The Effect of Fatigue on Throwing Performance in Handball Players: Systematic Review with Meta-Analysis

Background: Acute fatigue is frequently experienced during handball training and match play and may impair throwing performance; however, findings across studies are inconsistent. This systematic review and meta-analysis examined the acute effects of fatigue on throwing velocity and accuracy in handball. Methods: PubMed, MEDLINE Complete, CINAHL, and Scopus were searched from inception to 24 January 2026, supplemented by Google Scholar and citation tracking. Eligible studies included handball players exposed to an acute fatigue protocol with throwing-performance outcomes. Random-effects meta-analyses were conducted using standardized mean differences (Hedges' g), oriented so that negative values indicated worse performance under fatigue. Results: Τen studies met the inclusion criteria for qualitative synthesis. For quantitative synthesis, 10 comparisons contributed to the throwing-velocity meta-analysis and 6 comparisons contributed to the throwing-accuracy meta-analysis. Fatigue showed a small-to-moderate tendency to reduce throwing velocity (g = -0.31, 95% CI -0.65 to 0.03; I² = 77.8%). For throwing accuracy, the pooled estimate suggested a possible decline under fatigue (g = -0.82, 95% CI -1.95 to 0.31), but heterogeneity was very high (I² = 95.8%) and findings were sensitive to influential effects. Conclusions: Acute fatigue showed a small-to-moderate tendency to reduce throwing velocity in handball players, with more consistent impairments observed during jump-shot tasks and after localized upper-limb fatigue protocols. In contrast, no robust conclusion can be drawn for throwing accuracy/precision because heterogeneity was extremely high and studies used substantially different outcome definitions, including hit counts, success percentages, points-based scores, and spatial error. Therefore, accuracy findings should be interpreted with considerable caution.