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Interventions with Insufficient Evidence for Recommendation



Interventions with Insufficient Evidence for Recommendation: 
     Physical Training and Sports Injury Prevention Guidelines 
                                                 U.S. Army Public Health Command (Provisional) Injury Prevention

                  Warm‐Up and Cool‐Down Before and After Activity 

Evidence of the effectiveness of warm-up and cool-
down activites on the prevention of injuries is lacking;
therefore the JSPTIPWG cannot recommend for or
against this intervention. The work group recommends
that this specific research question be studied in
military populations.

Background: The JSPTIPWG made a conscious
decision to isolate those activities that may or may not
be performed in association with a warm-up. For
example, stretching is a common activity often
associated with a warm-up, but it is an activity that can be performed at any time during a training
session. Therefore, stretching is considered a separate intervention apart from the warm-up and is
discussed in an earlier paragraph of this report. Other types of activities like proprioceptive and
neuromuscular activities also are associated with the warm-up and often are found when searching the
literature for warm-up information. These types of activities may or may not be performed in association
with the warm-up and also are considered a separate intervention (discussed earlier). A systematic
review of warm-up activity found five studies, all of high quality (7–9 (mean=8) out of 11) and reporting
sufficient data (quality score>7) on the effects of warming up relative to reducing injury risk in humans.
Some of these studies included stretching among other activities. Three of the studies found that
performing a warm-up prior to performance significantly reduced the injury risk, and the other two studies
found that warming up was not effective in significantly reducing the number of injuries. Since the number
of studies showing no effect in preventing injuries is nearly the same as those showing a positive effect,
enough doubt is cast on the practice of warm-up such that the work group cannot recommend it at this
time. However, there is insufficient evidence to discontinue the strategy as well. The recent review of
literature provides a comprehensive reference list to which the reader is referred for the entire breadth of
studies on warm-up and associated activity.

**Information taken from Joint Services Physical Training Injury Prevention Work Group p. 83-166.

Fradkin, AJ, Gabbe BJ, Cameron PA, Does warming up prevent injury in sport? The evidence from randomized controlled trials. J
    Sci Med Sport. 2006 Jun;9(3):214-20.


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