{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:23:04Z","timestamp":1788916984729,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background: Acute fatigue is frequently experienced during handball training and match play and may impair throwing performance; however, findings across studies are inconsistent. This systematic review and meta-analysis examined the acute effects of fatigue on throwing velocity and accuracy in handball. Methods: PubMed, MEDLINE Complete, CINAHL, and Scopus were searched from inception to 24 January 2026, supplemented by Google Scholar and citation tracking. Eligible studies included handball players exposed to an acute fatigue protocol with throwing-performance outcomes. Random-effects meta-analyses were conducted using standardized mean differences (Hedges\u2019 g), oriented so that negative values indicated worse performance under fatigue. Results: \u03a4en studies met the inclusion criteria for qualitative synthesis. For quantitative synthesis, 10 comparisons contributed to the throwing-velocity meta-analysis and 6 comparisons contributed to the throwing-accuracy meta-analysis. Fatigue showed a small-to-moderate tendency to reduce throwing velocity (g = \u22120.31, 95% CI \u22120.65 to 0.03; I2 = 77.8%). For throwing accuracy, the pooled estimate suggested a possible decline under fatigue (g = \u22120.82, 95% CI \u22121.95 to 0.31), but heterogeneity was very high (I2 = 95.8%) and findings were sensitive to influential effects. Conclusions: Acute fatigue showed a small-to-moderate tendency to reduce throwing velocity in handball players, with more consistent impairments observed during jump-shot tasks and after localized upper-limb fatigue protocols. In contrast, no robust conclusion can be drawn for throwing accuracy\/precision because heterogeneity was extremely high and studies used substantially different outcome definitions, including hit counts, success percentages, points-based scores, and spatial error. Therefore, accuracy findings should be interpreted with considerable caution.<\/jats:p>","DOI":"10.3390\/jfmk11020191","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:04:36Z","timestamp":1778601876000},"page":"191","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Effect of Fatigue on Throwing Performance in Handball Players: Systematic Review with Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Stelios","family":"Hadjisavvas","sequence":"first","affiliation":[{"name":"Physiotherapy Program, Department of Health Sciences, University of Nicosia, Nicosia 2414, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8676-0603","authenticated-orcid":false,"given":"Irene-Chrysovalanto","family":"Themistocleous","sequence":"additional","affiliation":[{"name":"Physiotherapy Program, Department of Health Sciences, University of Nicosia, Nicosia 2414, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michalis A.","family":"Efstathiou","sequence":"additional","affiliation":[{"name":"Physiotherapy Program, Department of Health Sciences, University of Nicosia, Nicosia 2414, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6734-0291","authenticated-orcid":false,"given":"Elena","family":"Papamichael","sequence":"additional","affiliation":[{"name":"Physiotherapy Program, Department of Health Sciences, University of Nicosia, Nicosia 2414, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2504-0450","authenticated-orcid":false,"given":"Christina","family":"Michailidou","sequence":"additional","affiliation":[{"name":"Physiotherapy Program, Department of Health Sciences, University of Nicosia, Nicosia 2414, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3365-7768","authenticated-orcid":false,"given":"Manos","family":"Stefanakis","sequence":"additional","affiliation":[{"name":"Physiotherapy Program, Department of Health Sciences, University of Nicosia, Nicosia 2414, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-S\u00e1nchez, C., Navarro, R.M., Karcher, C., and de la Rubia, A. (2023). Physical demands during official competitions in elite handball: A systematic review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20043353"},{"key":"ref_2","first-page":"590","article-title":"Locomotion characteristics and match-induced impairments in physical performance in male elite team handball players","volume":"34","author":"Michalsik","year":"2013","journal-title":"Int. J. Sports Med."},{"key":"ref_3","first-page":"73","article-title":"Performance and kinematics of various throwing techniques in team-handball","volume":"10","author":"Wagner","year":"2011","journal-title":"J. Sports Sci. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"van den Tillaar, R. (2020). The effects of target location upon throwing velocity and accuracy in experienced female handball players. Front. Psychol., 11.","DOI":"10.3389\/fpsyg.2020.02006"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.1249\/MSS.0000000000000929","article-title":"Translating fatigue to human performance","volume":"48","author":"Enoka","year":"2016","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1152\/physrev.2001.81.4.1725","article-title":"Spinal and supraspinal factors in human muscle fatigue","volume":"81","author":"Gandevia","year":"2001","journal-title":"Physiol. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s40279-022-01748-2","article-title":"Fatigue and human performance: An updated framework","volume":"53","author":"Behrens","year":"2023","journal-title":"Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hadjisavvas, S., Efstathiou, M.A., Malliou, V., Giannaki, C.D., and Stefanakis, M. (2022). Risk factors for shoulder injuries in handball: Systematic review. BMC Sports Sci. Med. Rehabil., 14.","DOI":"10.1186\/s13102-022-00588-x"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1007\/s00167-018-4857-y","article-title":"Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts","volume":"26","author":"Asker","year":"2018","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1080\/24748668.2019.1649344","article-title":"Throwing speed in team handball: A systematic review","volume":"19","author":"Vila","year":"2019","journal-title":"Int. J. Perform. Anal. Sport"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hadjisavvas, S., Efstathiou, M.A., Themistocleous, I.C., Daskalaki, K., Malliou, P., Lewis, J., and Stefanakis, M. (2024). Can resistance training improve throwing performance in handball players? A systematic review and meta-analysis. BMC Sports Sci. Med. Rehabil., 16.","DOI":"10.1186\/s13102-024-00872-y"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s40798-024-00785-7","article-title":"The effect of specific strength training on throwing velocity in overarm throwing: A systematic review","volume":"10","author":"Fredriksen","year":"2024","journal-title":"Sports Med. Open"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Andrade, M.S., Koffes, F.C., Benedito-Silva, A.A., da Silva, A.C., and de Lira, C.A.B. (2016). Effect of fatigue caused by a simulated handball game on ball throwing velocity, shoulder muscle strength and balance ratio: A prospective study. BMC Sports Sci. Med. Rehabil., 8.","DOI":"10.1186\/s13102-016-0038-9"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bauer, J., Hagen, M., Weisz, N., and Muehlbauer, T. (2020). The influence of fatigue on throwing and YBT-UQ performance in male adolescent handball players. Front. Sports Act. Living, 2.","DOI":"10.3389\/fspor.2020.00081"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1515\/hukin-2016-0039","article-title":"Effects of fatigue on throwing performance in experienced team handball players","volume":"54","author":"Chirosa","year":"2016","journal-title":"J. Hum. Kinet."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_17","unstructured":"PROSPERO International Prospective Register of Systematic Reviews, University of York. Available online: https:\/\/www.crd.york.ac.uk\/prospero\/."},{"key":"ref_18","unstructured":"(2024). Chapter II: Planning a Cochrane Review (current online version). Cochrane Handbook for Systematic Reviews of Interventions, Cochrane."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2019). Cochrane Handbook for Systematic Reviews of Interventions, Wiley-Blackwell. [2nd ed.].","DOI":"10.1002\/9781119536604"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_21","unstructured":"Riskofbias.info (2026, January 24). RoB 2 for Crossover Trials (Tool and Guidance). Available online: https:\/\/www.riskofbias.info\/welcome\/rob-2-0-tool\/rob-2-for-crossover-trials."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_23","unstructured":"Deeks, J.J., Higgins, J.P.T., and Altman, D.G. (2024). Chapter 10: Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions (Current Online Version), Cochrane."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1037\/1082-989X.7.1.105","article-title":"Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs","volume":"7","author":"Morris","year":"2002","journal-title":"Psychol. Methods"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting meta-analyses in R with the metafor package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Belcic, I., Rodic, S., Dukaric, V., Rupcic, T., and Knjaz, D. (2021). Do blood lactate levels affect the kinematic patterns of jump shots in handball?. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182010809"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1016\/j.jclinepi.2011.03.017","article-title":"GRADE guidelines: 7. Rating the quality of evidence\u2014Inconsistency","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","unstructured":"Sch\u00fcnemann, H.J., Bro\u017cek, J., Guyatt, G., and Oxman, A. (2013). GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations, The GRADE Working Group."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: A simple funnel-plot\u2013based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref_32","first-page":"169","article-title":"Throwing effectiveness and rotational strength of the shoulder in team handball","volume":"47","author":"Zapartidis","year":"2007","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3062","DOI":"10.1080\/14763141.2023.2212645","article-title":"Comparison of throwing kinematics and muscle activation of female elite handball players with and without pain\u2014The effect of repeated maximal throws","volume":"24","author":"Torabi","year":"2025","journal-title":"Sports Biomech."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2697","DOI":"10.1519\/JSC.0000000000000959","article-title":"Influence of different work and rest distributions on performance and fatigue during simulated team handball match play","volume":"29","author":"Moss","year":"2015","journal-title":"J. Strength. Cond. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"253","DOI":"10.3233\/IES-193178","article-title":"Skeletal muscle fatigue does not affect shooting accuracy of handball players","volume":"27","author":"Bilge","year":"2019","journal-title":"Isokinet. Exerc. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5430\/jbei.v2n1p65","article-title":"The effects of aerobic fatigue on jump shot kinematics in team handball players","volume":"2","author":"Plummer","year":"2015","journal-title":"J. Biomed. Eng. Inform."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1080\/02640414.2016.1160143","article-title":"The effects of localised fatigue on upper extremity jump shot kinematics and kinetics in team handball","volume":"35","author":"Plummer","year":"2017","journal-title":"J. Sports Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1113\/jphysiol.2007.139477","article-title":"Muscle fatigue: What, why and how it influences muscle function","volume":"586","author":"Enoka","year":"2008","journal-title":"J. Physiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5114\/jhk\/162017","article-title":"Conditioning strategies for improving handball throwing velocity: A systematic review and meta-analyses","volume":"87","author":"Petruzela","year":"2023","journal-title":"J. Hum. Kinet."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Dambroz, F., Clemente, F.M., and Teoldo, I. (2022). The effect of physical fatigue on the performance of soccer players: A systematic review. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270099"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Sun, H., Soh, K.G., Mohammadi, A., Wang, X., Bin, Z., and Zhao, Z. (2022). Effects of mental fatigue on technical performance in soccer players: A systematic review with a meta-analysis. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.922630"}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/2\/191\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:14:37Z","timestamp":1779250477000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/2\/191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":41,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jfmk11020191"],"URL":"https:\/\/doi.org\/10.3390\/jfmk11020191","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]}}}