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Background: Advanced footwear technology improves average running economy compared with racing flats in sub-elite athletes. However, not all athletes benefit as performance changes vary from a 10% drawback to a 14% improvement. The main beneficiaries from such technologies, world-class athletes, have only been analyzed using race times. Objective: The aim of this study was to measure running economy on a laboratory treadmill in advanced footwear technology compared to a traditional racing flat in world-class Kenyan (mean half-marathon time: 59:30 min:s) versus European amateur runners. Methods: Seven world-class Kenyan and seven amateur European male runners completed a maximal oxygen uptake assessment and submaximal steady-state running economy trials in three different models of advanced footwear technology and a racing flat. To confirm our results and better understand the overall effect of new technology in running shoes, we conducted a systematic search and meta-analysis. Results: Laboratory results revealed large variability in both world-class Kenyan road runners, which ranged from a 11.3% drawback to a 11.4% benefit, and amateur Europeans, which ranged from a 9.7% benefit to a 1.1% drawback in running economy of advanced footwear technology compared to a flat. The post-hoc meta-analysis revealed an overall significant medium benefit of advanced footwear technology on running economy compared with traditional flats. Conclusions: Variability of advanced footwear technology performance appears in both world-class and amateur runners, suggesting further testing should examine such variability to ensure validity of results and explain the cause as a more personalized approach to shoe selection might be necessary for optimal benefit. [ABSTRACT FROM AUTHOR]