Effects of the FIFA 11+ program on performance, biomechanical measures, and physiological responses: A systematic review

•Mid-to-long-term application of the 11+ improves the majority of biomechanical measures, core stability, and balance.•The 11+ is not recommended for warming up before competition as it may acutely reduce performance.•The 11+ produces no impact on the technical skills.•Ankle responses to the 11+ have not been studied in football players.•Limited knowledge is available regarding physiological responses to the 11+. The side effects of the FIFA 11+ program on performance have not been generally reviewed. The objective of this study was to synthesize the literature on the effects of the 11+ on players’ performance. Five online databases (PubMed, Scopus, ScienceDirect, Springer, and Google Scholar) were searched (from April 2006 to March 2022) using predefined keywords and sub-keywords. The potential references were primarily recorded through Endnote and imported to Covidence. Out of the 123 references screened by 2 blinded researchers through the software, 59 full texts were assessed for eligibility, 33 of which were ultimately included. The quality of the studies and the risk of bias were then assessed. Study ID, title, place, aim, design, start/end dates, population description, study criteria, statistical analysis, and outcomes were extracted. Studies were conducted on male and female players aged 10–32 years old. The quality of the studies was moderate to high, and except for unclear bias for blinding outcome assessment, the risk of bias for all domains was low. Long-term application of the 11+ improved most biomechanical measures and physiological responses except for lower extremity stability, ankle evertors time latency, ankle dorsiflexion, and proprioception. Conversely, the 11+ showed acute negative effects on physical performance compared to dynamic warm-ups and non-significant effects on technical abilities. Mid-to-long-term implementation of the 11+ improved the majority of biomechanical and a couple of physical measures but showed no effects on technical skills. Precaution must be observed for using the 11+ before competitions, as it could acutely decrease physical/technical performance. Given the contradictory nature of the literature, further studies should evaluate the short-to-mid-term effects of the 11+. Further studies are required to address ankle responses to the 11+ intervention. [Display omitted]