This systematic review examines the influence of resistance training (RT) on the performance outcomes of elite athletes. Adhering to PRISMA guidelines, a comprehensive search across PubMed, Scopus, SPORTDiscus, and Web of Science databases was conducted, considering studies up to November 19, 2023. The inclusion criteria were elite athletes involved in high-level competitions. Studies were categorized by the competitive level among elite athletes, athlete’s sex, performance outcomes, and a training modality with subgroup analyses based on these factors. Thirty-five studies involving 777 elite athletes were included. The results of the meta-analysis revealed a large and significant overall effect of RT on sport-specific performance (standardized mean difference, SMD = 1.16, 95% CI: 0.65, 1.66), with substantial heterogeneity (I² = 84%). Subgroup analyses revealed differential effects based on the competitive level, the type of sport-specific outcomes, and sex. National elite athletes showed more pronounced (large SMD) benefits from RT compared to international elite athletes (small SMD). Global outcomes revealed a medium but non-significant (p > 0.05) SMD, while local outcomes showed a large SMD. Notably, female athletes exhibited a large SMD, though not reaching statistical significance (p > 0.05), probably due to limited study participants. No significant (p > 0.05) differences were found between heavy and light load RT. Resistance training is effective in improving sport-specific performance in elite athletes, with its effectiveness modulated by the competitive level, the type of the performance outcome, and athlete’s sex. The findings underscore the need for personalized RT regimens and further research, particularly in female elite athletes, as well as advanced RT methods for international elite athletes.
