Background: Warm-up strategies are widely used to enhance performance in aquatic sports, particularly in intermittent activities such as water polo, where rapid physiological readiness is required before exercise. Although combined warm-up approaches are frequently recommended, it remains unclear whether the greater physiological activation induced by these strategies translates into superior subsequent performance. Aim: To compare the physiological responses induced by in-water (IN) and combined warm-up strategies, and to determine whether these responses influence subsequent intermittent swimming performance in elite male water polo players. Methods: Ten international-level male water polo players completed two randomized warm-up conditions separated by 48 h. Both protocols lasted approximately 20 min and included mobility, activation, and water polo-specific exercises, while combined additionally incorporated dryland strength activation exercises. Heart rate (HR) and blood lactate concentration ([La*]) were assessed 5 min post-warm-up and 5 min following a Water Polo Intermittent Shuttle Test (WIST). Performance outcomes were determined by total distance covered and mean swimming velocity. Comparisons were conducted using paired t-tests with Cohen`s d, with significance set at p * 0.05. Results: No significant differences were observed between warm-up conditions in total distance covered (p=0.381, ES=0.29) and mean swimming velocity (1.42 ± 0.05 vs 1.43 ± 0.05 m·s*¹; p=0.302, ES=0.35). However, combined elicited higher physiological activation 5 min post-warm-up than IN, reflected by greater HR (p=0.034, ES=0.78) and [La*] (p=0.031, ES=0.82). Conversely, no significant differences were found 5 min post-WIST for HR (p=0.270, ES=0.37) or [La*] (p=0.969, ES=0.01). Conclusions: Combined induces greater physiological activation before exercise, as demonstrated by higher HR and [La*]. However, these responses do not seem to lead in improved performance or post-exercise physiological outcomes. The similar physiological responses observed following performance test may suggest that both warm-up strategies can adequately prepare athletes for subsequent high-intensity intermittent exercise. Thus, coaches can choose between different strategies according to logistical constraints and competition demands. While combined may be advantageous for maximizing pre-exercise physiological readiness, future studies should investigate whether these responses vary based on competitive level, sex, or specific match demands.
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