Work

The effect of exercise training modalities on the morphological and mechanical properties of the achilles tendon: a systematic review and network meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Introduction: The Achilles tendon (AT) is vital for sports performance yet highly susceptible to injury. Exercise can induce structural and mechanical adaptations, but the relative effectiveness of different protocols remains uncertain. This systematic review and network meta-analysis evaluated exercise-based interventions targeting AT morphology and mechanics in healthy adults. Methods: PubMed, Web of Science and Scopus were searched from inception to 18 Feb 2025. Randomized controlled trials (RCTs) were synthesized using random-effects network meta-analysis (Hedges' g). Risk of bias was assessed using a modified Downs and Black Quality Index. Results: = 1,388) contributed to the network across five intervention categories (15 subtypes). Short-term plyometric jump training ranked highest for increasing AT cross-sectional area (SUCRA 95.6%; SMD 1.33 vs. control). Long-term isometric plantar-flexion training ranked highest for improving stiffness (SUCRA 89.3%). Gait retraining ranked highest for AT length, elongation and strain (SUCRA 59.6%-77.1%), although networks for several outcomes were sparse and estimates imprecise. Stretching-focused programs generally ranked low across outcomes. Discussion: In healthy adults, progressive, higher-dose loading, particularly isometric plantar-flexion training and plyometric jump training, shows the most favorable rankings for AT adaptation. Rankings should be interpreted cautiously given heterogeneity and sparse networks for some outcomes; well-powered head-to-head RCTs with harmonised outcome definitions are needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, PROSPERO CRD420251009672.

Source: Frontiers in Sports and Active Living

DOI: 10.3389/fspor.2026.1782503

Authors: Baisheng Fu, Yihan Qian, Yuan Wang, Junjie Fang, Yaodong Gu, Xini Zhang

Institutions: Ningbo University, Ningbo No. 2 Hospital

Language: English

Topic: Tendon Structure and Treatment

Subfield: Orthopedics and Sports Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,353