditioning is yet to be determined for elite athletes specifically
(McGowan et al., 2015). PAP can be both a help and hindrance (Chiu et al., 2003 in Tillin and
Bishop, 2009) to performers depending upon how often and how intensely it is administered,
and for elite performers this can be a matter of professional success or decline. It should
therefore be treated with an according level of curiosity, and an optimal strategy for potentiation
should be investigated.

Objectives
This review will 1) identify the effect of performing a PAP-inducing protocol on subsequent
activity, 2) compare the effect of back-squat and plyometric conditioning activities and 3)
determine the most appropriate protocol for elite athletes to enhance performance.

Introduction

Mechanisms of PAP

The predominant mechanisms involved in PAP are the sensitivity of muscle filaments to sub-
maximal Ca2+ levels, the increased excitability of higher order motor units and the reduction in
muscular pennation angle post-maximal contraction (Villalon-Gasch et al., 2020; Blazevich &
Babault, 2019; McGowan et al., 2015; Mahlfeld et al., 2004; Sale, 2004). The process by which
myofilaments become more sensitive to calcium ions is the relative increase in the
phosphorylation of regulatory light chain myosin, which occurs at greater magnitude within type
2 muscle fibres (de Oliveira et al., 2020; Tillin & Bishop, 2009; Sale, 2004). Tillin & Bishop (2009)
and Sale (2004) gave significantly more detailed explanations of the relationship between calcium
ions and regulatory light chain myosin, tending to be more analytical of the scientific processes
than other literature on the subject.
Suitability of fast-twitch muscle fibres to the mechanism of PAP implicates potentiation as a
process to enhance powerful, ballistic activity rather than continuously sustained exercise.
Considering the nature of fast-twitch muscle fibres to fatigue quicker than type 1 fibres,
effectiveness of these mechanisms will depend greatly on the balance between potentiation and
fatigue. The contractile stimulus must be intense enough to initiate the mechanisms of PAP,
however if the muscle is pushed into a state of fatigue during the CA then its adverse
consequences will override potentiation (Seitz & Haff, 2016; McGowan et al., 2015; Tillin &
Bishop, 2009). A consequence of PAP depending in part on Ca2+ concentration is that isometric
contractions cannot be “potentiated” in the same way as concentric contractions. This is because
an isometric contraction occurs due to a saturation of calcium ions, meaning their stimulus
potential has already been reached regardless of Ca2+ sensitivity in myofilaments (Sale, 2004).

Conditioning activities

As previously mentioned, PAP is caused by a CA preceding a trial of maximal exertion. The

versatility of muscles to contract in various different ways (concentric, eccentric and isometric,
with some studies exploring the stretch-shortening cycle effect of plyometrics) has caused
questions such as: ‘do all contraction types elicit PAP?’ and ‘which contraction type causes the
most potentiation?’. Previous studies have determined the effectiveness of plyometric (George
et al., 2019), weighted concentric and/or eccentric (Asencio et al., 2020; Villalon-Gasch et al.,
2020; Bauer et al., 2019), isometric (Garcia et al., 2020) and mixed (Lagrange et al., 2020; de
Alcantara Borba et al., 2017; Seitz & Haff, 2016; McGowan et al., 2015; Tillin & Bishop, 2009)
conditioning protocols. All forms of muscular contraction have been shown to elicit PAP but each
have their own benefits and drawbacks. George et al. (2019) stated that plyometrics, convenient
because no equipment is necessary, are not often prescribed to untrained beginners due to the
ballistic demands of the activity and subsequent injury risk. Similarly, barbell exercises come with
the prerequisite skill level to be capable of performing the CA safely. The availability of equipment
such as a barbell, squat rack and sufficient weight to elicit PAP is an additional accessibility issue
addressed in the literature (Villalon-Gasch et al., 2020). In contrast, isometric exercises often
have a very shallow learning curve, making them suitable for less experienced performers (Garcia
et al., 2020). However, results from numerous studies suggest that they may not be the most
optimal method (Garcia et al., 2020; Lagrange et al., 2020; de Alcantara Borba et al., 2017; Tillin
& Bishop, 2009; Sale, 2004). As stated previously, the saturation of calcium ions within an
isometric contraction makes its relationship with PAP much less influential. Given that there are
numerous mechanisms at work during potentiation, namely muscle pennation angle changes and
the increased excitability of higher order motor units, it could be inferred that isometric
contractions are not as effective as other CAs because they do not influence calcium related
processes as strongly (Sale, 2004).

Trained versus untrained

Finding the balance between potentiation and fatigue during a CA is the key to maximising the
effects of PAP. Considering that fatigue occurs at different rates in every individual, the most
optimal protocol may be different for virtually everyone. Literature has supported this statement
and investigated the intricacies of it (Seitz & Haff, 2016; McGowan et al., 2015; Tillin & Bishop,
2009), with research being carried out to establish best practice for populations with varying
degrees of fitness. Chiu et al. (2003 [in Tillin & Bishop, 2009]) compared the effects of a back-
squat protocol on elite versus recreational performers. They observed a potentiating effect on
elite performers and a detrimental effect on recreational performers, and theorised that the
rigorous training of elite athletes provided them with enhanced fatigue resistance. The ability to
recover from a CA faster than average gives the performer options to 1) increase the intensity of
the stimulus and possibly elicit a higher level of PAP, 2) take shorter recovery between the CA
and main performance, thus saving time and 3) exploit the effects of PAP more frequently within
their training regimen, as they will be able to sustain a relatively higher training load (Villalon-
Gasch et al., 2020; Seitz & Haff, 2016; Sale, 2004).

Methodology

Literature search strategy

A systematic review is a form of secondary research which brings together the findings of existing
primary research to answer a research question (Zawacki-Richter et al., 2020). There are multiple
styles of systematic review which help to define the exact methodology which is being used. The
first style is a priori, where the study question and methods are adhered to rigidly from beginning
to end. The second style of review is iterative, when the question and methods may be adjusted
based on feedback from literature search results. Reviews may also be classed as meta-analyses,
which relate to interpreting quantitative data, and meta-syntheses, which relate to qualitative
data. Given the nature of results included within this review, expressed in terms of measured and
quantifiable distance and/or time, it fits the description of a meta-analysis. This review will also
be a priori in nature because the research question and aims are somewhat rigidly set from the
beginning. However, the search strategy may still be tailored for the quality and abundance of
literature that is found. This condition classifies the review as iterative as well. A purely a priori
review approach may not lead to an exhaustive review of the literature in all desired contexts
therefore being adaptable (iterative) in the approach can mitigate for the initial search strategy
not discovering all literature within the scope of the study objectives. A recognised systematic
review methodology will be adopted, such as the system that de Alcantara Borba et al. (2017)
and Seitz and Haff (2016) used to review the effects of PAP in a variety of contexts within the
sport of athletics.

Information source

Articles discussing post activation potentiation were sourced through research in the Discover
database. The search terms and exclusion criteria of this review were decided upon using key
words present in the study title and objectives. The initial search was conducted using the
following terms and constraints under three main themes (see Figure 1 below). Reference lists
were also screened for relevant literature that was omitted from the results list.

1st search term(s) AND 2nd search term(s)
elite AND athletics OR athlete plyometric* OR back-squat
AND "track and field" OR “back squat” OR “box
jump” OR “counter-
movement jump” OR “depth
jump”
Figure 1
AND 3rd search term(s)
potentiation OR “post
activation potentiation” OR
“postactivation potentiation”
OR PAP OR “potentiation
postactivation”

Boolean operators have been used to define search parameters in this study. Where “AND” is
capitalised, both accompanying terms must be present in a search item to appear in the results
list. Where “OR” is capitalised, the search item may include one or both terms to justify appearing
in the results list. Where a word is suffixed by “*”, for example “plyometric*”, any iterations of
the word (for example “plyometric” and “plyometrics”) can be responsible for the search item
appearing in the results list.

Eligibility criteria

For studies to be included within this review, they had to satisfy numerous constraints. They
must: 1) involve either a back-squat or plyometric conditioning activity preceding the trial effort,
but not both, 2) use an outcome measure which was specific and relevant to the sport of
athletics, for example a run, jump or throw, 3) be published from the year 2001 to the present
day, so that all information gathered was deemed relevant to contemporary areas of study, 4)
include participants who are deemed healthy so that no extraneous variables could influence
results, 5) include participants who, defined by the study authors, are classed as elite, 6) be
written in English.
Literature was therefore excluded based on the following criteria: 1) the conditioning activity
being used which was not either a back-squat or plyometric protocol, or if these activities were
combined so that comparison of protocols was made impossible, 2) the outcome measure was
not specific to athletics (for example, a cycling trial), 3) the publication date fell outside of the
period 2001-2021, 4) participants in the study were not deemed healthy, 5) the participants used
in the study were below an elite performance level, 6) the conditioning activity was performed
>1 hour before the outcome measure to ensure no extraneous variables significantly interfered
with results, 7) non-academic sources and sources which are not peer reviewed were not
considered in this study 8) the study was not retrievable.
Where each constraint above is numbered, this corresponds to the reason code system in Figure
2 (next page). For example, “Reason 6” as a justification for exclusion would correspond to a
study not being written in English.

Data extraction

After the first search, 1,554 results were found. After duplicates were removed, and automated
filters were applied to screen for publication date, peer-reviewed articles and English-written
texts, eligibility criteria were manually applied to screen the sample. Reasons were attributed to
each of the excluded studies, for example if the protocol used involved contrast training which is
a mixture of heavy resistance and plyometric activity. Data extracted from each of the nine
included studies relate to: the sample demographic (age, gender, health condition), performance
level of the participants, conditioning activity protocol (back-squat or plyometric, and the
repetition scheme performed), the outcome measure used and the overall findings of the study.
Data collection and screening is summarised by Figure 2 (below) in a PRISMA (2020) flow diagram.
 Identification of studies via Discover database

Records removed before

screening:
Identification

Duplicate records removed

Records identified from initial (n=275)
search: n = 1,554 Records marked as ineligible
by automation tools (n=492)
Reason 3: n=8
Reason 6: n=38
Reason 7: n=112
Reason 8: n=334

Records screened by title Records excluded

(n = 787) (n = 684)

Reports sought for retrieval Reports not retrieved

(n = 103) (n = 0)
Screening

Reports assessed for eligibility

(n = 103) Reports excluded:
Reason 1 (n = 19)
Reason 2 (n = 47)
Reason 4 (n = 0)
Reason 5 (n = 28)
Included

Studies included in review

(n = 9)

Figure 2
Quality assessment

An amended version of the Downs and Black (1998) checklist for methodological quality was used
to assess the risk of bias and quality of reporting in the nine articles used within this study (see
Figure 3 below). The studies faced assessment on 25 yes/no questions (yes=1, no=0) separated
into five categories. The total was divided by the maximum possible score to calculate a
percentage score.

Internal Internal
External
Reporting validity: validity: Power Total Score
Study validity
(9) bias confounding (1) /25 (%)
(3)
(6) (6)
Boullosa et 6 2 4 4 0 20 80
al. (2020)
Bogdanis et al. 7 1 5 3 1 17 68
(2017)
Lim & Kong 6 2 5 4 0 17 68
(2013)
Bellar et al. 8 2 5 5 0 20 80
(2012)
Lima et al. 5 1 4 4 0 14 56
(2011)
Kümmel et al. 7 2 3 4 1 17 68
(2016)
Weber et al. 4 0 5 5 0 14 56
(2008)
Makaruk 7 2 3 5 0 17 68
(2013)
Tomlinson et 5 1 4 3 1 14 56
al. (2020)
Figure 3
 Results
Sample (age, Main
body mass and Performance Control Conditioning Potentiating
Author(s) activity/activities Rest time activity Results
height if level protocol (Dependent effect?
(Independent variable)
provided) variable)
Boullosa et 10 male, 10 International: Complete rest 5 DJs 3 minutes 1000m time The DJ condition caused a Yes for males,
al. (2020) female endurance most have trial reduction in 1000m time for but not for
runners (males: competed at male athletes (162.4s vs females.
27.8  7 years, Pan-American 165.3s). This likely
62.3  5.2kg, and World originated from a faster first
170.2  3.4cm; Championships split (38.8s vs 40.3s). These
females: 25.9  results are statistically
5.3 years, 51.7  significant, the degree of
4.1kg, 161.3  which is more profound for
2.5cm). the first split.
Female athletes produced a
slower overall time, and a
greater blood lactate
concentration post-1000m
in the DJ condition.
Both male and female
athletes displayed better
CMJ performance after
testing in both conditions.
Bogdanis et al. 8 male National-level 7 minutes of 3 countermovement 10 minutes 6 LJ performance increased Yes, from the
(2017) decathletes (25.1 decathletes active recovery VJs 3 minutes before between competition from 3.0%/17.5cm in the 3rd 3rd jump
± 7.1 years, 76.1 ± who have followed by 3 the last 5 long jump jumps (with jumps attempt (P=0.046, d=0.56) to attempt
8.2kg, 179 ± 4cm). competed in minutes of rest attempts (1st the CA 4.8%/28.2cm in the 6th onwards.
the long jump attempt was a performed on attempt (P=0.0001, d=0.84).
baseline score).
 for 3 years or the 7th The improvement was due
more. minute) to an increase in vertical
velocity at take-off. The
increase was from +8.7% in
the 3rd round (P=0.0001,
d=1.82) to +17.7% in the 6th
round (P=0.0001, d=4.38).
Lim & Kong 12 male sprinters Well-trained, 4 minutes rest Isometric knee 4 minutes 30m sprint No significant differences for No, very
(2013) (22.4  3.2 years, male, national- extension (3 any protocol. Some subjects individualised
67.6  5.3kg, level sprinters. repetitions of 3s) vs responded to all protocols, responses were
174.6  4.6cm). isometric squat (3 and some responded only to observed to
repetitions of 3s) vs selected protocols. different
dynamic squat (3 protocols.
repetitions at 90%
1RM).
Bellar et al. 9 male, 8 female NCAA Division 5 warmup 5 warmup throws >3 minutes 3 Mean results for the +1.37kg Yes, there was
(2012) throwers (males: 1 or above: throws with with overweight competition treatment (16.08  2.5m) a statistically
20.8  1.7 years, NCAA D1 is the competition- implements (+1.37kg throws and +2.27kg (16.08  2.7m) similar effect
117.0  13.4kg, first tier of weight vs +2.27kg) were not significantly caused by
191.0  3cm; American implement different. However, the using each
females: 25.0  Collegiate mean for the competition- over-weight
4.6 years, 99.57  athletics. The weight implement implement.
25.6kg, 178.0  vast majority of treatment was significantly
10cm). performances lower than over-weight
at this level implement results (15.58 
would far 2.5m, p<0.02). Physically
exceed the stronger throwers
“elite” experienced more of a
standard potentiating effect than
defined within weaker throwers.
other studies in
this review.
Lima et al. 10 male sprinters Professional: 5 minutes rest 2 sets of 5 DJs 5, 10 and 15 CMJ and Significant reduction in the Yes for 50m
(2011) (20.6  2.6 years, representing (0.75m height; rest minutes 50m sprint 50m sprint time at both 10 sprint and CMJ
73.7  9.22kg, their city in intervals: 15 seconds (repeated test and 15 minutes post-DJs performance.
176.4  5.81cm). competitions. between reps, 3 trials) (6.452 + 0.23s vs 6.361 ±
 minutes between 0.23s and 6.299 ± 0.24s,
sets) p<0.01). CMJ height at 15
minutes post-DJs was a
significant increase on the
pre-test scores (45.8 ±
0.66cm vs 44.3 ± 0.63cm;
p<0.01).
Kümmel et al. 2 female, 3 male Competing at Rest 10 reactive hops 10-20 8x DJs with DJ height and external DJ Yes for DJ, but
(2016) sprinters international prior to each DJ or seconds 1 minute peak power significantly not for sprint
(females: 23  8 level. Further 30m sprint rest, 4x 30m increased compared to the times.
years, 181  3cm, details not sprints with control condition (+11%). No
79  8kg; males: specified. 5 minutes significant differences were
21  2kg, 186  rest (10 found in sprint times.
14cm, 99  19kg). minutes
between
DJs and
sprints)
Weber et al. 12 male sprinters NCAA Division 5 SJs (Full 5RM BS (Full 3 minutes SJs Mean SJ height significantly Yes for the BS
(2008) and jumpers (20.3 1: the first tier protocol: 7x protocol: 7x SJs, 5x increased in the BS condition protocol, but
 1.7 years, 180.1 of American SJs, 5x SJs, 7x BS, 7x SJs) (41.6  5.3cm vs 43.9  not for the SJ
 8.8 cm, 72.9  Collegiate SJs) 5.1cm) but decreased in the protocol.
8.1 kg). athletics. The SJ condition (42.7  5.8cm vs
vast majority of 41.4  5.1cm).
performances
at this level
would far
exceed the
“elite”
standard
defined within
other studies in
this review.
Makaruk 12 male sprinters Competing for Jogging and Traditional jumps vs Not specified CMJ, DJ and Both experimental Yes, rope jump
(2013) and jumpers (22.4 a first-division stretching rope jumps 5 alternate conditions caused significant and traditional
 3.1 years, 1.82  national club. leg bounds improvements in peak jump protocols
0.08m, 77  6kg). power and jump both
 height/distance for the CMJ, outperformed
DJ and 5 alternate leg the control.
bounds (p<0.001) compared
with the control condition.
Whilst there were no
significant differences
among experimental groups
in the CMJ and DJ, the rope
jump warmup significantly
increased bounding distance
(p<0.05).
Tomlinson et 12 male, 10 NCAA Division 8 minutes rest 2 sets of 8 reps 2 minutes 30m sprint, No statistical differences No
al. (2020) female sprinters 2: the second weighted SJs (loaded between sets, 3 minutes between control and
(males: 19.8  1.5 tier of at 13% body weight) 5 minutes rest, 30m plyometric protocol
years, 71.3  American between CA sprint outcomes.
8.5kg, 176.9  Collegiate and main
5.2cm; females: athletics. Most activity
19.1  1.3 years, performances
55.3  4.4kg, at this level
168.8  2.1cm). would satisfy
“elite” status
as defined
within the
other studies in
this review.

Figure 4: Data extraction table

Key:
• DJ = drop jump • VJ = vertical jump
• SJ = squat jump • RM = repetition maximum (e.g. 5RM)
• CMJ = counter-movement jump • BS = back-squat
• LJ = long jump
Discussion
The aim of this systematic review was to assess whether back-squatting or plyometrics are more
effective for eliciting PAP, specifically in the elite population of athletes. The review will discuss
its findings in direct relation to each of the study objectives stated preceding the introductory
section. Elite athletes are constantly looking for ways to improve their standard of performance,
and one of the mechanisms to accomplish this is the preparation immediately before a
competitive event. A simple, convenient protocol which can be used to enhance performance
could be extremely significant to athletes whose events are often decided by mere centimetres
or thousandths of a second. The literature which was sourced confirms that both back-squatting
and plyometrics have the potential to cause PAP independently (Boullosa et al., 2020; Bogdanis
et al., 2017; Kümmel et al., 2016; Makaruk, 2013; Bellar et al., 2012; Lima et al., 2011; Weber et
al., 2008), however no study has compared the two conditioning protocols with a significant
sample size or with a detailed level of reporting.

Theoretically, it is elite athletes who should experience the most significant benefits from PAP.
Trained performers can recruit more type 2 motor units during exercise which have a higher
contraction velocity, increased abundance of calcium ions and greater phosphorylation potential
of light myosin chains, making them structurally suited to facilitating PAP. Males also tend to
experience greater potentiation compared with females due to their ability to recruit more type
2 motor units (de Oliveira et al., 2020; de Alcantara Borba et al., 2017; Tillin & Bishop, 2009; Sale,
2004). Given the “fast-twitch” nature of type 2 muscle fibres and motor units, it could be
hypothesised that the most significant results would come from the trials of speed and power
within the pool of studies. In reality there was no observable correlation with this theory. It would
appear that the nature, intensity and duration of the conditioning activity is significant enough
to actually inhibit performance if programmed incorrectly, even in an elite population.
Objective (1): Identify the effect of a PAP-inducing protocol on subsequent
activity

At first it would appear that PAP protocols enhance performance: out of the nine studies included
in this review, potentiating effects were observed in seven. However, three of the seven
“successful” studies did not observe potentiation across the whole sample, adding to the body
of literature which suggests that PAP has a great deal of variability depending on the performer
undergoing the conditioning activity (MacIntosh et al., 2012; Rixon et al., 2007; Chiu et al., 2003;
Hamada et al., 2000). Throughout all nine studies there is a general trend towards a more intense
conditioning activity causing a greater potentiating effect. For example, in the Bellar et al. (2012)
study, participants were asked to perform five preparatory throws with overweight implements
before entering the period of three trial efforts and a significant difference was observed
between the overweight and the control sample. The reliability of this result is boosted by a p
value of <0.02, which indicates a statistically significant finding. Effectively, the participants
completed more than 60% of their total activity in the “conditioning” phase of the study. This is
a substantially more intense conditioning activity compared with Boullosa et al. (2020) who asked
performers to perform just five drop jumps before a 1000m time trial and measured little to no
significant change, even with a wider 95% confidence interval. Additionally, numerous studies
noted that stronger performers and/or performers of a higher standard experienced more of a
potentiating effect compared with their lesser developed or trained peers. The higher recovery
capacity of elite performers in both the short and long term compared with weaker athletes
makes it much easier for them to elicit PAP. They can afford to experience a more intense
stimulus, be granted less rest time before the main activity, and yet still display greater
potentiation because their attributes grant them a larger margin for error (Villalon-Gasch et al.,
2020; Seitz & Haff, 2016; Sale, 2004). It should also be noted that in studies where the
conditioning activity stimulus was deemed insufficient for the majority of the sample to
experience PAP, it was often the male portion of the sample who experienced some potentiating
effects. This is to be expected given their greater ability to recruit type 2 motor units during
intense activity bouts (de Alcantara Borba et al., 2017). The effect of a PAP-inducing protocol on
subsequent activity was beneficial overall: although some studies measured no significant
improvement, there were no studies that observed a decrement in performance during the main
activity. The degree of success seemed to depend predominantly on the intensity of the stimulus.
Intensity may have become a more significant factor due to the samples included in this review
being confined to an elite population and perhaps different trends would be observed in a more
average population. A second factor which became apparent when analysing the results was the
specificity of the conditioning activity to the main activity. Studies such as Bogdanis et al. (2017),
Makaruk (2013) and Bellar et al. (2012) who used experimental protocols which were very similar
to the main activity observed more significant positive outcomes compared with studies who
prescribed less specific experimental protocols such as Boullosa et al. (2020), Tomlinson et al.
(2020) and Lim & Kong (2013). The difference between specific potentiation activities and null
preparation, jogging and stretching, was particularly evident in Makaruk (2013) where an
extremely significant difference (p<0.001) was observed between the two. Further research
could focus on repeated trials of effort where the conditioning activity matches the main activity
to assess whether hyper-specificity coupled with near-maximum intensity has a greater positive
effect on an elite population. Coaches and athletes should consider 1) whether the conditioning
activity they use to elicit PAP sufficiently challenges the athlete relative to their physical
capabilities and 2) how closely their immediate preparation prior to a competitive event
resembles the event/discipline itself.

Objective (2): Compare the effect of back-squat and plyometric conditioning

activities

Unfortunately, only two studies which used a back-squat protocol satisfied all the eligibility
criteria within the search for literature. Weber et al. (2008) found a significant positive effect on
squat-jump performance by performing five back-squat repetitions at 85% of each athlete’s 1-
repetition maximum (p<0.05). In comparison with their control sample, a squat-jump
conditioning activity which yielded a negative effect on performance, back-squatting appeared
to have a superior effect over plyometrics. However, this study had two notable limitations, the
first of which was their sample consisted of purely male athletes. The well-documented
individualised responses PAP, and specifically its variation between sexes, render Weber et al.’s
findings much less applicable to the female athlete population. Secondly, and perhaps most
notably, the study prescribed a total of 14 plyometric squat-jumps within the back-squat
protocol. The mixing of plyometrics and back-squatting within the same protocol makes
comparison with a 100% plyometric conditioning activity more difficult. It could be argued that
plyometrics were partly responsible for the result of the back-squat protocol, and the
combination presents a third possible methodology to be investigated regarding athletic
performance enhancement which is not covered in the scope of this review. Nevertheless, by
comparing the back-squat protocol with the findings of other studies there are conclusions to be
drawn. A similar conditioning activity to Weber et al.’s control group was used in the Tomlinson
et al. study (2020), where athletes were asked to perform weighted (13% bodyweight) squat-
jumps. They also found no significant change (p<0.05), measured in 30m sprint performance,
which reinforces the possibility that back-squatting is a superior conditioning activity to
plyometrics in an elite population. Tomlinson et al.’s findings are also strengthened by a larger
sample size (22 vs 12) and more female participants (10 vs 0) compared with the Weber et al.
study, making them more applicable to a wider audience of elite athletes. Contrary to this
inference, Lim and Kong (2013) observed very individualised reactions to an isometric squat
protocol, none of which were significant (p<0.05). With an all-male elite athlete sample, their
sporadic results cannot be attributed to physical differences such as sex and performance level.
In addition to this, none of the above studies can be separated by statistical reliability as they
have used the same confidence interval of 95%. Instead, it may be reasonable to assume that an
isometric protocol is not conducive to eliciting PAP. Specificity of the conditioning activity is an
observable correlate with successfully enhancing performance (Bogdanis et al., 2017; Kümmel et
al., 2016; Makaruk, 2013; Bellar et al., 2012; Lima et al., 2011), and it is possible that the
underlying mechanisms of PAP are optimally activated when the performer completes a high-
force or high contractile velocity activity (or a combination of the two). Both force and velocity
demands correlate directly with type 2 motor unit recruitment: the site at which PAP operates
on a physiological level (Mazara et al., 2021; Del Vecchio et al., 2018). Establishing that, it would
be wise for further research to be conducted into the effectiveness of dynamic and moderate-
load squatting for eliciting PAP. At present, the majority of literature favours high-intensity and
hyper-specific plyometrics as the most optimal conditioning activity. However, there is evidence
to suggest that back-squatting could be as effective, if not more so, than plyometrics for
potentiating elite performers. This is due to the greater potential to intensify a back-squat
stimulus (by adding heavier load) and the higher responsiveness of elite performers to more
intense conditioning activities.

Objective (3): Determine the most appropriate protocol for elite athletes.

Of the nine studies sourced which satisfied all eligibility criteria: two studies described their
sample as “international” standard, three were “national”, two were NCAA Division 1, one was
NCAA Division 2 and one was “professional”. From the outset, it became clear that the definition
of “elite” would vary significantly between studies. Therefore, when screening studies by full text
the decision was made to include studies with participants at National level (or equivalent) and
above. NCAA Division 2 was also included based on both the competition qualifying times and
the consistently high level of performance displayed at that level. The definition of eligibility
criteria five used in this review should therefore be considered when interpreting its results.
Despite the slight variability of performance standard within the nine chosen studies, there is no
observable pattern of results in relation to this. Three studies achieved significant positive
changes across the whole sample with p values of <0.02 (Makaruk, 2013; Bellar et al., 2012; Lima
et al., 2011) indicating strong statistical significance, and higher relative performance level was
not a distinguishing factor between those and the other six. Instead, the pattern remained
related to the intensity and specificity of the conditioning activity in relation to the main activity.
The majority of studies presented a lack of challenge to their sample in this respect, which was
observable in Bogdanis et al. (2017) when performers experienced increased benefits with each
“main activity” trial beyond the third effort. The confidence interval in this study also grew larger
with each passing attempt, beginning at p=0.046 and culminating at p<0.01 in the sixth trial,
reliably indicating that performance enhancement hinges on sufficient conditioning stimulus. A
limitation of this study was that it only allowed a single attempt to count as a control distance
and observing the variability between each effort in the long jump competition this was an
extremely unreliable element to the study. Nevertheless, the cumulative volume of PAP-inducing
plyometrics was sufficient at the half-way point to generate significant improvement from the
initial control attempt. However, had the conditioning activity been condensed and intensified,
an earlier and/or higher peak in performance may have been observed. It has been well-
established that elite performers can both require and tolerate a higher intensity of conditioning
to elicit PAP than the general population for reasons previously discussed (Villalon-Gasch et al.,
2020; Seitz & Haff, 2016; Sale, 2004), however findings in the Bellar et al. (2012) study suggested
a point of diminishing returns when comparing protocols of different intensity. Both overweight
implements significantly outperformed their control (+2.27kg vs +1.37kg vs +0kg, p<0.02),
however the +1.37kg implement produced a longer-lasting peak in performance. The caveat to
this observation is that the “difference” between +2.27kg and +1.37kg treatments was not
statistically significant, which leaves an area for further research to be conducted. This study
alluded to a relationship between type 2 muscle fibre content (demonstrated by heavier personal
bests in lifts such as the squat and power clean) and responsiveness to either protocol. Further
research should be conducted into this beyond that which currently exists given the inconsistency
of PAP responses among samples within this review alone. Considering the literature available at
present, elite athletes should perform a plyometric conditioning activity which is very similar to
the main activity at a slightly higher intensity. The optimal rest interval, when combined with
optimal intensity, appears to sit anywhere between three and ten minutes. Whilst these
recommendations extend to a wide variety of explosive activities, they are limited to the realm
at which type 2 motor units provide the highest contribution towards performance outcome.
Literature suggests that the mechanisms which cause PAP are limited to short-term, high force
and high velocity demands. It would not be appropriate to elicit PAP and expect heightened
performance in, for example, a predominantly aerobic activity as seen in the Boullosa et al. (2020)
study. During the main activity in this case, type 2 motor unit recruitment would be relatively low
which would restrict the influence of PAP massively.
Strengths of this review

This systematic review of literature had numerous strengths, the first of which being the large
pool of literature that was retrieved during the earliest search (1,554 studies). Such a high
number of studies retrieved using Boolean operators enabled contemporary areas of research to
be identified, and the large bank of current knowledge informed many of the conclusions drawn
from the findings of this review. Tailored inclusion and exclusion criteria were applied to the
initial search results to ensure that each study included in the final review was completely
relevant to its research question and the protocols used within them were comparable. This is
essential to be able to draw significant conclusions, as without comparison it is not possible to
identify a consensus within literature. Additionally, very little comparisons between back-
squatting and plyometrics have been made with respect to their potential to elicit PAP, and none
within the context of athletics. The only study in this review which included both methodologies
in fact compared mixed methods with a plyometric approach, presenting a gap in the literature.
Given the highly individualised responses to PAP protocols, a configuration which works for one
demographic may be ineffective or detrimental to another. There is a necessity for elite
performers to operate consistently at a high level, both to maintain elite status and be
competitive at important events, therefore any protocols adopted within their own regimen
must be proven to work for other individuals of the same standard. This review has compared
studies which used an exclusively elite population, which makes its findings applicable in a niche
and under-researched area. Numerous studies within this review used outcome measures which
were specific to the context of athletic events, which further strengthens the ecological validity
of its results.

Limitations of this review

This review has multiple limitations which must be considered when interpreting its findings, and
it has exposed some aspects of current research which should be addressed. The first limitation
was a lack of literature surrounding back-squat protocols in elite athlete populations. Just two
studies satisfied all eligibility criteria and included a squatting conditioning activity, one of which
was a mixed-methods approach. A lack of data made comparison within the review more difficult,
especially regarding a changeable and individualised phenomenon such as PAP. The gaps in
literature surrounding back-squatting and PAP must be addressed with primary research.
Unfortunately, as a secondary research study it was beyond the scope of this review to do so. A
further limitation to this study is the possible discrepancy between definitions for “elite athlete”.
The decision was made to include athletes from a national standard and upwards, however this
may not match the definition of elite in a different study. Attempting to standardise such a
subjective term in the literature search could have interfered with the sample of data available,
hence the results of other studies may not be in agreement with this one despite also using the
term “elite”. “Athlete” is a term often used within literature to describe all performers of
competitive sport, including games players and individual sportspeople who do not participate
in track and field athletics. This study was exclusive to track and field athletes, however this could
affect comparisons with other studies who include all definitions of “athlete”. Additionally, the
individualised responses to PAP protocols make this review’s findings largely irrelevant to the
general or non-elite population.

Further research recommendations

Considering the findings of this review, further research should assess the effectiveness of
conditioning activities which are specific to the main activity, as in Bogdanis et al. (2017) and
Bellar et al. (2012), compared with more generic conditioning activities of the same intensity.
Activities which expressed similar movement patterns consistently achieved significant results,
however not enough research has been carried out to establish a certain relationship between
the two. A natural continuation of research into specificity would be to investigate whether single
leg conditioning protocols achieve greater potentiation in single leg main activities such as
sprinting. There have been no unilateral exercise studies to date, however one reason for this
may be safety and the ease of familiarisation with the conditioning activity. Trained, elite
performers would likely be very familiar with single leg plyometric and resistance training, making
this population a favourable place to begin investigation. Another area which has not been
explored sufficiently with primary research is the potential of the back-squat to elicit PAP in elite
athletes. Heavy-load resistance exercises recruit high numbers of type 2 motor units (Sterczala
et al., 2018), which are the site at which PAP mechanisms operate. It is therefore easy to draw a
theoretical connection between the two, however just two back-squatting studies satisfied the
eligibility criteria of this review. An aspect of every protocol which did not receive any
independent focus was the optimum rest period between a conditioning activity and the main
activity. Once the most effective form of conditioning is identified, it would be of great benefit to
establish the most effective period of rest to complement it. It is also possible that numerous
forms of conditioning are “optimal” depending on the rest time allowed. Preference towards
types of rest (active, passive) and volume of rest depend heavily on the individual, however the
literature concerning elite performers evidently does not agree on either due to the wide range
of rest protocols applied within this review.

Conclusion
To date, there have been an insufficient number of studies conducted which include back-squat
(as a standalone activity) or unilateral conditioning protocols. These are areas which future
research must focus on to draw fair comparisons and conclusions from the pool of existing data.
Presently, literature suggests that the elite population require an intense conditioning stimulus
which is performed through a highly specific motor pattern to the main activity. It can be inferred
that these two constraints ensure a high type 2 motor unit recruitment within the muscles which
are subsequently required to perform optimally, and local mechanisms responsible for PAP
within type 2 fibres are stimulated because of this (Villalon-Gasch et al., 2020; Blazevich &
Babault, 2019; McGowan et al., 2015; Mahlfeld et al., 2004; Sale, 2004). Elite performers require
an intense conditioning activity to have a significant benefit to performance because they have
more muscle fibres to recruit, and hence potentiate. They also have a superior capacity to recover
from intense activity compared with a general population, meaning that the point of diminishing
returns on conditioning intensity is delayed. Research into PAP is extremely influential due to the
fine margins of victory and defeat in the sport of athletics, especially at an elite level, and the
significant impact that short term preparation can have on performance. This review concludes
that plyometrics, when achieving adequate specificity and intensity, are a superior method for
eliciting PAP in elite athletes compared with back-squat protocols.
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