OBJECTIVE: To evaluate the effectiveness of running gait retraining on kinematics, kinetics, performance, pain, and injury in distance runners. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Seven electronic databases from inception to March 2021. TRIAL SELECTION CRITERIA: Randomized controlled trials that (1) evaluated running gait retraining compared to no intervention, usual training, placebo, or standard care and (2) reported biomechanical, physiological, performance, or clinical outcomes. DATA SYNTHESIS: Random-effects metaanalyses were completed, and the certainty of evidence was judged using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We categorized interventions into step rate, non-rearfoot footstrike, impact, ground contact time, and multiparameter subgroups. RESULTS: We included 19 trials (673 participants). Moderate-certainty evidence indicated step rate gait retraining increased step rate (SMD 1.03, 95% confidence interval (CI) 0.63 to 1.44; number of trials (N) = 4; I2 = 0%) and reduced average vertical loading rate (SMD -0.57, 95% CI -1.05 to -0.09, N = 3; I2 = 0%). Low-certainty evidence indicated non-rearfoot footstrike retraining increased knee flexion at initial contact (SMD 0.74, 95% CI 0.11 to 1.37; N = 2; I2 = 0%), but did not alter running economy (SMD 0.21, 95% CI -1.11 to 1.52; N = 3; I2 = 19%). Low-certainty evidence indicated multiparameter retraining did not alter running economy (SMD 0.32, 95% CI -0.39 to 1.02; N = 3; I2 = 19%) or performance (SMD 0.14, 95% CI -4.87 to 4.58; N = 2; I2 = 18%). Insufficient trials reported on pain outcomes. Two trials demonstrated reduced 1-year injury incidence following gait retraining. CONCLUSIONS: Gait retraining interventions altered step rate and knee kinematics, lowered vertical loading rates, and did not affect running performance.

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