The effects of integrative neuromuscular training on injury risk and athletic performance in athletes: a systematic review and meta-analysis

BACKGROUND: Integrative Neuromuscular Training (INT) is a multi-component training approach aimed at optimizing neuromuscular function, improving athletic performance, and reducing injury-related risks. While existing studies suggest that INT can improve injury risk factors and enhance performance, its effectiveness and underlying mechanisms remain contentious, with many existing studies lacking comprehensive quantitative synthesis and subgroup analyses. METHODS: A systematic search was conducted across nine databases from their inception to August 31, 2025, for randomized controlled trials (RCTs) on the application of INT in athletes. The Cochrane Risk of Bias Assessment Tool (ROB2) was used for quality assessment. Meta-analysis was performed using Stata/MP 17.0, with risk ratios (RR) for dichotomous outcomes and standardized mean differences (SMD) for continuous outcomes. Hedges' g and 95% confidence intervals (CI) were calculated for effect sizes, and publication bias was assessed using funnel plots and Begg's and Egger's tests. The GRADE method was employed to assess the quality of evidence. RESULTS: A total of 25 RCTs (10,124 participants) were included. The meta-analysis revealed that INT is associated with a reduced injury risk in athletes (RR = 0.73, 95% CI: 0.58-0.91, p = 0.004), as well as improvements in jump performance (SMD = 0.88, 95% CI: 0.58-1.17, p < 0.001), sprinting ability (SMD = 0.75, 95% CI: 0.44-1.06, p < 0.001), change-of-direction ability (SMD = 0.97, 95% CI: 0.38-1.57, p = 0.001), and dynamic balance (SMD = 0.91, 95% CI: 0.31-1.51, p = 0.003), However, significant heterogeneity was found in most studies, and according to ROB2, the majority of studies were categorized as "having some concerns". Therefore, the certainty of the evidence should be interpreted in the context of the GRADE framework. Subgroup analysis suggests that INT may be particularly effective in adult athletes (≥ 18 years), female athletes, football players, and those undergoing high-frequency (≥ 3 sessions/week) and longer-duration (single session > 30 min) interventions. CONCLUSION: Current evidence suggests that INT is associated with reduced injury risk and improvements in jump performance, sprinting, change-of-direction, and dynamic balance in athletes. Adult athletes, female athletes, and football players may benefit more significantly from INT, especially when the intervention frequency is ≥ 3 sessions per week and the duration exceeds 30 min per session. This study has been prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD420251131811) and was reported in strict adherence to the PRISMA 2020 guidelines. The complete PRISMA flowchart and relevant details can be found in the supplementary materials.