sports

Review
Physical Activity and Sports—Real Health Benefits: A
Review with Insight into the Public Health of Sweden
Christer Malm 1 , Johan Jakobsson 1, * and Andreas Isaksson 2
1 Sports Medicine Unit, Department of Community Medicine and Rehabilitation, Umeå University,
901 87 Umeå, Sweden; christer.malm@umu.se
2 Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77 Solna, Sweden;
andreas.isaksson@ki.se
* Correspondence: johan.jakobsson@umu.se




Received: 8 April 2019; Accepted: 21 May 2019; Published: 23 May 2019


Abstract: Positive effects from sports are achieved primarily through physical activity, but secondary
effects bring health benefits such as psychosocial and personal development and less alcohol
consumption. Negative effects, such as the risk of failure, injuries, eating disorders, and burnout, are
also apparent. Because physical activity is increasingly conducted in an organized manner, sport’s
role in society has become increasingly important over the years, not only for the individual but
also for public health. In this paper, we intend to describe sport’s physiological and psychosocial
health benefits, stemming both from physical activity and from sport participation per se. This
narrative review summarizes research and presents health-related data from Swedish authorities.
It is discussed that our daily lives are becoming less physically active, while organized exercise and
training increases. Average energy intake is increasing, creating an energy surplus, and thus, we are
seeing an increasing number of people who are overweight, which is a strong contributor to health
problems. Physical activity and exercise have significant positive effects in preventing or alleviating
mental illness, including depressive symptoms and anxiety- or stress-related disease. In conclusion,
sports can be evolving, if personal capacities, social situation, and biological and psychological
maturation are taken into account. Evidence suggests a dose–response relationship such that being
active, even to a modest level, is superior to being inactive or sedentary. Recommendations for
healthy sports are summarized.

Keywords: youth; adolescent; elderly; quality of life; relative age effect; exercise; strength
and conditioning

1. Introduction
Sport is a double-edged sword regarding effects on health. Positive effects are achieved primarily
through physical activity, which is the main part of most sports. Many secondary effects of sport
also bring health benefits, such as psychosocial development of both young [1] and old [2], personal
development [3], later onset, and less consumption of alcohol [4,5]. Finally, those who play sports
have a higher level of physical activity later in life [6], and through sport, knowledge of nutrition,
exercise, and health can be developed [7]. Negative effects include the risk of failure leading to poor
mental health [8,9], risk of injury [10,11], eating disorders [12], burnout [13], and exercise-induced
gastrointestinal tract discomfort [14]. In sport, there are unfortunately also reports of physical and
psychological abuse [15]. Negative aspects are more common in elite-level sports, where there is a fine
balance between maximum performance and negative health. A somewhat unexpected effect of sport
participation is that people submitting to planned training in some cases perform less physical activity
compared to those who are exercising without a set schedule. One explanation can be a reduced

Sports 2019, 7, 127; doi:10.3390/sports7050127 www.mdpi.com/journal/sports

Sports 2019, 7, 127 2 of 28

spontaneous physical activity in the latter group [16]. Because physical activity is increasingly executed
in an organized manner [17–19], sport’s role in society has become increasingly important over the
years, not only for the individual but also for public health.
In this paper, we describe the health effects of sport from a physiological and psychological
perspective, related both to physical activity and added values of sport per se. Initially, brief definitions
of various concepts related to physical activity and health are given. This is then followed by: (1) A
brief description of how physical activity and training affect our body from a physiological perspective;
(2) a report on the health effects of physical activity and training; and (3) sport’s specific influences on
the various dimensions of health. We chose to discuss the subject from an age-related perspective,
separating children/adolescents, adults, and the elderly, as well as separating for sex in each age group.

2. Definitions of Physical Activity, Exercise, Training, Sport, and Health

Definitions and terms are based on “Physical activity in the prevention and treatment of disease”
(FYSS, www.fyss.se [Swedish] [20]), World Health Organization (WHO) [21] and the US Department
of Human Services [22]. The definition of physical activity in FYSS is: “Physical activity is defined
purely physiologically, as all body movement that increases energy use beyond resting levels”. Health
is defined according to the World Health Organization (WHO) as: “[ . . . ] a state of complete physical,
mental and social wellbeing and not merely the absence of disease or infirmity” [21].
Physical activity can occur spontaneously (leisure/work/transport) or organized and be divided
according to purpose: Physical exercise is aimed primarily at improving health and physical capacity.
Physical training is aimed primarily at increasing the individual’s maximum physical capacity
and performance [23]. Physical inactivity is described as the absence of body movement, when
energy consumption approximates resting levels. People who do not meet recommendations for
physical activity are considered physically inactive and are sometimes called “sedentary”. Sport
can be organized by age, sex, level of ambition, weight or other groupings [24]. Sport can also be
spontaneous [7,17] and defined as a subset of exercises undertaken individually or as a part of a
team, where participants have a defined goal [7]. General recommendations for physical activity are
found in Table 1, not considering everyday activities. One can meet the daily recommendations for
physical activity by brief, high-intensity exercise, and remaining physically inactive for the rest of the
day, thereby creating a “polarization” of physical activity: Having a high dose of conscious physical
training, despite having a low energy expenditure in normal life due to high volumes of sedentary
time. Polarization of physical activity may lead to increased risk of poor health despite meeting the
recommendations for physical activity [25–27]. During most of our lives, energy expenditure is greater
in normal daily life than in sport, physical training, and exercise, with the exceptions of children and
the elderly, where planned physical activity is more important [28].

3. Aerobic and Muscle-Strengthening Physical Activity

Physical activity is categorized according to FYSS as: (1) Aerobic physical activity and
(2) muscle-strengthening physical activity. Physical activity in everyday life and exercise training
is mainly an aerobic activity, where a majority of energy production occurs via oxygen-dependent
pathways. Aerobic physical activity is the type of activity typically associated with stamina, fitness, and
the biggest health benefits [29–31]. Muscle-strengthening physical activity is referred to in everyday
language as “strength training” or “resistance training” and is a form of physical exercise/training
that is primarily intended to maintain or improve various forms of muscle strength and increase
or maintain muscle mass [32]. Sometimes, another category is defined: Muscle-enhancing physical
activity, important for maintenance or improvement of coordination and balance, especially in the
elderly [33]. According to these definitions, muscle-strengthening activities primarily involve the
body’s anaerobic (without oxygen) energy systems, proportionally more as intensity increases.
Sports 2019, 7, 127 3 of 28

Table 1. Recommendations regarding physical activity for different target groups. Note that additional
health effects can be achieved if, in addition to these recommendations, the amount of physical activity
increases, either by increasing the intensity or duration or a combination of both.

Target Group Recommendations Purpose

All children and adolescents are recommended at
least 60 minutes daily physical activity. Longer is
better.
The physical activity should be primarily of Development of muscles and skeletal
aerobic nature and the intensity moderate and nervous system.
(easy/medium pulse increase) to high (marked Maintain a healthy weight and a good
pulse increase). mental health.
Children and
Aerobic physical activity at high intensity at least Social development, integration, good
youth
3 times a week. self-esteem, and self-confidence.
Age 6–17 years
Muscle-strengthening physical activity 3 times a Enhanced learning ability.
week. Recommendations are universal, but
Weight-bearing activity, such as running and for individuals with illness, there may
jumping, is positive for bone mineral density. be special recommendations.
The physical activity level will gradually be
adapted to the individual’s biological and
psychosocial maturation.
All adults from 18 years of age and above are
Improvements in aerobic work
recommended to be aerobically physically active
capacity and muscle strength.
at least 150 minutes a week at a moderate
Recommendations are universal, but
intensity (medium pulse increase), or at least 75
for individuals with illness, there may
Adults minutes per week at vigorous intensity (marked
be special recommendations.
Age 18–64 pulse increase).
Profits from carrying out the activity
The activities should be distributed over at least
are lower risk of disease, such as
three separate days.
disturbed metabolism and certain
Muscle-strengthening physical activity at least
cancers and bone fractures.
twice a week should be performed.
Improvements in aerobic work
capacity, muscle strength, and balance.
Same recommendations as adults.
Recommendations are universal, but
Muscle strengthening exercises should be
for individuals with illness, there may
performed at a high velocity, if possible.
Elderly be special recommendations.
Balance training should be incorporated prior to
Age >64 Medical advice may be required
aerobic and muscle strengthening training.
before exercise commences. Benefits
Individuals with impaired ability should perform
of carrying out the activity are the
as much exercise as possible.
same as for adults, and better
functional health and independence.
Compiled from FYSS 2017 (www.fyss.se) and WHO 2017 (www.who.int).

Exercise intensity can be expressed in absolute or relative terms. Absolute intensity means the
physical work (for example; Watts [W], kg, or metabolic equivalent [MET]), while relative intensity is
measured against the person’s maximum capacity or physiology (for example; percentage of maximum
heart rate (%HR), rate of perceived exhaustion (RPE), W·kg−1 or relative oxygen uptake in L·min−1 ·kg−1
(VO2 )). In terms of recommendations to the public, as in Table 1, the intensity is often described
in subjective terms (“makes you breathe harder” for moderate intensity, and “makes you puff and
pant” for vigorous intensity) [27]. While objective criteria such as heart rate and accelerometry will
capture the intensity of activity, they may not distinguish between different types of physical activity
behaviors [34]. FYSS defines low intensity as 20%–39% of VO2 max, <40 %HR, 1.5–2.9 METs; moderate
intensity as 40%–59% of VO2 max, 60–74 %HR, 3.0–5.9 METs, and vigorous intensity as 60%–89% of
VO2 max, 75–94 %HR, 6.0–8.9 METs. Absolute intensity, however, can vary greatly between individuals
where a patient with heart disease may have a maximal capacity of <3 MET, and an elite athlete
>20 MET [35].
Sports 2019, 7, 127 4 of 28

4. How does the Body Adapt to Physical Activity and Training?

Adaption to physical activity and training is a complex physiological process, but may, in the
context of this paper, be simplified by a fundamental basic principle:” The general adaptation syndrome
(GAS)” [36–38]. This principle assumes that physical activity disturbs the body’s physiological balance,
which the body then seeks to restore, all in a dose-related response relationship. The overload principle
states that if exercise intensity is too low, overload is not reached to induce desired physiological
adaptations, whereas an intensity too high will result in fatigue and possibly overtraining. Thus,
for adaptation to occur, greater than normal stress must be induced, interspersed with sufficient
recovery periods for restoration of physiological balance [39]. During and immediately after physical
exercise/training, functions of affected tissues and systems are impaired, manifested as temporarily
decreased performance. You feel tired. In order to gradually improve performance capacity, repeated
cycles of adequate overload and recovery are required [40]. In practice, positive effects can be seen
after a relatively short period of a few weeks, but more substantial improvements if the training is
maintained for a longer period.
As a rule of thumb, it is assumed that all people can adapt to physical activity and exercise, but
the degree of adaptation depends on many factors, including age, heredity, the environment, and
diet [41–44]. The hereditary factor (genetics) may be the most critical for adaptation [45]. The degree
of adaptation also depends on how the person in question trained previously; a well-trained athlete
usually does not have the same relative improvement as an untrained one. Even if training is thought
to be specific to mode, intensity, and duration, there are some overlaps. For example, it has been found
that strength training in some individuals contributes to a relatively large positive impact on health and
endurance, effects previously associated primarily with aerobic exercise [46,47]. The overload principle
may, if applied too vigorously in relation to a person’s individual adaptation ability, have detrimental
effects, including reduced performance, injury, overtraining, and disease [10]. Training is a commodity
that must be renewed; otherwise, you gradually lose achieved performance improvements [48],
although some capacities, such as muscle memory, seem to persist for life [49].
General recommendations for health may be stated, but individual predispositions make general
training schedules for specific performance effects unpredictable. All exercise training should be
adjusted to individual purposes, goals, and circumstances.

5. Health Effects of Physical Activity and Training

Human biology requires a certain amount of physical activity to maintain good health and
wellbeing. Biological adaption to life with less physical activity would take many generations. People
living today have, more or less, the same requirements for physical activity as 40,000 years ago [50,51].
For an average man with a body weight of 70 kg, this corresponds to about 19 km daily walking in
addition to everyday physical activity [52]. For most people, daily physical activity decreases, while
planned, conscious exercise and training increases [19,53]. Unfortunately, average daily energy intake
is increasing more than daily energy output, creating an energy surplus. This is one reason for the
increasing number of overweight people, and a strong contributor to many health problems [54]. More
sedentary living (not reaching recommended level of physical activity), combined with increased
energy intake, impairs both physical and mental capabilities and increases the risk of disease. Despite
this, Swedes (as an example) seemed to be as physically active and stressed but had better general health
in 2015, compared to 2004 (Figure 1). Compared to 2004–2007, the Swedish population in 2012–2015
reported better overall health (more county-dots are blue) and less fatigue (smaller county-dots) with
similar level of physical activity (~65% indicated at least 30 min daily physical activity) and stress
(~13% were stressed).
 problems [54]. More sedentary living (not reaching recommended level of physical activity),
combined with increased energy intake, impairs both physical and mental capabilities and increases
the risk of disease. Despite this, Swedes (as an example) seemed to be as physically active and stressed
but had better general health in 2015, compared to 2004 (Figure 1). Compared to 2004–2007, the
Swedish population in 2012–2015 reported better overall health (more county-dots are blue) and less
Sports 2019, 7, 127
fatigue (smaller county-dots) with similar level of physical activity (~65% indicated at least 30 min 5 of 28
daily physical activity) and stress (~13% were stressed).

Figure 1. Selected
Figure 1.physical and mental
Selected physical health
and mental healthindicators
indicators of of a Sweden
a Sweden cohort,cohort, intorelation
in relation the degreeto the degree
of physical
of physical activity foractivity for the period
the period of years
of years 2004–2007 (N
2004–2007 = 29,254)
(N= 29,254) and years
and2012–2015 (N = 38,553). (N = 38,553).
years 2012–2015
Surveyed subjects are age 16 to 84 years old, with data representing median scores of four years, not
Surveyed subjects
normalizedareforage
age.16 to 84
Y-axis: years ofold,
Percentage with
subjects data “stressed”;
reporting representingX-axis: median
Percentage scores
of subjectsof four years,
not normalized for age. Y-axis: Percentage of subjects reporting “stressed”;
indicating physical active at least 30 minutes each day. Each dot represents one County (Län), dot- X-axis: Percentage of
size indicates self-reported fatigue, and color self-reported healthiness of the
subjects indicating physical active at least 30 minutes each day. Each dot represents one County (Län), County. If 70% of the
population states they are having “Good/Very good” health, the dot is blue. If less than 70% states
dot-size indicates self-reported fatigue, and color self-reported healthiness of the County. If 70% of the
they are having good/very good health, the dot is red. The circle indicated with a black arrow
population states they are
corresponds having
to nation “Good/Very
median. good”
The black line connectedhealth,
to the the dot
nation is blue.
circle If less
represents than 70% states they
the movement
in the X–Y plane
are having good/very good from the year
health, 2004
the to 2007,
dot and The
is red. from 2012 to 2015,
circle respectively.
indicated withData retrieved
a black from corresponds
arrow
the Public Health Agency of Sweden 2019-04-22 (www.folkhalsomyndigheten.se).
to nation median. The black line connected to the nation circle represents the movement in the X–Y
plane from the yearin2004
Results Figureto12007,
may in andpartfrom 2012 toby2015,
be explained respectively.
a polarization of whoData retrieved
is physically from
active: Somethe Public
individuals
Health Agency are extremely
of Sweden 2019-04-22 active, others very inactive, giving a similar central tendency
(www.folkhalsomyndigheten.se).
(mean/median). As physical activity and mental stress are not changed, but health is, the figure
indicates that other factors must be more important to our overall health and fatigue. Recently, a
Results in Figure 1 may in part be explained by a polarization of who is physically active: Some
national study of Swedish 11- to 15-year-olds concluded that this age group is inactive for most of
individuals are extremely
their time awake,active, othersstanding
that is, sitting, very inactive, giving
or moving very littlea[55].
similar central
Time as inactivetendency (mean/median).
increased with
age, from 67
As physical activity percent
and for 11-year-olds
mental stress aretonot
75 percent for 15-year-olds.
changed, but health The is,
study
thestates that indicates
figure in all age that other
groups, the inactive time is evenly distributed over the week, with school time, leisure time, and
factors must be more important to our overall health and fatigue. Recently, a national study of Swedish
weekend. Further, those who feel school-related stress have more inactive time, both overall and
11- to 15-year-olds concluded
during school that
hours, than thosethis
whoage
have group is inactive
less school-related for most of their time awake, that is,
stress.
sitting, standing or moving very little [55]. Time as inactive increased with age, from 67 percent for
11-year-olds to 75 percent for 15-year-olds. The study states that in all age groups, the inactive time is
evenly distributed over the week, with school time, leisure time, and weekend. Further, those who feel
school-related stress have more inactive time, both overall and during school hours, than those who
have less school-related stress.
People active in sports have, in general, better health than those who do not participate in sports,
because they are physically and mentally prepared for the challenges of sports, abilities that in many
cases can be transferred to other parts of life [56].
However, there is a certain bias in this statement. Sport practitioners are already positively
selected, because sickness and injury may prevent participation. As many health benefits of sport are
related to the level of physical activity, separation of sport and physical exercise may be problematic.
Regardless, societal benefits of these health effects can be seen in lower morbidity, healthier elderly,
and lower medical costs [7,57,58].
Health effects of physical activity in many cases follow a dose–response relationship; dose of
physical activity is in proportion to the effect on health [59,60]. Figure 2 depicts the relationship
between risk of death and level of physical activity, in a Finnish twin cohort, adjusted for smoking,
occupational group, and alcohol consumption [59]. Odds ratio (OR) for the risk of all-cause mortality
in a larger sample in the same study was 0.80 for occasional exercisers (p = 0.002, 95% CI = 0.69–0.91).
This dose–response relationship between risk of all-cause mortality and physical activity is evident
 because they are physically and mentally prepared for the challenges of sports, abilities that in many
cases can be transferred to other parts of life [56].
However, there is a certain bias in this statement. Sport practitioners are already positively
selected, because sickness and injury may prevent participation. As many health benefits of sport are
related to the level of physical activity, separation of sport and physical exercise may be problematic.
Regardless, societal benefits of these health effects can be seen in lower morbidity, healthier elderly,
Sports 2019, 7, 127
and lower medical costs [7,57,58].
6 of 28
Health effects of physical activity in many cases follow a dose–response relationship; dose of
physical activity is in proportion to the effect on health [59,60]. Figure 2 depicts the relationship
in several extensive
between risk studies
of death[60–62]. The
and level of totalactivity,
physical dose is in adetermined by the
Finnish twin cohort, intensity
adjusted (how strenuous),
for smoking,
occupational group, and alcohol consumption [59]. Odds ratio (OR) for the risk of all-cause mortality
duration (duration), and frequency (how often). While Figure 2 shows sex differences in death rates,
in a larger sample in the same study was 0.80 for occasional exercisers (p = 0.002, 95% CI = 0.69–0.91).
it is likely thatThissedentary
dose–responsebehavior is equally
relationship hazardous
between risk of all-causefor men and
mortality andphysical
women, butisinconsistent
activity evident results
sometime occur dueextensive
in several to inadequate assessment
studies [60–62]. measures,
The total dose or low
is determined statistical
by the power
intensity (how [59,63]. To obtain
strenuous),
duration (duration), and frequency (how often). While Figure 2 shows sex differences in death rates,
the best possible development due to physical exercise/training, both for prevention and treatment
it is likely that sedentary behavior is equally hazardous for men and women, but inconsistent results
purposes, a basicsometime understanding of howassessment
occur due to inadequate these variables
measures, affect the dosepower
or low statistical of activity isobtain
[59,63]. To required, as well
as understanding the besthow they
possible can be due
development modified toexercise/training,
to physical suit individual both requirements. A physically active
for prevention and treatment
population ispurposes,
important a basic understanding of how these variables affect the dose of activity is required, as well
for the health of both the individual and society, with sport participation being
as understanding how they can be modified to suit individual requirements. A physically active
one, increasingly important,
population is important motivator for of
for the health exercise.
both the individual and society, with sport participation
being one, increasingly important, motivator for exercise.

Figure 2. Relative
Figure risk (odds
2. Relative ratio;
risk (odds OR)
ratio; of
OR)premature
of prematuredeath
death inin relationship
relationship tooflevel
to level of activity,
physical physical activity, in
in 286 male and 148 female twin pairs, adjusted for smoking, occupational group, and use of alcohol
286 male and 148 female twin pairs, adjusted for smoking, occupational group, and use of alcohol [59].
[59].

There is strong
Therescientific evidence
is strong scientific supporting
evidence supporting an anassociation
association between
between physicalphysical exercise/training
exercise/training
and goodand
and good physical physical and mental
mental health. health.
ForFor example: AAreduction
example: reductionin musculoskeletal disorders and
in musculoskeletal disorders and
reduced disability due to chronic disease [27,64], better mental health with reduced anxiety [65,66],
reduced disability due to chronic disease [27,64], better mental health with reduced anxiety
insomnia [67], depression [31], stress [68], and other psychological disorders [69]. Physical and mental
[65,66],
insomnia [67], depression
health [31],
problems are stress
related [68],
to an and other
increased psychological
risk of developing disorders
a number [69].
of our major Physical
public health and mental
diseases
health problems areand may contribute
related to prematurerisk
to an increased deathof(Table 2).
developing a number of our major public health
diseases and may contribute to premature death (Table 2).
 Sports 2019, 7, 127 7 of 28

Table
Table 2. Health-relatedTable physiological
2. Health-related 2. physiological
Health-relatedeffects of of
effects aerobic
aerobic
physiological and muscle
and
effects strengthening
muscle strengthening
of aerobic physical
and muscle physical activity.
activity.
strengthening Green
Green circle
physical indicates
circle indicates
activity. that thethe
that
Green activity contributes
activity
circle contributes
indicates with
that the withanan
effect,
activity whereas
effect, whereaswith an effect,
contributes
aTable
a red red 2. Health-related
circle indicates
circle indicates that thatphysiological
the activity
the activityhaseffects
no
has no of
proven aerobic
proveneffect.and
effect. muscle
Orange
Orange strengthening
circle indicates
circle indicates physical
that the
that activity.
activity
the activity Green
may
may in circle
some
in some indicates
cases
casesbe that the activity contributes with an effect, whereas
effective.
be
whereas a red circle indicates that the activity has no proven effect. Orange circle indicates that the activity may in some cases be effective.effective.
e 2. Health-related
a red circle Table 2. that
physiological
indicates Health-related
effects
the of
activity physiological
aerobic and
has nomuscle
proven effects
effect.ofOrange
aerobic
strengthening and muscle
physical
circle strengthening
activity.
indicates Green
that thecircle physical
mayactivity.
indicates
activity inthat theGreen
some circle
activity
cases indicateswith
be contributes
effective. that the activity
an effect, contributes with an effect, whereas
whereas
Table
Effects 2. Health-related physiological effects of aerobic and muscle strengthening physical activity. Green circle indicates that the activity contributes with an effect, whereas
circle indicates thaton
Effects on
the the Body
the
aactivity
red Body
circlehasindicates that
no Effects
proven the
theactivity
effect.
on Orangehas
Body no proven
circle indicateseffect. Orange
that the circle
activity mayindicates Health
in some Health
that Effects
theEffects
cases activity
be may
effective.
Health in some cases be effective.
Effects Aerobic
Aerobic Strength
Aerobic Strength
Strength
Tablea red2.circle
Effects indicates
on the Body
Health-related that the activity
physiological has no
effects proven and
of of
aerobic effect. Orange
muscle circle indicates
strengthening that the
physical activity
activity. mayEffects
Green
Health in some
circle cases that
indicates be effective.
thethe
activity contributes with anan
effect, whereas
Aerobic Strength
r proportion
ger proportionTable 2. Health-related
slow-twitch
slow-twitch
Larger fibers
fibers physiological
[70,71]
proportion [70,71] effects
Lower aerobic
Lower risk and
forfor
risk muscle
metabolicstrengthening
metabolic syndrome physical
risk forwith
syndrome with activity.
increased
increased Green
exchangecircle
exchange indicates
of of
gases
gases that
andand activity
nutrition contributes
of gases[71,72]
nutrition [71,72] with effect, whereas
ffects on the
a red Body
circle indicatesEffects
that on
the theslow-twitch
Body
activity hashas
fibers
no proven
[70,71]
effect. Orange
Lower
circle indicates Health
metabolic
that theEffects
activity
syndrome
may
with increased
in in
some Health
cases
exchange
Effects
be be
effective.
and nutrition [71,72]
Aerobic Strength Aerobic Strength
ger proportion
Tablea red2.circle
Effects indicates
slow-twitch
on the Body
Health-related that
fibers the activity
[70,71]
physiological effectsnoof proven
Lower
aerobic effect.
risk
and forOrange
muscle circle
metabolic indicates
syndrome
strengthening that
physical the
with activity
increased
activity. may
Green exchange
circle some cases
of
indicates gases
thateffective.
and
the nutrition
activity [71,72]
contributes with an[76]
effect,
r proportion
ger proportion slow-twitch
slow-twitch [73]
[73] Increased
Increased strength,
strength, coordination
coordination andand
Increased strength, balance
balance Health
in in
coordinationelderly Effects
and[74]
elderly and
[74]
balanceandin in
in sickness
sickness
elderly [75],
[74] lower
[75],
and inlower risk
sickness for
risk for
[75], fall
fall
lower [76] whereas
Aerobic Strength
n slow-twitch aLarger
ger proportion red
proportionEffects proportion
fibers
circle on [70,71]
Larger
indicates
thethe
slow-twitch
slow-twitch
proportion
that
Body [73]
Lower
the activityfibers
risk
slow-twitch
has [70,71]
no for metabolic
[73]
proven Lowercircle
syndrome
effect.strength,
Increased Orange risk for
with metabolic
increased
indicates
coordination that syndrome
exchange
the
andwith activity
balance in
Health
with
of
may inincreased
gases
elderly some
Effects
andcases
[74] and exchange
nutrition
be of gases
[71,72]
effective.
inthat
sickness and nutrition
[75],contributes
lower riskwith [71,72]
for fall [76] whereas
ger
ation
mation Table
of of
new new slow-twitch
Effects
capillarieson
2. capillaries
Health-related
[71] fibers
Body
[71] [70,71] effects of
physiological Lower and
aerobic
Increased
Increased risk for metabolic
muscle
aerobic
aerobic risk for
strengthening
capacity
capacity [71] fallphysical
syndrome
[71] [76] increased
activity. Green
Health exchange of gases
circle indicates
Effects andactivity
the nutrition [71,72] an effect, Aerobic
Aerobic Strength
Strength
nmation Larger
slow-twitch proportion
[73] slow-twitch Increased
[73] Increased strength, coordination and balance in
strength, coordination and balance in elderly [74] and in sickness [75], lower risk for fall [76]elderly [74] and in sickness [75], lower risk for fall [76]
r aof
proportion
ger proportion
proportionnew
red capillaries
circle indicates
slow-twitch
Effects on the
slow-twitch [71]
that
fibers
Body
Formation [73] the
of activity
[70,71]
new has
capillariesno Increased
proven
Lower
[71] effect.
Increased
risk aerobic
Orange
strength,
for capacity
circle
metabolic [71]
indicates
coordination
syndrome
Increased that
and the
with
aerobic activity
balance
increased
capacity inmay
[71]
Health in
elderly some
exchange
Effects [74]cases
ofand be
gasesin effective.
sickness
and [75],
nutrition lower
[71,72] risk for fall [76]
ger
oved
proved endothelial
endothelial slow-twitch
function
Table 2. Health-relatedTable[71]
function 2.fibers
[71] [70,71] effects
physiological
Health-related Lower
Lower
physiological
of risk
aerobic for
risk
effects
and musclemetabolic
ofcardiovascular
for cardiovascular
aerobic syndrome
strengthening
and muscle disease
disease
physical with
[77],
[77],
strengthening increased
improved
improved
activity. physical
Green exchange
function
function
circle
activity. inofin
indicates
Green gases
heart
heart
that
circleand
disease nutrition
disease
the [78]
indicates
activity[78]
that [71,72]
contributes
the activity an effect, Aerobic
withcontributes whereas Strength
with an effect, whereas
w capillaries Formation
[71] of new capillariesIncreased [71] aerobic capacityIncreased[71] aerobic capacity [71]
proved
mation
rreased endothelial
aofred
proportion
proportion new function
capillaries
slow-twitch
circle indicates
slow-twitch
Effects on avolume
thered [71]
[73] [71]
circle
that
fibers
Body
Improved the
indicates
activitythat
[70,71]
endothelial has the
function
Lower
Increased
Increased
no Increased
proven
activity
Increased
Lower
[71] riskrisk
effect. for
strength,
aerobic
hasaerobic
no Orangecardiovascular
proven
strength,
for coordination
capacity
circle
effect.
metabolic [71]
indicates
Orange
coordination
syndrome
Lower
disease
and
circle
that
and the
with
riskphysical
for
[77],
balance
indicates improved
activity
balance
increased
cardiovascular in elderly
that
inmay the function
[74]
in activity
elderly some
exchange
disease and
[74]casesin
may
and beheart
sicknessdisease
ineffective.
in
ofimproved
[77], gases some
sickness
and [75],
cases [78]
lower
beheart
[75],
nutrition
function in risk
effective.
lower
[71,72] for
riskwith
disease forfall
[78] [76]
fall [76] Aerobic
ger
ased proportion
mitochondrial
mitochondrial
Table slow-twitch
2.[71] volume
Health-related
Table [73]
2.[46][46]
physiological
Health-related effects Increased
physiological
of aerobiceffects
and aerobic
muscle
of capacity
capacity
aerobic [79]
strengthening
and [79]
muscle strengthening Health
activity. physical
GreenEffects
circle
activity.
indicates Strength
eelial
2. Health-related
Improved
function physiological
endothelial effects of
function aerobic
Lower[71] and
risk formuscle strengthening
cardiovascular Lower physical
risk
disease for activity.
cardiovascular
[77], improved Green circle indicates
disease
function in[77],
heartthat theGreen
improved
disease that
circle
activity the
indicates
activity
contributes
function
[78] that
contributes
with
in heart the activity
an effect,
disease contributes
an effect,
whereas
[78] whereas
with an effect, whereas
r eased
ation
proved
mation ofmitochondrial
new
of
proportion
a new
red capillaries
endothelial capillaries
slow-twitch
circle volume
function
indicates
a [71]
red [71]
[73]
circle
that [46]
[71]the
indicates
activitythat
has the
no Increased
Increased
Lower
Increased
Increased
proven
activity effect.
has noaerobic
aerobic
risk for
strength,
aerobic
Orange
proven capacity
capacity
cardiovascular
coordination
capacity
circle
effect. [79]
[71]
[71]
indicates
Orange disease
and
circle
that the[77],
balance
indicates improved
activityin elderly
that
may the
in function
[74]
activity
some and
casesin
may beheart
sickness
in disease
effective.
some [75],
cases be[78]
lower risk
effective. for fall [76]
oved
dr circle
proved glucose
proportion
glucose
Table transport
slow-twitch
Effects
indicates transport
2. that on
the the[80]fibers
[80]
Effects
Body
activity
Increased
Health-related
Table has [70,71]
onnothe Body
proven
mitochondrial
2. physiological
Health-related effect.
volume
effects Lower
physiological
of [46] risk
Lower
Orange
aerobic or
for
risk
circle
effects
and metabolic
ormetabolic
metabolic
indicates
muscle
of aerobic syndrome/Type-2
thatsyndrome
syndrome/Type-2
the
Increased
strengthening
and muscleactivity with
aerobicmay
physical indiabetes
increased
capacity
strengthening diabetes
some
activity. [81]
exchange
cases
[79]
Health
physical
Green [81] of
be effective.
Effects
circle Health
activity. gases
indicates
Green and
Effects
that
circle
the nutrition
indicates
activitythat[71,72]
contributes
the activity an effect, Aerobic
withcontributes whereas Strength
with an effect, Aerobic
whereas Strength
ondrial volume Increased [46] mitochondrial volume Increased [46] aerobic capacityIncreased [79] aerobic capacity [79]
proved
oved
ationeased glucose
endothelial
ofmitochondrial transport
function volume[80]
[71] [46] Lower
Lower
Increasedriskriskforor metabolic
cardiovascular
aerobic capacity syndrome/Type-2
disease
[79] [77], diabetes
improved [81]
function in inheart disease [78]
proved
oved
rffects
proved anew
endothelial
insulin
proportion red
insulin capillaries
circle
sensitivity
slow-twitch
Effects function
indicates
sensitivity
on a
the
[71]
red
[82][73]
[82]
Effects
Body [71]
circle
that the
indicates
on activity
the that
Bodyhas the
no Increased
Lower
Increased
proven
activity
Improved
Improved aerobic
risk
effect.
has no for
strength,
Orange
proven
health
health incapacity
cardiovascular
coordination
circle
effect.
people
in people [71]
indicates
Orange
with
with disease
and
circle
that
Type-2
Type-2the[77],
balance
indicates improved
activity
diabetes in that
diabetes elderly
may
[82],the
[82],in function
[74]
activity
some
prevention and
cases
prevention may be
of heart
sickness
in disease
effective.
some
Typ-2
of Typ-2 of[75],
cases
diabetes be
diabetes[78]
lower risk for fall[71,72]
effective.
[83]
[83] [76]
e transport onLarger
the
Improved
[80]Bodyproportion Improved
glucose
Table fibers
slow-twitch
transport [70,71]
glucose
2. Health-related [80]
Lower fibers
transport risk [70,71]
Lower
[80]
or
physiologicalmetabolicrisk for
effects Lower
metabolic
Lower
of aerobic risk
risk
syndrome/Type-2 andfor
syndrome
Lower
or metabolic
risk
metabolic
muscle or
diabetes
Healthwith syndrome
increased
metabolic
syndrome/Type-2
[81]
strengthening
Effects with
physical exchange
syndrome/Type-2
Health increased
Effects Health
diabetes
activity. of gases
Green exchange
diabetes
Effects
[81] and
[81]
circle nutrition
indicates gases and
[71,72]
that thenutrition
activity Aerobic
contributesStrength
Aerobic Strength
with an effect, Aerobic
whereas Strength
proved
ased
proved
oved
ationeased insulin
mitochondrial
glucose
endothelial
mitochondrial
ofheart
new sensitivity
transportvolume
function
capillaries volume [82]
[80]
[71]
[71] [46] [46] Improved
Increased
Lower
Lower
Increasedrisk health
aerobic
riskforor in people
capacity
metabolic
cardiovascular
aerobic
aerobic capacity
capacity [79]with
syndrome/Type-2
disease
[79]
[71] Type-2[77], diabetes
diabetes
improved [82], [81] prevention
function in heartof Typ-2
disease diabetes
[78] [83]
ased eased heart capacity
capacity
Effects on[71][71]
a red
the circle
[73]
Effects
Body indicates
on the that the
[73]
Body Lower
Lower
Increased risk
activity risk risk
has no forfor
strength,cardiovascular
provencardiovascular
Increased coordination
strength,
effect. Orangedisease
disease
and
circle [77],
[77],
coordination
balance fewer
indicates fewer
inand depressions
that depressions
elderly
balance
the [74]
activityin
and[84,85],
[84,85],
elderly
may in also
sickness
in [74]
somealsoin
and inchildren
[75],
cases children
in lower
sickness
be of [86]
[86]
risk
effective. [75],
for lower
fall [76]
risk for fall [76]
nreased
oved
proportion
sensitivity
slow-twitch Larger
Improved
Table
heart
glucose
slow-twitch
[82] proportion
2.fibers
capacity
transport
Improved
insulin
[70,71]
Health-related
Table
[71]
[80]
fibers
slow-twitch
sensitivity[70,71]
insulin
2. physiological [82]
Lower
Health-related fibers
sensitivity
Improved risk
effects [70,71]
Lower
[82]
health
for
physiological
of ineffects
metabolic
aerobic
Lower
Lower riskandfor
people
risk
or
Lower
metabolic
Improved
with
syndrome
muscle
of
for aerobic risk
Type-2 for
syndrome
Improved
health
with
strengthening
and
cardiovascular
metabolic
metabolic
increased
muscle
syndrome/Type-2
with
health
inphysical
diabetes people
disease
syndrome
in
[82],
strengtheningincreased
people
with Health
prevention
exchange
activity.
[77], fewer
diabetes
with
with
Type-2of
physical
Greenexchange
of
gasesincreased
Type-2
Effects
diabetes
Typ-2
circle and
activity.
depressions
[81]
of
diabetes
Health gases
[82],exchange
diabetes
nutrition
indicates
Green
[84,85],
and
[82],
Effects
that
circle[83]nutrition
of
prevention
prevention
[71,72]
the
indicates
also
gases
activity
in
of and
[71,72]
Typ-2
that Typ-2nutrition
contributes
children the[86]diabetes
diabetes
activity [71,72]
[83]
[83] effect, Aerobic
withcontributes
an whereas Strength
with an effect, Aerobic
whereas Strength
proved
ased
proved
oved
ased
ationeased insulin
mitochondrial
glucose
endothelial
skeletal
ofskeletal
new
Formation sensitivity
transport
volume
volume
capillaries volume
function
ofandnewand [82]
[80]
[71][46]
mineral
[71] mineral
capillaries content
content
[71] [87]
[87] Improved
Increased
Lower
Lower
Improved
Improved risk health
aerobic
riskforor
skeletal
skeletal
aerobic in people
capacity
metabolic
cardiovascular
health
health
capacity [79]
[88,
aerobic with
syndrome/Type-2
disease
89]
[88,
[71] 89] Type-2
capacity [77], diabetes
[71] diabetes
improved [82], [81] prevention
function in heartof Typ-2
disease diabetes
[78] [83]
r
apacity
n proportiona red
Larger
Increased
[71]
slow-twitch circle
slow-twitchindicates
proportion
hearta red circle
that
[73] the
indicates
slow-twitch
fibers
Effects
capacity activity
[70,71]
on[71]the
Lower that
has
[73]
Increased
fibers
Body the
riskno Increased
proven
activity
strength,
[70,71]
Lower
for strength,
effect.
has no Increased
Orange
proven
coordination
risk
cardiovascularfor Lower coordination
circle
metabolic and
risk
disease strength,
effect. indicates
for Orange
balance
syndrome
metabolicand
coordination
circle
that
inwith
cardiovascular
[77], fewer balance
the
indicates
elderly activity
syndrome
depressions in
[74]
increased and
disease elderly
that
may
and balance
withthein [74]
activity
some
incircle
exchange
[77],
[84,85], in
sickness
increased
fewer
alsoand elderly
cases
ofmay in be
[75],
gases sickness
in
exchange
depressions
in children[74]
lower
and and
effective.
some [75],
cases
risk
nutrition
of inbe lower
sickness
for
gases
[84,85],
[86] fall
and risk
effective.
[76]
[71,72]
also [75],
for
nutrition
in lower
fall
inchildren [76]
risk
[71,72]
[86] for fall [76]
oved eased
eased Table
skeletal
insulin
heart 2.[73]
volume
sensitivity
capacity
Increased
Health-related
Table
[71]and
[82] 2. heart
mineral
capacity
physiological
Health-related
content
[71]
effects
physiological
[87]of aerobic
Improved
Improved
Lower effects
and
risk muscle
of aerobic
skeletal
health
for in
Lower
strengthening
and
health
people
cardiovascular
risk
muscle
[88,
with 89]
for
physical
Type-2
disease
cardiovascular
strengthening
activity.
diabetes
[77], fewer
disease
physical
Green
[82],
[77],
Health
activity.
prevention
depressions
fewer
indicates
Green of
depressions
Effects
[84,85],that
circle
Typ-2 the
indicates
also diabetes
in
[84,85],
activity that also
contributes
children[83]the children
activity
[86]
[86]
withcontributes
an with an effect, Aerobic
effect, whereas whereas Strength
oved
proved
ased
oved
proved glucose
insulin
mitochondrial
body
body
endothelial
Improved transport
sensitivity
composition
composition volume
function [80]
endothelial [82]
[30]
[30]
[71][46]function [71] Lower
Improved
Increased
Lower
Lower risk
risk or
aerobic
riskfor metabolic
health
for in
capacity
metabolic
Lower metabolic
cardiovascular
risk syndrome/Type-2
people [79]
syndrome
for with
syndrome Type-2
cardiovascular
disease [81][81]
[77], diabetes
diabetes
improved
disease [81]
[82],
[77], prevention
function
improved in heartof Typ-2
function
disease indiabetes
[78]
heart [83]
disease [78]
ation
wr volume of
capillaries
proportion new
Formation
aLarger
red
Increased
and capillaries
[71]
circle
slow-twitch
mineral of new
indicates
a
skeletal [71]
red capillaries
circle
that
[73]
content volume the
indicates
[87] [71]
Increased
activity
and that
has
[73]
mineral
Improved the
no Increased
aerobic
proven
activity
content
skeletal aerobic
capacity
effect.
has
[87]
health no Increased
strength,[71]
Orange
proven
Improved
[88, capacity
89]circleaerobic
coordination
effect. [71]
strength,
indicates
Orange
skeletal capacity
and
coordination
circle
that
health the [71]
balance
indicates
[88, activity
89] inandelderly
that
may balance
thein [74]
activity
some in
and elderly
cases
may in besickness
in [74] and
effective.
some [75],
cases inbe lower
sickness risk
effective. [75],
for lower
fall [76]
risk for fall [76]
proved
ased body
heart Effects proportion
composition
capacity on[71]theEffectsslow-twitch
Body
Increased[30] on thevolume
skeletal fibers [70,71]
Body andLower mineral
Lower content
riskriskforLower
for [87] risk
metabolic
cardiovascular for
Improved metabolic
syndrome skeletal syndrome
[81]health with
[88,89]
Health increased
Effects Health exchange
Effects of gases and nutrition [71,72] Aerobic Strength Aerobic Strength
oved eased
eased skeletal
insulin
Table
heart volume
sensitivity
2. Health-related
capacity [71]and
[82]
Table mineral
2. physiologicalcontent
Health-related [87]of
effects
physiologicalImproved
Improved
aerobic
Lower effects
and
risk skeletal
health
muscle
of
for in
aerobic health
people
strengthening
and
cardiovascular [88,disease
with
muscle 89]
Type-2
physical [77],
strengthening
disease fewer
diabetes
activity.
[77], depressions
[82],
physical
fewer Green prevention
circle
activity.
depressions [84,85],
indicates
Green of also
Typ-2
that
circlethe in children
diabetes
indicates
activity [83]
that [86]
contributes
the[86]
activity
withcontributes
an effect, whereas
with an effect, whereas
oved
proved
ased
ationelial
omposition
glucose
blood
ofblood
mitochondrial
Increased
endothelial
Improved
new
Formation
function
Improved
transport
pressure
pressure
capillaries
[30] [71] of
body
[80]
regulation
regulation
mitochondrial
volume
function
endothelial
new [71]
[71] [46] [90,91]
capillaries
composition
[90,91]
volume
function [71]
[30]
Lower
[46]
[71] risk
Lower
Lower
Increased
Lower
Increased
for
risk
risk
metabolic
or
for
risk
aerobic
aerobic
cardiovascular
metabolic
forcardiopulmonary
Increased
Lower capacity
cardiovascular
risk
capacity
Increased
Lower
syndrome disease
risk
syndrome/Type-2
cardiopulmonary
aerobic
for
aerobic[79]
[71]
[77],
strength,
for
[81]
disease
disease
capacity
cardiovascular
disease
capacity
improved
metabolic coordination
[92]
[79]
[77],
[71]
diabetes
[92]
improved
disease
function
syndrome and
[81]
in[77],
function
heart
balance
[81] improved in[84,85],
disease
in heart
elderly function
[78]
also
disease
[74] and
in
in children
[78]
heart
in disease
sickness [78]
[75], lower risk for fall [76]
r proportion
proved
ased blood
skeletal Effects
aLarger
red slow-twitch
circle
pressure
volume on
proportion the
indicates Effects
ImprovedBody
fibers
a regulation
andred circle
that
mineral on
slow-twitch
body
the the
[70,71]
indicates
activity
[90,91]
content [73]
Body
fibers
composition
that
has
[87] [70,71]
the
no Lower
[30]
proven
activity
Lower
Improved risk
effect.
has for
no
risk Lower
metabolic
Orange
proven
for
skeletal risk
circle
effect.for
syndrome
Lower
cardiopulmonary
health metabolic
risk
indicates
Orange
[88, 89] forwith
circle
that syndrome
the increased
metabolic
indicates
disease activity
[92] with
syndrome
Healththat
may exchange
theinincreased
Effects [81]Health
activity
some of
cases
maygases
exchange
Effects
be and in
ineffective.
some nutrition
ofchildren
cases gases and
[71,72]
be effective. nutrition [71,72] Aerobic Strength Aerobic Strength
proved
ased
oved eased body
heart
skeletal
insulin
glucose
Improved composition
capacity volume
sensitivity
transport [71]
glucose and
[82]
[80] [30]mineral
transport content
[80] [87]of Lower
Lower
Improved
Improved
Lower
Lower risk
riskriskforfor
health
risk
or for
Lower metabolic
cardiovascular
skeletal
for in
metabolic health
cardiopulmonary
people
cardiopulmonary
risk syndrome
[88,
withdisease
89]
syndrome/Type-2
or disease
Type-2
metabolic [81]
[77],
disease fewer
indiabetes
elderly
diabetes
in
syndrome/Type-2 depressions
[94,95]
[82],
elderly [81] and
prevention
[94,95] [84,85],
and
diabetes Alzheimer’s
of also
Typ-2
Alzheimer’s
[81] [96]
diabetes
[96] that [83][86]
ased
oved
ondrial
proved
pressure mitochondrial
blood Increased
Table
endothelial
Improved
volume
blood 2.
lipid
Formation
Improved lipid
regulation
Table [46] mitochondrial
volume
Health-related
function
profile Table
endothelial
profile
of
blood
[90,91]
2. Health-related [71]
[93] [46]
2.
[93]
newpressure
capillaries volume
physiological
Health-related
function Increased
[71]
regulation
Lower
physiological [46]
effects
[71] risk Increased
physiologicalaerobic
Lower
aerobic
[90,91]
effectsfor of risk aerobic
effects
and
capacity
cardiopulmonary
aerobic for
and Increased
muscle
of
Lower
[79]
Lower capacity
aerobic
cardiovascular
muscle risk
risk aerobic
strengthening
and for
aerobic
for
disease [79]
muscle capacity
physical
cardiovascular
disease
capacity
cardiopulmonary
strengthening[92] physical [79]
strengthening
activity.
[77],
[71] physical
improved
disease Green
disease
activity. [77],
Green circle
activity.
function
[92] indicates
improved
circle Green
in heart
indicates that
circle
functionthe
indicates
disease
that activity
the in [78]
heart
activity contributes
the
diseaseactivity
contributes with
[78] contributes
anan
with effect, whereas
with
effect, an effect, whereas
whereas
oved r proportion
body Larger slow-twitch
proportion
composition [73]
[30]
Improved slow-twitch
fibers [70,71]
blood [73]
fibers
pressure Increased
[70,71]Lower
Lower
No
regulationNoeffect risk
effect
[90,91]strength,
risk
onfor Increased
for
Lower coordination
metabolic
blood
on blood risk
lipid strength,
cardiopulmonary
lipid for
syndrome
profiles
Lower metabolicand
coordination
riskinfor
profiles balance
disease
with
[81] syndrome
children
in inand
increased
children
cardiopulmonary inand
and elderly
elderly balance
with [94,95]
exchange
adolescents [74]
increased
adolescents
disease in
and
andelderly
ofmay
[97]
[92] in
gases
[97] sickness
exchange[74]
Alzheimer’s and [75],
and nutrition in
of gases lower
sickness
[96] and risk
[71,72] [75],
for lower
fall
nutrition [71,72] [76]
risk for fall [76]
proved
ased
ased skeletal blood pressure
volume a regulation
and mineral [90,91]
content [87] Lower
Improved risk for
skeletal cardiopulmonary
health [88, 89] disease [92]
proved
oved
ased
e transport
body
heart
blood
insulin
glucose aEffects
aImproved
red
mitochondrial
Increased
Table
lipidon
composition
capacity
circle
sensitivity
red 2.circle
transport
[80]
[71]the
indicates
profile
insulin
glucose
Health-related
Effects
red
[80]
Body
[82]
indicates
mitochondrial
volume
Table
[30]
circle
that
[93]
sensitivity
that
transport
2.[46]
on
thethe the
indicates
activity
volume
physiological
Health-related[80]
Lower
Body
[82]
activitythat
has
[46]
the
has
risk
effects
nono Lower
Lower
proven
activity
Improved
proven
Lower
Increased
for
physiological
of
or aerobic
risk
risk
metabolic
No
risk
effect.
has for
no
or
effects
effect and
for
Orange
proven
health
effect.Lower
aerobic
cardiopulmonary
metabolic
cardiovascular
Improved
in
Orange
metabolic
Increased
Lower
muscle
of aerobic
circle
effect.
people
risk
capacity
risk aerobic
diseasefor
strengthening
syndrome/Type-2
on blood and
lipid
syndrome
disease
indicates
Orange
health
circle with in
indicates
syndrome/Type-2
or metabolic
[79]
muscle
profiles
circle
that
Type-2
people
capacity
cardiopulmonary
in elderly
[81]
[77],
the
that
physical
diabetes
in the
[79]
[94,95]
strengthening
fewer
indicates Health
activity
diabetes
with activity
syndrome/Type-2
diabetes
activity.
[81]
children
depressions
that
may
Type-2
[82],
disease
and
physical
and
Effects
the
may
[81]in
inin
Alzheimer’s
Green circle
Health
activity
some
diabetes
prevention
some
diabetes
elderly
activity.
adolescents
[84,85],
cases
[82],
cases
[96]
indicates
Green
[97]
Effects
be
of in
[81] be
[94,95]
also
that
in
effective.
some
prevention
Typ-2 cases
effective.
circle and
the
children
diabetes beTyp-2
of
Alzheimer’s
indicates
activity that
[86]diabetes [83]
effective.
[83]
contributes[96]
the activity
with contributes
anan effect,
Aerobic Strength
whereas
with
Aerobic
an effect, whereas
Strength
ation
proved of Improved
new
Formation
Table
peripheral
peripheral capillaries
2.
nerve endothelial
of
nerve new [71]
Health-related
function
function function
capillaries
[98]
[98] [71]
physiological [71] effects Increased
of
Better aerobic
Better aerobic
and
coordination,Increased
strength,
coordination, capacity
muscle aerobic
balance
balance cardiovascular
[71]
strengthening
coordination
strength,and capacity
and andphysical
coordination
reaction
reaction [71]
balance disease
activity.
[98,99],inand
[98,99], [77],
Green
elderly
balance
especially
especially improved
circle
[74] in
and
in indicates
elderly
in
children
in function
that
sickness
children [74]and the
and
and in
[75], heart
activity
in
elderly lower disease
contributes
sickness
elderly [100] risk
[100] [78]
[75],
for with
lower
fall [76] effect,
risk for whereas
fall [76]
oved
oved r
proved proportion
ipid blood
body Larger
Improved
profile
blood slow-twitch
[93]
pressureproportion
composition
pressure blood [73]
regulation
[30] slow-twitch
lipid profile
[90,91] [73]
[93] Lower
Lower
Lower risk
riskrisk
for
forfor cardiopulmonary
cardiopulmonary
metabolic Lower
syndrome risk disease
disease
for[81] [92]in
cardiopulmonary elderly [94,95]
disease and
in Alzheimer’s
elderly [94,95] and [96]
Alzheimer’s [96]
ased
proved
oved
proved
skeletal
r proportion aLarger
heart
blood
insulin red
Increased
Improved
glucose
peripheral
red
volume
slow-twitch
proportion
circle
capacity
lipid
sensitivity
aEffects
transport
circle heart
[71]a regulation
and
Improved
indicates
profile
insulin
on
nerve the
glucose red mineral
fibers
slow-twitch
circle
that
capacity
[82] [93] blood
the
sensitivity
Effects
[80]
indicatesBody
transport
function that on [90,91]
content
[70,71]
[71]
the lipid
indicates
activity
No
the
[98] [82]
[80]Body
activity
[87]
fibers
profile
that
has
effecthas [70,71]
the
no
on[93] Lower
Improved
Lower
proven
activity
blood
Improved
Lower
no Better
proven risk
risk
risk
effect.
has
lipid no for
skeletal
for Lower
No
Orange
proven
health
or
cardiopulmonary
profiles health
metabolic
effectrisk
circle
cardiovascular
Improved
Lower in
metabolic
coordination,
effect. Orange people
risk on
effect.
incircle [88,
for
syndrome
health 89]
metabolic
blood
indicates
Orange
children disease
lipid
and
cardiovascular
withdisease
in
syndrome/Type-2
or
balance Type-2
metabolic
and
indicates with
circle
that
people syndrome
profiles
the
[77], [92]
increased
indicates
activity
adolescentsfewer
diabetes
with inthat
disease
syndrome/Type-2
reaction
that the Type-2
diabetes
[98,99],
activity with
exchange
children
may
[97] thein increased
depressions
[82],[77],
[81]
especially
may in and
activity
some
fewer
diabetes
prevention
diabetes
some of gases
exchange
adolescents
cases
may
[84,85],
in bein
depressions
[82], of
[81]
children
cases be and
also
prevention
Typ-2 nutrition
effective.
some in
andof
[97]
cases gases
[84,85],
effective. beTyp-2
children
diabetes of
elderly and
[71,72]
also
[83] nutrition
effective.
[86]
in
[100] children
diabetes [71,72]
[83] [86] Aerobic Strength
oved
ationsensitivityTable
endothelial
of [82]
Improved
new Effects
Increased
Formation 2.of on
Health-related
function
capillaries the
mitochondrial
endothelial
of new Body
[71]
[71] volume
physiological
function
capillaries Improved
[71] [46]
effects
[71] health
of
Lower
No
Increasedin
aerobic people
risk
effect and for
on with
Increased
muscle
Lower
aerobic Type-2
cardiovascular
blood
Increased risk aerobic
No
strengthening
lipid
capacity for diabetes
effect capacity
on
cardiovascular
disease
profiles
aerobic[71] in
capacity [82],
blood
physical [79]
lipid
[77],
children
[71] Health
prevention
activity. profiles
Green
Health
improved
disease
and Effects
in of
Effects
[77],
function
adolescents Health
Typ-2
children
circle
improved and
indicates
in
[97] Effects
diabetes
heart
function[83]
adolescents
that the
disease [97]
activity
inactivity
[78]
heart contributes
disease with
[78] anan effect, whereas Aerobic
Aerobic Strength Strength
nced
oved anced release
release
blood Tableof signaling
pressure2. signaling
Health-relatedsubstances
regulation substances
[90,91] [84,101]
physiological [84,101] effects Lower
Better
Better
of
Lower
Lower
Increased risk
sleep
aerobic sleep
riskriskfor
and
for for
strength,cardiopulmonary
[102],
[102],less
muscle lessanxiety
anxiety
strengthening
cardiopulmonary
cardiopulmonary
Increased coordination
strength, [68],disease
[68],
and treatment
disease
disease
coordination in
treatment
physical [92]
balance elderly
in of
activity.of
elderly
inand [94,95]
depression
depression
Green
elderly [94,95]
balance [74]and
circle[31]
in
and Alzheimer’s
[31]
indicates that
Alzheimer’s
elderly
in sickness
[74] the
and[96] [96]
[75],in lower contributes
sickness risk[75],
for with
lower
fall [76] effect,
risk forwhereas
fall [76]
oved
eral
ased r
proved body
nerve
proportion
blood
heart
a Improved
composition
function
Larger
skeletal
Increased
blood slow-twitch
lipid
capacity
red circle
lipid peripheral
[98]
proportion
volume profile
skeletal
heart
[71]and
indicates
profile [30]
[73]
[93]
capacity
that
[93] nerve
slow-twitch
mineral
volume the [71] function
Better
content
and
activity [73]
mineral
[87]
has [98]
no Lower
coordination,
content
Improved
Lower
proven risk
[87]
risk for
balance Better
skeletal
effect. for and
Improved
Lower
Orange coordination,
metabolic
health
cardiovascular
risk
circle syndrome
reaction
skeletal
[88,
for [98,99],
89]
indicates balance
health
cardiovascular
disease [81]
that [88,
[77],
the and
especially89]
fewer reaction
disease
activity in children
depressions
may [77],
in [98,99],
fewer
some and especially
elderly
[84,85],
depressions
cases be also in
[100]
in
effective. children
[84,85],
children alsoand
[86]
in elderly
children [100][86]
oved
hanced
apacity insulin
r proportion release
Larger
[71]
Improvedsensitivity
2.of
aEffects insulin
signaling
slow-twitchon
proportion
glucose [82]
thethe
Improved sensitivity
substances
Effects
Body
fibers
transport on
slow-twitch the
[70,71]
peripheral [82]
Lower[84,101]
[80]Body
fibersrisk
nerve Improved
has[70,71]
forBetter
Lower
function health
sleep
risk
cardiovascular
[98] for Improved
in
[102], people
less
metabolic
Lower disease
risk health
anxiety
for with
syndrome
or
Better in Type-2
metabolic
[77], fewer
metabolic people
[68], with
coordination, diabetes
with
treatment
syndrome
increased
depressions
syndrome/Type-2
balance Type-2
Healthof[82],
with
and diabetes
prevention
depression
exchange
[84,85], increased
also
indiabetes
reaction
Effects of[82],
[31]
in of
gases
[98,99],
Health prevention
Typ-2
exchange
beand
children
[81] especially
Effects diabetes
nutrition
of
[86] of
gases
in Typ-2
[83]
and
[71,72]
children diabetes
with [83]
nutrition
and elderly [71,72]
[100]
effect, Aerobic
proved
ger
ased
oved
proved peripheral
proportion
endothelial red
mitochondrial
Increased
Table
Improved
hippocampus
hippocampus
circle nerve
slow-twitch
Effects function
endothelial
function function
indicates
mitochondrial
volume
on
Health-related
function[71] that
fibers
[46]
Body [98]
the
function
[103]
[103]
activity
[70,71]
volume
physiological [46]
effects
[71] No
no Better
Lower
Noeffect
proven
Lower
Increased
of aerobic
Improved coordination,
risk
effect
Improved
Lower risk
on
risk
and blood
effect.for
aerobic Orange
muscle
for
onLower
blood
cognition
cognition
for
lipid
metabolic
Increased balance
capacity profiles
circle
aerobic
strengthening
cardiovascular
risk
lipid
and and
cardiopulmonary for and
indicates
syndrome
[79]
profiles
memory
memory in reaction
children
capacity that
physical
cardiovascular
disease in
[104], withthe
[79] [98,99],
and
activity
increased
activity.
[77],
children
[104],
disease less improved
inlessdisease Green
Health
and
medication especially
adolescents
may
medication
elderly exchange
[77],circle
function
Effects
adolescents
[94,95]
some
[103] in
[97]
indicates
improved
[103]
and in children
cases
of
[97] gases
heart
Alzheimer’sthat
functiontheand
effective.
and
disease elderly
nutrition
activity
in
[96] [78]
heart [100]
[71,72]
contributes
disease [78] an Aerobic Strength
whereas Aerobic
Strength Strength
ation
oved of of
blood
body
bloodnew
Formation
Enhanced
signaling Table
Improved capillaries
pressure
substances
2.
composition
lipid of new
release [71]
regulation
Health-related
body
profile [30] capillaries
of
[84,101] signaling
composition
[93] [90,91] [71]
Better
physiological substances
[30] sleep
effects Increased
[84,101]
[102],
of
Lower less
aerobic
risk aerobic
for
and Increased
Better
anxiety capacity
muscle
Lower sleep
[68],
metabolicrisk aerobic
cardiopulmonary [71]
[102],
treatment
strengthening
for
syndrome capacity
less
metabolic of anxiety
disease [71]
[92]
depression
physical
[81] syndrome [68],
activity. treatment
[31]
Green
[81] of
circle depression
indicates that [31]
the activity contributes with an effect, whereas
ased
proved
oved r volume
lger
hanced skeletal
heart Increased
red
and
release volume
capacity
hippocampus
proportionaLarger
peripheral slow-twitch skeletal
heart
[71]
proportion
circlenerve
mineral and
indicates
insulin mineral
volume
capacity
function
[73]
function
content slow-twitch
that [98]
the
[87]
sensitivity
fibers content
[71]
[103] and
activity
[70,71] [82]mineral
[73]
Improved [87]no
has
fibers content
Improved
Increased
Lower
Improved
Better
proven
skeletal
[70,71] [87]
risk skeletal
for
coordination,
Increasedeffect.
health for Improved
strength,
Increased
Lower
Orange
[88,
strength,
Improved health
cardiovascular
cognition89] risk
and
balance
circle
metabolic skeletal
[88,
coordination
strength,
for
health
for 89]
and
indicates
coordination
syndrome in health
metabolicand
cardiovascular
disease
memory reaction
that
and
people
with [88,
coordination
balance
[77],
[104],
the 89]
fewer
[98,99],
activity
balance
with
syndrome
increasedinand
disease
less elderly
in
Type-2 balance
depressions
medication[77],
especially
may in
elderly
with [74]
fewer
some
diabetes
exchange in
and
[103]
in
[74]
increased elderly
of in
[84,85],
children
cases
and
[82], be
gases sickness
depressions
in
exchange[74]
alsoand and
in
effective.
sickness
prevention
and [75],inoflower
[84,85],
children
elderly
nutrition
of [75],
gases sickness
also
[100]
lower
Typ-2
and risk
[86]
[71,72]in [75],
forfor
risk
diabetes
nutrition lower
fallfall
children [83][76]
risk
[76] for
[86]
[71,72] fall [76]
ger
oved
proved
ased
ve
itive
oved
proportion
glucose
effects Improved
peripheral
mitochondrial
Increased
proportion
effects
Tableaon
endothelial 2.of
Effects
transport
Effects
on
red
Improved mental signaling
mental
circle
on
slow-twitch
nerve
onthe
Enhanced
glucose
Health-related [80]
the
capacityBody
capacity
indicates
function
endothelial
substances
[73]
function
mitochondrial
volume
slow-twitch [46]
Body
[71]
release
transport
fibers
[105]
that [98]
volume
[105]
physiological
the
function
of
[70,71] [84,101]
[80] signaling
activity [46]
effects
[71] has no No Better
substances
Lower
Better
effect
Increased
Lower
Counteract
of Counteract
aerobic
proven
Lower
sleep
risk
riskandor
brain
effect.
for
[102],
[84,101]
Lower
metabolic
coordination,
on blood
aerobic
risk Increased
for
brain
muscle less
risk
lipid anxiety
Better
balance
capacity
metabolic profiles
aerobic
degeneration
Orange
Lower degeneration
strengthening
circle
cardiopulmonary
cardiovascular
risk for
[79]sleep
syndrome/Type-2
or and
by
indicates
[68],
metabolic
inby treatment
[102],
reaction
children
capacity
syndrome diseases
cardiovascular
disease
less
with[79]
diseases
physical
that
disease the
[77],in
anxiety
syndrome/Type-2
diabetes
Health
[106]
activity.[106]of
[98,99],
and
increased
activity
elderly
improved
disease
depression
and[68],
[81]
Effects
and
Green
Health may age
[94,95]
[77],
treatment
indiabetes
especially
adolescents
exchange
age
circle
Effects
function[107]
[107]
some
and
improved
[31]
in
[97] of
indicates of
cases
depression
[81]
children
gases
Alzheimer’s
in heart that and
and
the
be disease
effective.
function
[31]
elderly
nutrition
activity
[96]
in [78]
heart
[100]
[71,72]
contributes
disease with an effect, Aerobic
[78] Aerobic Strength
whereas Strength
oved ampus
ation blood
body function
pressure
Improved
composition
ofhippocampus
bloodnew
Formationcapillaries
lipid hippocampus
[103]
blood
ofregulation
body
profile new pressure
[30]
composition
[71]
[93] capillaries function
[90,91] Improved
regulation
[30]
[71] [103] cognition
[90,91]
Lower and
risk for Improved
memory
Lower
aerobic metabolicrisk
capacity cognition
[104],
cardiopulmonary for less
syndrome
aerobic metabolic
[71] and
medication
cardiopulmonary
disease
capacity[81] memory
syndrome
[71] [103]
[92]89][106] [104],
disease
[81] less
[92] medication [103]
ased
nced
r
hanceditive
omposition
mation
proved
oved skeletal
proportiona Increased
effects
release
of
insulin new
Larger
peripheral
red on
Improved
Table
release volume
of
[30] mental
circle
sensitivity
slow-twitch
Effects 2.
of skeletal
signaling
capillaries
heart
proportion
nerve and
indicates
insulin [82]
Health-related
signaling
on the mineral
volume
capacity
substances
[71]
capacity
[73]
function
functionslow-twitch
that
fibers
Body the
sensitivity content
[105]
[71]
[103]
[98] and
activity
[70,71] [82]
physiological
substances mineral
[84,101]
Lower [73][87]
has
[84,101]riskno
effects content
Improved
Counteract
Increased
Better
forImproved
Better
proven
Improved
Increased
Lower
of
Better [87]
sleep
metabolic
Increased skeletal
effect.
risk
aerobic for
and
sleep Improved
brain
strength,
Increased
[102],
syndrome
aerobic
Lower
cognition
coordination,
Orange
health
Improved
in
strength, health
less
balance
circle
people
metabolic
muscle
[102], skeletal
[88,
degeneration
coordination
strength,
anxiety
risk
and[81]
capacity for
health 89]
and
indicates
with
coordination
syndrome
strengthening
less anxiety in health
[68],
[71] by
and
reaction
that
Type-2
people
and
with [88,
diseases
coordination
balance
treatment
cardiovascular
memory [104],
the
physical
[68], [98,99],
activity
diabetes
with
balance
increased
treatment in
ofand
disease
less Type-2
activity.in
of and
elderly
balance
depression
medication[77],
especially
may
[82], in
elderly
exchange
Green
depressionage
[74]
fewer
some
diabetes
prevention [107]
in
and
[31]
[103]
in
[74]
circle elderly
of in
children
cases
[82],
and be
of
gases
indicates
[31] sickness
depressions
in [74]and and
effective.
prevention
Typ-2
sickness
and
that [75],in
[84,85],
elderly
diabetes
nutrition
the of
[75],lower
sickness
activity also
[100]
Typ-2
[83]
lower risk
[71,72]in [75],
for
diabetes
risk
contributes lower
fall
children
for [83]
fall
with [76]
anrisk
[86]
[76] for
effect, fall [76]
whereas
oved
proved glucose
ger proportion
proportion
immune
immune transport
function glucose
slow-twitch
function [80]
Improved
[108] transport
[108] hippocampus
[73] [70,71] [80] function [103]
Decreased
No effect risk
Decreased onorblood
Lower
metabolic
overall
overall risk
lipid
risk syndrome/Type-2
forordisease
Improved
profiles
for metabolic
disease cognitionsyndrome/Type-2
in[109,110],
children
[109,110], diabetes
and memory
Health [81]
anti-inflammatory
and adolescents
anti-inflammatory diabetes
[104],
Effects less
[97] [81]
medication
effects
effects [103]
[111,112]
[111,112] Aerobic Strength
nger
ased
oved mentalmitochondrial
blood
Increased
Positive
capacity
Table
endothelial
Improved
slow-twitch
Effects
2.circle
pressure
mitochondrial
volume
effects
[105]on
Health-related
acomposition
red blood
function the
on
regulation
endothelial
indicates
fibers
[46]
Body
mental
pressure
[71]
volume
capacity
physiological
[90,91] Counteract
regulation
function
that the
[46]
[105]
effects
[71]
activity has of
[90,91]
no
Lower
Increased
brain
Lower degeneration
aerobic
Lower
proven risk
riskand for
for
for
aerobic
Lower
muscle
effect.Lower
metabolic
Increased
capacity
Counteractby aerobic
cardiopulmonary
risk brain
diseases
for
strengthening
cardiopulmonary
risk
cardiovascular
Orange for
circle
syndrome
[79] capacity
degeneration
[106]
cardiopulmonary
disease
physical
cardiopulmonary
disease
cardiovascular
disease
indicates
with
and [79]
age
in increased
activity.
[77],
that [92]
the by
[107]
elderly
improved
disease
activitydiseases
disease
Green
Health
disease
exchange
[94,95]
[77],
may circle
Effects
[92]
function[106]
ininimproved
elderly
and of[94,95]
and
indicates
some in
gases
age
Alzheimer’s
heart
cases that
function
and
[107]
the
be disease
effective.
nutrition
andactivity
[96]
Alzheimer’s
in [78]
heart
[71,72]
contributes
disease[96][78]
with an effect, whereasAerobic Strength
proved
ation
pressure
oved
nced
ased itive
mation body
ofimmune
bloodnew
Formation
hippocampus
effects
release
heart oncapillaries
regulation
Improved
lipid
endothelialof
Increased
capacity mental body
function
signalingof
heart
[71] new
function
[90,91]
profile
blood
function
skeletal [30]
composition
[108]
[71]
[93] capillaries
lipid
capacity [103]
[71]
volume
substances
capacity profile
[105]
[71] [30]
[71]
Lower
and [93]
[84,101] risk
mineral for Decreased
Improved
Counteract
Increased
Better
Lower aerobic
cardiopulmonary
Lower
content risk
[87]
sleep
risk formetabolic
overall
Increased
cognition
Improved
brain
strength,
[102],
forLower capacity
and
less syndrome
aerobic
memory
disease
cardiovascular
skeletal
degeneration
coordination
anxiety
cardiovascular
risk for metabolic
disease
[71]
[92] capacity
health
[68], by
and [81]
[104],
disease syndrome
[109,110],
[71]
less
[77],
[88,
diseases
balance
treatment
cardiovascular
disease [77], 89][106]
fewerin
of
disease [81]
anti-inflammatory
medication
improved and
elderly
depression
depressions
[77], [103]
function
age
[74]
fewer[107]
and
[31] in
[84,85],effects
heart
sickness
depressions also [111,112]
disease
in [75],
[84,85],
children[78]
lower
also risk
[86]
in for fall
children [76]
[86]
rrngthening
proved
ger
oved
proportion
gthening
oved proportionaof
insulin
proportion
glucose
new
hippocampus
the
peripheral
red the
Improved
Improved
capillaries
slow-twitch
connection
circlenerve
connection
sensitivity
slow-twitch
Effects
transport
insulin
on
slow-twitch the
Positive
indicates
glucose [80]
[71]
[73]
function
between
function
[82] between
fibers
Body
that [103]
[98]
sensitivity
effects
[73] the
transport
brain,
[70,71]
onbrain,
[82]
mental
activity
[80] hascapacity No Increased
Improved
Better
no Improved
Increased
Lower
proven
Lower [105]
effect
Decreased
Decreased
risk
risk on
effect.or
aerobic
cognition
coordination,
health
for Improved
blood
riskNo
Orange
Lower
in
strength, capacity
effect
lipid
metabolic
riskforfor
and
balance
people
metabolic
circle
risk
disease
health
Counteract
on
profiles [71]
memory
and
with
coordination
syndrome
blood
indicates inType-2
syndrome/Type-2
diseaseor in
metabolic
[114],
[114],
[104],
reaction
people
and
with
brain
lipid
that
improved
less
[98,99],
diabetes
with
balance
increased
degeneration
children
profiles
the
improved
medication
Type-2
Health
and
activity
syndrome/Type-2in
diabetes in
metabolism
especially
[82],
elderly
may
metabolism by diabetes
adolescents
children
[81]in [103]
prevention
exchange
diseases
Effects someand in
[74]
diabetes
[115],
[115],
children
[82],
and
[106]
[97]
cases ofin
be
[81]
decreased and
decreased
andnutrition
prevention
ofadolescents
gases Typ-2
sickness
and
age
effective.
risk
elderly
diabetes
[107]
[97]
risk for
[100]
of Typ-2
[75], [83]
lower
[71,72]
depression
for depression
diabetes
[116]
[116]
[83][76] Aerobic Strength
risk for fall
ne ger
ased function
proportion
ngthening [108]
the
mitochondrial
Increased immune
slow-twitch
connection
mitochondrial
volume function
fibers
between
[46] [108][46]
Decreased
[70,71]
brain,
volumeLower risk overall
Lower
Lower
Increased
for risk for
riskforDecreased
aerobic
cardiopulmonary disease
for
Lower metabolic
cardiopulmonary
Increased risk
capacity overall
[109,110],
for
aerobic
disease syndromerisk
cardiopulmonary
[79]
in for
disease
capacity
elderly disease
anti-inflammatory
with in improved
[79]
[94,95] elderly [109,110],
increased
disease
and effects
exchange
[94,95] anti-inflammatory
[111,112]
in improved
Alzheimer’s elderly
and of gases
Alzheimer’s
[94,95]
[96] and[96] effects [111,112]
nutrition
Alzheimer’s [71,72]
[96][78]
oved
ve
bolism
proved
ation
oved
ased blood
endothelial
effects
abolism
eased ofand and
immune
new on
hippocampus
blood pressure
Improved
Improved
skeletal mental
immune
mitochondrialimmune
lipid
endothelialEffects
volume blood
function
body
function
capillaries regulation
endothelial
capacity
function
function
profile
blood
on
skeletal
and
functionthepressure
[71]
function
volume[108]
[71]
[93]
lipid [103]
Body
mineral
volume
[71] [90,91]
[105]
[113]
composition [113]
[46]
profileregulation
function
content
and [30]
[93][71]
mineral
[87] [90,91]
Lower
Counteract
Increased
Decreased
Increased
Improved
content
Lower risk
[87] for
brain cardiopulmonary
aerobic
Lower
overall
aerobic
cognition
skeletal
risk Improved
for risk
cardiovascular
degeneration
capacity
risk
capacity
and
health for
for
skeletal
cardiovascular [88, cardiopulmonary
[79]by
metabolic
disease
[71]
memory 89] disease
cardiovascular
disease
health
disease [77],
diseases [92]
syndrome
[109,110],
[104], less
[88,
[77], [106]
89] disease
disease and
[81][77],
age [92]
function
anti-inflammatory
medication
improved [107]
[103]
function in heart
function
effects
heart disease in
[111,112]
disease [78]
heart
[78] disease
ovedrritive
nced
emation
oved effects
proportion
connection
abolism
Table
release
heart
proportion
ipid insulin
on
Improved
and
of
Increased
of
profile
peripheralcapacity
new
Improved mental
2. signaling
Health-related
slow-twitch
Strengthening
between
sensitivity
immune
Effects
heart
on
[71]
capillaries
slow-twitch
[93] nerve capacity
peripheral
Improved
the
brain,
insulin
substances
capacity
[82][71]
[73]
function
fibers
sensitivity
function
the Body
[105]
physiological
nerve[71]
[98]
[70,71]
immune
connection
[113]No
[84,101]
function effects
function
between
[82] effect
[98]
on
of Counteract
Increased
aerobic
Better
Lower
Lower
[108]
No
brain,effect
Improved
sleep
Decreased
Increased
Increased
blood
risk
riskand
on
lipid
for
for brain
strength,
muscle
[102],
risk
Lower
blood
No
health
Improved
in
strength,
profiles
degeneration
coordination
strengthening
less
for anxiety
disease
cardiovascular
aerobic
coordination,Better risk
capacity
balance
metabolic
effect
lipid
people
in
for
coordination,
Decreased
on
profiles
health
[114],
[71]
and
syndrome
blood
with
coordination
children in
by
and diseases
physical
[68],reaction
in
balance
treatment
improved
cardiovascular
disease balance
Type-2with
overall
lipid
children
people
and and
activity.
[77], [106]
[98,99],
risk
profilesand
increased
diabetes
with
balance
adolescents for
and
in
of
metabolism
fewer Health
disease and
elderly
Green
depression
reaction
in
Type-2especially
diseaseexchange
adolescents
children
[82],
in[97]
elderly
age
[74]
circle
Effects
depressions
[77], [107]
[98,99],
[109,110],
diabetesand
prevention
and
indicates
[31]
[115],
fewer in
[74] of in
children
[97]
sickness
decreased
[84,85], that
depressions
especially
gases
[82],
and of
also
andthe
and
anti-inflammatory
adolescentsprevention
Typ-2
in disease,
risk
in
in
sickness
[75],
activityfor
[84,85],
children
elderly
children
nutrition
[97]
diabetes of
[75],
lower
[100]
effects
Typ-2 andrisk
contributes
depression
also [86]
[71,72]
[83]
lower
for
inelderly
[111,112]
diabetes
risk
fall[100]
with
[116]
children an[76]effect, whereas
[86] Aerobic Strength
[83][76] Aerobic Strength
for[115]
fall
ger
proved
ased
oved proportion
glucose
a Improved
intestinal
intestinal
red
mitochondrial
ngthening
immuneIncreased
the slow-twitch
transport
function
circle glucose
function
indicates[80]
mitochondrial
connection
function volume[108] [73]the
transport
[14,113]
[14,113]
that
[46]
between volume [80]
Decreased
activity
brain, has
[46] no Lower
Improved
risk Improved
for
proven
Increased
Decreased risk
disease
effect. for
or
health
aerobic cardiopulmonary
Lower
metabolic
health [117],
Decreased
[114],
Orange
Increased
overall risk
[117],
improved
circle
capacity
risk for
mitigatedcardiopulmonary
syndrome/Type-2
or metabolic
mitigated
risk for
indicates
aerobic
for [79]
disease disease
disease
metabolism
that
capacity the
[109,110], in
[114], Health
elderly
syndrome/Type-2
metabolic
metabolic activity
[79] disease
diabetes
syndrome,
syndrome,
improved
[115], Effects
[94,95]
[81]
decreased
may
anti-inflammatoryin in elderly
and
diabetes
obesity,
obesity,
metabolism
some riskAlzheimer’s
cases [94,95]
[81]
liverliver
for
be
effects and
disease,
[115],
depression
effective.
[111,112] [96]
Alzheimer’s
and
decreasedand some
[116] some
risk [96]
cancers
cancers
for [115]
depression [116]
proved
ve
oved glucose
endothelial
effects
body on
Improved transport
mental
composition blood
function
bodycapacity[80]
pressure
[71]
[30] [105]
composition regulation
[30] [90,91] Lower
Counteract
Lower riskrisk or
brain
forLowermetabolic
risk
cardiovascular
degeneration
metabolic for syndrome/Type-2
cardiopulmonary
syndrome disease
by
metabolic [77],
diseases
[81] syndrome diabetes
[106] disease
improved and
[81]age [81]
[92]
function[107] inof heart disease [78]
oved reased
proved
ation
ger
asedmmune
nced
proved
asederal
mation
ofmitochondrial
immune
blood
proportion new
hippocampus
proportion
skeletal
peripheral
heart
nerve
lipid
Increased
endothelial
Improved
intestinal
Increased
of
volume
metabolism
function
release
Enhancedof function
capillaries
profile
slow-twitch
capacity
function
new nerve blood
slow-twitch volume
function
skeletal
and
function
[113]
signaling and
release
peripheral
heart
[71]
[98]
capillaries
[108]
[71]
[93]
lipid
immune
[73]
function
Strengthening
function [14,113]
capacity
[71]
[46]
[103]
fibers
mineral
volume
[71]
substances
of profile
signaling
nerve
[98] [70,71]
content
and
function
the
[71]
[93]
mineral
[84,101]
function [87]
connection
Better [113]
substances [98] Increased
Decreased
Increased
Lower
content
Improved
Increased
Better
[84,101]
between
Lower
coordination,
No
sleep
Decreased risk
[87] aerobic
overall
aerobic
cognition
coordination,
Improved
effect
Increased brain,
risk on
for
skeletal
Improved
strength,
[102],
Better
risk
health
for
balance Lower for capacity
risk
capacity
and
metabolic
health
less
sleep
diseasefor
skeletal
cardiovascular [88,
coordination
anxiety
coordination,
balance
[117],
cardiovascular
blood
No
aerobic and
effectrisk Decreased
for
reaction
lipid on
profiles
capacity
[79]
disease
[71]
memorysyndrome
[102],89]
[114],
and
mitigated health
disease
[68],and
less [109,110],
[104],
improved
reaction
balance
risk
cardiovascular
blood disease
[98,99],
[71] in
lipid for less
with
[88,
[77],
balance
treatment
anxiety 89]
disease
metabolic
[77],
anti-inflammatory
medication
increased
improved
in
[68],
of elderly
depression
treatment
metabolism
[98,99],
and
fewer
especially
children
profiles reaction
disease
and in inespecially
[114],
syndrome,
[103]
exchange
function
[74]
improved
depressions
[77],
children
adolescents
children
and
of
[31]
[115],
[98,99],
fewer
and in
obesity,
and ineffects
gases
depressionheart
sickness
decreased
children
especially
metabolism
[84,85],
[97] liver
depressions
elderly
adolescents also
[111,112]
and
disease
and[31]
risk
in
disease,
in
[100]
nutrition
[75], for
elderly
children
[115],
[84,85],
[97] and
children[78]
lower [71,72]
risk
depression
[100]
decreased
alsoand
some
[86]
in for fall[100]
[116]
elderly
risk for
cancers
children [76]
[115]
[86]
rabolism
proportion
gthening
oved insulin
glucoseand
the
Improved immune
slow-twitch
sensitivity
connection
transport insulin
glucosefunction
[82]fibers
between
[80] transport[113]
sensitivity[70,71]
brain, [82]
[80] Lower
Improved
Lower risk
risk for
health
or metabolic
Improved
Lower in
metabolic people
risk syndrome
health
for with in Type-2with
people
cardiopulmonary
syndrome/Type-2
or metabolic increased
diabetes
with
syndrome/Type-2Type-2
disease
diabetes exchange
[82],
[81] diabetes
prevention
in elderly
diabetes of gases
[82], of
[81] and
prevention
Typ-2
[94,95] andnutrition
diabetes of [71,72]
Typ-2
Alzheimer’s [83] diabetes
[96] [83][76]
proved
ased
oved
proved
ve
nal
ger
oved
ation insulin
mitochondrial
ngthening
immune
blood
function
eased proportion
body
of onthe
Improved
glucose sensitivity
connection
function
pressure
Effects
endothelial
effects mental
[14,113]
mitochondrial
new
hippocampus volume
blood
transport
on
function
slow-twitch
composition
capillaries body [108]
capacity
intestinal [82]
metabolism
regulation
the [30]
volume
[71]
hippocampus
function [46]
between
pressure
[80]
Body
[71][73] and
[90,91]
[105]
function
composition[46]
[103] brain,
immune
regulation
function [14,113]
Improved
[30] function
[103] [90,91] Improved
Increased
Decreased
Lower [113]
Increased
Lower
Counteract
health
Decreased risk
[117],
Increased
Increased
Improved for
risk health
aerobic
overall
strength,
Lower
or
brain
mitigated
risk
aerobic for
aerobic
cognition in
risk people
capacityfor
cardiopulmonary
risk
metabolic
cardiovascular
degeneration
Improved
metabolic
disease for
health
metabolic
capacity
capacity
and [79]
syndromewith
disease
depression
coordination by
[117],
metabolic
[114],
[79]
[71]
cognition
memory Type-2
[109,110],
[116]
and
cardiopulmonary
disease
syndrome/Type-2
disease [77],
diseases
mitigated
syndrome,
[81]
improved
[104],
and diabetes
balance
[92]
syndrome
memory
less [106] disease
diabetes
improved
obesity,
metabolism
Health and[82],
anti-inflammatory
in elderly
metabolic
[81]
medication
[104], age
liver
Effects
less prevention
[92]
[81]
function [74]
[107]
syndrome,
disease,
[115],
[103] effects
and
in in
heart
and
decreased
medication of Typ-2
[111,112]
sickness
disease
obesity,
somerisk
[103] diabetes
[75],
[78]
liver
cancers
for lower[83]
disease,
[115]
depression risk
and for
[116] fall
some cancers [115] Strength
Aerobic
nced Improved
release
Enhancedof blood
signaling
release lipid
substances
of profile
signaling [93]
[84,101]
substances Better
[84,101]sleep
Decreased [102],
Better
risk less
for sleep
anxiety
disease [102], [68],
[114], less treatment
anxiety
improved [68],
of depression
treatment
metabolism of
[31]
[115], depression
decreased [31]
risk for depression
oved
ased
proved
bolism
ased r of peripheral
and
proportion
abolism heart
Improved
skeletal
Increased
signaling
endothelial
intestinal
and
volume
immune
Increased
nerve
substances
slow-twitch
immune
capacity
peripheral
function
skeletal
and
function
function
function
heart
[71]
mineral
volume
[84,101]
[14,113]
[73]
function
capacity
nerve
[71] [98]
[113]
[113]
[71]
function
content
and
Better mineral
[87]
sleep[98] content
Improved
[102],
Lower coordination,
Improved
Increased
Lower
[87]
less
risk
skeletal
Improved
anxiety
risk for
health
strength,
forNo
Lower
coordination,
balance
health
[68],
[117],
cardiovascular
risk
skeletal
[88,
treatment
cardiovascular and
mitigated
coordination
effect on forblood reaction
balance
89]disease
health
of
and
lipid
cardiovascular
disease
[88,
metabolic
balance[98,99],
depression
[77],
profiles
[77],
and
89]
fewer
reaction
especially
[31]
improved
syndrome,
in
in
disease elderly
children
depressions
[77],
[98,99],
functionin
obesity,
[74]
and
fewer and children
especially
heart
inliver
[84,85],
depressions
andin
disease,
sickness
adolescents also
elderly
children
disease
[75],
[97]
in [84,85],and
children[78][100]
lower and
some
also risk
[86]
in for[116]
elderly
cancers fall[100]
children [115]
[76]
[86]
gthening insulin
Improved
the sensitivity
connection insulin [82] sensitivity
between brain, [82] Improved health
Improved
in people health
Improvedwith indisease
Type-2
people
health diabetes
with
[117], Type-2
[82],
mitigated diabetes
prevention
metabolic [82], of prevention
syndrome, Typ-2 diabetes
obesity, ofliver
Typ-2
[83] diabetes
disease,
[96]and some[83]
ovedreased
mation
proved
ased
oved
proved
ve heart
glucose
blood
proportion of
insulinnew
mitochondrial
immuneImproved
glucose
endothelial
effects capacity
transport
capillaries
sensitivity
function
pressure
Positive
on slow-twitch
mental blood
transport
function
effects [71]
volume[80]
[108][71]
[82]
regulation
capacity
on [46]
pressure
fibers
[80]
[71]
mental [90,91]
[105] regulation
[70,71]
capacity [90,91]
[105] Lower
Lower
Increased
Improved
Increased
Decreased
Lower
Lower
Counteract risk
riskriskfor
or
for
risk for
Lower
aerobic
health
aerobic
overall
Lower
or
brain cardiovascular
cardiopulmonary
metabolic
metabolicrisk
capacity
risk
metabolic for
cardiopulmonary
risk
cardiovascular
Counteract
degeneration for
for cardiopulmonary
syndrome/Type-2
capacity
in people [71]
[79]with
disease
syndrome disease
Type-2
[109,110],
cardiopulmonary
disease
syndrome/Type-2
brain disease with
degeneration
by [77],
[77],
diseases in
[92] fewer
elderly
disease
diabetes
diabetes depressions
[94,95]
[81]
[82],
anti-inflammatory
increased disease
diabetes
improved
[106]
by diseases
and inprevention
[92]
exchange
[81]
functionelderly
andofand [84,85],
Alzheimer’s
[94,95]
effects
in gases
heartof also
and
Typ-2
[111,112]
and in
[96]
nutrition
disease children
Alzheimer’s
diabetes
[78] [71,72][86]
[83]
oved
nced
oved
proved
bolismampus
ationeased hippocampus
blood Improved
release lipid
Enhanced
intestinal
body function of
mitochondrial
ofandImproved
new
intestinal
profile
signaling
function
composition
capillaries
immune body
[103]
Improved
hippocampus
function
blood
release
function
[93]
lipid
substances
[30]of
[14,113]
composition
volume
peripheral[71]
function [14,113]
intestinal
[103]
[46]
nerve
[113]
function
profile
signaling function
[93]
[84,101]
[30]
Improved
function [103]
substances [98]
[14,113]
Decreased
Improved
Better
[84,101]
Improved
Lower
cognition sleep
Increased
Increased
No Improved
effect risk
and risk
for for
cognition
Improved
[102],
Better
health
Lower
aerobic
on
disease
and
less
sleep
[117],
metabolic
memory
aerobic
health
blood
No
anxiety
risk
capacity
capacity
[117],
effect
lipid for[114],
cognition
memory
[102],
mitigated
syndrome
[104],
coordination,
cancers
on
improved
[68],
less
metabolic
less
[79]
[71]
mitigated
profiles
blood [115]
in
[104],
and
lipid[81]
medication
balance memory
less
treatment
anxiety
metabolicsyndrome
metabolic
children
profiles
metabolism
and [68],
of
[103]
and [81]age
medication
[104],
depression
syndrome,treatment
reaction
syndrome,
in
less
adolescents
children
[106]
[107]
[115],
[103]
obesity,of
[98,99], decreased
medication
[31]
obesity,
and
depression
[97] liver age
especially
liver
adolescents
[107]
risk
[103]
disease,[31]
in
disease,
for
and
children
[97]
depression
and some and
some
[116][115]
cancers
elderly
cancers [100]
[115]
ased skeletal
heart Increasedvolume
capacity skeletal
heart
[71]and mineral
volume
capacity content
[71]and mineral
[87] content
Improved
Lower [87]
risk skeletal
forImproved
Lower health
cardiovascular
risk skeletal
[88,
forwith 89] health
cardiovascular
disease [88,
[77], 89]
fewer
disease depressions
[77], fewer [84,85],
depressions also in [84,85],
children also [86]
in[96]
children [86]
oved
oved
ased
oved
vereased
gthening
proved
proved eased skeletal
insulin
heart
glucose
proportion the
endothelial
insulin
mitochondrial
immune
effects Improved
Positive
on
hippocampus lipid
volume
sensitivity
connection
capacity
transport
slow-twitch
function
mental function
sensitivity [71]
volume
immune
effects
and
[82]
[80]
[108]
capacity
on
hippocampus
function
profile [73]
[82]
[93]
lipid
mineral
between [71]
[46]
function
mental[105]
[103]
content
brain,
function
profile [108]
capacity
[93]
[87]Improved
[105]
[103]
Improved
Lower
Increased
Lower
Improved
Increased
Decreased
Counteract
Decreased
Improved
riskrisk
or skeletal
health
forLower
for
strength,
aerobic
overall
brain
risk for
cognition
in health
people
cardiopulmonary
risk
cardiovascular
metabolic
health capacity
Decreased
risk
Counteract for
degeneration
Improved disease
and
for
coordination
in [88,
[79]
overall
disease
brain
[114],
cognition
memory
89]
syndrome/Type-2
people with Type-2
cardiopulmonary
disease
disease
and
risk Type-2
[109,110],
for
degeneration
by diseases
improved
[104],
and
diabetes
[77],
balance
disease
memory
less
fewer
diabetes
[106]
by
metabolism
[82],
improved
indiabetes
elderly
indisease[82],
anti-inflammatory
[109,110],
diseases
and
medication
[104],
prevention
[94,95]
age infunction
depressions
elderly
[81]
less
elderly
[74]andand
prevention ofsickness
[84,85],
in
anti-inflammatory
[106]
[107]
[115],
[103] effects
and
decreased
medication
Typ-2
heart
Alzheimer’s
[94,95]
of
age and
also
Typ-2 diabetes
disease
[111,112]
[107]
risk
[103]
[96]
diabetes
effects
for
[78]
Alzheimer’s
in
[75], children[83]
lower
depression
[86]
risk
[83]
[111,112] for fall [76]
[116]
oved
n
proved
oved mentalblood Improved
glucose
intestinal
peripheral
Sports pressure
capacity
Enhanced
endothelial
Improved
2019,
Sports 7,
2019, function
x;
7,nerve
doi:
x; blood
[105]
transport regulation
release
function
peripheral
FOR
doi: FOR pressure
[80]
of
[71]
[14,113]
function
PEERPEER [90,91]
signaling
nerve
[98]
REVIEW
REVIEWregulation
Counteract
substances
function [90,91]
[98] Lower
brain
Lower
[84,101]
Improved
Better risk for
degeneration
risk Lower
or
health
coordination, cardiopulmonary
by
[117],risk
metabolic
Better sleep
cardiovascular for
diseases
mitigated
coordination,
balance cardiopulmonary
and disease
[106]
syndrome/Type-2
[102], less
disease and
anxiety
[77],
metabolic
reaction
balance [92]
age disease
[107]
diabetes
[68],
improved
syndrome,
[98,99],
and
www.mdpi.com/journal/sports treatment
reaction
www.mdpi.com/journal/sports especially[92]
[81]
function
obesity,of
[98,99],in depression
in heart
liver
children
especially [31]
disease
disease,
andin and[78]
elderly
children some
[100]
and cancers
elderly [115]
[100]
oved
bolism body Improved
composition body [30]
composition [30] Lower risk forLower
metabolicrisk for
syndrome
metabolic [81] syndrome [81]
ased
proved
ation
oved eased
gthening
oved eased ofand
skeletal
body
heartnew
insulin
glucose
immune
Sports
immune
Increased
Improved
2019,
volume
composition
capacity
mitochondrial
skeletal volume
capillaries
sensitivity
Strengthening
heartthe connection
capacity
transport
function
7, x;
function
skeletal
[71]and
immune
doi: volume
and mineral
[71]
[82]
the
[71]
volume
[30]
between
[80]
[108]
FOR
[113]
[46]
mineral
connection
function
PEER
content
and
content
brain,
REVIEW
mineral
[87]
between
[108]
No
[87]brain, effect
content
Improved
Lower
Lower
Increased
Improved
Increased
Improved
Lower
Lower
Decreased
risk
risk
on
[87]
risk blood
forNo
skeletal
for
aerobic
aerobic
health
risk
or for
effect
Improved
in lipid
health
metabolic
cardiovascular
skeletal capacity
metabolic
overall
Decreased peopleon
profiles
capacity
health
cardiovascular
risk
blood
skeletal
[88,
[71]89]
syndrome
with
syndrome/Type-2
foroverall
disease
in
lipid
disease
[79]
[88, 89] children
health
Type-2
disease
risk
profiles
[88,
[81]
[77],
[109,110],diabetes
[77],
formemory
and
89]
fewer in adolescents
fewer
diabetes
disease
children
depressions
[82],
[81]
anti-inflammatory
www.mdpi.com/journal/sports [109,110],
and[97]
prevention
depressions
adolescents
[84,85], also
of Typ-2
[84,85],
anti-inflammatory
effects also
[97]
in children
diabetes
[111,112] in children
effects [83][86]
[86]
[111,112]
ne ve effects
function Positive
on mental
[108] effects capacity
on mental[105] capacity
Decreased [105] Lower
Counteract
overall
Decreased risk
risk for
for
riskLower
brain cardiopulmonary
Counteract
disease
Decreased
for risk
degeneration for
brain
[109,110],
disease risk cardiopulmonary
[114],
for disease
degeneration
by diseases indiabetes
anti-inflammatory
disease
improved [114],elderly
[106]
by disease
metabolism [94,95]
diseases
and
improved age
effectsin elderly
and
[106]
[107]
[115],
metabolismAlzheimer’s
and
[111,112] [94,95]
decreased age and
[107]
[115],
risk [96]
Alzheimer’s
decreased
for depressionrisk [96]
for
[116]
depression
proved
ased
nced
oved
oved
bolism
proved
ased
insulin
blood
body
and
Improved
mitochondrial
release
Enhanced
intestinal
peripheral
Improvedof
lipid sensitivity
function
pressure
Improved
blood
skeletal nerve
composition
metabolism
immune
hippocampus
signaling volume
release
peripheral
profile
pressure
volume blood
body and
[82]
[93]
lipid
regulation [46]
substances
of
[14,113]
function
pressure
[30]
function
and composition
immune
regulation
mineral nervefunction
signaling
[98]
profile
[90,91]
[113] [84,101]
[93]
regulation
[30]
function
[90,91]
content
[103]
substances
function [98]
[90,91]
[113]
[87]
Improved
Increased
Better
[84,101]
Improved
Lower
Improved
sleep health
coordination,
risk for Improved
aerobic
[102],
Better
health
Lower
for
skeletal
in
less people
capacity
sleep
[117], cognition
anxiety
coordination,
balance
cardiopulmonary
metabolicrisk for [79]
[102],
mitigated with
and
syndrome
cardiopulmonary
health [88,
[68],
less
metabolic
89]
Type-2
and
treatment
anxiety
metabolic
reaction
balance
cardiopulmonary
disease
[81] [68],
[98,99],
and
[92]
syndrome
disease [92]
of [82],
[104],
depression
syndrome,treatment
reaction less
especially
disease
[81]
prevention
medication
obesity,of
[98,99],
[92] [31]
in depression
liver
children of
especially Typ-2
[103]
disease,
and[31]
in diabetes
and
elderly
children some [83]
[100]
and cancers
elderly [100] [116]
[115]
proved
oved
ased
oved 7, x;
eased
gthening glucose
doi: FOR
body
endothelial
heart
skeletal
insulin PEER
capacity transport
Sports
REVIEW
composition
function
volume
sensitivity
Strengthening
the connection [71] 2019,
and[80]
[82]
the 7,
[30]
[71] x; doi:
mineral
between
connection FOR PEER
content
brain, betweenREVIEW
[87] No Lower
Lowereffect
Improved
Improved
brain, riskrisk
on foror
for
blood
No metabolic
metabolic
cardiovascular
effect
skeletal
health in lipid on
health
people syndrome/Type-2
www.mdpi.com/journal/sports
syndrome
profiles
blood
[88,
withdisease
in
89]lipid [81]
[77],
children
Type-2 profiles
diabetes diabetes
improved
fewer
and in [81]
www.mdpi.com/journal/sports
function
depressions
adolescents
children
[82], and
prevention in
[97] heart
[84,85],
adolescents
of disease
also
Typ-2 in
[97]
diabetes [78]
children [83][86]
eeased
oved connection
immune
SportsImproved
heart 2019,
Positive between
function
7, x;
capacity immune
doi:
effects brain,
[108]
FOR
[71] on function
PEER
mental REVIEW [108] [103]
capacity [105] Decreased
Lower overall
risk Decreased
for risk foroverall
cardiovascular
Counteract disease
brain risk[109,110],
formemory
disease anti-inflammatory
www.mdpi.com/journal/sports
disease
degeneration [77], fewer
by [109,110],
depressions
diseases anti-inflammatory
[106] effects
and[84,85], [111,112]
also effects
in children [111,112]
[86]
oved
nced
oved
oved
bolism
proved
glucose
hippocampus
blood
body
and
Improved
release
Enhanced
intestinal
Improved transport
of signaling
function
pressure
composition
metabolism
peripheral
insulin
blood immune
Improved
lipid nerve
release
blood
sensitivity
profile
[80]
hippocampus
function
intestinal
regulation
function
and
peripheral
blood
[103]
substances
of
[14,113]
pressure
[30]
immune
function
[82]
[93]
lipid
function
signaling
function
[90,91]
[113]
nerve
[98]
[84,101]
function
profile
substances
Decreased
[14,113]
regulation
function
[93] [113]
[98]
Lower
Decreased
Improved
Lower
Better
risk [84,101]
Improved
[90,91] Lower
Lower
Better
Improved
risk
risk
sleep
risk
or
risk
health
risk
for
metabolic
Decreased
for
cognition
forImproved
Lower
[102],
forcoordination,
disease Better
Improved
for
Lower
Better
health
disease
and
cardiopulmonary
less
[114],
[117],risk
sleep syndrome/Type-2
risk
for
anxiety
improved [114],
cognition
memory
mitigated
cardiopulmonary
metabolicrisk health
cardiopulmonary
for
coordination,
balance
in people
for
and
improved
[117],
with
[104],
and
cardiopulmonary
[102], [68],disease
less treatment
anxiety
metabolism
metabolic
cardiopulmonary
syndrome disease indiabetes
[114],
less
mitigated
disease
[81]
reaction
balance
Type-2 [92]metabolism
in improved
medication
elderly [104],
disease
[68],
of
[115],
syndrome,
[98,99],
and
diabetes
[81]
metabolic
elderly
disease
reaction
less
[94,95]
depression
treatment
decreased
especially
[82],
in[115],
metabolism
[103]
medication
elderly
and
obesity,
[94,95]
[92] of
[31]
syndrome,
[98,99], and
in
prevention forage
decreased
Alzheimer’s
[94,95]
depression
risk liver
children
especially
of
[107]
[115],
risk
[103]
and
disease,
obesity,
Alzheimer’s and
Typ-2in
decreased
[31]
depression for
[96]and
liver
[96]
elderly
children
depression
Alzheimer’s
[116]
diabetes some risk
disease,
[100]
and
for
[96][116]
cancers
[83] and depression
elderly some
[115] [116]
[100]cancers [115]
ased
proved
ased mmune
gthening blood
mitochondrial
skeletal
body
heart
Sports function
blood pressure
volume
capacity
lipid
Strengthening
the
2019, connection
7, x; doi: volume
[113]
composition [71]and
profile
FOR regulation
the
PEER [46]
mineral
[30]
[93]
between
connection
REVIEW [90,91]
content
brain, [87]
between Lower
Increased
Improved
Lower
Lower
brain, riskriskforfor
aerobic
skeletal
risk for cardiopulmonary
capacity
health
metabolic
cardiovascular [79]
[88, 89]
syndrome
disease disease
[81]
[77], [92]
fewer
www.mdpi.com/journal/sports depressions [84,85], also in children [86]
oved eased
ve effects
oved skeletal
Improved
insulin
SportsPositive
on mental
hippocampus
Improved volume
sensitivity
2019, 7, x; immune
doi:
effects and
[82]
FOR
capacity
on
hippocampus
function mineral
function
PEER
mental REVIEW
[105]
[103] content
[108]
capacity
function [87] No
[105]Lower
[103] effect
Improved
Improved
No effect
Counteract
Decreased
Improved on blood
No
health
onLower
brain
risk effect
skeletal
Decreased
in
blood lipid
Counteract
cognition peopleon
health
lipidprofiles
degeneration
Decreased
for
Improved disease
and blood
brain
risk [88,
overall
with
profiles
[114],
cognition
memory in
89]lipid
risk children
Type-2 for
degeneration
by
for[117], profiles
diseases
disease
improved
[104],
and disease
diabetesand
[106]
[114],
memory
less byin
www.mdpi.com/journal/sports
in mitigated
children and
metabolismadolescents
children
[109,110],
[82],
improved
medication adolescents
diseases
and
[104], age
less and
[106]
[107]
[115], [97]
adolescents
anti-inflammatory
prevention
metabolism
[103] [97]
and of
decreased
medication Typ-2
age [107]
[115], [97] effects
diabetes
riskdecreased
[103] for [111,112]
[83]
depressionrisk for
[116]
depression [116][115]
oved intestinal
Improved functionintestinal[14,113]
of function [14,113] Improved risk for
health cardiopulmonary
Improved
[117],risk for
mitigated
health cardiopulmonary
disease
metabolic in inelderly
ofdisease
syndrome, [94,95]
metabolic in elderly
and
obesity,
syndrome,Alzheimer’s
[94,95]
liver and [96]
Alzheimer’s [96]
nced
nal
bolism
oved
proved eased blood
release
heart
function
glucose
and
body
blood
blood pressure
Enhancedof signaling
capacity
[14,113]
transport
metabolism
immune
composition
Improved
lipid profile
pressure regulation
release
[71]
and
blood [80]
function substances
immune
[30]
[93]
lipid
regulation [90,91]
signaling
[113] [84,101]
substances
Improved
function
profile
[90,91] [93] [113] healthLower
Lower
Better
[84,101]
Lower
Lower risk
sleep
[117],
riskrisk
for
or
risk for
[102],
Bettercardiopulmonary
cardiopulmonary
mitigated
for less
metabolic
for sleep
metabolic anxiety
cardiovascular [102],
metabolic [68],
syndrome/Type-2
syndrome
cardiopulmonary less disease
disease
treatment
anxiety
disease
syndrome,
[81]
disease [92]
[77], elderly
[68],
fewer
obesity,
diabetes
[92] [94,95]
depression
treatment
depressions
liver
[81] ofand
[31]
disease, anddisease,
depression
[84,85], obesity,
Alzheimer’s [31]
also
some inand
liver
[96] some
disease,
children
cancers [115] cancers
[86] and some
[115] cancers
Sports 2019, 7, 127 8 of 28

5.1. Effects on Physical Health

The effects of physical activity and exercise are both acute (during and immediately after) and
long-lasting. Effects remaining after a long period of regular physical activity have far-reaching
consequences for health and are described below. For example, some muscle enzymes’ activity can
be quickly increased by physical exercise/training but just as quickly be lost when idle [118]. Other
changes remain for months or years even if training ends—for instance, increased number and size of
muscle fibers and blood vessels [49,119,120]. Good health, therefore, requires physical activity to be
performed with both progression and continuity. Most of the conducted physical exercise/training is a
combination of both aerobic and muscle strengthening exercise, and it can be difficult to distinguish
between their health effects (Table 2).
To describe ill-health, indicators of life expectancy, disease incidence (number), and prevalence
(how often) are used [121]. In describing the relationship between physical activity and falling ill
with certain diseases, the dose–response relationship, the effect size (the risk reduction that is shown
in studies), and the recommended type and dose of physical activity are considered [122]. Table 3
shows the relative effects of regular physical activity ton the risk of various diseases (US Department
of Human Services, 2009). The greatest health gains are for people who move from completely
sedentary to moderately active lifestyles, with health effects seen before measurable improvements in
physical performance. Previously, most scientific studies collected data only on aerobic physical activity.
However, resistance exercise also shows promising health (mental and physical) and disease-prevention
effects [123–127].
Aerobic physical activity has been shown to benefit weight maintenance after prior weight loss,
reduce the risk of metabolic syndrome, normalize blood lipids, and help with cancer/cancer-related
side effects (Tables 2 and 3), while effects on chronic pain are not as clear [29].
Muscle-strengthening physical activity has, in contrast to aerobic exercise, been shown to reduce
muscle atrophy [128], risk of falling [75], and osteoporosis [74] in the elderly. Among the elderly, both
men and women adapt positively to strength training [129]. Strength training also prevents obesity [130],
enhances cognitive performance if done alongside aerobic exercise [131], counteracts the development
of neurodegenerative diseases [132–134], reduces the risk of metabolic syndrome [135], counteracts
cancer/cancer-related side effects [135,136], reduces pain and disability in joint diseases [137], and
enhances bone density [137,138]. The risk of falling increases markedly with age and is partly a result of
reduced muscle mass, and reduced coordination and balance [76,139,140]. A strong correlation between
physical performance, reduced risk of falls, and enhanced quality of life is therefore, not surprisingly,
found in older people [141]. Deterioration in muscle strength, but not muscle mass, increases the risk
of premature death [142] but can be counteracted by exercise as a dose–response relationship describes
the strength improvement in the elderly [122,143]. Recommendations state high-intensity strength
training (6–8 repetitions at 80% of 1-repetition maximum) as most effective [144]. Muscle strengthening
physical activity for better health is recommended as a complement to aerobic physical activity [29].
Amongst the elderly, vibration training can be an alternative to increase strength [145].
Sports 2019, 7, 127 9 of 28

Table 3. Disease prevention effects of regular physical activity.

Recommendations for Physical Dose-Response Differences between Sex,

Health Condition Risk Reduction1 or Health Improvement
Activity2 Relationship Age, Ethnicity etc.
All-cause mortality 30% (44% elderly) General recommendations Yes No
Cardiovascular disease 20%–35% General recommendations Yes Insufficient evidence
Metabolic syndrome 30%–40% General recommendations Yes No
General recommendations, data
Type-2 diabetes 25%–42% Yes Insufficient evidence
primarily on aerobic PA
Brain cancer: Limited evidence2 ; Breast
cancer: 20%; Bladder cancer: 13%–15%;
Breast cancer: Weaker
Colon cancer: 30%; Endometrial cancer:
evidence for Hispanic and
17%–35%;
Black women.
Esophageal cancer3 : 6%–21%; Gastric Renal & thyroid cancer:
Gastric cancer: Weaker
cancer: 19%; Head & neck cancers: No.
evidence for women
15%–22%, limited evidence; Hematological General recommendations, data Lung, hematological, head
Cancer Renal cancer: Weaker
cancers: No-low effect, limited evidence3 ; primarily on aerobic PA and neck cancers: Limited
evidence for Asians
Lung cancer: 13%–26%; Ovarian cancer: evidence.
Lung cancer: Greater effect
Limited/conflicting evidence; Pancreatic & Other; Yes.
for women
prostate cancer: Limited evidence; Renal
Other: Limited evidence/No
cancer: 11%–23%; Rectal cancer: No risk
known difference
reduction, limited evidence; Thyroid
cancer: No risk reduction
Overweight and obesity PA alone, without diet intervention only General recommendations,
Yes No
(weight loss) has an effect at large volume combined with diet interventions
Overweight and obesity General recommendations,
PA supports weight maintenance Limited evidence Insufficient evidence
(weight maintenance) stronger evidence for aerobic PA
Hip fracture: Largest effect
General recommendations
36%–68% for hip fracture in elderly women
Skeletal health including muscle- strengthening Yes
1%–2% increased bone density Bone density: Largest effect
physical activity
in women
Magnitude is highly variable and
Muscle mass Weight bearing activity Yes Decreased effect with age
mode-dependent
Sports 2019, 7, 127 10 of 28

Table 3. Cont.

Recommendations for Physical Dose-Response Differences between Sex,

Health Condition Risk Reduction1 or Health Improvement
Activity2 Relationship Age, Ethnicity etc.
30% increased chance to counteract or General recommendations
Functional Increased functional
postpone a decrease in functional including muscle- and Functional health: Yes
strength/capacity capacity mostly seen in
strength/capacity skeletal-strengthening physical Falls: No/unclear
(middle age and older) older adults ages 65 or more.
30% lower risk of falls activity
Depression 20%–30% lower General recommendations Yes No
Improved quality, sleep onset latency and
Sleep General recommendations No No
total sleep time
Distress 20%–30% lower General recommendations No No
Dementia 20%–30% lower General recommendations No No
Insufficient evidence for
Improved for preadolescent children and
Cognition General recommendations Conflicting findings adolescents and adults.
adults aged 50 years or older
Ethnicity: No.
Compiled from US Department of Health and Human Service, https://health.gov/paguidelines/report/ [62,146] 1 : Risk reduction refers to the relative risk in physically active samples in
comparison to a non-active sample, i.e., a risk reduction of 20% means that the physically active sample has a relative risk of 0.8, compared to the non-active sample, which has 1.0. 2 : In
general, general recommendations for PA that are described and referred to herein apply to most conditions. However, in some cases, more specific recommendations exist, more in
depth described by the US Department of Health and Human Service, amongst others [62]. 3 : Evidence is dependent on cancer subtype; refer to US Department of Health and Human
Service [62] for in-depth guidance. PA = Physical.
Sports 2019, 7, 127 11 of 28

5.2. Effects on Mental Health

Mental illness is a global problem affecting millions of people worldwide [147]. Headache, stress,
insomnia, fatigue, and anxiety are all measures of mental ill health. The term “ill health” constitutes a
collection of several mental health problems and symptoms with various levels of seriousness. Studies
have compared expected health benefits from regular physical activity for improvement of mental
health with other treatments, for example, medication. Most recent studies show that physical activity
and exercise used as a primary, or secondary, processing method have significant positive effects
in preventing or alleviating depressive symptoms [31,148–151] and have an antidepressant effect in
people with neurological diseases [152]. Training and exercise improve the quality of life and coping
with stress and strengthen self-esteem and social skills [69,153]. Training and exercise also lessen
anxiety in people who are diagnosed with an anxiety- or stress-related disease [68], improve vocabulary
learning [154], memory [155,156], and creative thinking [157].
The same Swedish data as used in Figure 1 show that between the years 2004–2007 and 2012–2015
anxiety, worry, and insomnia decreased but were not obviously correlated to the slightly increased
level of physical activity in the population during the same period. Thus, in a multifactorial context,
the importance of physical exercise alone cannot be demonstrated in this dataset.
Some of the suggested physiological explanations for improved mental health with physical
activity and exercise are greater perfusion and increased brain volume [107,158], increased volume of the
hippocampus [106], and the anti-inflammatory effects of physical activity, reducing brain inflammation
in neurological diseases [159]. Physical exercise may also mediate resilience to stress-induced depression
via skeletal muscle peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α),
enhancing kynurenine conversion to kynurenine acid, which in turn protects the brain and reduces the
risk for stress-induced depression [153]. Further, increased release of growth factors, endorphins, and
signaling molecules are other exercise-induced enhancers of mental health [69].

6. How Sport Affects Health

Sport’s main purposes are to promote physical activity and improve motor skills for health and
performance and psychosocial development [56]. Participants also gain a chance to be part of a
community, develop new social circles, and create social norms and attitudes. In healthy individuals,
and patients with mental illness, sport participation has been shown to provide individuals with
a sense of meaning, identity, and belonging [160,161]. Whether the sport movement exists or not,
training and competition including physical activity will happen. Sport’s added values, in addition to
the health benefits of physical activity, are therefore of interest. Some argue that it is doubtful, or at least
not confirmed, that health development can come from sport, while others believe that healthy sport
is something other than health, reviewed in depth by Coakley [162]. In a sporting context, health is
defined as subjective (e.g., one feels good), biological (e.g., not being sick), functional (e.g., to perform),
and social (e.g., to collaborate) [163]. Holt [56] argued that the environment for positive development
in young people is distinctly different from an environment for performance, as the latter is based on
being measured and assessed. That said, certain skills (goal setting, leadership, etc.) can be transferred
from a sporting environment to other areas of life. The best way to transfer these abilities is, at the
moment, unclear.
Having the goal to win at all costs can be detrimental to health. This is especially true for
children and adolescents, as early engagement in elite sports increases the risk of injury, promotes
one-dimensional functional development, leads to overtraining, creates distorted social norms, risks
psychosocial disorders, and has the risk of physical and psychological abuse [15,164]. Of great
importance, therefore, is sport’s goal of healthy performance development, starting at an early age. For
older people, a strong motivating factor to conduct physical activity is sports club membership [165].
One can summarize these findings by stating sport’s utility at the transition between different stages of
the life; from youth to adulthood and from adulthood to old age. There, sports can be a resource for
good physical and mental health [166].
Sports 2019, 7, 127 12 of 28

Sports 2019, 7, x FOR PEER REVIEW 2 of 29

Today, a higher proportion of the population, compared to 50 years ago, is engaged in organized
sports, and tostages of the
a lesser life; from
extent youth to spontaneous
performs adulthood and from adulthood
sports (Figure to old
3), age. There, sports
something thatcan be a
Engström showed
resource for good physical and mental health [166].
in 2004 [17] and Today,
is confirmed by dataof from
a higher proportion The Swedish
the population, comparedSports
to 50 yearsConfederation (www.rf.se). Commented
ago, is engaged in organized Of the [M83]: incorrect ref order
87. You jumped the numbers in between
surveyed individuals
sports, and toina 2001, 50%–60%
lesser extent performs ofspontaneous
children and sportsyoung people
(Figure 3), said
something they
that were active in a
Engström
showed
sports club. The in 2004
trend has [17]continued
and is confirmed by datasimilar
showing from The progression
Swedish Sports Confederation
to 2011, with (www.rf.se).
up to 70% of school
Of the surveyed individuals in 2001, 50%–60% of children and young people said they were active in
students playing sports
a sports club. Theintrend
a club. Furthermore,
has continued showing the study
similar shows
progression that with
to 2011, those active
up to 70% ofin sport clubs also
school
spontaneously do more
students playingsports
sports in[167]. Similar data
a club. Furthermore, fromshows
the study the that
yearsthose2007–2018,
active in sportcompiled
clubs also from open
sources at Thespontaneously
Swedish Sports do moreConfederation,
sports [167]. Similarconfirm
data fromthethe trend
years 2007–2018,
with ancompiled
even higherfrom open Commented [M84]: incorrect ref order
share of youths
sources at The Swedish Sports Confederation, confirm the trend with an even higher share of youths
participatingparticipating
in organized sports,sports,
compared toto1968 and2001
2001 (Figure 4). 87. You jumped the numbers in between
in organized compared 1968 and (Figure 4).

Commented [M85]: incorrect ref order

Figure 3. Spontaneous sport has decreased over the last decades, to the advantage of organized sport. 87. You jumped the numbers in between
Figure 3. Spontaneous sport has decreased over the last decades, to the advantage of organized
Data compiled from Engström, 2004, The Swedish Research Council for Sport Science.
sport.
Sports 2019,
Data compiled 7, x FOR
from PEER REVIEW
Engström, 2004, The Swedish Research Council for Sport Science. 3 of 29 Commented [M86]: incorrect ref order
Taking part in sports can be an important motivator for physical activity for older people 87. You jumped the numbers in between
[165,166]. With aging, both participation in sports (Figure 4) and physical activity in everyday life
[168] decreases. At the same time, the number of people who are physically active both in leisure and Commented [M87]: incorrect ref order
in organized sports increases (The Public Health Agency of Sweden 2017; 87. You jumped the numbers in between
www.folkhalsomyndigheten.se). Consequently, among elderly people, a greater proportion of the
Commented [M88]: incorrect ref order
physical activity occurs within the context of sport [8,28]. Together, research shows that organized
sports, in clubs or companies, are more important for people’s overall physical activity than ever 87. You jumped the numbers in between
before. Groups that are usually less physically active can be motivated through sport—for example, Commented [M89]: incorrect ref order
elderly men in sport supporters’ clubs [169], people in rural areas [170], migrants [171], and people
87. You jumped the numbers in between
with alternative physical and mental functions [172]. No matter how you get your sporting interest,
it is important to establish a physical foundation at an early age to live in good health when you get Commented [M90]: incorrect ref order
older (Figure 5). As seen in Figure 5, a greater sport habitus at age 15 results in higher physical activity 87. You jumped the numbers in between
at 53 years of age. Early training and exposure to various forms of sports are therefore of great
importance. Participation creates an identity, setting the stage for a high degree of physical activity Commented [M91]: incorrect ref order
later in life [173]. 87. You jumped the numbers in between

Commented [M92]: incorrect ref order

87. You jumped the numbers in between

Figure 4. Data compiled

Figure from open
4. Data compiled sources
from open report
sources Sport
report Sport Statistics
Statistics (Idrotten
(Idrotten i siffror)
i siffror) at at The Swedish
The Swedish
Sports Confederation
Sports Confederation for the2011
for the year year 2011 (www.rf.se).
(www.rf.se).

Taking part in sports can be an important motivator for physical activity for older people [165,166].
With aging, both participation in sports (Figure 4) and physical activity in everyday life [168] decreases.
At the same time, the number of people who are physically active both in leisure and in organized sports
increases (The Public Health Agency of Sweden 2017; www.folkhalsomyndigheten.se). Consequently,
among elderly people, a greater proportion of the physical activity occurs within the context of
sport [8,28]. Together, research shows that organized sports, in clubs or companies, are more important
Sports 2019, 7, 127 13 of 28

for people’s overall physical activity than ever before. Groups that are usually less physically active
can be motivated through sport—for example, elderly men in sport supporters’ clubs [169], people
in rural areas [170], migrants [171], and people with alternative physical and mental functions [172].
No matter how you get your sporting interest, it is important to establish a physical foundation at an
early age to live in good health when you get older (Figure 5). As seen in Figure 5, a greater sport
habitus at age 15 results in higher physical activity at 53 years of age. Early training and exposure to
various forms of sports are therefore of great importance. Participation creates an identity, setting the
Figure 4. Data compiled from open sources report Sport Statistics (Idrotten i siffror) at The Swedish
stage for a high degree of physical activity later in life [173].
Sports Confederation for the year 2011 (www.rf.se).

Figure 5. OddsFigure 5. Odds

ratio (OR)ratio
of(OR) of physical
physical activityat
activity at age
age 53
53inin
relation to Sport
relation to habitus
Sport athabitus
age 15. Sport
at age 15. Sport
habitus (“the total physical capital"), including cultural capital, athletic diversity, and grades in
habitus (“the total physical capital"), including cultural capital, athletic diversity, and grades in physical
physical education and health are, according to Engström [173], the factors most important for being Commented [M93]: incorrect ref order
education and health active
physically are, according to Engström
in later life. For [173], on
a further discussion thesport
factors most
habitus, the important for being
readers are referred to physically
87. You jumped the numbers in between
active in later life. For
Engström, a further
2008 discussion
[173]. Numbers on show
above bar sportthehabitus, the readers
95% confidence interval.are
** =referred
significantto Engström,
difference from “Very low”, p < 0.01. *** = p < 0.001.
2008 [173]. Numbers above bar show the 95% confidence interval. ** = significant difference from Commented [M94]: incorrect ref order

“Very low”, p < 0.01. = the

***on p <Health
0.001.of Children and Young People 87. You jumped the numbers in between
7. Sport’s Effects

7. Sport’s EffectsThe
oneffects of participation in organized sports for children and young people are directly linked
the Health of Children and Young People
to physical activity, with long term secondary effects; an active lifestyle at a young age fosters a more
The effects of participation in organized sports for children and young people are directly linked
to physical activity, with long term secondary effects; an active lifestyle at a young age fosters a more
active lifestyle as an adult. As many diseases that are positively affected by physical activity/exercise
appear later in life, continued participation in sport as an adult will reduce morbidity and mortality.
It must be emphasized that good physical and mental health of children and young people
participating in sport requires knowledge and organization based on everyone’s participation. Early
specialization counteracts, in all regards, both health and performance development [174,175].

7.1. Positive Aspects

According to several reviews, there is a correlation between high daily physical activity in
children and a low risk for obesity, improved development of motor and cognitive skills, as well
as a stronger skeleton [176,177]. Positive effects on lipidemia, blood pressure, oxygen consumption,
body composition, metabolic syndrome, bone density and depression, increased muscle strength, and
reduced damage to the skeleton and muscles are also described [178,179]. If many aspects are merged
in a multidimensional analysis [8,173], the factors important for future good health are shown to be
training in sports, broad exposure to different sports, high school grades, cultural capital, and that one
takes part in sport throughout childhood (Table 4).
Sports 2019, 7, 127 14 of 28

Table 4. Compiled health profiles for men and women at the age of 20 years, depending on participation
in organized sports at the age of 5, 7, 8, 10, 14, and 17 years.

Girls Boys
Physical Activity at Age 20 Years
Sport Participation as Young
Participate Quit Never Participate Quit Began late

ò ò

ò ò
Medium/Intense physical activity

ò ò
Current MET ⇔ ⇔ ⇔
Body stature ⇔ ⇔ ⇔ ⇔ ⇔ ⇔
Body weight ⇔ ⇔ ⇔ ⇔ ⇔ ⇔

ò ò ò
Fat (%) ⇔ ⇔ ⇔

ò
ò ò ò

ò ò ò

ò ò
Fat free mass (kg)

ò ò ò

ò ò
Fat free mass index (kg·m-2 )
Physical health (SF-12) ⇔ ⇔ ⇔
Mental health (SF-12) ⇔ ⇔ ⇔ ⇔ ⇔ ⇔

ò
Depression (DASS-21) ⇔ ⇔ ⇔ ⇔ ⇔
Anxiety (DASS-21) ⇔ ⇔ ⇔ ⇔ ⇔ ⇔
Stress (DASS-21) ⇔ ⇔ ⇔ ⇔ ⇔ ⇔
Classification with repeated latent class analysis creates three groups for girls and boys, respectively: Children who
never participated (girls only), participated, quit prematurely, or began late (only boys) in sports. Arrows indicate
whether participation in sports at young age has an effect on health at 20 years of age. Green up arrow is positive,
red down arrow negative, and a horizontal black double arrow shows that sport had no significant effect. Modified
from Howie et. al., 2016 [8].

Psychological benefits of sports participation of young people were compiled by Eime et al. [1],
where the conclusion was that sporting children have better self-esteem, less depression, and better
overall psychosocial health. One problem with most of these studies, though, is that they are
cross-sectional studies, which means that no cause–effect relationship can be determined. As there is a
bias for participating children towards coming from socially secure environments, the results may be
somewhat skewed.

7.2. Negative Aspects

As Tables 4 and 5 show, there are both positive and negative aspects of sports. Within children’s
and youth sports, early specialization to a specific sport is a common phenomenon [175]. There is
no scientific evidence that early specialization would have positive impact, neither for health nor
for performance later in life [175]. No model or method including performance at a young age can
predict elite performance as an adult. By contrast, specialization and competitiveness can lead to
injury, overtraining, increased psychological stress, and reduced training motivation, just to mention
a few amongst many negative aspects [174,175]. Another important aspect is that those who are
excluded from sports feel mentally worse [8]. As there is a relationship between depressive episodes in
adolescence, and depression as adults [116], early exclusion has far-reaching consequences. Therefore,
sports for children and young people have future health benefits by reducing the risk of developing
depression and depressive symptoms, as well as improved wellbeing throughout life.
While some degree of sport specialization is necessary to develop elite-level athletes, research
shows clear adverse health effects of early specialization and talent selection [180]. More children born
during the fall and winter (September–December) are excluded [181], and as a group, they are less
physically active than spring (January–April) children, both in sports and leisure (Figure 6). In most
sports and in most countries, there is a skewed distribution of participants when sorted by birth-date,
and there are more spring children than fall children among those who are involved in sport [182–186].
Because a large part of the physical activity takes place in an organized form, this leads to lower
levels of physical activity for late-born persons (Malm, Jakobsson, and Julin, unpublished data). Early
orientation and training in physical activity and exercise will determine how active you are later in
Sports 2019, 7, 127 15 of 28

life. Greater attention must be given to stimulating as many children and young people as possible to
participate in sport as long as possible, both in school and on their leisure time. According to statistics
from the Swedish Sports Confederation in 2016, this relative-age effect persists throughout life, despite
more starting than ending with sport each year [18].
When summarize, the positive and negative aspects of sport at a young age can be divided into
three categories: (1) Personal identification, (2) social competence, and (3) physiological capacity,
briefly summarized in Table 5. A comprehensive analysis of what is now popularly known as “physical
literacy” has recently been published [187].

Table 5. Positive and negative aspects with sport (at young age).

Aspect Positive Negative

Emotional fatigue
Better self-esteem One-dimensional identity
Better academic results Risk of abuse
That endurance and hard work pay off Increased stress
Independence and responsibility Injuries
Making wise decisions Temptation for doping
Keep a positive attitude Fear of punishment
Manage stress Fear of failure
Set clear goals Feeling pressure from the surroundings
Higher assessment of skills Fear of disappointing surroundings
Personal
Higher working standards Risk of burnout
Better discipline Risk of overtraining
Late alcohol store Poor sleep
Lower alcohol consumption (in most sports) Decrepit
Less drugs Repeated infections
Greater social capital Risk of self-sacrifice
Better relationships with adults Risk of self-injury
Uses TV/PC less Increased risk of destructive decisions
Lower risk of school dropout (doping, cheating etc.)
Risk of depression in case of rejection
The usefulness of teamwork
Good communication
Larger contributions to society later in life
Larger contributions to the family later in
life Less integrated with the family
Social
Lower crime Social isolation from other society
Opportunity in developing countries
Increased chance of being active in sports
clubs as older
Easier to reach with education
Greater physical literacy
Physical fatigue
Abilities to live a healthy life as adult and
Increased injury risk
elderly
Risk of eating disorders
Less smoking
Overtraining
Less drugs
Temptation for doping
Physiological Lower body fat
Risk of abuse (physical and mental)
Larger muscle mass
Unilateral training and development
Beneficial metabolism
For Para athletes, injury can be a double
Higher aerobic and anaerobic capacity
handicap
Lower risk for fractures as older
Worse oral health
Reduced general disease risk
Sports 2019, 7, 127 16 of 28
Sports 2019, 7, x FOR PEER REVIEW 7 of 29

Figure 6. TheFigure
figure shows
6. The figure the distribution
shows ofof7597
the distribution children
7597 children aged
aged 10 and
10 years years andwho
younger younger
in 2014 who in 2014
were registered as active in one particular, individual sport in Sweden (data compiled from the
were registered as active in one particular, individual sport in Sweden (data compiled from the Swedish
Swedish Sport Confederation, www.rf.se). Spring, Summer, and Fall represent January–April, May–
Sport Confederation,
August, and www.rf.se). Spring,
September–December, Summer, and Fall represent January–April, May–August,
respectively.
and September–December, respectively.
7.3. Relevance of Sports
7.3. Relevance of Sports
Sports can make children and young people develop both physically and mentally and
contribute with health benefits if planned and executed exercise/training considers the person’s own
Sports can make children and young people develop both physically and mentally and contribute
capacities, social situation, and biological as well as psychological maturation. In children and
with health benefits if itplanned
adolescents, and
is especially executed
important exercise/training
to prevent considers
sports-related injuries the person’s
and health problems, asowna capacities,
number of these problems are likely to remain long into adulthood,
social situation, and biological as well as psychological maturation. In children and adolescents, sometimes for life. it is [M112]: incorrect ref orde
Commented
Comprehensive training is recommended, which does not necessarily mean that you have to
especially important to prevent sports-related injuries and health problems,
participate in various sports. What is required is diverse training within every sport and club.as a number of
87.these
You jumped the numbers in between
problems areResearch
likely toshows remain long into adulthood,
that participation in various sportssometimes for life.
simultaneously Comprehensive
during childhood and training is [M113]: incorrect ref orde
Commented
recommended, adolescence is mostnot
which does favorable for healthy
necessarily and lifelong
mean participation
that you have to[8,173,188,189].
participate in various sports. What is 87. You jumped the numbers in between
required is diverse
8. Sport’straining
Effects onwithin every
the Health sport
of Adults andand
the club.
ElderlyResearch shows that participation in various Commented [M114]: incorrect ref orde
sports simultaneously during childhood and adolescence is most favorable for healthy
Adults who stop participating in sports reduce their physical activity and have health risks equal and lifelong
87. You jumped the numbers in between
participationto[8,173,188,189].
people who have neither done sports nor been physical [190,191]. Lack of adherence to exercise
Commented [M115]: incorrect ref orde
programs is a significant hindrance in achieving health goals and general physical activity
recommendations in adults 87. You jumped the numbers in between
8. Sport’s Effects on the Health ofand the elderly
Adults and[192].
theWhile several socioeconomic factors are related to
Elderly
exercise adherence, it is imperative that trainers and health care providers are informed about factors
Commented [M116]: incorrect ref orde
Adults that
whocanstop be modulated, such as in
participating intervention intensity their
sports reduce (not to physical
high), duration (not too
activity andlong), and health risks
have 87. You jumped the numbers in between
supervision, important for higher adherence, addressed more in depth by Rivera-Torres, Fahey and
equal to people who have neither done sports nor been physical [190,191]. Lack of adherence to
Rivera [192]. Commented [M117]: incorrect ref orde
exercise programs is a aging
Healthy significant hindrance
is dependent in achieving
on many factors, such as thehealth
absence goals and
of disease, general
good physicalphysical
and activity
87. You jumped the numbers in between
mental health,
recommendations and social
in adults andcommitment
the elderly (especially
[192]. through
While team sports
several or group activities)factors
socioeconomic [193]. are related
Increased morbidity with age may be partly linked to decreased physical activity. Thus, remaining Commented [M118]: incorrect ref orde
to exercise adherence, it is imperative that trainers and health care providers are informed about
or becoming active later in life is strongly associated with healthy aging [194]. With increased age, 87. You jumped the numbers in between
factors that can beis modulated,
there less involvement such as intervention
in training intensity
and competition (not
(Figure 4), andto high),
only 20% ofduration (not too long), and
adults in Sweden
Commented [M119]: incorrect ref orde
supervision, are active, at least
important fortohigher
some extent, in sports clubs,
adherence, and the largest
addressed moreproportion
in depthofby adults who exercise Fahey
Rivera-Torres, and
do it on their own. The following sections describes effects beyond what is already provided for 87. You jumped the numbers in between
Rivera [192].children and youths.
Healthy aging is dependent on many factors, such as the absence of disease, good physical Commented [M120]: incorrect ref orde
8.1. Positive Aspects 87. You jumped the numbers in between
and mental health, and social commitment (especially through team sports or group activities) [193].
Increased morbidity with age may be partly linked to decreased physical activity. Thus, remaining
or becoming active later in life is strongly associated with healthy aging [194]. With increased age,
there is less involvement in training and competition (Figure 4), and only 20% of adults in Sweden are
active, at least to some extent, in sports clubs, and the largest proportion of adults who exercise do it
on their own. The following sections describes effects beyond what is already provided for children
and youths.

8.1. Positive Aspects

Participation in sports, with or without competition, promotes healthy behavior and a better
quality of life [166]. Exclusion from sports at a young age appears to have long-term consequences,
as the previously described relative age effect (Figure 6) remains even for master athletes (Malm,
Sports 2019, 7, 127 17 of 28

Jakobsson, and Julin, unpublished data). Because master athletes show better health than their
peers [95], actions should be taken to include adults and elderly individuals who earlier in life were
excluded from, or never started with sport [195]. As we age, physical activity at a health-enhancing
intensity is not enough to maintain all functions. Higher intensity is required, best comprising
competition-oriented training [196,197]. One should not assume that high-intensity exercise cannot be
initiated by the elderly [198]. Competitive sports, or training like a competitive athlete as an adult, can
be one important factor to counter the loss of physical ability with aging [199]. In this context, golf
can be one example of a safe form of exercise with high adherence for older adults and the elderly,
resulting in increased aerobic performance, metabolic function, and trunk strength [200,201].

8.2. Negative Aspects

Increased morbidity (e.g., cardiovascular disease) with aging is seen also among older athletes [202]
and is associated with the same risk factors as in the general population [203]. An increased risk of
cardiovascular disease among adults (master) compared to other populations has been found [204].
Unfortunately, the designs and interpretations of these studies have been criticized, and the incidence
of cardiac arrest in older athletes is unclear [205]. In this context, the difference between competitive
sports aiming to optimize performance and recreational sports has to be taken into account, where
the former is more likely to induce negative effects due to high training loads and/or impacts during
training and games. Although high-intensity training even for older athletes is positive for aerobic
performance, it does not prevent the loss of motor units [206].
Quality of life is higher in sporting adults compared to those who do not play sports, but so is the
risk of injury. When hit by injury, adults and young alike may suffer from psychological disorders
such as depression [207], but with a longer recovery time in older individuals [208]. As with young
athletes, secession of training at age 50 years and above reduces blood flow in the brain, including the
hippocampus, possibly related to long-term decline in mental capacity [209].

8.3. Relevance of Sport

As for children and young people, many positive health aspects come through sport also for
adults and the elderly [210]. Sport builds bridges between generations, a potential but not elucidated
drive for adults’ motivation for physical activity. The percentage of adults participating in competitive
sports has increased in Sweden since 2010, from about 20 percent to 30 percent of all of those who are
physically active [18], a trend that most likely provides better health for the group in the 30–40 age
group and generations to come.

9. Recommendations for Healthy Sport

• 1. Plan exercise, rest, and social life. For health-promoting and healthy-aging physical activity,
refer to general guidelines summarized in this paper: Aerobic exercise three times a week,
muscle-strengthening exercise 2–3 times a week.
• 2. Set long-term goals.
• 3. Adopt a holistic performance development including physiological, medical, mental, and
psychosocial aspects.
• 4. Monitor physiological health over time:

# a. Exercise load (time, intensity, volume);

# b. Recovery (sleep, resting heart rate, appetite, estimated fatigue, etc.);
# c. Sickness (when–where–how, type of infections, how long one is ill, etc.);
# d. Repeat type- and age-specific physical tests with relevant evaluation and feedback;
# e. Frequency of injuries and causes.
• 5. Monitor mental health over time:
Sports 2019, 7, 127 18 of 28

# a. Motivation for training, competition, and socializing;

# b. Personal perception of stress, anxiety, depression, alienation, and self-belief;
# c. Repeat type- and age-specific psychological tests with relevant evaluation and feedback.
• 6. Register and interpret signs of overtraining, such as reduced performance over time, while
maintaining or increasing exercise load.

Author Contributions: C.M. and A.J. conceived and designed the review. C.M., A.J., J.J. and interpreted the data
and drafted the manuscript. J.J. edited the manuscript, tables, and figures. All authors approved the final version.
Funding: This work was supported by the Swedish Sports Confederation.
Conflicts of Interest: The authors declare no conflict of interest.

References
1. Eime, R.M.; Young, J.A.; Harvey, J.T.; Charity, M.J.; Payne, W.R. A systematic review of the psychological and
social benefits of participation in sport for children and adolescents: Informing development of a conceptual
model of health through sport. Int. J. Behav. Nutr. Phys. Act. 2013, 10, 98. [CrossRef] [PubMed]
2. Nowak, P.F. Amateur Sports of the Elderly: A Chance for Health and a Higher Quality of Life. Adv. Aging
Res. 2014, 3, 222–229. [CrossRef]
3. Fraser-Thomas, J.; Strachan, L. Personal developemnt and performance? In Health and Elite Sport: Is High
Performance Sport a Healthy Pursuit? Baker, J., Safai, P., Fraser-Thomas, J., Eds.; Routledge Research in Sport,
Culture and Society; Taylor & Francis Group: Londond, UK, 2015.
4. Lopez Villalba, F.J.; Rodriguez Garcia, P.L.; Garcia Canto, E.; Perez Soto, J.J. Relationship between sport and
physical activity and alcohol consumption among adolescents students in Murcia (Spain). Arch. Argent.
Pediatr. 2016, 114, 101–106. [CrossRef]
5. Elofsson, S.; Blomdahl, U.; Åkesson, M.; Lengheden, L. Dricker ungdomar i idrotsförening mindre alkohol än de
som inte är med i en idrotsförening? Stockholm stads idrottsförvalnintg: Stockholm, Sweden, 2014.
6. Kjonniksen, L.; Anderssen, N.; Wold, B. Organized youth sport as a predictor of physical activity in adulthood.
Scand. J. Med. Sci. Sports 2009, 19, 646–654. [CrossRef]
7. Khan, K.M.; Thompson, A.M.; Blair, S.N.; Sallis, J.F.; Powell, K.E.; Bull, F.C.; Bauman, A.E. Sport and exercise
as contributors to the health of nations. Lancet 2012, 380, 59–64. [CrossRef]
8. Howie, E.K.; McVeigh, J.A.; Smith, A.J.; Straker, L.M. Organized Sport Trajectories from Childhood to
Adolescence and Health Associations. Med. Sci. Sports Exerc. 2016, 48, 1331–1339. [CrossRef]
9. Rice, S.M.; Purcell, R.; De Silva, S.; Mawren, D.; McGorry, P.D.; Parker, A.G. The Mental Health of Elite
Athletes: A Narrative Systematic Review. Sports Med. 2016, 46, 1333–1353. [CrossRef]
10. Schwellnus, M.; Soligard, T.; Alonso, J.M.; Bahr, R.; Clarsen, B.; Dijkstra, H.P.; Gabbett, T.J.; Gleeson, M.;
Hagglund, M.; Hutchinson, M.R.; et al. How much is too much? (Part 2) International Olympic Committee
consensus statement on load in sport and risk of illness. Br. J. Sports Med. 2016, 50, 1043–1052. [CrossRef]
11. Soligard, T.; Schwellnus, M.; Alonso, J.M.; Bahr, R.; Clarsen, B.; Dijkstra, H.P.; Gabbett, T.; Gleeson, M.;
Hagglund, M.; Hutchinson, M.R.; et al. How much is too much? (Part 1) International Olympic Committee
consensus statement on load in sport and risk of injury. Br. J. Sports Med. 2016, 50, 1030–1041. [CrossRef]
[PubMed]
12. Joy, E.; Kussman, A.; Nattiv, A. 2016 update on eating disorders in athletes: A comprehensive narrative
review with a focus on clinical assessment and management. Br. J. Sports Med. 2016, 50, 154–162. [CrossRef]
13. Brenner, J.S. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics 2007, 119,
1242–1245. [CrossRef]
14. Clark, A.; Mach, N. Exercise-induced stress behavior, gut-microbiota-brain axis and diet: A systematic review
for athletes. J. Int. Soc. Sports Nutr. 2016, 13, 43. [CrossRef]
15. Lang, M.; Hartill, M. Safeguarding, Child Protection and Abuse in Sport: International Perspectives in Research,
Policy and Practice; Taylor & Francis: Abingdon-on-Thames, UK, 2014.
16. Pontzer, H.; Durazo-Arvizu, R.; Dugas, L.R.; Plange-Rhule, J.; Bovet, P.; Forrester, T.E.; Lambert, E.V.;
Cooper, R.S.; Schoeller, D.A.; Luke, A. Constrained Total Energy Expenditure and Metabolic Adaptation to
Physical Activity in Adult Humans. Curr. Biol. 2016, 26, 410–417. [CrossRef]
Sports 2019, 7, 127 19 of 28

17. Engström, L.-M. Barns och ungdomars idrottsvanor i förändring. Svensk Idrottsforskning: Organ för Centrum
för Idrottsforskning 2004, 4, 10–15.
18. The Swedish Sports Confederation. Sport statisitcs [Idrotten i siffror}; Confederation, T.S.S., Ed.; The Swedish
Sports Confederation: Stockholm, Sweden, 2015.
19. SCB. Levnadsförhållanden: Fritid 2006-2007 [Living Conditions: Recreation 2006-2007]; 118; Statistics Sweden:
Stockholm, Sweden, 2009.
20. Swedish National Institute of Publich Health Physical Activity in the Prevention and Treatment of Disease (FYSS);
Swedish National Institute of Publich Health, and Swedish Professional Associations for Physical Activity:
Järna, Sweden, 2017.
21. WHO. Physical activity. Available online: http://www.who.int/topics/physical_activity/en/ (accessed on
19 November 2017).
22. US Department of Human Services. Physical Activity Guidelines Advisory Committee report, 2008. To the
Secretary of Health and Human Services. Part A: Executive Summary; 0029-6643; US Department of Human
Services: Washington, DC, USA, 2009; pp. 114–120.
23. Publich Health Agency of Sweden. Vad är Fysisk Aktivitet? [What Is Physical Activity?]; Publich Health Agency
of Sweden: Solna, Sweden, 2016; Volume 2016.
24. Swedish Research Council for Sport Science (CIF). Sport Relevance [Idrottsrelevans]; Swedish Research Council
for Sport Science (CIF): Stockholm, Sweden, 2016; Volume 2016.
25. Healy, G.N.; Wijndaele, K.; Dunstan, D.W.; Shaw, J.E.; Salmon, J.; Zimmet, P.Z.; Owen, N. Objectively
measured sedentary time, physical activity, and metabolic risk: The Australian Diabetes, Obesity and
Lifestyle Study (AusDiab). Diabetes Care 2008, 31, 369–371. [CrossRef]
26. Matthews, C.E.; George, S.M.; Moore, S.C.; Bowles, H.R.; Blair, A.; Park, Y.; Troiano, R.P.; Hollenbeck, A.;
Schatzkin, A. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am. J.
Clin. Nutr. 2012, 95, 437–445. [CrossRef]
27. Stamatakis, E.; Gale, J.; Bauman, A.; Ekelund, U.; Hamer, M.; Ding, D. Sitting Time, Physical Activity, and
Risk of Mortality in Adults. J. Am. Coll. Cardiol. 2019, 73, 2062–2072. [CrossRef]
28. Ratzlaff, C.R.; Doerfling, P.; Steininger, G.; Koehoorn, M.; Cibere, J.; Liang, M.; Wilson, D.R.; Esdaile, J.;
Kopec, J. Lifetime trajectory of physical activity according to energy expenditure and joint force. Arthritis
Care Res. 2010, 62, 1452–1459. [CrossRef] [PubMed]
29. Geneen, L.J.; Moore, R.A.; Clarke, C.; Martin, D.; Colvin, L.A.; Smith, B.H. Physical activity and exercise for
chronic pain in adults: An overview of Cochrane Reviews. Cochrane Database Syst. Rev. 2017, 4, CD011279.
[CrossRef]
30. Liberman, K.; Forti, L.N.; Beyer, I.; Bautmans, I. The effects of exercise on muscle strength, body composition,
physical functioning and the inflammatory profile of older adults: A systematic review. Curr. Opin. Clin.
Nutr. Metab. Care 2017, 20, 30–53. [CrossRef]
31. Schuch, F.B.; Vancampfort, D.; Richards, J.; Rosenbaum, S.; Ward, P.B.; Stubbs, B. Exercise as a treatment for
depression: A meta-analysis adjusting for publication bias. J. Psychiatr. Res. 2016, 77, 42–51. [CrossRef]
32. Schoenfeld, B.J.; Wilson, J.M.; Lowery, R.P.; Krieger, J.W. Muscular adaptations in low-versus high-load
resistance training: A meta-analysis. Eur. J. Sport Sci. 2016, 16, 1–10. [CrossRef]
33. Muehlbauer, T.; Gollhofer, A.; Granacher, U. Associations Between Measures of Balance and Lower-Extremity
Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis.
Sports Med. 2015, 45, 1671–1692. [CrossRef] [PubMed]
34. Timperio, A.; Salmon, J.; Rosenberg, M.; Bull, F.C. Do logbooks influence recall of physical activity in
validation studies? Med. Sci. Sports Exerc. 2004, 36, 1181–1186. [CrossRef]
35. Garber, C.E.; Blissmer, B.; Deschenes, M.R.; Franklin, B.A.; Lamonte, M.J.; Lee, I.M.; Nieman, D.C.; Swain, D.P.
American College of Sports Medicine position stand. Quantity and quality of exercise for developing
and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults:
Guidance for prescribing exercise. Med. Sci. Sports Exerc. 2011, 43, 1334–1359. [CrossRef]
36. McEwen, B.S. Stressed or stressed out: What is the difference? J. Psychiatry Neurosci. Jpn. 2005, 30, 315–318.
37. Selye, H. Stress and the general adaptation syndrome. Br. Med. J. 1950, 1, 1383–1392. [CrossRef]
38. Kraemer, W.J.; Ratamess, N.A. Fundamentals of resistance training: Progression and exercise prescription.
Med. Sci. Sports Exerc. 2004, 36, 674–688. [CrossRef] [PubMed]
Sports 2019, 7, 127 20 of 28

39. Baechle, T.R.; Earle, R.W. Essentials of Strength Training and Conditioning, 3rd ed.; Human Kinetics: Champaign,
IL, USA, 2008.
40. Ronnestad, B.R.; Ellefsen, S.; Nygaard, H.; Zacharoff, E.E.; Vikmoen, O.; Hansen, J.; Hallen, J. Effects of 12
weeks of block periodization on performance and performance indices in well-trained cyclists. Scand. J. Med.
Sci. Sports 2014, 24, 327–335. [CrossRef]
41. Ahtiainen, J.P.; Walker, S.; Peltonen, H.; Holviala, J.; Sillanpaa, E.; Karavirta, L.; Sallinen, J.; Mikkola, J.;
Valkeinen, H.; Mero, A.; et al. Heterogeneity in resistance training-induced muscle strength and mass
responses in men and women of different ages. Age 2016, 38, 10. [CrossRef]
42. Davidsen, P.K.; Gallagher, I.J.; Hartman, J.W.; Tarnopolsky, M.A.; Dela, F.; Helge, J.W.; Timmons, J.A.;
Phillips, S.M. High responders to resistance exercise training demonstrate differential regulation of skeletal
muscle microRNA expression. J. Appl. Physiol. (Bethesda Md. 1985) 2011, 110, 309–317. [CrossRef] [PubMed]
43. Timmons, J.A. Variability in training-induced skeletal muscle adaptation. J. Appl. Physiol. (Bethesda Md.
1985) 2011, 110, 846–853. [CrossRef] [PubMed]
44. Vollaard, N.B.; Constantin-Teodosiu, D.; Fredriksson, K.; Rooyackers, O.; Jansson, E.; Greenhaff, P.L.;
Timmons, J.A.; Sundberg, C.J. Systematic analysis of adaptations in aerobic capacity and submaximal energy
metabolism provides a unique insight into determinants of human aerobic performance. J. Appl. Physiol.
(Bethesda Md. 1985) 2009, 106, 1479–1486. [CrossRef] [PubMed]
45. Venezia, A.C.; Roth, S.M. Recent Research in the Genetics of Exercise Training Adaptation. Med. Sport Sci.
2016, 61, 29–40. [CrossRef]
46. Porter, C.; Reidy, P.T.; Bhattarai, N.; Sidossis, L.S.; Rasmussen, B.B. Resistance Exercise Training Alters
Mitochondrial Function in Human Skeletal Muscle. Med. Sci. Sports Exerc. 2015, 47, 1922–1931. [CrossRef]
47. Verdijk, L.B.; Snijders, T.; Holloway, T.M.; J, V.A.N.K.; LJ, V.A.N.L. Resistance Training Increases Skeletal
Muscle Capillarization in Healthy Older Men. Med. Sci. Sports Exerc. 2016, 48, 2157–2164. [CrossRef]
48. Mujika, I.; Padilla, S. Detraining: Loss of training-induced physiological and performance adaptations. Part
I: Short term insufficient training stimulus. Sports Med. 2000, 30, 79–87. [CrossRef]
49. Gundersen, K. Muscle memory and a new cellular model for muscle atrophy and hypertrophy. J. Exp. Biol.
2016, 219, 235–242. [CrossRef]
50. Leonard, W.R. Size counts: Evolutionary perspectives on physical activity and body size from early hominids
to modern humans. J. Phys. Act. Health 2010, 7 (Suppl. 3), S284–S298. [CrossRef]
51. Leonard, W.R.; Robertson, M.L. Nutritional requirements and human evolution: A bioenergetics model.
Am. J. Hum. Biol. 1992, 4, 179–195. [CrossRef]
52. Cordain, L.; Gotshall, R.W.; Eaton, S.B.; Eaton, S.B., 3rd. Physical activity, energy expenditure and fitness: An
evolutionary perspective. Int. J. Sports Med. 1998, 19, 328–335. [CrossRef]
53. SCB. Levnadsförhållanden: Fritid 1976-2002 [Levnadsförhållanden: Fritid 2006-2007 [Living conditions: Recreation
1976-2002]]; 103; Statistics Sweden: Stockholm, Sweden, 2004.
54. Church, T.S.; Thomas, D.M.; Tudor-Locke, C.; Katzmarzyk, P.T.; Earnest, C.P.; Rodarte, R.Q.; Martin, C.K.;
Blair, S.N.; Bouchard, C. Trends over 5 decades in U.S. occupation-related physical activity and their
associations with obesity. PLoS ONE 2011, 6, e19657. [CrossRef]
55. The Public Health Agency of Sweden. Children’s and Youth’s Pattern of Movement; The Public Health Agency
of Sweden: Solna, Sweden 2019.
56. Holt, N.L.; Neely, K.C.; Slater, L.G.; Camire, M.; Cote, J.; Fraser-Thomas, J.; MacDonald, D.; Strachan, L.;
Tamminen, K.A. A grounded theory of positive youth development through sport based on results from a
qualitative meta-study. Int. Rev. Sport Exerc. Psychol. 2017, 10, 1–49. [CrossRef]
57. Andersen, L.B.; Mota, J.; Di Pietro, L. Update on the global pandemic of physical inactivity. Lancet 2016, 388,
1255–1256. [CrossRef]
58. Das, P.; Horton, R. Physical activity-time to take it seriously and regularly. Lancet 2016, 388, 1254–1255.
[CrossRef]
59. Kujala, U.M.; Kaprio, J.; Sarna, S.; Koskenvuo, M. Relationship of leisure-time physical activity and mortality:
The Finnish twin cohort. JAMA 1998, 279, 440–444. [CrossRef]
60. Hills, A.P.; Street, S.J.; Byrne, N.M. Physical Activity and Health: “What is Old is New Again”. Adv. Food
Nutr. Res. 2015, 75, 77–95. [CrossRef] [PubMed]
Sports 2019, 7, 127 21 of 28

61. Arem, H.; Moore, S.C.; Patel, A.; Hartge, P.; Berrington de Gonzalez, A.; Visvanathan, K.; Campbell, P.T.;
Freedman, M.; Weiderpass, E.; Adami, H.O.; et al. Leisure time physical activity and mortality: A detailed
pooled analysis of the dose-response relationship. JAMA Internal Med. 2015, 175, 959–967. [CrossRef]
[PubMed]
62. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Scientific
Report; U.S. Department of Health and Human Services: Washington, DC, USA, 2018.
63. Blair, S.N. Physical inactivity and cardiovascular disease risk in women. Med. Sci. Sports Exerc. 1996, 28,
9–10. [CrossRef] [PubMed]
64. Booth, F.W.; Roberts, C.K.; Laye, M.J. Lack of exercise is a major cause of chronic diseases. Compr. Physiol.
2012, 2, 1143–1211. [CrossRef]
65. Wegner, M.; Helmich, I.; Machado, S.; Nardi, A.E.; Arias-Carrion, O.; Budde, H. Effects of exercise on anxiety
and depression disorders: Review of meta- analyses and neurobiological mechanisms. CNS Neurol. Disorders
Drug Targets 2014, 13, 1002–1014. [CrossRef]
66. Bennett, K.; Manassis, K.; Duda, S.; Bagnell, A.; Bernstein, G.A.; Garland, E.J.; Miller, L.D.; Newton, A.;
Thabane, L.; Wilansky, P. Preventing Child and Adolescent Anxiety Disorders: Overview of Systematic
Reviews. Depress Anxiety 2015, 32, 909–918. [CrossRef]
67. Lopresti, A.L.; Hood, S.D.; Drummond, P.D. A review of lifestyle factors that contribute to important
pathways associated with major depression: Diet, sleep and exercise. J. Affect. Disord. 2013, 148, 12–27.
[CrossRef] [PubMed]
68. Stubbs, B.; Vancampfort, D.; Rosenbaum, S.; Firth, J.; Cosco, T.; Veronese, N.; Salum, G.A.; Schuch, F.B.
An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders:
A meta-analysis. Psychiatry Res. 2017, 249, 102–108. [CrossRef] [PubMed]
69. Knochel, C.; Oertel-Knochel, V.; O’Dwyer, L.; Prvulovic, D.; Alves, G.; Kollmann, B.; Hampel, H. Cognitive
and behavioural effects of physical exercise in psychiatric patients. Progr. Neurobiol. 2012, 96, 46–68.
[CrossRef] [PubMed]
70. Craig, D.M.; Ashcroft, S.P.; Belew, M.Y.; Stocks, B.; Currell, K.; Baar, K.; Philp, A. Utilizing small nutrient
compounds as enhancers of exercise-induced mitochondrial biogenesis. Front. Physiol. 2015, 6. [CrossRef]
71. Wilson, M.G.; Ellison, G.M.; Cable, N.T. Basic science behind the cardiovascular benefits of exercise. Heart
2015, 101, 758–765. [CrossRef]
72. Hellsten, Y.; Nyberg, M. Cardiovascular Adaptations to Exercise Training. Compr. Physiol. 2015, 6, 1–32.
[CrossRef]
73. Wilson, J.M.; Loenneke, J.P.; Jo, E.; Wilson, G.J.; Zourdos, M.C.; Kim, J.S. The effects of endurance, strength,
and power training on muscle fiber type shifting. J. Strength Cond. Res. 2012, 26, 1724–1729. [CrossRef]
74. Cadore, E.L.; Pinto, R.S.; Bottaro, M.; Izquierdo, M. Strength and endurance training prescription in healthy
and frail elderly. Aging Dis. 2014, 5, 183–195. [CrossRef]
75. Tofthagen, C.; Visovsky, C.; Berry, D.L. Strength and balance training for adults with peripheral neuropathy
and high risk of fall: Current evidence and implications for future research. Oncol. Nurs. Forum. 2012, 39,
E416–E424. [CrossRef] [PubMed]
76. Cho, S.I.; An, D.H. Effects of a Fall Prevention Exercise Program on Muscle Strength and Balance of the
Old-old Elderly. J. Phys. Ther. Sci. 2014, 26, 1771–1774. [CrossRef] [PubMed]
77. Kyu, H.H.; Bachman, V.F.; Alexander, L.T.; Mumford, J.E.; Afshin, A.; Estep, K.; Veerman, J.L.; Delwiche, K.;
Iannarone, M.L.; Moyer, M.L.; et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic
heart disease, and ischemic stroke events: Systematic review and dose-response meta-analysis for the Global
Burden of Disease Study 2013. BMJ 2016, 354, i3857. [CrossRef] [PubMed]
78. Pearson, M.J.; Smart, N.A. Effect of exercise training on endothelial function in heart failure patients:
A systematic review meta-analysis. Int. J. Cardiol. 2017, 231, 234–243. [CrossRef]
79. Nielsen, J.; Gejl, K.D.; Hey-Mogensen, M.; Holmberg, H.C.; Suetta, C.; Krustrup, P.; Elemans, C.P.H.;
Ortenblad, N. Plasticity in mitochondrial cristae density allows metabolic capacity modulation in human
skeletal muscle. J. Physiol. 2017, 595, 2839–2847. [CrossRef] [PubMed]
80. Richter, E.A.; Hargreaves, M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol. Rev. 2013, 93,
993–1017. [CrossRef] [PubMed]
Sports 2019, 7, 127 22 of 28

81. Marson, E.C.; Delevatti, R.S.; Prado, A.K.; Netto, N.; Kruel, L.F. Effects of aerobic, resistance, and combined
exercise training on insulin resistance markers in overweight or obese children and adolescents: A systematic
review and meta-analysis. Prev. Med. 2016, 93, 211–218. [CrossRef]
82. Way, K.L.; Hackett, D.A.; Baker, M.K.; Johnson, N.A. The Effect of Regular Exercise on Insulin Sensitivity
in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Metab. J. 2016, 40, 253–271.
[CrossRef] [PubMed]
83. Conn, V.S.; Koopman, R.J.; Ruppar, T.M.; Phillips, L.J.; Mehr, D.R.; Hafdahl, A.R. Insulin Sensitivity Following
Exercise Interventions: Systematic Review and Meta-Analysis of Outcomes Among Healthy Adults. J. Prim
Care Community Health 2014, 5, 211–222. [CrossRef]
84. Schuch, F.B.; Deslandes, A.C.; Stubbs, B.; Gosmann, N.P.; Silva, C.T.; Fleck, M.P. Neurobiological effects
of exercise on major depressive disorder: A systematic review. Neurosci. Biobehav. Rev. 2016, 61, 1–11.
[CrossRef]
85. Schuch, F.B.; Vancampfort, D.; Sui, X.; Rosenbaum, S.; Firth, J.; Richards, J.; Ward, P.B.; Stubbs, B. Are lower
levels of cardiorespiratory fitness associated with incident depression? A systematic review of prospective
cohort studies. Prev. Med. 2016, 93, 159–165. [CrossRef] [PubMed]
86. Zahl, T.; Steinsbekk, S.; Wichstrom, L. Physical Activity, Sedentary Behavior, and Symptoms of Major
Depression in Middle Childhood. Pediatrics 2017, 139. [CrossRef]
87. Colaianni, G.; Mongelli, T.; Colucci, S.; Cinti, S.; Grano, M. Crosstalk Between Muscle and Bone Via the
Muscle-Myokine Irisin. Curr. Osteoporos. Rep. 2016, 14, 132–137. [CrossRef] [PubMed]
88. Giangregorio, L.M.; McGill, S.; Wark, J.D.; Laprade, J.; Heinonen, A.; Ashe, M.C.; MacIntyre, N.J.;
Cheung, A.M.; Shipp, K.; Keller, H.; et al. Too Fit to Fracture: Outcomes of a Delphi consensus process
on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral
fractures. Osteoporos. Int. 2015, 26, 891–910. [CrossRef] [PubMed]
89. Papa, E.V.; Dong, X.; Hassan, M. Resistance training for activity limitations in older adults with skeletal
muscle function deficits: a systematic review. Clin. Interv. Aging. 2017, 12, 955–961. [CrossRef] [PubMed]
90. Casonatto, J.; Goessler, K.F.; Cornelissen, V.A.; Cardoso, J.R.; Polito, M.D. The blood pressure-lowering effect
of a single bout of resistance exercise: A systematic review and meta-analysis of randomised controlled trials.
Eur. J. Prev. Cardiol. 2016, 23, 1700–1714. [CrossRef] [PubMed]
91. MacDonald, H.V.; Johnson, B.T.; Huedo-Medina, T.B.; Livingston, J.; Forsyth, K.C.; Kraemer, W.J.;
Farinatti, P.T.V.; Pescatello, L.S. Dynamic Resistance Training as Stand-Alone Antihypertensive Lifestyle
Therapy: A Meta-Analysis. J. Am. Heart Assoc. 2016, 5, e003231. [CrossRef] [PubMed]
92. Ettehad, D.; Emdin, C.A.; Kiran, A.; Anderson, S.G.; Callender, T.; Emberson, J.; Chalmers, J.; Rodgers, A.;
Rahimi, K. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review
and meta-analysis. Lancet 2016, 387, 957–967. [CrossRef]
93. Chen, Y.C.; Tsai, J.C.; Liou, Y.M.; Chan, P. Effectiveness of endurance exercise training in patients with
coronary artery disease: A meta-analysis of randomised controlled trials. Eur. J. Cardiovasc. Nurs. 2017, 16,
397–408. [CrossRef] [PubMed]
94. Bachi, A.L.; Rocha, G.A.; Sprandel, M.C.; Ramos, L.R.; Gravina, C.F.; Pithon-Curi, T.C.; Vaisberg, M.;
Maranhao, R.C. Exercise Training Improves Plasma Lipid and Inflammatory Profiles and Increases Cholesterol
Transfer to High-Density Lipoprotein in Elderly Women. J. Am. Geriatr. Soc. 2015, 63, 1247–1249. [CrossRef]
95. Climstein, M.; Walsh, J.; Debeliso, M.; Heazlewood, T.; Sevene, T.; Adams, K. Cardiovascular risk profiles of
world masters games participants. J. Sports Med. Phys. Fitness 2018, 58, 489–496.
96. Anstey, K.J.; Ashby-Mitchell, K.; Peters, R. Updating the Evidence on the Association between Serum
Cholesterol and Risk of Late-Life Dementia: Review and Meta-Analysis. J. Alzheimers Dis. 2017, 56, 215–228.
[CrossRef] [PubMed]
97. Stoedefalke, K. Effects of exercise training on blood lipids and lipoproteins in children and adolescents.
J. Sports Sci. Med. 2007, 6, 313–318. [PubMed]
98. Hvid, L.G.; Strotmeyer, E.S.; Skjodt, M.; Magnussen, L.V.; Andersen, M.; Caserotti, P. Voluntary muscle
activation improves with power training and is associated with changes in gait speed in mobility-limited
older adults - A randomized controlled trial. Exp. Gerontol. 2016, 80, 51–56. [CrossRef] [PubMed]
99. Jackson, W.M.; Davis, N.; Sands, S.A.; Whittington, R.A.; Sun, L.S. Physical Activity and Cognitive
Development: A Meta-Analysis. J. Neurosurg. Anesthesiol. 2016, 28, 373–380. [CrossRef] [PubMed]
Sports 2019, 7, 127 23 of 28

100. Ludyga, S.; Gerber, M.; Brand, S.; Holsboer-Trachsler, E.; Puhse, U. Acute effects of moderate aerobic exercise
on specific aspects of executive function in different age and fitness groups: A meta-analysis. Psychophysiology
2016, 53, 1611–1626. [CrossRef]
101. Dinoff, A.; Herrmann, N.; Swardfager, W.; Liu, C.S.; Sherman, C.; Chan, S.; Lanctot, K.L. The Effect of
Exercise Training on Resting Concentrations of Peripheral Brain-Derived Neurotrophic Factor (BDNF):
A Meta-Analysis. PLoS ONE 2016, 11, e0163037. [CrossRef] [PubMed]
102. Kelley, G.A.; Kelley, K.S. Exercise and Sleep: A Systematic Review of Previous Meta-analyses And A
Meta-analysis: 284 Board #121 June 1, 9: 30 AM - 11: 00 AM. Med. Sci. Sports Exerc. 2016, 48, 68–69.
[CrossRef]
103. Kandola, A.; Hendrikse, J.; Lucassen, P.J.; Yucel, M. Aerobic Exercise as a Tool to Improve Hippocampal
Plasticity and Function in Humans: Practical Implications for Mental Health Treatment. Front. Hum. Neurosci.
2016, 10, 373. [CrossRef]
104. Smith, G.E. Healthy Cognitive Aging and Dementia Prevention. Am. Psychol. 2016, 71, 268–275. [CrossRef]
[PubMed]
105. Shaffer, J. Neuroplasticity and Clinical Practice: Building Brain Power for Health. Front. Psychol. 2016, 7,
1118. [CrossRef] [PubMed]
106. Ryan, S.M.; Nolan, Y.M. Neuroinflammation negatively affects adult hippocampal neurogenesis and cognition:
Can exercise compensate? Neurosci. Biobehav. Rev. 2016, 61, 121–131. [CrossRef] [PubMed]
107. Boraxbekk, C.J.; Salami, A.; Wahlin, A.; Nyberg, L. Physical activity over a decade modifies age-related decline
in perfusion, gray matter volume, and functional connectivity of the posterior default-mode network-A
multimodal approach. Neuroimage 2016, 131, 133–141. [CrossRef]
108. Dhabhar, F.S. Effects of stress on immune function: The good, the bad, and the beautiful. Immunol. Res. 2014,
58, 193–210. [CrossRef]
109. Brodin, P.; Davis, M.M. Human immune system variation. Nat. Rev. Immunol. 2017, 17, 21–29. [CrossRef]
110. Gjevestad, G.O.; Holven, K.B.; Ulven, S.M. Effects of Exercise on Gene Expression of Inflammatory Markers
in Human Peripheral Blood Cells: A Systematic Review. Curr. Cardiovasc. Risk Rep. 2015, 9, 34. [CrossRef]
111. Runhaar, J.; Bierma-Zeinstra, S.M. Should exercise therapy for chronic musculoskeletal conditions focus on
the anti-inflammatory effects of exercise? Br. J. Sports Med. 2016. [CrossRef]
112. Codella, R.; Luzi, L.; Inverardi, L.; Ricordi, C. The anti-inflammatory effects of exercise in the syndromic
thread of diabetes and autoimmunity. Eur. Rev. Med. Pharmacol. Sci. 2015, 19, 3709–3722. [PubMed]
113. Mika, A.; Fleshner, M. Early-life exercise may promote lasting brain and metabolic health through gut
bacterial metabolites. Immunol. Cell Biol. 2016, 94, 151–157. [CrossRef] [PubMed]
114. Thomas, R.J.; Kenfield, S.A.; Jimenez, A. Exercise-induced biochemical changes and their potential influence
on cancer: A scientific review. Br. J. Sports Med. 2016. [CrossRef]
115. Marchesi, J.R.; Adams, D.H.; Fava, F.; Hermes, G.D.; Hirschfield, G.M.; Hold, G.; Quraishi, M.N.; Kinross, J.;
Smidt, H.; Tuohy, K.M.; et al. The gut microbiota and host health: A new clinical frontier. Gut 2016, 65,
330–339. [CrossRef]
116. McKercher, C.; Sanderson, K.; Schmidt, M.D.; Otahal, P.; Patton, G.C.; Dwyer, T.; Venn, A.J. Physical activity
patterns and risk of depression in young adulthood: A 20-year cohort study since childhood. Soc. Psych.
Psych. Epid. 2014, 49, 1823–1834. [CrossRef] [PubMed]
117. von Martels, J.Z.; Sadaghian Sadabad, M.; Bourgonje, A.R.; Blokzijl, T.; Dijkstra, G.; Faber, K.N.; Harmsen, H.J.
The role of gut microbiota in health and disease: In vitro modeling of host-microbe interactions at the
aerobe-anaerobe interphase of the human gut. Anaerobe 2017, 44, 3–12. [CrossRef]
118. Bogdanis, G.C. Effects of physical activity and inactivity on muscle fatigue. Front. Physiol. 2012, 3, 142.
[CrossRef]
119. Eriksson, A. Strength Training and Anabolic Steroids: A Comparative Study of the Vastus Lateralis, a Thigh
Muscle and the Trapezius, a Shoulder Muscle, of Strength-Trained Athletes. Ph.D. Thesis, Umeå University,
Umeå, Sweden, 2006.
120. Eriksson, A.; Kadi, F.; Malm, C.; Thornell, L.E. Skeletal muscle morphology in power-lifters with and without
anabolic steroids. Histochem. Cell Biol. 2005, 124, 167–175. [CrossRef] [PubMed]
121. Stevens, G.A.; Alkema, L.; Black, R.E.; Boerma, J.T.; Collins, G.S.; Ezzati, M.; Grove, J.T.; Hogan, D.R.;
Hogan, M.C.; Horton, R.; et al. Guidelines for Accurate and Transparent Health Estimates Reporting: The
GATHER statement. Lancet 2016, 388, e19–e23. [CrossRef]
Sports 2019, 7, 127 24 of 28

122. Borde, R.; Hortobagyi, T.; Granacher, U. Dose-Response Relationships of Resistance Training in Healthy Old
Adults: A Systematic Review and Meta-Analysis. Sports Med. 2015, 45, 1693–1720. [CrossRef] [PubMed]
123. Northey, J.M.; Cherbuin, N.; Pumpa, K.L.; Smee, D.J.; Rattray, B. Exercise interventions for cognitive function
in adults older than 50: A systematic review with meta-analysis. Br. J. Sports Med. 2018, 52, 154–160.
[CrossRef]
124. Gordon, B.R.; McDowell, C.P.; Lyons, M.; Herring, M.P. The Effects of Resistance Exercise Training on Anxiety:
A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials. Sports Med. 2017, 47,
2521–2532. [CrossRef]
125. Keilani, M.; Hasenoehrl, T.; Baumann, L.; Ristl, R.; Schwarz, M.; Marhold, M.; Sedghi Komandj, T.; Crevenna, R.
Effects of resistance exercise in prostate cancer patients: A meta-analysis. Support. Care Cancer 2017, 25,
2953–2968. [CrossRef]
126. Yamamoto, S.; Hotta, K.; Ota, E.; Mori, R.; Matsunaga, A. Effects of resistance training on muscle
strength, exercise capacity, and mobility in middle-aged and elderly patients with coronary artery disease:
A meta-analysis. J. Cardiol. 2016, 68, 125–134. [CrossRef]
127. Mammen, G.; Faulkner, G. Physical activity and the prevention of depression: A systematic review of
prospective studies. Am. J. Prev. Med. 2013, 45, 649–657. [CrossRef]
128. Csapo, R.; Alegre, L.M. Effects of resistance training with moderate vs heavy loads on muscle mass and
strength in the elderly: A meta-analysis. Scand. J. Med. Sci. Sports 2016, 26, 995–1006. [CrossRef]
129. Churchward-Venne, T.A.; Tieland, M.; Verdijk, L.B.; Leenders, M.; Dirks, M.L.; de Groot, L.C.; van Loon, L.J.
There Are No Nonresponders to Resistance-Type Exercise Training in Older Men and Women. J. Am. Med.
Dir. Assoc. 2015, 16, 400–411. [CrossRef]
130. Garcia-Hermoso, A.; Ramirez-Velez, R.; Ramirez-Campillo, R.; Peterson, M.D.; Martinez-Vizcaino, V.
Concurrent aerobic plus resistance exercise versus aerobic exercise alone to improve health outcomes in
paediatric obesity: A systematic review and meta-analysis. Br. J. Sports Med. 2018, 52, 161–166. [CrossRef]
131. Groot, C.; Hooghiemstra, A.M.; Raijmakers, P.G.; van Berckel, B.N.; Scheltens, P.; Scherder, E.J.; van der
Flier, W.M.; Ossenkoppele, R. The effect of physical activity on cognitive function in patients with dementia:
A meta-analysis of randomized control trials. Ageing Res. Rev. 2016, 25, 13–23. [CrossRef]
132. Chung, C.L.; Thilarajah, S.; Tan, D. Effectiveness of resistance training on muscle strength and physical
function in people with Parkinson’s disease: A systematic review and meta-analysis. Clin. Rehabil. 2016, 30,
11–23. [CrossRef]
133. Kang, H.; Lu, J.; Xu, G. The effects of whole body vibration on muscle strength and functional mobility in
persons with multiple sclerosis: A systematic review and meta-analysis. Mult. Scler. Relat. Disord. 2016, 7,
1–7. [CrossRef]
134. Portugal, E.M.; Vasconcelos, P.G.; Souza, R.; Lattari, E.; Monteiro-Junior, R.S.; Machado, S.; Deslandes, A.C.
Aging process, cognitive decline and Alzheimer’s disease: Can strength training modulate these responses?
CNS & Neurol. Disorders Drug Targets 2015, 14, 1209–1213.
135. Bacchi, E.; Negri, C.; Zanolin, M.E.; Milanese, C.; Faccioli, N.; Trombetta, M.; Zoppini, G.; Cevese, A.;
Bonadonna, R.C.; Schena, F.; et al. Metabolic effects of aerobic training and resistance training in type
2 diabetic subjects: A randomized controlled trial (the RAED2 study). Diabetes Care 2012, 35, 676–682.
[CrossRef] [PubMed]
136. Steindorf, K.; Schmidt, M.E.; Klassen, O.; Ulrich, C.M.; Oelmann, J.; Habermann, N.; Beckhove, P.; Owen, R.;
Debus, J.; Wiskemann, J.; et al. Randomized, controlled trial of resistance training in breast cancer patients
receiving adjuvant radiotherapy: Results on cancer-related fatigue and quality of life. Ann. Oncol. 2014, 25,
2237–2243. [CrossRef] [PubMed]
137. Ciolac, E.G.; Rodrigues-da-Silva, J.M. Resistance Training as a Tool for Preventing and Treating
Musculoskeletal Disorders. Sports Med. 2016, 46, 1239–1248. [CrossRef]
138. Castrogiovanni, P.; Trovato, F.M.; Szychlinska, M.A.; Nsir, H.; Imbesi, R.; Musumeci, G. The importance of
physical activity in osteoporosis. From the molecular pathways to the clinical evidence. Histol. Histopathol.
2016, 31, 1183–1194. [CrossRef]
139. Johansson, J.; Nordstrom, A.; Nordstrom, P. Greater Fall Risk in Elderly Women Than in Men Is Associated
With Increased Gait Variability During Multitasking. J. Am. Med. Dir. Assoc. 2016, 17, 535–540. [CrossRef]
Sports 2019, 7, 127 25 of 28

140. Gillespie, L.D.; Robertson, M.C.; Gillespie, W.J.; Lamb, S.E.; Gates, S.; Cumming, R.G.; Rowe, B.H.
Interventions for preventing falls in older people living in the community. Cochrane Database Syst. Rev. 2009,
Cd007146. [CrossRef]
141. Svantesson, U.; Jones, J.; Wolbert, K.; Alricsson, M. Impact of Physical Activity on the Self-Perceived Quality
of Life in Non-Frail Older Adults. J. Clin. Med. Res. 2015, 7, 585–593. [CrossRef]
142. Mitchell, W.K.; Williams, J.; Atherton, P.; Larvin, M.; Lund, J.; Narici, M. Sarcopenia, dynapenia, and the
impact of advancing age on human skeletal muscle size and strength: A quantitative review. Front. Physiol.
2012, 3, 260. [CrossRef]
143. Csapo, R.; Gormasz, C.; Baron, R. Functional performance in community-dwelling and institutionalized
elderly women. Wiener Klinische Wochenschrift 2009, 121, 383–390. [CrossRef]
144. Mayer, F.; Scharhag-Rosenberger, F.; Carlsohn, A.; Cassel, M.; Muller, S.; Scharhag, J. The intensity and effects
of strength training in the elderly. Deutsches Arzteblatt Int. 2011, 108, 359–364. [CrossRef]
145. Stewart, V.H.; Saunders, D.H.; Greig, C.A. Responsiveness of muscle size and strength to physical training in
very elderly people: A systematic review. Scand. J. Med. Sci. Sports 2014, 24, e1–10. [CrossRef]
146. Physical Activities Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report,
2008; Department of Health and Human Services: Washington, DC, USA, 2008.
147. Olesen, J.; Gustavsson, A.; Svensson, M.; Wittchen, H.U.; Jonsson, B. The economic cost of brain disorders in
Europe. Eur. J. Neurol. 2012, 19, 155–162. [CrossRef]
148. Josefsson, T.; Lindwall, M.; Archer, T. Physical exercise intervention in depressive disorders: Meta-analysis
and systematic review. Scand. J. Med. Sci. Sports 2014, 24, 259–272. [CrossRef] [PubMed]
149. Rosenbaum, S.; Tiedemann, A.; Sherrington, C.; Curtis, J.; Ward, P.B. Physical activity interventions for
people with mental illness: A systematic review and meta-analysis. J. Clin. Psychiatry 2014, 75, 964–974.
[CrossRef] [PubMed]
150. Aberg, M.A.; Waern, M.; Nyberg, J.; Pedersen, N.L.; Bergh, Y.; Aberg, N.D.; Nilsson, M.; Kuhn, H.G.; Toren, K.
Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish prospective
population-based study. Br. J. Psychiatry 2012, 201, 352–359. [CrossRef] [PubMed]
151. Carroll, D.D.; Blanck, H.M.; Serdula, M.K.; Brown, D.R. Obesity, physical activity, and depressive symptoms
in a cohort of adults aged 51 to 61. J. Aging Health 2010, 22, 384–398. [CrossRef] [PubMed]
152. Adamson, B.C.; Ensari, I.; Motl, R.W. Effect of exercise on depressive symptoms in adults with neurologic
disorders: A systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 2015, 96, 1329–1338. [CrossRef]
[PubMed]
153. Agudelo, L.Z.; Femenia, T.; Orhan, F.; Porsmyr-Palmertz, M.; Goiny, M.; Martinez-Redondo, V.; Correia, J.C.;
Izadi, M.; Bhat, M.; Schuppe-Koistinen, I.; et al. Skeletal muscle PGC-1alpha1 modulates kynurenine
metabolism and mediates resilience to stress-induced depression. Cell 2014, 159, 33–45. [CrossRef] [PubMed]
154. Schmidt-Kassow, M.; Deusser, M.; Thiel, C.; Otterbein, S.; Montag, C.; Reuter, M.; Banzer, W.; Kaiser, J. Physical
Exercise during Encoding Improves Vocabulary Learning in Young Female Adults: A Neuroendocrinological
Study. PLoS ONE 2013, 8, e64172. [CrossRef] [PubMed]
155. Erickson, K.I.; Voss, M.W.; Prakash, R.S.; Basak, C.; Szabo, A.; Chaddock, L.; Kim, J.S.; Heo, S.; Alves, H.;
White, S.M.; et al. Exercise training increases size of hippocampus and improves memory. Proc. Natl. Acad.
Sci. USA 2011, 108, 3017–3022. [CrossRef]
156. Winter, B.; Breitenstein, C.; Mooren, F.C.; Voelker, K.; Fobker, M.; Lechtermann, A.; Krueger, K.; Fromme, A.;
Korsukewitz, C.; Floel, A.; et al. High impact running improves learning. Neurobiol. Learn. Mem. 2007, 87,
597–609. [CrossRef]
157. Oppezzo, M.; Schwartz, D.L. Give your ideas some legs: The positive effect of walking on creative thinking.
J. Exp. Psychol. 2014, 40, 1142–1152. [CrossRef]
158. Kramer, A.F.; Marquez, D.X.; McAuley, E.; Kim, J.S.; Erickson, K.I.; Hu, L.; Scalf, P.E.; Prakash, R.;
Colcombe, S.J.; Elavsky, S. Aerobic Exercise Training Increases Brain Volume in Aging Humans. J. Gerontol.
2006, 61, 1166–1170. [CrossRef]
159. Spielman, L.J.; Little, J.P.; Klegeris, A. Physical activity and exercise attenuate neuroinflammation in
neurological diseases. Brain Res. Bull. 2016, 125, 19–29. [CrossRef]
160. Soundy, A.; Freeman, P.; Stubbs, B.; Probst, M.; Roskell, C.; Vancampfort, D. The Psychosocial Consequences
of Sports Participation for Individuals with Severe Mental Illness: A Metasynthesis Review. Adv. Psychiatry
2015, 2015, 8. [CrossRef]
Sports 2019, 7, 127 26 of 28

161. Hassmen, P.; Koivula, N.; Uutela, A. Physical exercise and psychological well-being: A population study in
Finland. Prev. Med. 2000, 30, 17–25. [CrossRef]
162. Coakley, J. Youth Sports: What Counts as “Positive Development?”. J. Sport Soc. Issues 2011, 35, 306–324.
[CrossRef]
163. Seligman, M.E.P. Positive Health. Appl. Psychol. 2008, 57, 3–18. [CrossRef]
164. Rongen, F.; Cobley, S.; McKenna, J.; Till, K. Talent identification and development. In Health and Elite Sport: Is
High Performance Sport a Healthy Pursuit? Baker, J., Safai, P., Fraser-Thomas, J., Eds.; Routledge Research in
Sport, Culture and Society; Taylor & Francis Group: London, UK, 2015.
165. Baker, J.; Fraser-Thomas, J.; Dionigi, R.A.; Horton, S. Sport participation and positive development in older
persons. Eur. Rev. Aging Phys. Act. 2010, 7, 3–12. [CrossRef]
166. Walsh, D.W. Sport as a Resource Caravan: Examining the Role and Efficacy of Sport as a Resource Provider
for Adults in Transition. Ph.D. Thesis, University of Texas at Austin, Austin, TX, USA, 2014.
167. Rehn, A.; Möller, A. Den organiserade idrottens betydelse för spontanidrott; Gymnastik- och Idrottshögskolan:
Stockholm, Sweden, 2011.
168. Ratzlaff, C.R. Good news, bad news: Sports matter but occupational and household activity really matter -
sport and recreation unlikely to be a panacea for public health. Br. J. Sports Med. 2012, 46, 699–701. [CrossRef]
169. Lewis, C.J.; Reeves, M.J.; Roberts, S.J. Improving the physical and mental well-being of typically hard-to-reach
men: An investigation of the impact of the Active Rovers project. Sport Soc. 2017, 20, 258–268. [CrossRef]
170. Dunleavy, N. Proposed cuts to sport and recreation could hinder health of northern communities. CMAJ.
2008, 178, 1129. [CrossRef]
171. Kim, J.; Kim, M.; Henderson, K.A.; Han, A.; Park, S.H. Serious engagement in sport and health benefits
among Korean immigrants in the USA. Int. J. Qual. Stud. Health Well-Being 2016, 11, 31340. [CrossRef]
172. Perrier, M.J.; Shirazipour, C.H.; Latimer-Cheung, A.E. Sport participation among individuals with acquired
physical disabilities: Group differences on demographic, disability, and Health Action Process Approach
constructs. Disabil. Health J. 2015, 8, 216–222. [CrossRef] [PubMed]
173. Engström, L.-M. Who is physically active? Cultural capital and sports participation from adolescence to
middle age—A 38-year follow-up study. Phys. Educ. Sport Pedagog. 2008, 13, 319–343. [CrossRef]
174. Brenner, J.S.; Council On Sports Medicine and Fitness. Sports Specialization and Intensive Training in Young
Athletes. Pediatrics 2016, 138. [CrossRef]
175. LaPrade, R.F.; Agel, J.; Baker, J.; Brenner, J.S.; Cordasco, F.A.; Cote, J.; Engebretsen, L.; Feeley, B.T.; Gould, D.;
Hainline, B.; et al. AOSSM Early Sport Specialization Consensus Statement. Orthop. J. Sports Med. 2016, 4,
2325967116644241. [CrossRef]
176. Tan, V.P.; Macdonald, H.M.; Kim, S.; Nettlefold, L.; Gabel, L.; Ashe, M.C.; McKay, H.A. Influence of physical
activity on bone strength in children and adolescents: A systematic review and narrative synthesis. J. Bone
Miner. Res. 2014, 29, 2161–2181. [CrossRef] [PubMed]
177. Timmons, B.W.; Leblanc, A.G.; Carson, V.; Connor Gorber, S.; Dillman, C.; Janssen, I.; Kho, M.E.; Spence, J.C.;
Stearns, J.A.; Tremblay, M.S. Systematic review of physical activity and health in the early years (aged 0-4
years). Appl. Physiol. Nutr. Metab. 2012, 37, 773–792. [CrossRef] [PubMed]
178. Janssen, I.; Roberts, K.C.; Thompson, W. Is adherence to the Canadian 24-Hour Movement Behaviour
Guidelines for Children and Youth associated with improved indicators of physical, mental, and social
health? Appl. Physiol. Nutr. Metab. 2017, 42, 725–731. [CrossRef]
179. Fedewa, M.V.; Gist, N.H.; Evans, E.M.; Dishman, R.K. Exercise and insulin resistance in youth: A meta-analysis.
Pediatrics 2014, 133, e163–e174. [CrossRef]
180. Jayanthi, N.; Pinkham, C.; Dugas, L.; Patrick, B.; Labella, C. Sports specialization in young athletes:
Evidence-based recommendations. Sports Health 2013, 5, 251–257. [CrossRef]
181. Wattie, N.; Schorer, J.; Baker, J. The relative age effect in sport: A developmental systems model. Sports Med.
2015, 45, 83–94. [CrossRef]
182. Delorme, N.; Raspaud, M. The relative age effect in young French basketball players: A study on the whole
population. Scand. J. Med. Sci. Sports 2009, 19, 235–242. [CrossRef]
183. Fumarco, L.; Gibbs, B.G.; Jarvis, J.A.; Rossi, G. The relative age effect reversal among the National Hockey
League elite. PLoS ONE 2017, 12, e0182827. [CrossRef]
184. Geithner, C.A.; Molenaar, C.; Henriksson, T.; Fjellman-Wiklund, A. Relative Age Effects in Women’s Ice
Hockey. Women Sport Phys. Act. J. 2018, 26, 124–133. [CrossRef]
Sports 2019, 7, 127 27 of 28

185. Gerdin, G.; Hedberg, M.; Hageskog, C.A. Relative Age Effect in Swedish Male and Female Tennis Players
Born in 1998(-)2001. Sports 2018, 6, 38. [CrossRef]
186. Jones, C.; Visek, A.J.; Barron, M.J.; Hyman, M.; Chandran, A. Association between relative age effect and
organisational practices of American youth football. J. Sports Sci. 2018, 1–8. [CrossRef]
187. Edwards, L.C.; Bryant, A.S.; Keegan, R.J.; Morgan, K.; Cooper, S.M.; Jones, A.M. ‘Measuring’ Physical
Literacy and Related Constructs: A Systematic Review of Empirical Findings. Sports Med. 2017. [CrossRef]
188. Bahr, R. Demise of the fittest: Are we destroying our biggest talents? Br. J. Sports Med. 2014, 48, 1265–1267.
[CrossRef]
189. Kenttä, G.; Svensson, M. Idrottarens återhämtningsbok, fysiologiska, psykologiska och näringsmässiga fakta för snabb
och effektiv återhämtning; SISU Idrottsböcker: Stockholm, Sweden, 2008.
190. Blair, S.N.; Kohl, H.W., 3rd; Barlow, C.E.; Paffenbarger, R.S., Jr.; Gibbons, L.W.; Macera, C.A. Changes in
physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 1995, 273,
1093–1098. [CrossRef]
191. Paffenbarger, R.S., Jr.; Kampert, J.B.; Lee, I.M.; Hyde, R.T.; Leung, R.W.; Wing, A.L. Changes in physical
activity and other lifeway patterns influencing longevity. Med. Sci. Sports Exerc. 1994, 26, 857–865. [CrossRef]
192. Rivera-Torres, S.; Fahey, T.D.; Rivera, M.A. Adherence to Exercise Programs in Older Adults: Informative
Report. Gerontol. Geriatr. Med. 2019, 5, 2333721418823604. [CrossRef]
193. McPhee, J.S.; French, D.P.; Jackson, D.; Nazroo, J.; Pendleton, N.; Degens, H. Physical activity in older age:
Perspectives for healthy ageing and frailty. Biogerontology 2016, 17, 567–580. [CrossRef]
194. Hamer, M.; Lavoie, K.L.; Bacon, S.L. Taking up physical activity in later life and healthy ageing: The English
longitudinal study of ageing. Br. J. Sports Med. 2014, 48, 239–243. [CrossRef]
195. Cobley, S.; Baker, J.; Wattie, N.; McKenna, J. Annual age-grouping and athlete development: A meta-analytical
review of relative age effects in sport. Sports Med. 2009, 39, 235–256. [CrossRef]
196. Unhjem, R.; Nygard, M.; van den Hoven, L.T.; Sidhu, S.K.; Hoff, J.; Wang, E. Lifelong strength training
mitigates the age-related decline in efferent drive. J. Appl. Physiol. (Bethesda Md. 1985) 2016, 121, 415–423.
[CrossRef]
197. Power, G.A.; Allen, M.D.; Gilmore, K.J.; Stashuk, D.W.; Doherty, T.J.; Hepple, R.T.; Taivassalo, T.; Rice, C.L.
Motor unit number and transmission stability in octogenarian world class athletes: Can age-related deficits
be outrun? J. Appl. Physiol. (Bethesda Md. 1985) 2016, 121, 1013–1020. [CrossRef]
198. Matelot, D.; Schnell, F.; Kervio, G.; Ridard, C.; Thillaye du Boullay, N.; Wilson, M.; Carre, F. Cardiovascular
Benefits of Endurance Training in Seniors: 40 is not too Late to Start. Int. J. Sports Med. 2016, 37, 625–632.
[CrossRef]
199. Lepers, R.; Stapley, P.J. Master Athletes Are Extending the Limits of Human Endurance. Front. Physiol. 2016,
7, 613. [CrossRef]
200. Parkkari, J.; Natri, A.; Kannus, P.; Manttari, A.; Laukkanen, R.; Haapasalo, H.; Nenonen, A.; Pasanen, M.;
Oja, P.; Vuori, I. A controlled trial of the health benefits of regular walking on a golf course. Am. J. Med. 2000,
109, 102–108. [CrossRef]
201. Broman, G.; Johnsson, L.; Kaijser, L. Golf: A high intensity interval activity for elderly men. Aging Clin.
Exp. Res. 2004, 16, 375–381. [CrossRef]
202. Kiss, O.; Sydo, N.; Vargha, P.; Edes, E.; Merkely, G.; Sydo, T.; Merkely, B. Prevalence of physiological and
pathological electrocardiographic findings in Hungarian athletes. Acta Physiol. Hung. 2015, 102, 228–237.
[CrossRef] [PubMed]
203. Shapero, K.; Deluca, J.; Contursi, M.; Wasfy, M.; Weiner, R.B.; Lewis, G.D.; Hutter, A.; Baggish, A.L.
Cardiovascular Risk and Disease Among Masters Endurance Athletes: Insights from the Boston MASTER
(Masters Athletes Survey to Evaluate Risk) Initiative. Sports Med. Open 2016, 2, 29. [CrossRef] [PubMed]
204. Yankelson, L.; Sadeh, B.; Gershovitz, L.; Werthein, J.; Heller, K.; Halpern, P.; Halkin, A.; Adler, A.; Steinvil, A.;
Viskin, S. Life-threatening events during endurance sports: Is heat stroke more prevalent than arrhythmic
death? J. Am. Coll. Cardiol. 2014, 64, 463–469. [CrossRef]
205. Strimel, W.J.; O’Riordan, M.J. Sudden cardiac arrest in long distance races: Considering the full context.
J. Am. Coll. Cardiol. 2015, 65, 407–408. [CrossRef]
Sports 2019, 7, 127 28 of 28

206. Piasecki, M.; Ireland, A.; Coulson, J.; Stashuk, D.W.; Hamilton-Wright, A.; Swiecicka, A.; Rutter, M.K.;
McPhee, J.S.; Jones, D.A. Motor unit number estimates and neuromuscular transmission in the tibialis
anterior of master athletes: Evidence that athletic older people are not spared from age-related motor unit
remodeling. Physiol. Rep. 2016, 4. [CrossRef]
207. Moreira, N.B.; Mazzardo, O.; Vagetti, G.C.; De Oliveira, V.; De Campos, W. Quality of life perception of
basketball master athletes: Association with physical activity level and sports injuries. J. Sports Sci. 2016, 34,
988–996. [CrossRef]
208. Haigh, E.A.P.; Bogucki, O.E.; Sigmon, S.T.; Blazer, D.G. Depression Among Older Adults: A 20-Year Update
on Five Common Myths and Misconceptions. Am. J. Geriatr. Psychiatry 2018, 26, 107–122. [CrossRef]
209. Alfini, A.J.; Weiss, L.R.; Leitner, B.P.; Smith, T.J.; Hagberg, J.M.; Smith, J.C. Hippocampal and Cerebral Blood
Flow after Exercise Cessation in Master Athletes. Front. Aging Neurosci. 2016, 8, 184. [CrossRef]
210. Lazarus, N.R.; Harridge, S.D.R. Declining performance of master athletes: Silhouettes of the trajectory of
healthy human ageing? J. Physiol. 2017, 595, 2941–2948. [CrossRef]

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC BY) license (http://creativecommons.org/licenses/by/4.0/).