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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Physiol.</journal-id>
<journal-title>Frontiers in Physiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Physiol.</abbrev-journal-title>
<issn pub-type="epub">1664-042X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fphys.2021.738878</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Physiology</subject>
<subj-group>
<subject>Systematic Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Effect of Functional Training on Physical Fitness Among Athletes: A Systematic Review</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Xiao</surname> <given-names>Wensheng</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1402119/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Soh</surname> <given-names>Kim Geok</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x0002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/587751/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Wazir</surname> <given-names>Mohd Rozilee Wazir Norjali</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Talib</surname> <given-names>Othman</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Bai</surname> <given-names>Xiaorong</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Bu</surname> <given-names>Te</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1237379/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Sun</surname> <given-names>He</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Popovic</surname> <given-names>Stevo</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Masanovic</surname> <given-names>Bojan</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
<xref ref-type="aff" rid="aff7"><sup>7</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Gardasevic</surname> <given-names>Jovan</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia</institution>, <addr-line>Seri Kembangan</addr-line>, <country>Malaysia</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Sports Studies, Faculty of Education Studies, Universiti Putra Malaysia</institution>, <addr-line>Seri Kembangan</addr-line>, <country>Malaysia</country></aff>
<aff id="aff3"><sup>3</sup><institution>Department of Science and Technical Education, Faculty of Educational Studies, Universiti Putra Malaysia</institution>, <addr-line>Seri Kembangan</addr-line>, <country>Malaysia</country></aff>
<aff id="aff4"><sup>4</sup><institution>Department of Sports Studies, Faculty of Education Studies, Hunan Normal University</institution>, <addr-line>Changsha</addr-line>, <country>China</country></aff>
<aff id="aff5"><sup>5</sup><institution>Faculty for Sport and Physical Education, University of Montenegro</institution>, <addr-line>Podgorica</addr-line>, <country>Montenegro</country></aff>
<aff id="aff6"><sup>6</sup><institution>Montenegrin Sports Academy (MSA)</institution>, <addr-line>Podgorica</addr-line>, <country>Montenegro</country></aff>
<aff id="aff7"><sup>7</sup><institution>Montenegrosport</institution>, <addr-line>Podgorica</addr-line>, <country>Montenegro</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Vassilis Mougios, Aristotle University of Thessaloniki, Greece</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Ugur &#x000D6;dek, Nev&#x0015F;ehir Haci Bekta&#x0015F; Veli University, Turkey; Patrik Drid, University of Novi Sad, Serbia; Bilal Bi&#x000E7;er, Mustafa Kemal University, Turkey</p></fn>
<corresp id="c001">&#x0002A;Correspondence: Kim Geok Soh <email>kims&#x00040;upm.edu.my</email></corresp>
<fn fn-type="other" id="fn001"><p>This article was submitted to Exercise Physiology, a section of the journal Frontiers in Physiology</p></fn></author-notes>
<pub-date pub-type="epub">
<day>06</day>
<month>09</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="collection">
<year>2021</year>
</pub-date>
<volume>12</volume>
<elocation-id>738878</elocation-id>
<history>
<date date-type="received">
<day>09</day>
<month>07</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>13</day>
<month>08</month>
<year>2021</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2021 Xiao, Soh, Wazir, Talib, Bai, Bu, Sun, Popovic, Masanovic and Gardasevic.</copyright-statement>
<copyright-year>2021</copyright-year>
<copyright-holder>Xiao, Soh, Wazir, Talib, Bai, Bu, Sun, Popovic, Masanovic and Gardasevic</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract><p>There is evidence that functional training is beneficial for the overall physical fitness of athletes. However, there is a lack of a systematic review focused on the effects of functional training on athletes&#x00027; physical fitness. Thus, the aimed of the present review is to clarify the effects of functional training on physical fitness among athletes. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) <italic>Statement</italic> guidelines, the systematic search of PubMed, SCOPUS, EBSCOhost (SPORTDiscus), and CINAHL Plus databases was undertaken on <italic>the 2nd November</italic> 2020 to identify the reported studies, using a combination of keywords related to functional training, physical fitness, <italic>and</italic> athletes. <italic>From the 145 studies</italic>, only nine articles met all eligibility criteria and were included in the systematic review. The assessment was performed on the Pedro scale, and the quality of the study included in the nine studies was fair (ranging from 3 to 4). The results showed that speed (<italic>n</italic> = 6) was the <italic>aspect of physical fitness</italic> studied in functional training interventions, followed by muscular strength (<italic>n</italic> = 5), power (<italic>n</italic> = 4), balance (<italic>n</italic> = 3), body composition (<italic>n</italic> = 3), agility (<italic>n</italic> = 3), flexibility (n = 1) and muscular endurance (<italic>n</italic> = 1). Existing evidence concludes that functional training significantly impacts speed, muscular strength, power, balance, and agility. <italic>Furthermore, there are still limit numbers of evidence showing effect of</italic> functional training on flexibility and muscular endurance. In contrast, no significant improvement was found in body composition where functional training was conducted.</p>
<p><bold>Systematic Review Registration:</bold> <ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero">https://www.crd.york.ac.uk/prospero</ext-link>, identifier: CRD4202123092.</p></abstract>
<kwd-group>
<kwd>flexibility</kwd>
<kwd>muscular endurance</kwd>
<kwd>body composition</kwd>
<kwd>balance</kwd>
<kwd>speed</kwd>
</kwd-group>
<contract-sponsor id="cn001">Chinese Academy of Medical Sciences<named-content content-type="fundref-id">10.13039/501100005150</named-content></contract-sponsor>
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<ref-count count="59"/>
<page-count count="12"/>
<word-count count="10135"/>
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</front>
<body>
<sec sec-type="intro" id="s1">
<title>Introduction</title>
<p>Athletes&#x00027; successful performance is usually attributed to the unique combination of talent and physical fitness, technical, tactical, and psychological qualities (Smith, <xref ref-type="bibr" rid="B52">2003</xref>). Among those criteria, physical fitness is considered the most critical quality to determine athletes&#x00027; competitive ability (Gabbett et al., <xref ref-type="bibr" rid="B22">2007</xref>). Excellent physical fitness is essential for improving the athletes&#x00027; technical and tactical level and performance and is the basic requirement for competing athletes under high-intensity training (Chunlei, <xref ref-type="bibr" rid="B11">2016</xref>). The loss of an athlete&#x00027;s physical fitness component can jeopardize this ability and lead to sports injuries (Dengguang and Yang, <xref ref-type="bibr" rid="B14">2007a</xref>). For example, in tennis players, <italic>decreased muscle strength and postural control limits</italic> the ability to start quickly and change direction, which further hinders their ability to hit the ball effectively and maintain a stable body, and also increased the likelihood of sports injuries (Kovacs, <xref ref-type="bibr" rid="B30">2006</xref>).</p>
<p>A substantial number of publications proved a significant positive correlation between physical fitness components and exercise training intervention. <italic>The American College of Sports Medicine guidelines support the use of traditional resistance training, traditional resistance training enhances physical fitness performance by gradually increasing exercise load during the training process (Feito et al.</italic>, <xref ref-type="bibr" rid="B19"><italic>2018</italic></xref><italic>). However, the training specificity literature has shown that the benefits of traditional resistance training for improving physical fitness is rarely transferred to sports performance (Li et al.</italic>, <xref ref-type="bibr" rid="B33"><italic>2019</italic></xref><italic>; Li</italic>, <xref ref-type="bibr" rid="B32"><italic>2021</italic></xref><italic>). Most of the traditional resistance training methods are not multi-articular and multiplanar; these aspects seem fundamental for eliciting greater sports performance (Fernandez-Fernandez et al.</italic>, <xref ref-type="bibr" rid="B20"><italic>2016</italic></xref><italic>; Santos-rosa et al.</italic>, <xref ref-type="bibr" rid="B50"><italic>2020</italic></xref><italic>). On the other hand</italic>, a new exercise training method that has recently received much attention to developing athletes&#x00027; physical fitness is functional training (Feito et al., <xref ref-type="bibr" rid="B19">2018</xref>). Several studies have confirmed that functional training can enhance speed (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), muscular strength (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), power (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), balance (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>), body composition (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), agility (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>), flexibility (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>) and muscular endurance (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). Additionally, other research has discovered positive effects of functional training on physical fitness in football players (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), handball players (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), martial artists (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>), tennis players (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>) and volleyball players (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). Despite the significance of functional training for improving the physical fitness components among athletes, there is no publication that summarized crucial information on the impacts of functional training protocols on physical fitness among athletes.</p>
<p>Conceptually, functional training refers to the training of partial chains and connections in the human motion chain that involves completing specific target actions, including multi-dimensional motion trajectory acceleration, deceleration, and stability training activities that meet the characteristics of particular target actions (Cook, <xref ref-type="bibr" rid="B12">2012</xref>). The action mode of functional training involves acceleration, deceleration and stability of multiple joints and planes. The action mode determines the broad participation and effective pertinence of functional training (National Academy of Sports Medicine, <xref ref-type="bibr" rid="B42">2001</xref>). Moreover, Boyle believes that the essence of functional training is purposeful training. It is a multi-plane exercise in stable control and weight-bearing. It is a series of exercises that involve balance and proprioception and are supported by body parts (Boyle, <xref ref-type="bibr" rid="B5">2016</xref>). Therefore, functional training differs from traditional resistance training; it can be any exercise performed to enhance a specific movement or activity (Pacheco et al., <xref ref-type="bibr" rid="B45">2013</xref>). With a definition this broad, the literature on functional training has incorporated various exercise programs with varying designs and focuses. The principle of functional training is the specificity of training, which means that training in a specific activity is the best way to maximize the performance in that particular area (Hawley, <xref ref-type="bibr" rid="B25">2008</xref>). In other words, the closer the training is to the desired outcome (i.e., a specific task or performance criterion), the better the result will be. For example, when the functional training program includes the element of strength training, the training improves the outcome of muscle strength (Skelton et al., <xref ref-type="bibr" rid="B51">1995</xref>; Alexander et al., <xref ref-type="bibr" rid="B1">2001</xref>; Gin&#x000E9;-Garriga et al., <xref ref-type="bibr" rid="B23">2010</xref>). The results presented by the different studies on functional training effects on physical fitness components among athletes are encouraging, but limited scientific information is available to determine its possible benefits on the different <italic>physical fitness components</italic> of performance. Therefore, this systemtic review aimed of the present review is to clarify the effects of functional training on physical fitness among athletes.</p>
</sec>
<sec sec-type="methods" id="s2">
<title>Methods</title>
<sec>
<title>Protocol and Registration</title>
<p>The data selection, collection and analysis of this review were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., <xref ref-type="bibr" rid="B41">2009</xref>) and were prospectively registered on the International Prospective Register of Systematic Reviews; <ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero">https://www.crd.york.ac.uk/prospero</ext-link>, CRD4202123092.</p>
</sec>
<sec>
<title>Search Strategy</title>
<p>The literature search was undertaken in four international databases: the SCOUPS, PubMed, EBSCOhost (SPORTDiscus), and CINAHL Plus. The search was conducted on <italic>the 2th November</italic>, 2020. In each database, a search was conducted by title, taking a predefined combination of keywords: (&#x0201C;functional training&#x0201D; OR &#x0201C;functional exercise&#x0201D; OR &#x0201C;functional skill<sup>&#x0002A;</sup>&#x0201D; OR &#x0201C;functional task training&#x0201D; OR &#x0201C;therapeutic exercise&#x0201D;) AND (&#x0201C;physical fitness&#x0201D; OR &#x0201C;physical endurance&#x0201D; OR &#x0201C;cardiorespiratory fitness&#x0201D; OR &#x0201C;physical conditioning&#x0201D; OR &#x0201C;skill-related fitness&#x0201D; OR &#x0201C;skill related fitness&#x0201D; OR &#x0201C;skill related physical&#x0201D; OR &#x0201C;skill-related physical&#x0201D; OR &#x0201C;skill related physical fitness&#x0201D; OR &#x0201C;skill-related physical fitness&#x0201D; OR &#x0201C;fitness, physical&#x0201D; OR &#x0201C;speed&#x0201D; OR &#x0201C;power&#x0201D; OR &#x0201C;reaction time&#x0201D; OR &#x0201C;agility&#x0201D; OR &#x0201C;balance&#x0201D; OR &#x0201C;coordination&#x0201D; OR &#x0201C;health related physical fitness&#x0201D; OR &#x0201C;health related physical&#x0201D; OR &#x0201C;health related fitness&#x0201D; OR &#x0201C;health-related physical&#x0201D; OR &#x0201C;health-related fitness&#x0201D; OR &#x0201C;health-related physical fitness&#x0201D; OR &#x0201C;aerobic endurance&#x0201D; OR &#x0201C;muscular strength&#x0201D; OR &#x0201C;muscular endurance&#x0201D; OR &#x0201C;body composition&#x0201D; OR &#x0201C;flexibility&#x0201D;) AND (&#x0201C;player<sup>&#x0002A;</sup>&#x0201D; OR &#x0201C;athlete<sup>&#x0002A;</sup>&#x0201D; OR &#x0201C;sportsman<sup>&#x0002A;</sup>&#x0201D; OR &#x0201C;sportswoman<sup>&#x0002A;</sup>&#x0201D; OR &#x0201C;sportsperson<sup>&#x0002A;</sup>&#x0201D; OR &#x0201C;Jock<sup>&#x0002A;</sup>&#x0201D;). We also explored other relevant articles in the reference lists of the studies included in the review and examined the reference lists of previous related reviews. All titles were manually searched for potential inclusion. Reference lists of retrieved papers, authors&#x00027; names, and review articles were retrieved manually for additional relevant citations.</p>
</sec>
<sec>
<title>Eligibility Criteria</title>
<p>We used the PICOS (population, intervention, comparison, outcome, study designs) criteria as the inclusion criteria, is presented in <xref ref-type="table" rid="T1">Table 1</xref>. Only records presenting functional training on aspect of physical fitness of athletes were included. Thus, studies were included if they met the following criteria: (1) A full text, peer-reviewed study published in English, describing the use of athletes (male and female) to explore the effects of functional training interventions on physical fitness, randomized controlled trial (RCT), non-randomized controlled trial (Non-RCT) with two or more groups, and single-group trials with pretest and post-test design; (2) In this study, only included studies on planned and organized functional training intervention to improve or maintain physical fitness. Notably, studies using functional training or combinations of functional training and other exercise training interventions (e.g., resistance training) were also included from this review; (3) Investigate the effects of functional training on physical fitness among athletes and assess at least one physical fitness component outcome; (4) There were no restrictions on the sample size, study location, and intervention time for the included studies.</p>
<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption><p>Inclusion criteria according to the PICOS conditions.</p></caption>
<table frame="hsides" rules="groups">
<tbody>
<tr>
<td valign="top" align="left"><bold>Items</bold></td>
<td valign="top" align="left"><bold>Detailed inclusion criteria</bold></td>
</tr>
<tr>
<td valign="top" align="left">Population</td>
<td valign="top" align="left">Athletes (male/female)</td>
</tr>
<tr>
<td valign="top" align="left">Intervention</td>
<td valign="top" align="left">Functional training</td>
</tr>
<tr>
<td valign="top" align="left">Comparison</td>
<td valign="top" align="left">Two or more groups and single-group trials</td>
</tr>
<tr>
<td valign="top" align="left">Outcome</td>
<td valign="top" align="left">Physical fitness (speed, power, reaction time, agility, balance, coordination, aerobic endurance, muscular strength, muscular endurance, body composition, flexibility)</td>
</tr>
<tr>
<td valign="top" align="left">Study designs</td>
<td valign="top" align="left">RCT or Non-RCT</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>Studies were excluded if they met several exclusion criteria: (1) Studies that combined functional training interventions with additional non-exercise training (e.g., psychological interventions) and interventions including unsupervised training courses were not included in the study; (2) Studies published articles, meeting abstracts, case reports, and short communications in languages other than English were excluded; and (3) Observational studies and interventions focusing solely on counseling for functional training implementation were excluded.</p>
</sec>
<sec>
<title>Study Selection</title>
<p>The retrieved studies were imported into Mendeley reference management software to remove any duplicates. Firstly, the search strategies were assisted by an experience librarian. Secondly, two independent reviewers (Xiao, Bai) screened the titles and abstracts of all the identified articles in the initial screening phase to identify relevant studies. Irrelevant materials were removed from the database before assessing all other titles and abstracts using our predetermined inclusion and exclusion criteria. Articles that remain at the end and enter a qualitative synthesis must have the whole text, and the whole text must be read. Items for which the full text is not available are dropped. If there were any disagreements, a third reviewer (Soh) was consulted until a consensus was achieved.</p>
</sec>
<sec>
<title>Data Extraction and Quality Assessment</title>
<p>After the data search was complete, data were obtained from eligible studies in a predetermined extraction form [Including, (1) Author, title, publication year; (2) Research design; (3) Sample size, control group; (4) Participant characteristics (age, gender, etc.); (5) Intervention features (type, length, and frequency); (6) Measures index, and (7) Research outcomes]. One author abstracted information into the standard form and the other author checked it.</p>
<p>The PEDro scale (<ext-link ext-link-type="uri" xlink:href="http://www.pedro.org.au">www.pedro.org.au</ext-link>) has been proven to be a useful measure of the quality of experimental methodology in developing a systematic review, and has good validity and reliability (Lima et al., <xref ref-type="bibr" rid="B34">2013</xref>). The PEDro scale is designed to evaluate the four fundamental methodological aspects of a study, such as random process, blind technique, group comparison and data analysis. The assessment of the 11 items in the PEDro scale was performed by two well-trained, independent raters using a yes (1 point) or No (0 points) response rating scale, and disagreements were resolved by a third rater. However, the eligibility criteria were not considered in the total score since this was related to external validity. The total PEDro score ranges from 0 to 10 points, and higher scores reflect a better methodological quality. The higher the PEDro score, the higher the quality of the corresponding method. Studies scoring 8 to 10 were considered to be methodologically excellent in quality, those ranging from 5 to 7 to be good in quality, while a score between 3 and 4 is fair in quality, and those scoring below 3 to be poor in quality (Foley et al., <xref ref-type="bibr" rid="B21">2003</xref>). The judgment of overall scientifific evidence was based on number, methodological quality and consistency of outcomes of the studies in three levels of evidence: (1) strong evidence, provided by generally consistent findings in multiple (&#x02265;2) number and results studies, (2) moderate evidence, when only one study is available or findings are inconsistent in multiple (&#x02265;2) studies, (5) no evidence, when no case-control studies are found.</p>
</sec>
</sec>
<sec sec-type="results" id="s3">
<title>Results</title>
<p>The search results were screened and read by formulating literature inclusion and exclusion criteria. This systematic review contains nine articles involving RCT and Non-RCT on the effects of functional training on physical fitness among athletes. They were published between the years of 2009&#x02013;2020. In <xref ref-type="table" rid="T2">Table 2</xref>, the studies&#x00027; characteristics are presented.</p>
<table-wrap position="float" id="T2">
<label>Table 2</label>
<caption><p>Characteristics of the studies examined in the present review.</p></caption>
<table frame="hsides" rules="groups">
<thead><tr>
<th valign="top" align="left"><bold>Study</bold></th>
<th valign="top" align="left"><bold>Design</bold></th>
<th valign="top" align="left"><bold>Type of athletes</bold></th>
<th valign="top" align="left"><bold>Population characteristics</bold></th>
<th valign="top" align="left"><bold>Interventions</bold></th>
<th valign="top" align="left"><bold>Type of exercise training</bold></th>
<th valign="top" align="left"><bold>Measures index</bold></th>
<th valign="top" align="left"><bold>Outcomes</bold></th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Oliver and Brezzo (<xref ref-type="bibr" rid="B43">2009</xref>)</td>
<td valign="top" align="left">Pre-post test</td>
<td valign="top" align="left">Collegiate athletes (volleyball and soccer players)</td>
<td valign="top" align="left">Sex: F, TB: NR, EG1 = 15, Age: 19.9 &#x000B1; 1.8yr., WT: 71.8 &#x000B1; 8.5kg, ht.: 174.5 &#x000B1; 11.9cm, BMI: NR, CG = 11, Age: 18.5 &#x000B1; 0.5yr., WT: 63.3 &#x000B1; 6.7kg, ht.: 166.4 &#x000B1; 5.6cm, BMI: NR</td>
<td valign="top" align="left">Freq.: 4 times/week, time: 10 min, length: 13 weeks</td>
<td valign="top" align="left">Functional balance training group (EG1), control group (CG)</td>
<td valign="top" align="left">Body composition (WT, BF, BMI), strength (quadra-ped: left, right; single leg squat (left, right), muscular endurance (sit up), balance (biodex balance test: left, right)</td>
<td valign="top" align="left">Single leg squat (right, left)&#x02191;, sit up&#x02191;, BMI&#x02194;, WT&#x02194;, BF&#x02194;, quadra-ped (left, right)&#x02194;, Biodex (right, left)&#x02194;</td>
</tr>
<tr>
<td valign="top" align="left">Tomljanovi&#x00107; et al. (<xref ref-type="bibr" rid="B56">2011</xref>)</td>
<td valign="top" align="left">Pre-post test</td>
<td valign="top" align="left">Moderately trained athlete</td>
<td valign="top" align="left">Sex: M, TB&#x02265;146 months, Age: 22&#x02013;25yr., EG1 = 11, WT: 78.89 &#x000B1; 12.32, ht.: 179.69 &#x000B1; 6.39, CG = 12, WT: 82.42 &#x000B1; 12.92, ht.: 185.00 &#x000B1; 10.58, BMI: NR</td>
<td valign="top" align="left">Freq.: 3 times/week, time: NR, Length: 5 weeks</td>
<td valign="top" align="left">Functional training (EG1), traditional resistance training (CG)</td>
<td valign="top" align="left">Agility (5-10-5 test, HEX), power (CMJ: AT, PEAKPWR, JH, GCT), strength (SMB, LMB), speed (10 m, 20 m, 10&#x02013;20 m), body composition (WT, ht., BF%, BF, LBM, H2o)</td>
<td valign="top" align="left">HEX&#x02191;, SMB&#x02191;, JH&#x02191;, PEAKPWR&#x02191;, GCT&#x02191;, LMB&#x02194;, AT&#x02194;, 5&#x02013;10&#x02013;5&#x02194;, 10m&#x02194;, 20 m&#x02194;, 10&#x02013;20 m&#x02194;, WT&#x02194;, ht.&#x02194;, BF%&#x02194;, BF&#x02194;, LBM&#x02194;, H2o(I)&#x02194;</td>
</tr>
<tr>
<td valign="top" align="left">Sander et al. (<xref ref-type="bibr" rid="B49">2013</xref>)</td>
<td valign="top" align="left">Pre-post test</td>
<td valign="top" align="left">Elite youth soccer players</td>
<td valign="top" align="left">EG1 = 65, EG2 = 56, Sex: NR, TB&#x02265;146 months, mean age: 15.1yr., Mean ht.: 170.9, Mean WT: 62.3, BMI: NR</td>
<td valign="top" align="left">Freq.: NR, time: NR, Length: 8 days</td>
<td valign="top" align="left">Completed the NWP first and the WPS 4 days later (EG1), completed the WPS first and the NWP 4 days later (EG2)</td>
<td valign="top" align="left">Speed (linear sprint: 5 m, 10 m, 15 m, 20 m, 25 m, 30 m, and CDS:5 m left and right, 10m left and right)</td>
<td valign="top" align="left">5 m&#x02191;, 10 m&#x02191;, 15 m&#x02191;, 20 m&#x02191;, 25 m&#x02191;, 30 m&#x02191;, 5 m left&#x02194;, 5 m right&#x02191;, 10 m left&#x02191;, 5 m right&#x02191;</td>
</tr>
<tr>
<td valign="top" align="left">Elbadry (<xref ref-type="bibr" rid="B18">2014</xref>)</td>
<td valign="top" align="left">Pre-post test</td>
<td valign="top" align="left">Young handball players</td>
<td valign="top" align="left">EG1: n = 10, Sex: F, TB: 3 &#x000B1; 0.7yr., Age: 13 &#x000B1; 1.5yr, WT: 44 &#x000B1; 2.7, ht.: 147 &#x000B1; 2.95, BMI: NR; CG: n = 10, Sex: F, TB: 3 &#x000B1; 0.8yr., Age: 14 &#x000B1; 1.8yr, WT: 42 &#x000B1; 3.4, ht.: 148 &#x000B1; 3.11, BMI: NR</td>
<td valign="top" align="left">Freq.: 3 times/week, time: 60 min, Length: 10weeks</td>
<td valign="top" align="left">Functional strength training group (EG1), control group (CG)</td>
<td valign="top" align="left">Balance (SST, dynamic balance), strength (handgrip, LS, BS)</td>
<td valign="top" align="left">SST&#x02191;, Dynamic balance&#x02191;, Handgrip Strength&#x02194;, LS&#x02194;, BS&#x02191;</td>
</tr>
<tr>
<td valign="top" align="left">Alonso-Fern&#x000E1;ndez et al. (<xref ref-type="bibr" rid="B2">2017</xref>)</td>
<td valign="top" align="left">Pre-post test</td>
<td valign="top" align="left">Handball players</td>
<td valign="top" align="left">Sex: F, TB&#x02265; 60 months., Age: 15.2 &#x000B1; 0.6yr., EG1 = 7, WT: 63.17 &#x000B1; 9.44, ht.: 164 &#x000B1; 5, BMI: 23.83 &#x000B1; 3.46, CG = 7, WT:67.29 &#x000B1; 0.03, ht.: 166 &#x000B1; 9.24, BMI: 24.61 &#x000B1; 3.93,</td>
<td valign="top" align="left">Freq.: 2 times/week, time: 10 min, Length: 8 weeks</td>
<td valign="top" align="left">Combining strength, coordination and plyometric exercises (EG1), Control group (CG)</td>
<td valign="top" align="left">Body composition (WT, BMI, BF%,), VO2max), speed (RSA), power (CMJ: AT, JH, GCT, PEAKPWR)</td>
<td valign="top" align="left">WT&#x02194;, BMI&#x02194;, BF%&#x02191;, AT&#x02194;, JH&#x02194;, GCT&#x02194;, PEAKPWR&#x02194;, RSA&#x02191;,</td>
</tr>
<tr>
<td valign="top" align="left">Yildiz et al. (<xref ref-type="bibr" rid="B59">2019</xref>)</td>
<td valign="top" align="left">Pre-mid-post test</td>
<td valign="top" align="left">Prepubertal tennis players</td>
<td valign="top" align="left">EG1 = 10, EG2 = 10, CG = 8, Sex: NR, TB: 3.1 &#x000B1; 1.1yr., Age: 9.6 &#x000B1; 0.7yr., WT: 31.3 &#x000B1; 4.1, ht.: 134.1 &#x000B1; 6.8, BMI: NR</td>
<td valign="top" align="left">Freq.: 3 times/week, time: 65-70 min, Length: 8 weeks</td>
<td valign="top" align="left">Functional training group (EG1), Traditional training group (EG2), Control group (CG)</td>
<td valign="top" align="left">Flexibility (Sit and reach), power (CMJ), speed (10 m test), agility (T-test), balance (RDB, LDB, SB)</td>
<td valign="top" align="left">Sit and reach&#x02191;, CMJ&#x02191;, 10 m test&#x02191;, T-test&#x02191;, RDB&#x02191;, LDB&#x02191;, SB&#x02191;</td>
</tr>
<tr>
<td valign="top" align="left">Baron et al. (<xref ref-type="bibr" rid="B4">2020</xref>)</td>
<td valign="top" align="left">Pre-post test</td>
<td valign="top" align="left">Young football players</td>
<td valign="top" align="left">EG1: n = 20, Sex: NR, TB: NR, Age: 16.8 &#x000B1; 0.6 yr., WT: 66.5 &#x000B1; 7.4 kg, ht.: 175.7 &#x000B1; 6.4 cm, BMI: 21.5 &#x000B1; 1.8</td>
<td valign="top" align="left">Freq.: NR, time: 70-90 min, Length: 12 weeks</td>
<td valign="top" align="left">Functional training (EG1)</td>
<td valign="top" align="left">Speed and acceleration (0-5 m, 5&#x02013; 10 m, 10&#x02013;30 m, 30 m)</td>
<td valign="top" align="left">0-5 m &#x02194;, 5&#x02013;10 m&#x02191;, 10&#x02013;30 m&#x02191;, 30 m&#x02191;</td>
</tr>
<tr>
<td valign="top" align="left">Keiner et al. (<xref ref-type="bibr" rid="B28">2020</xref>)</td>
<td valign="top" align="left">Pre-post test</td>
<td valign="top" align="left">Elite adolescent soccer players</td>
<td valign="top" align="left">EG1: n = 11, EG2: n = 11, EG3: n = 14. CG: n = 12 Sex: NR, TB: NR, Age: 17.45 &#x000B1; 0.52yr, WT: 73.0 &#x000B1; 7.0 kg, ht.: 1.78 &#x000B1; 0.06 m, BMI: NR</td>
<td valign="top" align="left">Freq.: 2 times/week, time: 60 min, Length: 10 months</td>
<td valign="top" align="left">Traditional strength training (EG1), plyometrics and sprint training (EG2), functional training group (EG3), control group (CG)</td>
<td valign="top" align="left">Speed (20 m, CDS: CODSR, CODSL), power (SJ: AT, JH), strength(1RM)</td>
<td valign="top" align="left">20 m&#x02191;, CDS (CODSR, CODSL)&#x02191;, SJ&#x02191;, 1RM&#x02191;</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p><italic>&#x02191;, significant within-group improvement from pretest to post-test; &#x02194;, non-significant within-group change from pretest to post-test; WT, weight; ht, height; M, Male; yr, year; NR, not reported; Freq., frequency; CG, control group; EG, experimental group; HEX, hexagon test; 5&#x02013;10&#x02013;5 test, 5&#x02013;10&#x02013;5 meter shuttle run test; SMB, standing overarm medicine ball throw; LMB, lying medicine ball throw; SST, Static strength test; OMBT, overhead medicine ball throw; CMJ, vertical counter movement jump; AT, air time; JH, jump height; GCT: ground contact time; PEAKPWR, power peak; NWP, regular soccer warm-up; WPS, warm-up program supplemented with functional exercises; CDS, change of direction sprint; HIIT, high-intensity interval training; RSA, repeated sprint ability; BM, body mass; BF%, body fat mass percentage; BF, body fat; LBM, lean body mass; H2o(I), total body water; RDB, right dynamic balance; LDB, left dynamic balance; SB, static balance; FJ, ten-fold jump; SQ, Squat for 30s; PU, Push-ups, TLPP, Torso lifting from a prone position for 30s, SJ, Jump performance; 1RM, 1 repetition maximum (squat maximum strength performance); SHR, Shuttle run; LS, leg strength; BS, back strength</italic>.</p>
</table-wrap-foot>
</table-wrap>
<sec>
<title>Study Selection</title>
<p><xref ref-type="fig" rid="F1">Figure 1</xref> shows the flow chart of records selection. A total of 143 potential articles were identified through the electronic database search (36 from PubMed; 107 from SCOPUS; 0 from EBSCOhost (SPORTDiscus); 0 from CINAHL Plus), and additional relevant articles in screening the reference lists of studies that were included in the review and reference lists of previous related reviews (<italic>n</italic> = 1), and Google Scholar (<italic>n</italic> = 1). After exclusion of the duplicates (15), the title and abstract of 130 were assessed for eligibility. After elimination at the title and abstract level 48 articles, the remaining 82 articles were subsequently read. After reading, another 73 articles were eliminated, leaving nine relevant articles that satisfied the inclusion criteria and were included in the qualitative synthesis.</p>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption><p>PRISMA flow chart of the study selection process.</p></caption>
<graphic xlink:href="fphys-12-738878-g0001.tif"/>
</fig>
</sec>
<sec>
<title>Study Quality Assessment</title>
<p>An assessment of the study quality, according to the PEDro list, is presented in <xref ref-type="table" rid="T3">Table 3</xref>. The mean PEDro score of the included studies was 3.44 (range 3&#x02013;4), which indicates that the included studies were of fair quality, and none of the studies met all the PEDro list quality criteria. All studies specified their eligibility criteria, similar baseline group, between-group comparisons, point measure and variability. None of the studies reported on allocation concealment, blind subject, blind therapist, blind assessor, or intention to treat analysis, except for three studies which described random allocation (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>), and only one study reported follow-ups (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). Nevertheless, it is challenging to include blind subjects, blind therapists, and blind assessors as participants and assessors, since the included studies were exercise training interventions. This situation calls for higher quality and better evidence level studies to be conducted in the future.</p>
<table-wrap position="float" id="T3">
<label>Table 3</label>
<caption><p>Summary of methodological quality assessment scores.</p></caption>
<table frame="hsides" rules="groups">
<thead><tr>
<th valign="top" align="left"><bold>References</bold></th>
<th valign="top" align="center"><bold>Oliver and Brezzo (<xref ref-type="bibr" rid="B43">2009</xref>)</bold></th>
<th valign="top" align="center"><bold>Tomljanovi&#x00107; et al. (<xref ref-type="bibr" rid="B56">2011</xref>)</bold></th>
<th valign="top" align="center"><bold>Sander et al. (<xref ref-type="bibr" rid="B49">2013</xref>)</bold></th>
<th valign="top" align="center"><bold>Elbadry (<xref ref-type="bibr" rid="B18">2014</xref>)</bold></th>
<th valign="top" align="center"><bold>Cherepov and Shaikhetdinov (<xref ref-type="bibr" rid="B10">2016</xref>)</bold></th>
<th valign="top" align="center"><bold>Alonso-Fern&#x000E1;ndez et al. (<xref ref-type="bibr" rid="B2">2017</xref>)</bold></th>
<th valign="top" align="center"><bold>Yildiz et al. (<xref ref-type="bibr" rid="B59">2019</xref>)</bold></th>
<th valign="top" align="center"><bold>Baron et al. (<xref ref-type="bibr" rid="B4">2020</xref>)</bold></th>
<th valign="top" align="center"><bold>Keiner et al. (<xref ref-type="bibr" rid="B28">2020</xref>)</bold></th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Eligibility criteria</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
</tr>
<tr>
<td valign="top" align="left">Random allocation</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
</tr>
<tr>
<td valign="top" align="left">Allocation concealment</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
</tr>
<tr>
<td valign="top" align="left">Group similar at baseline</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
</tr>
<tr>
<td valign="top" align="left">Blind therapist</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
</tr>
<tr>
<td valign="top" align="left">Blind assessor</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
</tr>
<tr>
<td valign="top" align="left">Follow-up</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
</tr>
<tr>
<td valign="top" align="left">Intention to treat analysis</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">0</td>
</tr>
<tr>
<td valign="top" align="left">Between group comparisons</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
</tr>
<tr>
<td valign="top" align="left">Point measure and variability</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1</td>
</tr>
<tr>
<td valign="top" align="left">PEDro score</td>
<td valign="top" align="center">4</td>
<td valign="top" align="center">4</td>
<td valign="top" align="center">3</td>
<td valign="top" align="center">3</td>
<td valign="top" align="center">3</td>
<td valign="top" align="center">4</td>
<td valign="top" align="center">4</td>
<td valign="top" align="center">3</td>
<td valign="top" align="center">3</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec>
<title>Population Characteristics</title>
<p>The nine included studies&#x00027; population characteristics were reported based on the following aspects: (1) Athlete classification. In the included literature, only one article did not report the athlete classification (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>) but only reported moderately trained athletes, and eight articles reported the type of athlete, including football players (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), martial artists (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>), handball players (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), tennis players (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>) and volleyball players (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>); (2) Sample size. In total, the nine studies consisted of 330 subjects, ranging from 14 (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>) to 121 (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>) participants, with a median of 26 (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>) and mean of 36.7; (3) Gender. All nine studies focused on athletes, three studies focused on females (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), one study focused on male (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), and the remaining five studies did not report gender (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>); (4) Age. Most studies report the subjects&#x00027; age, except for one (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>), and only one study reported the age range of the subjects (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). An analysis of age reports in seven studies found that the age range of the subjects ranged from 9.6 years to 25 years (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>); (5) Body Mass Index. Most studies reported the height and weight of the subjects (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), only two studies reported the BMI of the subjects (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>), and only one study did not state the weight, height, BMI of the subjects (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>). For the consistency of literature analysis, the following formula was used to calculate the BMI of the subjects in the relevant studies: BMI = weight (kg)/height<sup>2</sup> (m). The BMI of the participants in the study ranged from 17.26 to 24.4 kg/m<sup>2</sup>; (6) Training background. Among the nine studies, five studies reported the training background of athletes (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>) while the other four studies did not describe the training background (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). For the consistency of literature analysis, the training background of the athletes was recorded in months. The training background of the subjects ranged from 36 months to 146 months.</p>
</sec>
<sec>
<title>Interventions Characteristics</title>
<p>The nine included studies&#x00027; intervention characteristics were reported based on the following aspects: (1) Training length. The shortest intervention length is 8 days (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>) and the longest being 10 months (Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>); (2) Duration of each training session. Most studies reported the duration of each training session (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), only three studies did not state the duration (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>). The duration of each training session analysis of 6 research reports found that they ranged from 10 min (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>) to 90 min (Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>); (3) Training frequency. Among the nine studies included, six studies reported frequency of training (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>) while the other three studies did not (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>). The frequency analysis of 6 research reports found that the frequency ranged from 2 times/week to 4 times/week (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>).</p>
</sec>
<sec>
<title>Outcome and Measures</title>
<p>The outcomes for the present study were grouped according to the effects of functional training on different physical fitness components among athletes. All authors of this study independently classified the papers according to other research topics (components). Disagreements were resolved through discussion among all authors until a consensus was reached.</p>
</sec>
<sec>
<title>Effect of Functional Training on Speed</title>
<p>Six of the nine studies included in this systematic review presented inferences about the effect of functional training on speed performance (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). The speed tests used in these studies included linear sprint test of 5 m (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>), 10 m (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>), 15 m (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>), 20 m (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), 25 m (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>) and 30 m (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>). They also included change of direction sprint test (5 m left and right test, 10 m left and right test) (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), repeated sprint ability test (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), and acceleration test (0&#x02013;5 m, 5&#x02013;10 m, 10&#x02013;20 m, 10&#x02013;30 m, 0&#x02013;30 m) (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>). The subjects included young football players (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), moderately trained athletes (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), handball female players (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>) and prepubertal tennis players (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>). Four studies showed improvement in linear sprint test (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), change of direction sprint test (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>) and repeated sprint ability test (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>). Additionally, Baron et al. (<xref ref-type="bibr" rid="B4">2020</xref>) observed a significant improvement for 5&#x02013;10 m test and 10&#x02013;30 m test, contrary to the 0&#x02013;5 m test and 0&#x02013;30 m test. However, only one study did not observe any significant change in 10, 20, and 10&#x02013;20 m tests (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>).</p>
</sec>
<sec>
<title>Effect of Functional Training on Muscular Strength</title>
<p>Muscular strength was only evaluated in five of the studies that were included in this review (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). The aspects valued and assessment tools used were pull up (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>), medicine ball throwing (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>), pronequadra-ped core test, single-leg squat test (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>), 1 repetition maximum (Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), handgrip strength test and static strength test (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>). The subjects include martial artists (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>), moderately trained athletes (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), collegiate women athletes (volleyball and soccer players) (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>), elite adolescent soccer players (Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>) and young handball players (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>). Studies conducted by Cherepov and Shaikhetdinov (<xref ref-type="bibr" rid="B10">2016</xref>) and Keiner et al. (<xref ref-type="bibr" rid="B28">2020</xref>) revealed a significant increase in muscular strength after the functional training intervention. Nonetheless, three studies observed a significant improvement on standing overarm medicine ball throw (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), leg squat (right and left) (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>), back strength test (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>), but no significant change on lying medicine ball throw (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), quadra-ped left and right test (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>), leg strength test and handgrip strength test (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>).</p>
</sec>
<sec>
<title>Effect of Functional Training on Power</title>
<p>Among the nine studies included in this review, four studies reported on power (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), and five studies did not report on it (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>). The aspects valued and assessment tools used involved vertical countermovement jump test (jump height, air time, ground contact time, power peak) (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). The subjects include moderately trained athletes (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), female handball players (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), prepubertal tennis players (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>) and elite adolescent soccer players (Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). One study had an 8-week intervention period (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>), while the other study had an intervention period of 10 months (Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). The results of these studies reveal that functional training can improve power (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). On the other hand, Tomljanovi&#x00107; et al. (<xref ref-type="bibr" rid="B56">2011</xref>) observed a significant improvement in the countermovement jump test (jump height, ground contact time, power peak) but not for the vertical counter movement jump test (air time) (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). However, only one study reported that the 8-week functional training did not yield significant results in the vertical counter movement jump test (flight time, jump height, ground contact time, and power peak) (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>).</p>
</sec>
<sec>
<title>Effect of Functional Training on Balance</title>
<p>Balance (static and dynamic balance) was valued only in three of the nine studies included in this review. The measurement tools were the dynamic balance (right and left), static balance (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>), biodex balance test (left and right) (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>) and standing stork test (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>). The subjects include prepubertal tennis players (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>), collegiate women athletes (volleyball and soccer players) (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>), and young handball players (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>). One study reported an 8-week intervention period (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>), while the other studies had an intervention period of 10 weeks (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>). The results of these studies reveal that functional training can improve balance (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>). Nevertheless, one study reported that 13 weeks of functional training did not significantly improve balance (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>).</p>
</sec>
<sec>
<title>Effect of Functional Training on Body Composition</title>
<p>The body composition aspect appeared to be undervalued by the studies included in this review. Only three of the studies assessed this aspect by using different measurement tools like body weight (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), body height (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), body fat mass percentage (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), lean body mass (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), total body water (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), body mass index (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>) and body fat (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>). The subjects include moderately trained athletes (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), handball players (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>) and collegiate women athletes (volleyball and soccer players) (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). Two studies observed no significant effect of functional training on body composition (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). However, Alonso-Fern&#x000E1;ndez et al. (<xref ref-type="bibr" rid="B2">2017</xref>) observed a significant improvement in body fat, but not for body weight and body mass index (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>).</p>
</sec>
<sec>
<title>Effect of Functional on Agility</title>
<p>Agility was not the main aspect in many of the studies included in this review. Only three studies valued this criterion through four exercises: shuttle run 3 &#x000D7; 10 m (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>), agility 5&#x02013;10&#x02013;5 test, hexagon test (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>) and <italic>T</italic>-test (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>). The subjects include martial artists (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>), moderately trained athletes (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>) and prepubertal tennis players (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>). Studies conducted by Cherepov and Shaikhetdinov (<xref ref-type="bibr" rid="B10">2016</xref>) and Yildiz et al. (<xref ref-type="bibr" rid="B59">2019</xref>) revealed significant increases in agility after the functional training intervention. In contrast, Tomljanovi&#x00107; et al. (<xref ref-type="bibr" rid="B56">2011</xref>) observed a significant improvement in the hexagon test but no significant change on the agility 5&#x02013;10&#x02013;5 test.</p>
</sec>
<sec>
<title>Effect of Functional Training on Flexibility</title>
<p>Only one study included in this systematic review presented inferences about the effect of functional training on flexibility. The flexibility was measured based on the sit and reach test, commonly used in health-related and physical fitness test batteries to evaluate the hamstring and lower back flexibility (Hui and Yuen, <xref ref-type="bibr" rid="B26">2000</xref>). The participants of this study were pre-pubertal tennis players. This study revealed a highly significant improvement in flexibility after 8 weeks of functional training (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>).</p>
</sec>
<sec>
<title>Effect of Functional Training on Muscular Endurance</title>
<p>Muscular endurance was assessed in one out of the nine studies included in this review (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). This study uses the one-minute sit up test to evaluate muscular endurance (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). The study subjects included female collegiate volleyball and soccer players. Oliver and Brezzo (<xref ref-type="bibr" rid="B43">2009</xref>) reported positive results in this aspect after the intervention.</p>
</sec>
</sec>
<sec sec-type="discussion" id="s4">
<title>Discussion</title>
<p>This systematic review provides a comprehensive overview of the impact of functional training physical fitness among athletes and their bey relevant knowledge for athletes to improve their physical fitness. This revision is intended to be different from other published studies on using the functional training intervention among athletes. The main findings indicated that functional training could increase physical fitness (speed, strength, power, flexibility, agility, balance, aerobic, and muscular endurance) among athletes. However, no data was found in reaction time and coordination reporting. The reviewed papers varied significantly regarding the participants (type of athletes, age, and gender) and the physical fitness components studied. Nonetheless, functional training may be an effective physical fitness intervention among athletes based on positive findings in these studies. Following the framework in the &#x0201C;Results&#x0201D; section, the physical fitness components of the studies were analyzed in detail.</p>
<sec>
<title>Effect of Functional Training on Speed</title>
<p>Most sports experts agree that speed, an elementary motor skill, is vital to succeeding in many sports disciplines (Karaleji&#x00107; et al., <xref ref-type="bibr" rid="B27">2014</xref>). Six studies evaluated this component in their research by using the linear sprint test (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), change of direction sprint test (Sander et al., <xref ref-type="bibr" rid="B49">2013</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>), and repeated sprint ability test (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), which yielded significantly positive results. However, one study reported that some of the measures of repeated sprint ability test (5&#x02013;10 m, 10&#x02013;30 m) exhibited a significant increase, but there was no significant change on repeated sprint ability test (0&#x02013;5 m, 0&#x02013;30 m) after functional training (Baron et al., <xref ref-type="bibr" rid="B4">2020</xref>). Furthermore, only one study did not observe a significant effect of functional training on linear sprint test (10, 20, 10&#x02013;20 m test) (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). This finding may be a result of improvements in functional status and increased speed. Campa et al. (<xref ref-type="bibr" rid="B8">2019</xref>) also demonstrated that better movement patterns might improve speed performance. However, wrong movement patterns will negatively impact the ability to perform fundamental movement patterns with precision and appropriate efficiency, besides increasing the risk of athletic injuries (Kollock et al., <xref ref-type="bibr" rid="B29">2019</xref>).</p>
</sec>
<sec>
<title>Effect of Functional Training on Muscular Strength</title>
<p>Strength has a great influence on physical fitness components. Athletes must intensify strength training to improve their skills and maintain a good competitive state in their respective fields (Dengguang and Yang, <xref ref-type="bibr" rid="B15">2007b</xref>). Meanwhile, muscle strength can be divided into upper limb muscle strength study (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>) and lower limb muscle strength study (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). Three studies reported on upper limb strength; one study reported significant improvement in muscular strength (pull up, 3 kg stuffed ball overhead throwing) (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>) while the other study reported no significant increases in static strength test (handgrip strength and back strength test) (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>). However, only one study reported that some of the measures of upper limb muscular strength have significant increases (standing overarm medicine ball throw), but there was no significant improvement in the muscular strength test (lying medicine ball throw) (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>).</p>
<p>Regarding those studies that assessed muscle strength of lower limbs, one study reported significant improvement in muscular strength (1 RM) (Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). On the contrary, no significant improvement in muscular strength (static strength test: leg strength test) was found in another study (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>). Furthermore, one study reported that some of the measures of lower limb muscular strength (left leg squat and right leg squat) showed significant improvements, but the findings were not statistically significant (quadra-ped left and right test) (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). In terms of upper limb muscular strength, better results are observed in studies with long-term interventions (Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). In addition, only one of the five included studies on muscle strength reported on upper limb muscular strength and lower limb muscular strength (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>). Therefore, more research should analyze strength.</p>
</sec>
<sec>
<title>Effect of Functional Training on Power</title>
<p>Based on the findings of four studies that analyze the benefits of functional training on power, it was not possible to draw a definite conclusion on this aspect. Two studies confirmed that functional training programs increase athletes&#x00027; performances in the vertical countermovement jump test (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>; Keiner et al., <xref ref-type="bibr" rid="B28">2020</xref>). However, these two studies alone are not enough to support the idea that functional training is beneficial in improving athletes&#x00027; power, and it is worth noting that this hypothesis has been supported by literature from non-athlete participants (Miszko et al., <xref ref-type="bibr" rid="B40">2003</xref>; Liu et al., <xref ref-type="bibr" rid="B35">2014</xref>).</p>
<p>In addition, Tomljanovi&#x00107; et al. (<xref ref-type="bibr" rid="B56">2011</xref>) reported that some of the measures of vertical countermovement jump test (jump height, ground contact time, power peak) were statistically significant, but there was no significant increase in the vertical countermovement jump test (air time) (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). The functional training program consisted of mostly upper body exercises, which did not test the performance of the lower body. This improvement may be mainly related to neural coordination of movement (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). However, another study reported that high-intensity interval training protocols based on functional exercises program had no significant increases in power (flight time, jump height, jump speed) (Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>). This finding is consistent with the studies by Buchheit et al. (<xref ref-type="bibr" rid="B6">2009</xref>) and Rey et al. (Via&#x000F1;o-Santasmarinas et al., <xref ref-type="bibr" rid="B57">2018</xref>). However, these data opposed the reported results by Dello Iacono et al. (<xref ref-type="bibr" rid="B13">2016</xref>) involving handball players because the functional training program might not be enough to stimulate the neuromuscular system related to power (Luo et al., <xref ref-type="bibr" rid="B36">2005</xref>). Power in the upper/lower extremities is necessary to produce explosive actions among athletes (Girard and Millet, <xref ref-type="bibr" rid="B24">2009</xref>; Chelly et al., <xref ref-type="bibr" rid="B9">2010</xref>). However, the included study only reported the effect of functional training on lower body power but ignored the effect of functional training on upper body power, which was an important gap in the existing literature. Therefore, it is necessary to consider and correct the research on power in functional training.</p>
</sec>
<sec>
<title>Effect of Functional Training on Balance</title>
<p>The static and dynamic balance were tested in three of the nine studies included in this review. Two studies confirmed that a functional training program increases static balance and dynamic balance (Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>). This finding may be explained by the adaptations that occurred in all the sensory systems assisting postural control, such as the vestibular, visual, and the somatosensory and motor systems controlling muscular output (Taube et al., <xref ref-type="bibr" rid="B54">2008</xref>; Latorre Rom&#x000E1;n et al., <xref ref-type="bibr" rid="B31">2015</xref>).</p>
<p>However, only one study conducted was observed that performance in the biodex balance test (left, right) was not significantly improved (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). This observation may result from all the subjects being in-season, not only in practice and competition, but also in a regimen strength and conditioning program (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). Therefore, the interference of other factors (e.g., exercise training factors) should be avoided in future research.</p>
</sec>
<sec>
<title>Effect of Functional Training on Body Composition</title>
<p>Three studies showed no significant effect of functional training on body weight (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), body height (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), body mass index (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>), lean body mass (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>), and total body water (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). The study by Alonso-Fern&#x000E1;ndez et al. (<xref ref-type="bibr" rid="B2">2017</xref>) reported statistically significant improvement in body fat, whereas two other studies showed no statistical significance in terms of body composition (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). These results are in line with those obtained by Camacho-cardenosa et al. (<xref ref-type="bibr" rid="B7">2016</xref>) who found no statistically significant reduction in body fat. Considering that calorie intake and food monitoring have a statistically significant impact on this variable, it is safe to assume that athletes with more regular and stable eating habits may enhance body composition quality (Mettler et al., <xref ref-type="bibr" rid="B39">2010</xref>).</p>
</sec>
<sec>
<title>Effect of Functional Training on Agility</title>
<p>Agility is an essential component in most field and team sports. Traditional definitions of agility have simply identified speed in directional changes as the defining component (Draper and Lancaster, <xref ref-type="bibr" rid="B17">1985</xref>). Out of the three studies that investigated agility (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Cherepov and Shaikhetdinov, <xref ref-type="bibr" rid="B10">2016</xref>; Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>), only one of them reported that the agility 5-10-5 test did not demonstrate significant improvement (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>). The explanation of these results may be the improved power qualities and enhanced postural control of the subjects (Markovi&#x00107; et al., <xref ref-type="bibr" rid="B38">2007</xref>). In contrast, the impact of power and explosive strength is lower in speed-led agility tests (e.g., agility 5&#x02013;10&#x02013;5) (Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>).</p>
<p>Furthermore, in a study that compared the functional movement screen training and traditional training on agility in 62 elite male high school baseball players, the training program included static stretching, and it was showed that functional movement screen program improves flexibility (trunk flexion forward, trunk extension backward, the splits) (Song et al., <xref ref-type="bibr" rid="B53">2014</xref>). Despite the findings reported in previous studies, functional training may be an effective way to increase agility. Future research should consider exercise items in functional training and only determine the effect of functional training on speed-led agility tests.</p>
</sec>
<sec>
<title>Effect of Functional Training on Flexibility</title>
<p>The sit and reach is a field test used to assess hamstring and lower back flexibility (Baltaci et al., <xref ref-type="bibr" rid="B3">2003</xref>). This study found that the functional training group showed significant improvement at sit and reach, whereas no significant improvements were observed in the traditional training and control groups (Yildiz et al., <xref ref-type="bibr" rid="B59">2019</xref>). Similarly, Weiss et al. reported that the 7 weeks functional training program intervention resulted in significant improvements in the flexibility of college students (non-athletes) (Weiss et al., <xref ref-type="bibr" rid="B58">2010</xref>), which is different from the participants included in the study. However, the functional training intervention can significantly improve the flexibility of the participants. Therefore, these results can only be regarded as weak evidence at present, and they need to be compared to more exercise training interventions.</p>
</sec>
<sec>
<title>Effect of Functional Training on Muscular Endurance</title>
<p>Muscular endurance was measured with a one-minute sit up test (Pritchard et al., <xref ref-type="bibr" rid="B46">2001</xref>). In the studies, the no intervention group also showed significant improvement on the one-minute sit up test. The intervention group&#x00027;s significant improvement and the non-intervention group may be due to the routine training program during the season (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>). However, the sit up test measures rectus abdominal endurance and not deep core musculature (Diener, <xref ref-type="bibr" rid="B16">1995</xref>), which may be why the intervention group and non-intervention group did not show significant improvement.</p>
</sec>
</sec>
<sec id="s5">
<title>Limitations</title>
<p>Overall, this review provides substantial evidence of fair quality and the beneficial effects of different functional training programs on physical fitness among athletes. However, there are several limitations to this review. Firstly, only four studies reported the gender of athletes (Oliver and Brezzo, <xref ref-type="bibr" rid="B43">2009</xref>; Tomljanovi&#x00107; et al., <xref ref-type="bibr" rid="B56">2011</xref>; Elbadry, <xref ref-type="bibr" rid="B18">2014</xref>; Alonso-Fern&#x000E1;ndez et al., <xref ref-type="bibr" rid="B2">2017</xref>). If present, it could be important, as there are differences in assessing physical fitness components based on gender. This may impact the final research results. Secondly, none of the studies included in this review stated the sample size calculation method. Determining the sample size is influenced by several factors, including the purpose of the study, population size, the risk of selecting a &#x0201C;bad&#x0201D; sample, and the allowable sampling error (MacCallum et al., <xref ref-type="bibr" rid="B37">1999</xref>). Thus, inappropriate, inadequate, or excessive sample sizes can influence quality and accuracy (Rodr&#x000ED;guez del &#x000C1;guila and Gonz&#x000E1;lez-Ram&#x000ED;rez, <xref ref-type="bibr" rid="B48">2014</xref>). If the sample size calculation method in the included research is wrong, it may influence the outcome of the study. Thirdly, most studies did not document or control exercises that were performed by participants outside of the study setting. Additionally, most studies did not consider the influence of temperature, time, and other factors on physical fitness among athletes. Finally, the studies did not have any short-term or long-term follow-up, making it difficult to predict the long-term impact of functional training on physical fitness among athletes.</p>
</sec>
<sec sec-type="conclusions" id="s6">
<title>Conclusion</title>
<p>The present analysis of this systematic review provides strong evidence that functional training improved physical fitness in terms of speed, muscular strength, power, balance, and agility, while there is moderate evidence of the effect on flexibility and muscular endurance. No significant improvement was found in body composition. The results support the principle of specificity in training, where the best gains in performance are achieved when the training closely mimics the performance (Hawley, <xref ref-type="bibr" rid="B25">2008</xref>; Reilly et al., <xref ref-type="bibr" rid="B47">2009</xref>). Furthermore, functional training is a relatively new training modality, but it recently has gained momentum among physical fitness training and has been identified as a &#x0201C;Top 10 Fitness Trend&#x0201D; in 2018 (Thompson, <xref ref-type="bibr" rid="B55">2017</xref>), with four of the nine studies being published in the past 3 years. Moreover, review trials show that functional training was most common in resistance and strength training. Nevertheless, it is necessary to be cautious about the results in view of the limitations outlined in the present study. To better understand the effectiveness of functional training in improving athletes&#x00027; physical fitness, additional research to examine the effect of functional training on physical fitness components according to the difference in the type of athletes is encouraged. It will help verify the effectiveness of functional training to improve the physical fitness components among different types of athletes and promote functional training in the field of modern sports science (Osipov et al., <xref ref-type="bibr" rid="B44">2017</xref>).</p>
</sec>
<sec sec-type="data-availability-statement" id="s7">
<title>Data Availability Statement</title>
<p>The original contributions presented in the study are included in the article/supplementary material&#x0201E; further inquiries can be directed to the corresponding author.</p>
</sec>
<sec id="s8">
<title>Author Contributions</title>
<p>The literature search and selection of studies was performed by authors WX and KS. Following an initial screen of titles and abstracts WX, full scrutiny of potentially eligible studies was independently screened by WX and KS using the specific inclusion criteria. OT arbitrated any disagreements in study inclusion. Study quality assessment was performed by WX. All authors contributed to manuscript revision, read, and approved the submitted version.</p>
</sec>
<sec sec-type="COI-statement" id="conf1">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s9">
<title>Publisher&#x00027;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
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<fn-group>
<fn fn-type="financial-disclosure"><p><bold>Funding.</bold> The study was supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Science, grant numbers: 2020-JKCS-022; and scientific research fund project of Tianjin Education Commission of China phased research results of the research project on the current situation and mode of integration of Tianjin sports and medicine, grant numbers: 2018SK145.</p>
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