Study aim: Real-time EEG neurofeedback (NFB) training is gaining popularity as a cognitive-motor enhancement tool in elite sports. However, its protocol-specific effectiveness across disciplines and outcome domains remains unclear. This systematic review and meta-analysis examined the effects of real-time EEG NFB in elite athletes, focusing on protocol characteristics, targeted outcomes, and effect sizes. Material and methods: A search of six databases (2000-2025) identified 24 studies involving national- or international-level athletes. Protocols were categorized by frequency band (e.g., SMR, beta, theta), sport discipline, and performance domain (cognitive, motor, psychological). Risk of bias was assessed using RoB 2 and ROBINS-I; GRADE was applied to evaluate evidence certainty. Eleven studies provided quantitative data for meta-analysis using standardized mean differences (SMD). Results: Most studies involved individual sports, with judo, archery, and shooting most common. SMR and beta protocols dominated in precision sports; theta protocols were prevalent in combat sports. Meta-analysis showed a large pooled effect (SMD = 1.26; 95% CI: 1.05-1.45), with high heterogeneity (I2 = 94.1%). GRADE indicated moderate certainty for cognitive and psychological outcomes. Conclusion: EEG NFB appears effective in enhancing attention, motor control, and anxiety regulation in elite athletes. However, methodological variability highlights the need for standardized protocols and further replication.
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