Football to tackle overweight in children

Effects of Small-Sided Soccer Games on Physical Fitness and Cardiometabolic Health Biomarkers in Untrained Children and Adolescents: A Systematic Review and Meta-Analysis

Objective: This systematic review and meta-analysis aimed to determine the benefits of an exercise intervention based on small-sided soccer games (SSSGs) on health-related physical fitness and cardiometabolic health in previously untrained children and adolescents. Methods: A systematic search on PubMed/MEDLINE, Web of Science, Scopus, Cochrane, and EBSCO databases was performed. Randomized or non-randomized controlled trials conducted in previously untrained children or adolescents (age < 18 years) that assessed the effect of SSSG-based intervention on health-related physical fitness and cardiometabolic risk biomarkers were included. Primary outcomes were cardiorespiratory fitness and waist circumference. Evidence was synthesized as the mean difference or standardized mean difference using a random-effects meta-analysis. The quality of evidence was assessed using ROB2 and ROBINS-I tools. Results: Sixteen studies (n = 2872 participants) were included in this meta-analysis. SSSGs significantly improved cardiorespiratory fitness (SMD, 0.12 [0.01; 0.23]) and showed a non-significant trend in decreased waist circumference (-7.49 cm [-15.03; 0.06]). Additionally, SSSGs significantly decreased systolic (MD, -3.85 mmHg [-5.75; -1.94]) and diastolic blood pressure (MD, -1.26 mmHg [-2.44; -0.08]) and triglycerides (-30.34 mg·dL-1 [-45.99; -14.69]). No effects on body composition or other cardiometabolic risk biomarkers were observed. After a sensitivity analysis, waist circumference and muscle strength were also shown to improve significantly following SSSGs. Comparisons between SSSG and other types of exercise interventions showed no differences in improved physical fitness or cardiometabolic risk. Conclusions: SSSG-based interventions effectively improve cardiorespiratory fitness, blood pressure, triglycerides, muscle strength, and waist circumference. There is less evidence of the effects of SSSGs on other health markers. Particular attention should be given to improving SSSG protocol reporting in future studies.

Early sports specialization in Japanese young soccer players and related factors

Although understanding the status of sports participation is essential for preventing injuries in young athletes, the level of specialization and relevant information in Japan is unknown. This study aimed to clarify the status of sports specialization and examine the relationships between specialization and training status in Japanese young soccer players. Four hundred Japanese young male soccer players were included. The players' parents completed a web questionnaire that consisted of three-point questions regarding specialization and training status (year, days of playing soccer, age when starting soccer). The level of specialization and accompanying information were calculated, and data were compared by specialization status. Of the participants, 53.8% demonstrated a high level of specialization. In addition, 74.5% considered soccer more important than other sports, 89.0% trained in soccer for more than 8 months of the year, and 74.0% had quit other sports to focus on soccer or played only soccer. The proportion of participants who played only soccer was significantly higher in the high-specialization group (37.6%) than in the moderate-specialization (22.5%; P < .01) and low-specialization (7.1%; P < .01) groups. By specialization status at grades 4 to 6 (9-12 years), 40.3% of participants demonstrated a high level of specialization. Young Japanese soccer players tend toward early specialization. Factors contributing to the high specialization level are being active throughout the year and rarely playing other sports. Training volume should be controlled, and an environment allowing young soccer players to participate in other sports simultaneously is needed, with early specialization being avoided.

Impact of Soccer-Based Training Interventions on Anthropometric Measures Among Children and Adolescents With Overweight/Obesity: A Systematic Review, Meta-Analysis, and Assessment of Certainty of Evidence

PURPOSE

This systematic review and meta-analysis aimed to systematically examine and summarize recent evidence on the effects of soccer-based training (SBT) on anthropometric measures in children and adolescents with overweight/obesity.

METHODS

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines, a thorough literature search across 7 electronic databases was conducted on October 11, 2023. The studies' methodological quality was evaluated using the QualSyst tool, followed by conducting a meta-analysis with a random-effects model, and the certainty of evidence was assessed.

RESULTS

Six studies were included, with 4 studies of strong methodological quality and 2 studies of moderate methodological quality. The results of the meta-analysis revealed SBT decreases fat mass percentage (effect size [ES] = 0.47 [small]; P = .002), with no significant effect of SBT on body mass index (ES = 0.180 [small]; P = .275), body mass (ES = 0.183 [trivial]; P = .212), fat-free mass (ES = 0.074 [trivial]; P = .635), or waist circumference (ES = 0.358 [small]; P = .053). The certainty of evidence was moderate for all outcomes.

CONCLUSIONS

SBT appears to decrease fat mass percentage, without affecting body mass, body mass index, fat-free mass, or waist circumference in obese/overweight children and adolescents. These findings require further investigation given the moderate certainty of evidence.

REGISTRATION

The protocol of this review was registered in the Open Science Framework database (https://doi.org/10.17605/OSF.IO/8P4V2).

FIFA 11+ KIDS in the prevention of soccer injuries in children: a systematic review

BACKGROUND

The "FIFA 11+" is an injury prevention program conceived for soccer athletes aged over 14. The use of FIFA 11+ Kids in soccer was associated with a reduction of the overall risk of injuries in children by 48%, and of 74% for serious injuries. However, to the best of our knowledge, a systematic review of the literature on the effects of FIFA 11+ Kids is still missing. Therefore, a systematic review was conducted to ascertain the benefits of the "FIFA 11+ KIDS" program in children who practice soccer.

METHODS

This systematic review was conducted according to the PRISMA recommendations and prospectively registered in PROSPERO. The electronic search was conducted in the following databases: Web of Science, PubMed, Medline via Ovid, EMBASE and SportDiscuss via EBSCO. Database searches were performed in January 2024. This review included studies that evaluated the effects of the "FIFA 11+ KIDS" program. Eligible studies had to describe program implementation and the mean age of the children.

RESULTS

A total of 11 articles were included in this systematic review from a pool of 8513 articles screened across various databases. These articles involved over 10,000 young participants from 8 countries, primarily aged 7-14 years, with the majority being soccer athletes. Study quality varied, with four categorized as high, four as good, and three as fair quality. Objectives varied across studies, with four focusing on FIFA 11+ Kids' efficacy in injury prevention, five examining its impact on performance and physical abilities, and two assessing its effects on children's focus and attention skills. Notably, injury prevention studies reported around a 50% reduction in overall injuries and nearly 60% in severe injuries, with a dose-response relationship observed with increased weekly sessions. Significant improvements were noted in physical and functional tests such as the Y balance, jump tests, and various soccer skills, along with positive effects on children's focus and attention, as indicated by 13-18% improvements in Attention Scale for Elementary School Children (ASESC) scores.

CONCLUSION

The FIFA 11+ KIDS injury prevention program appears to be effective in reducing injuries in young football players. This can positively influence player and team overall performance and might support the long-term athlete development of these young athletes. These findings highlight the importance and necessity of injury prevention in young athletes.

Exploring the relationship among soccer-related knowledge, attitude, practice, and self-health in Chinese campus soccer education

China has promoted campus soccer for over a decade due to its potential health benefits. The study aimed to explore soccer knowledge (SK), soccer attitude (SA), soccer practice (SP), and health status among Chinese freshmen and sophomore undergraduates who had received campus soccer education. Of the 7419 participants, 1,069 were valid and included in the analysis. Structural equation modeling (SEM) results indicated SK is positively associated with SA (p < 0.001), but negatively with SP (p < 0.01). SA was positively linked to SP (p < 0.001). SK indirectly affected SP through SA (Z = 13.677). Random forest-tree-structured Parzen estimators (RF-TPE) with SHAP indicated SP holds primary importance with a strong negative impact on health. Additionally, differences in rankings for SK, SA, and SP were observed among gender and urban-rural groups. These results reveal current campus soccer education is suboptimal to health promotion.

Effects of "Football and Nutrition for Health" program on body composition, physical fitness, eating behaviours, nutritional knowledge, and psychological status among 7 to 10 years school children

Introduction

Noncommunicable diseases and obesity are between the major health threat due to consumption of unhealthy foods and limited time spent on physical activities, a situation of particular concern among children. Since children spend most of their time at school, this study intends to investigate the effect of a school intervention program, which combines recreational football and nutrition education, on body composition, physical fitness, physical activity, blood pressure and heart rate, eating behaviours, nutritional knowledge, and psychological status in elementary school children.

Methods

A total of 67 children, between 7 and 10 years old, were allocated into three groups: the Football Group (FG) which held 2 weekly sessions of 60 min of recreational football, the Nutrition and Football Group (NFG) which held 2 sessions per week of 60 min of recreational football plus 60 min of nutritional education and the Control Group (CG) which maintained its usual curriculum. The intervention lasted 12 weeks. All measurements were collected before and after the intervention.

Results

Intervention groups significantly (p < 0.05) improved BMI Z-score, rest heart rate, horizontal jump and shuttle test, physical activity level, and psychosocial health. The NFG group significantly decreased (p < 0.05) waist-to-height ratio and blood pressure, and significantly increased (p < 0.05) nutritional knowledge, fruit, and fish consumption. While FG significantly decreased (p < 0.05) the percentage of fat mass and significantly increased (p < 0.05) muscle mass and performance in the 20 m sprint.

Discussion

The results have shown to improve nutritional status, explosive strength, aerobic and neuromuscular fitness, as well as increase the level of physical activity. The nutritional education sessions contributed to increase nutritional knowledge and to improve the consumption of healthy food groups in a ludic-educational way. The "Football and Nutrition for Health" program was able to induce short-term improvements in several health markers, highlighting the role of the school curriculum in children's health.

An analysis of pain intensity, injury incidence, and their associations with socio-demographic factors in high school athletes: A cross-sectional study during the COVID-19 pandemic

This cross-sectional study explored the relationship between pain intensity, injury incidence, and sociodemographic factors in 120 high school athletes (mean age 16.78±0.91) participating in various sports. The aims of this study are to examine the correlation between factors and Verbal Rating Scale (VRS) for pain intensity, to investigate the correlation between sport types and injured region, and to explore the correlation between injured regions and VRS during training and game competition. Using VRS, we found 64 (53.3%) participants experienced pain during training, with varying degrees of intensity. Chi-square analysis revealed a significant association between VRS scores and school grade (p = 0.044) and cool-down practices (p = 0.037). However, no significant associations were found with gender, age, or sport type. In game competition, 29 (24.2%) participants reported experiencing pain. Here, there was no significant association between VRS and any considered variables. Lower limb injuries were predominant (n = 64), particularly to the knee (n = 23) and ankle/foot (n = 18). Certain sports, like Athletics, Karate-Do, Football, and Western Boxing, demonstrated multiple injury sites, whereas Thai boxing was associated primarily with ankle and foot injuries. Pain intensity varied by injury location, with the highest 'worst pain' reported for elbow injuries during training and knee injuries during competition. Significant associations were found between injured region and pain intensity level during both training and competition (p<0.001). Our findings highlight the need for injury prevention strategies and pain management among high school athletes, emphasizing proper cool-down activities. Further research is warranted to confirm these findings and explore underlying mechanisms.

Association between Soccer Participation and Liking or Being Proficient in It: A Survey Study of 38,258 Children and Adolescents in China

Soccer participation among children and adolescents is low in China. To achieve a coordinated development of soccer in all regions and to promote the physical health of children and adolescents, this study aims to identify the influencing factors regarding the participation of children and adolescents in soccer programs through a cross-sectional analysis of the “soccer population” of children and adolescents. A total of 38,258 children and adolescents aged 7–18 years were included in this study. In addition, the analysis was conducted by dividing the regions where the children and adolescents live into three parts according to socioeconomic status, and by incorporating five dimensions, including environment, family, school, community, and individual levels to find the influencing factors of children and adolescents’ participation in soccer. Chi-square test, Pearson’s correlation, and one-way logistic regression analyses were used. The results showed that the area (r = 0.487) and the average annual precipitation (r = −0.367) were associated with the participation of children and adolescents in soccer programs. Moreover, the percentage of children and adolescents who participated in soccer programs (24.5%) was higher than those who liked soccer or were proficient in it (14.4%). Meanwhile, parental encouragement and support (OR = 0.627; 95% CI, 1.102–3.179), as well as the accessibility (OR = 0.558; 95% CI, 1.418–2.155), availability (OR = 1.419; 95% CI, 1.179–1.707), and safety of sports facilities (OR = 0.316; 95% CI, 0.614–0.865), influence children and adolescents’ participation in soccer programs.

Physical activity interventions for the mental health of children: A systematic review

OBJECTIVE

This systematic review explored the effectiveness of using physical activity (PA) interventions to enhance psychological well-being and reduce psychological ill-being (e.g., anxiety and depression) in children aged six to 11 years old from the general population.

METHODS

Electronic databases were searched for studies published between January 2005 and June 2020: Web of Science, ProQuest Psychology Journals, PsycINFO, Pub Med, ASSIA, CINHAL PLUS, SPORTDiscus, EMBASE and Wiley Online Library. Search terms included 'physical activity intervention', 'psychological well-being' and 'child*'. After removing duplicates, 11 390 studies were independently screened by two authors based on inclusion/exclusion criteria and assessed for risk of bias.

RESULTS

A total of 23 studies were narratively synthesized and categorized into four domains: Quality of Life (QOL), body image, self-esteem and psychological ill-being. Evidence was provided for the impact of PA interventions in improving QOL, body image and self-esteem. Despite the positive effect on psychological well-being, evidence for a reduction in the frequency and severity of symptoms associated with psychological ill-being in children is less clear.

CONCLUSIONS

Reviewed studies support the use of PA interventions in enhancing the psychological well-being of children in school and community settings. More research is warranted to understand the impact of PA interventions on reducing psychological ill-being in children from the general population.

EFFECTS OF A SMALL-SIDED SOCCER PROGRAM ON HEALTH PARAMETERS IN OBESE CHILDREN

ABSTRACT Introduction: Childhood obesity is increasing and, as a consequence, it generates health complications resulting from sedentary behavior and low levels of physical fitness. There are few studies involving children, metabolic and cardiorespiratory profiles, and soccer. Objective: The purpose was to measure the effects of a 12-week recreational small-sided soccer program on cardiometabolic risk and individual responses to cardiometabolic risk factors in overweight or obese boys. Methods: Thirteen boys aged 8-12 years (34.9±11.6% body fat) participated in a 12-week recreational small-sided soccer training program with two 80-minute sessions per week at intensities over 80% of the maximal heart rate. Anthropometric characteristics, cardiorespiratory fitness, metabolic profile, individual responses to peak oxygen uptake (VO2peak), maximal workload (Wmax), fasting blood glucose, insulin, HOMA-IR, LDL-C, HDL-C, TC, and TG were measured both pre- and post-training. Results: Considering the individual responses of the participants, recreational soccer training was effective in improving variations in maximum power and exhaustion time, as well as promoting at least one beneficial change in cardiometabolic risk factors in 84% of the overweight or obese children. There were no differences between pre- and post-program anthropometric characteristics, metabolic profiles, or VO2peak values. Conclusion: Twelve-week recreational small-sided soccer programs were able to improve maximal power and anaerobic capacity and maintain cardiometabolic risk factor levels in overweight and obese boys. Level of evidence I; High-quality prospective study (all patients were enrolled at the same stage of disease, with >80% of patients enrolled) .

Recreational Soccer Training Effects on Pediatric Populations Physical Fitness and Health: A Systematic Review

This systematic review analyzed the effects of recreational soccer programs on physical fitness and health-related outcomes in youth populations. Studies were sought in the following databases: (i) PubMed, (ii) Scopus, (iii) SPORTDiscus, and (iv) Web of Science. The eligibility criteria included (1) population: youth (<18 years old) populations with no restrictions on sex or health condition; (2) intervention: exposure to a recreational soccer training program of at least four weeks duration; (3) comparator: a passive or active control group not exposed to a recreational soccer training program; (4) outcomes: physical fitness (e.g., aerobic, strength, speed, and change-of-direction) or health-related measures (e.g., body composition, blood pressure, heart rate variability, and biomarkers); (5) study design: a randomized parallel group design. The search was conducted on 6 September 2022 with no restrictions as to date or language. The risk of bias was assessed using the PEDro scale for randomized controlled studies. From a pool of 37,235 potentially relevant articles, 17 were eligible for inclusion in this review. Most of the experimental studies revealed the beneficial effects of recreational soccer for improving aerobic fitness and its benefits in terms of blood pressure and heart-rate markers. However, body composition was not significantly improved by recreational soccer. The main results revealed that recreational soccer training programs that are implemented twice a week could improve the generality of physical fitness parameters and beneficially impact cardiovascular health and biomarkers. Thus, recreational soccer meets the conditions for being included in the physical education curriculum as a good strategy for the benefit of the general health of children and young people.

Effects and dose-response relationships of exercise intervention on weight loss in overweight and obese children: a meta-regression and system review

The aim of this study was to determine the effect of different exercise doses on weight loss in obese/overweight children. PubMed, Embase, SPORTDiscus, and the Cochrane library were searched from inception to November 2020 for randomized controlled trials. Fourty six trials involving 2,599 obese/overweight children were finally included. Different exercise dose interventions had different impacts. Exercise intervention reduce body weight (BW) by 1.46 kg (95% CI, -2.35 to -0.56, p=0.001), body fat percentage (BF%) by 2.24 (95% CI, -2.63 to -1.84, p<0.001) and body mass index (BMI) by 1.09 kg/m² (95% CI, -1.45 to -0.73, p<0.001). Each MET-h/week was association with 0.147 kg (95% CI, -0.287 to -0.007, p=0.039) decrease in BW, 0.060 (95% CI, -0.118 to -0.002, p=0.042) decrease in BF%, and 0.069 kg/m² (95% CI, -0.125 to -0.014, p=0.015) decrease in BMI. The findings suggest that there is a positive liner between exercise dose and weight loss, each MET-h/week associated with 0.147 kg, 0.060 and 0.069 kg/m² decrease in body weight, BF%, BMI, respectively.

Analysis of the Running Ability Mining Model of Football Trainers Based on Dynamic Incremental Clustering Algorithm

Fast-running ability is a very important basic quality of football players. However, players are dynamic. It is difficult for coaches to grasp the running speed, instantaneous acceleration, and other indicators of small athletes in real time with the naked eye. Therefore, to accurately test the performance of athletes in fast-running ability, this paper studies the running ability mining model of football coaches based on the dynamic incremental clustering algorithm. According to scientific procedures and methods, the evaluation model and standard of running ability of Chinese elite female football players are established. The effectiveness of the model is 0.83, as verified by the standard recognition method, which shows that the evaluation model is efficient. The research considers the denoising of the original data. The model has rich data and standard test methods and procedures. It can be used as a measure of the running ability of China's elite female football players in a certain period and range. The research solves the problem of the insufficient running ability of domestic football players. It provides an important reference for training the next generation of excellent national football players.

Players with high physical fitness are at greater risk of injury in youth football

The aim of this study was to investigate physical fitness, football-specific skills, and their association with injury risk in youth football. Altogether 447 male and female players aged 9-14 years (median 12 years) participated in performance tests and prospective follow-up. The physical fitness tests included five-jump test for distance, 30-m sprint, football-specific figure of eight agility, countermovement jump, and Yo-Yo intermittent endurance test level 1. The football-specific skill tests included dribbling and passing tests. Injuries and exposure were registered during the 20-week follow-up. Our candidate risk factors were low/high level of physical fitness measured with a composite score of physical fitness tests and low/high level of football-specific skills measured with a composite score of dribbling and passing tests. Secondarily, we investigated performance in individual tests and their association with injury risk. During the follow-up, players reported 565 injuries (264 acute and 301 overuse injuries). High level of physical fitness was associated with increased rate of all injuries (age-, sex-, and mean team exposure-adjusted IRR: 1.28, 95% CI: 1.04-1.58). The level of football-specific skills had no influence on the overall injury rate. Burden of overuse injuries, but not acute injuries was significantly higher in most fit players compared with the players in the reference group (IRR: 2.09, 95% CI: 1.04-4.24). In conclusion, most fit players were at greater risk of sustaining injuries in youth competitive football.

Acceleration profile of high-impact movements during young football games: a cross-sectional study involving healthy children

Repetitive high-impact movements cause growth-related injuries in children. This study aimed to identify which movements during junior football games require >6 G and >8 G acceleration and the frequency at which they occur. Additionally, we compared the components of acceleration among movements with >8 G resultant acceleration. Eleven young male footballers (10.7 ± 0.4 years) played 8-a-side games while wearing a tri-axial accelerometer on their upper back. The number and frequency of the movements that generated >6 G and >8 G were calculated, and each directive acceleration of the top five items was compared using two-way ANOVA to examine the effect of movements. The frequency of movements that generated >6 G and >8 G acceleration during junior football games was 8.70 case/min and 2.62 case/min, respectively. The top five >8 G movements were braking and pre-braking in shuffle, slowdown, stop, and run/jog items. The vertical acceleration was significantly greater during braking in shuffle than during slowdown, stop, and run/jog and also greater during stop and pre-braking in shuffle than during run/jog movement. This pilot study suggests that decelerated movements mainly provoked high-impact situations and may be key actions for preventing overuse injury in young footballers.

Effects of Small-Sided Soccer Games on Physical Fitness, Physiological Responses, and Health Indices in Untrained Individuals and Clinical Populations: A Systematic Review

BACKGROUND

Small-sided soccer games (SSSG) are a specific exercise regime with two small teams playing against each other on a relatively small pitch. There is evidence from original research that SSSG exposure provides performance and health benefits for untrained adults.

OBJECTIVES

The aim of this systematic review was to summarize recent evidence on the acute and long-term effects of SSSG on physical fitness, physiological responses, and health indices in healthy untrained individuals and clinical populations.

METHODS

This systematic literature search was conducted in four electronic databases (PubMed, Web of Science, SPORTDiscus) from inception until June 2019. The following key terms (and synonyms searched for by the MeSH database) were included and combined using the operators "AND", "OR", "NOT": ((soccer OR football) AND ("soccer training" OR "football training" OR "soccer game*" OR "small-sided soccer game*") AND ("physical fitness" OR "physiological adaptation*" OR "physiological response*" OR health OR "body weight" OR "body mass" OR "body fat" OR "bone composition" OR "blood pressure")). The search syntax initially identified 1145 records. After screening for titles, abstracts, and full texts, 41 studies remained that examined the acute (7 studies) and long-term effects (34 studies) of SSSG-based training on physical fitness, physiological responses, and selected alth indices in healthy untrained individuals and clinical populations.

RESULTS

No training-related injuries were reported in the 41 acute and long-term SSSG studies. Typically, a single session of SSSG lasted 12-20 min (e.g., 3 × 4 min with 3 min rest or 5 × 4 min with 4 min rest) involving 4-12 players (2 vs. 2 to 6 vs. 6) at an intensity ≥ 80% of HR_max. Following single SSSG session, high cardiovascular and metabolic demands were observed. Specifically, based on the outcomes, the seven acute studies reported average heart rates (HR) ≥ 80% of HR_max (165-175 bpm) and mean blood lactate concentrations exceeding 5 mmol/l (4.5-5.9 mmol/l) after single SSSG sessions. Based on the results of 34 studies (20 with healthy untrained, 10 with unhealthy individuals, and 4 with individuals with obesity), SSSG training lasted between 12 and 16 weeks and was performed 2-3 times per week. SSSG had positive long-term effects on physical fitness (e.g., Yo-Yo IR1 performance), physiological responses including maximal oxygen uptake (VO_2max) [+ 7 to 16%], and many health-related markers such as blood pressure (reductions in systolic [- 7.5%] and diastolic [- 10.3%] blood pressure), body composition (decreased fat mass [- 2 to - 5%]), and improved indices of bone health (bone mineral density: [+ 5 to 13%]; bone mineral content: [+ 4 to 5%]), and metabolic (LDL-cholesterol [- 15%] as well as cardiac function (left-ventricular internal diastolic diameter [+ 8%], end diastolic volume [+ 21%], left-ventricular mass index [+ 18%], and left-ventricular ejection fraction [+ 8%]). Irrespective of age or sex, these health benefits were observed in both, untrained individuals and clinical populations.

CONCLUSIONS

In conclusion, findings from this systematic review suggest that acute SSSG may elicit high cardiovascular and metabolic demands in untrained healthy adults and clinical populations. Moreover, this type of exercise is safe with positive long-term effects on physical fitness and health indices. Future studies are needed examining the long-term effects on physical fitness and physiological adaptations of different types of SSSG training (e.g., 3 vs. 3; 6 vs. 6) in comparison to continuous or interval training in different cohorts.

Weight stigma experiences and self-exclusion from sport and exercise settings among people with obesity

BACKGROUND

A central strategy to tackle the health risks of obesity is regular physical activity (PA), exercising and participating in sports. However, people with obesity regularly experience weight-related stigma and discrimination in sport and exercise settings. Research has indicated that they often cope with such experiences by simply excluding themselves from sport and exercise. Meanwhile, self-exclusion as a coping strategy has not been fully understood and it remains unclear to what extent self-exclusion from PA settings is accompanied by general inactivity among people with obesity. The goal of this interview study was to determine to what extent physical inactivity among adults with obesity is the result of weight stigma-induced self-exclusion in and from sport and PA settings.

METHODS

We conducted semi-structured interviews with thirty adult men and women with obesity (average BMI: 40.64) and asked them about experiences with their body, weight stigma and coping behaviours in sport and exercise settings across their lifespans. Employing constant comparative analysis and a thematic network approach, we analysed the interview data to identify the most common reasons for and different strategies of self-exclusion.

RESULTS

Participants reported that they excluded themselves from sport and exercise settings due to traumatic weight stigma experiences, self-discrimination and fear of stigma, using a variety of strategies. Exposure to discrimination was prevented by selectively avoiding certain settings or strategically frequenting them at certain times only, but also by exercising in 'safe' spaces, e.g. at home. Furthermore, people with obesity reported strategically managing their social relations in order to avoid stigmatising reactions by others in exercise settings, for example by exercising individually and avoiding social PA. Most notably, our results strongly indicate that not all self-excluding coping strategies result in less exercising.

CONCLUSIONS

In order to successfully promote physical activity among people with obesity, the various forms of self-exclusion should be taken into account as pathways of stigma regarding physical activity. People with obesity may exclude themselves from certain PA settings, yet could still be exercising on their own or in other ways. One focus of public health strategies should thus be directed at the potentially socially isolating effects.

Prevalence of Prediabetes and Type 2 Diabetes Mellitus in Football Players: A Novel Multi Football Clubs Cross Sectional Study

Sports offer great benefits, improving health and reducing the risk of illnesses. This study’s aim was to investigate the prevalence of prediabetes and type 2 diabetes mellitus in football players compared to population based non-elite athlete control subjects. Initially 1100 male volunteers, (550) football players, and (550) population based non-elite athlete control subjects were interviewed. After socio-demographic and medical history analysis, 756 (378) nonsmoker male football players and (378) nonsmoker male control subjects were recruited. The control subjects were not involved in regular sports activities such as football, volleyball, badminton, cricket, hockey, and swimming. Participants with a known history of anemia, blood diseases, diabetes mellitus, and malignancy were excluded from the study. The mean age of football players was 31.80 ± 5.46 years, Body Mass Index (BMI) was 26.40 ± 2.08 (kg/m²), and the mean age of control subjects was 32.32 ± 4.37 years, and BMI was 26.66 ± 1.87 (kg/m²). The selected football players have been playing football for about 2 h a day, 3 days per week, and so the total mean duration of playing football was 1.08 years. American Diabetes Association (ADA) based criteria on Glycated Hemoglobin (HbA1c) was used to investigate prediabetes and type 2 diabetes mellitus. In football players the prevalence of prediabetes was 30 (7.93%) and type 2 diabetes mellitus (T2DM) was 6 (1.59%) compared to population based matched non-elite athlete control subjects where the prediabetes was 71 (18.78%) and T2DM was 89 (23.54%) (p = 0.001). Among football players there was a 7-fold decrease in T2DM compared to control subjects. Football recreational activities markedly reduce the prevalence of prediabetes and T2DM. The study findings demonstrate the benefits of football and other such sport activities and emphasize the urgent need for promoting football based physical activities as a physiological preventive strategy against the globally growing diabetes epidemic.

Structure, Intensity and Player Duels in Under-13 Football Training in Switzerland

We evaluated the structure (i.e., the different training parts), contents (i.e., the various activities used), intensity and occurrence of contact situations and headers during training sessions in under-13 football in Switzerland. A total of 242 players from 20 different teams on average aged 11.4 (SD 0.7) years participated. The participants were filmed during a typical training session while they were equipped with a heart rate sensor. The sessions were systematically recorded to allow for detailed analyses. Furthermore, a preliminary and explorative analysis of the influence of the level of play on these results was conducted. The overall findings indicated that training included 33.4% playing forms, 29.5% training forms, 28.4% inactivity time and 8.7% athletics. The highest heart rates were achieved in the playing forms (166 min⁻¹, 83% HR_max) compared to the other two activities (training forms 154 min⁻¹, 77% HR_max; athletics 150 min⁻¹, 75% HR_max). Each player had 12.8 duels and 0.6 headers per training. Overall, most duels were conducted from the anterior direction. Playing forms induce higher cardio-circulatory load as well as a better learning environment. Potentially dangerous situations like contact with other players or headers occurred in a single player on average every six min during a training session.

School-based soccer practice is an effective strategy to improve cardiovascular and metabolic risk factors in overweight children

We examined the effects of a 6-month school-based soccer programme on cardiovascular (CV) and metabolic risk factors in overweight children. Methods: 40 boys [8-12 years; body mass index (BMI) >2 standard deviations of WHO reference values] participated in complementary school-based physical education classes (two sessions per week, 45-90 min each). The participants were divided into a soccer group (SG; n = 20) and a control group (CG; n = 20). The SG intervention involved 3 extra-curricular school-based soccer sessions per week, 60-90 min each. The intervention lasted for 6-months. All measurements were taken at baseline and after 6-months. From baseline to 6-months, the SG significantly improved (p < .05) BMI z-score, waist circumference, waist-to-height ratio, percentage of fat mass, percentage of fat-free mass, diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol, but no such improvements were observed for the CG. After the intervention, the prevalence of soccer participants with normal waist-to-height ratio (30 vs. 5%; p = .037), systolic blood pressure (90 vs. 55%; p = .039), total cholesterol (80 vs. 65%; p = .035) and LDL-C (90 vs. 75%; p = .012) were significantly higher than at baseline. The findings suggest that a 6-month school-based soccer intervention program represents an effective strategy to reduce CV and metabolic risk factors in overweight children prepared to take part in a soccer program.

The Impact of Parental Incarceration on Sport Participation Trajectories from Adolescence to Young Adulthood

Given the potential negative effects of parental incarceration on millions of people, it is critical to examine the possible short- and long-term effects of parental incarceration on individuals. This study examines the effect of parental incarceration on the sports participation trajectories of children ranging from adolescence to young adulthood. Group-based trajectory models were set up using SAS analytics software to examine how parental incarceration affects the sports participation trajectories of children from adolescence to young adulthood. Data were drawn from the first four waves of the National Longitudinal Study of Adolescent Health in the United States (N = 6504). Neither paternal nor maternal incarceration had any significant effect on the trajectories of male participants. On the other hand, females who experienced father incarceration were more likely to be in the low-stable versus high-decreasing group (coefficient = -0.721, p < 0.05). Based on the results of this study, we conclude that programs promoting sports participation are needed for females who have experienced paternal incarceration. The results of this study also suggest that group-based trajectory modeling is a useful technique to examine the trajectories of sports participation from adolescence through to young adulthood.

Layperson-Led vs Professional-Led Behavioral Interventions for Weight Loss in Pediatric Obesity: A Systematic Review and Meta-analysis

IMPORTANCE

The appropriate approach for weight loss among children and adolescents with overweight and obesity remains unclear.

OBJECTIVE

To evaluate the difference in the treatment outcomes associated with behavioral weight loss interventions led by laypersons and professionals in comparison with unsupervised control arms among children and adolescents with overweight and obesity.

DATA SOURCES

For this systematic review and meta-analysis, the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, the Cochrane Library, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases were searched from January 1, 1996, to June 1, 2019.

STUDY SELECTION

Included in this study were randomized clinical trials (RCTs) of behavioral interventions lasting at least 12 weeks for children and adolescents (aged 5-18 years) with overweight and obesity. Exclusion criteria included non-RCT studies, interventions lasting less than 12 weeks, adult enrollment, participants with other medical diagnoses, pharmacological treatment use, and articles not written in English. Two of 6 reviewers independently screened all citations. Of 25 586 citations, after duplicate removal, 78 RCTs (5780 participants) met eligibility criteria.

DATA EXTRACTION AND SYNTHESIS

A bayesian framework and Markov chain Monte Carlo simulation methods were used to combine direct and indirect associations. Random-effects and fixed-effect network meta-analysis models were used with the preferred model chosen by comparing the deviance information criteria. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

MAIN OUTCOMES AND MEASURES

The immediate and sustained changes in weight and body mass index (BMI) standardized mean difference (SMD) were primary outcomes planned before data collection began, whereas waist circumference and percent body fat were secondary outcomes. The hypothesis being tested was formulated before the data collection.

RESULTS

Of 25 586 citations retrieved, we included 78 RCTs (5780 participants), with a follow-up of 12 to 104 weeks. Compared with the control condition, random-effects models revealed that professional-led weight loss interventions were associated with reductions in weight (mean difference [MD], -1.60 kg [95% CI, -2.30 to -0.99 kg]; 68 trials; P < .001) and BMI (SMD, -0.30 [95% CI, -0.39 to -0.20]; 59 trials; P < .001) that were not sustained long term (weight MD, -1.02 kg [95% CI, -2.20 to 0.34 kg]; 21 trials; P = .06; BMI SMD, -0.12 [95% CI, -0.46 to 0.21]; 20 trials; P < .001). There was no association between layperson-led interventions and weight loss in the short-term (MD, -1.40 kg [95% CI, -3.00 to 0.26 kg]; 5 trials; P = .05) or long-term (MD, -0.98 kg [95% CI, -3.60 to 1.80 kg]; 1 trial; P = .23) compared with standard care. No difference was found in head-to-head trials (professional vs layperson MD, -0.25 kg [95% CI -1.90 to 1.30 kg]; 5 trials; P = .38).

CONCLUSIONS AND RELEVANCE

This systematic review and meta-analysis found that professional-led weight loss interventions were associated with short-term but not sustained weight reduction among children and adolescents with overweight or obesity, and the evidence for layperson-led approaches was insufficient to draw firm conclusions.

Comparison of 10 vs. 20 min neuromuscular training for the prevention of lower extremity injuries in male youth football: A cluster randomised controlled trial

The aim of this study was to compare the effects of 20 min neuromuscular training with a programme of 10 min in youth football players. 342 (15.4 ± 1.7 years) male football players from 18 teams were included, and cluster-randomized by team into two intervention groups. Both groups performed an injury prevention programme twice a week over five months using the same exercises but a different duration. The first intervention group (INT10, n = 175) performed the programme for 10 min, the second intervention group (INT20, n = 167) for 20 min. Primary outcomes were lower extremity (LE) injuries. Secondary outcomes were injury type, severity, mechanism and compliance to the intervention. 13 teams with 185 players were included for final analysis. No significant group difference was found between INT10 (6.37 per 1000 h) and INT20 (7.20 per 1000 h) for the incidence rate ratio of the lower extremities (IRR = 1.03, 95% confidence interval 0.59, 1.79), nor for the distribution of injury location, type, severity or mechanism. The results show that performing preventive exercises for 10 min is no less effective than 20 min in youth football players. Shorter training sessions can, therefore, be effectively used for injury prevention.

TRIAL REGISTRATION

DRKS00015282.

Eight months of school-based soccer improves physical fitness and reduces aggression in high-school children

School-based programmes have shown promising results in the reduction of aggressive behaviour, but the effectiveness of physical activity modalities among adolescents remains to be determined. The aim of this study was to determine the effects of a school-based soccer programme on physical fitness and aggression in adolescent students. One hundred and five high school students were randomized to a small-sided soccer training group (SG) or a control group (CG). In addition to the regular physical education classes performed as part of a curriculum, the SG completed eight months of small-sided soccer training twice a week after school. Aerobic fitness (YYIR1), vertical jump (VJ), backward overhead medicine ball throw (BOMBT), and Buss and Perry's aggression questionnaire were evaluated before and after eight months of training. Greater improvements were observed in the SG than in the CG in the BOMBT (%diff=4.3, ŋp 2=.308) and YYIR1 tests (%diff=2.2, ŋp 2=.159), and physical aggression subscale (%diff=-12.1, ŋp 2=.144). Extra, school-based recreational soccer for adolescents was accompanied by a significant improvement in physical fitness, compared to physical education classes only. Moreover, the implementation of recreational soccer into regular physical education classes seems to be a potentially appropriate stimulus for reducing aggression in high-school students.

The effects of dopamine receptor genes on the trajectories of sport participation from adolescence through young adulthood

Background: Although previous studies suggest that dopamine receptor genes partially affect physical activity-related behaviours, all of these studies were cross-sectional studies that examined the effects of dopamine receptor genes on physical activity-related behaviours at some point in time. Therefore, the nature and extent of this relationship across the lifespan are even more uncertain.Aim: The purpose of this study is to examine the effects of dopamine receptor genes (i.e. DRD2, DRD4 and DRD5) on sport participation trajectories from adolescence to young adulthood.Subjects and methods: This study used the National Longitudinal Study of Adolescent Health data (wave 1-4). Group-based trajectory modelling was used to investigate the effect of dopamine receptor genes on the probability of being in each sport participation trajectory group.Results: A three-group model was the best fitting model for men whereas a two-group model was the best fitting model for women. The more participants possess the A1 allele of the DRD2, the less likely they are to be in the "high-decreasing group" rather than the "low-stable group" in both men and women. In male participants, the more participants carry the A1 allele of the DRD2, the more likely they are to be in the "high-stable group" rather than the "high-decreasing group" (coefficient = 0.206, p<.05).Conclusions: These results can contribute to the literature by providing important information on the effects of dopamine receptor genes on sport participation trajectories from adolescence through young adulthood.

Weight Stigma Experiences and Physical (In)activity: A Biographical Analysis

INTRODUCTION

People with obesity often report experiences of weight-related discrimination. In order to find out how such experiences throughout the life course are related to physical activity behavior, we exploratively studied activity-related biographies of people with obesity from a social constructivist perspective.

METHODS

We collected biographical data of 30 adults (mean age 37.66 years; 14 males and 16 females) with obesity (average BMI 40.64, including a range from 33 to 58) using a biography visualization tool that allows participants to map developmental courses and critical life experiences over their life course.

RESULTS

Participants remembered a continuous decrease of physical activity from childhood to mid-adulthood. Weight-related discrimination, both in sport and non-sport settings, was especially experienced in adolescence and mid-adulthood. Against the background of our findings, we assume that the degree of felt stigma rather than the stigmatizing behavior itself influences physical activity behavior over the life course.

CONCLUSION

The results of our exploratory study reiterate the detrimental effect weight stigma can have on health behaviors. Initiatives are needed to reduce weight stigma in exercise contexts; additionally, initiatives to promote physical activity should focus on helping individuals with obesity to establish coping strategies to reduce the experienced burden from weight stigma.

Recreational football is medicine against non-communicable diseases: A systematic review

The purpose of this research was to conduct a systematic review of published articles related to the effect of recreational football on non-communicable diseases. A systematic review of Web of Science, SPORTDiscus, MEDLINE, and PubMed databases was performed according to PRISMA guidelines. Only empirical studies were included. There were no restrictions on the types of study design eligible for inclusion. The primary outcome measures result from the potential effects of recreational football on non-communicable diseases (eg, blood pressure, bone density, LDL cholesterol, and fat mass). A total of 44 articles met the inclusion criteria and were included. Recreational football is shown to: (a) decrease blood pressure and resting heart rate, improve cardiac structure and functioning, as well as increase maximal oxygen uptake in both sexes; (b) reduce cholesterol and triglycerides levels, increase insulin sensitivity, and have a positive impact on glycemic control; (c) improve bone mineralization, increase both bone mineral density and content, as well as acting as a stimulus for osteogenesis; and (d) be clearly beneficial for bone health, while slightly beneficial for body composition, muscle strength, and maximal oxygen uptake in adults with prostate cancer. The present systematic review demonstrated the benefits of recreational football practice on non-communicable diseases related to cardiovascular and bone health, body composition, type 2 diabetes, and prostate cancer. The effectiveness of recreational football on the aforementioned diseases may be related to age and gender; however, further research is required.

Association between Club Sports Participation and Physical Fitness across 6- to 14-Year-Old Austrian Youth

Changes in social and built environments most likely contribute to a decline in physical activity (PA) and physical fitness in children and adolescents. Organized sports may be an important component in ensuring adequate fitness, which is an important aspect in general health and well-being. The present study examines differences by club sports participation in cardiorespiratory endurance, muscular strength, power, speed, agility, flexibility and balance in 3293 (55.1% male) Austrian children and adolescents between 6 and 14 years of age. Anthropometric measurements (height and weight) were taken and participants completed the German motor test during regular class time. Even though there was no significant difference in body weight between club sports participants and non-club sports participants, club sports participation was associated with higher physical fitness, particularly regarding endurance, strength, power, and agility. Differences by club sports participation, however, declined during the elementary school years (6-10 years of age), while they became more pronounced during middle school years (10-14 years of age). Club sports participation, therefore, may be a viable option in the promotion of physical fitness, particularly during adolescence. At younger ages, other sources of PA, such as physical education and free play, however, should be considered to ensure sufficient fitness levels that contribute to a healthy and active lifestyle.

Physical Fitness and Body Composition in 10-12-Year-Old Danish Children in Relation to Leisure-Time Club-Based Sporting Activities

This study investigated whether the physical fitness and body composition of 10–12-year-old Danish children are related to participation in leisure-time club-based sporting activities. The study involved 544 Danish 10–12-year-old 5th-grade municipal schoolchildren (269 boys and 275 girls, 11.1 ± 0.4 years). After answering a questionnaire about leisure-time sporting activities, the children were divided into four groups: football club participation (FC; n=141), other ball games (OBG; n=42), other sports (OS; n=194), and no sports-club participation (NSC; n=167). The children completed a battery of health and fitness tests, including a 20 m sprint test, a standing long-jump test, the Yo-Yo IR1 children's test (YYIR1C), and body composition, blood pressure, resting heart rate (HR_rest), and the flamingo balance test. The children engaged in club-based ball games (FC and OBG) had higher (p<0.05) lean body mass than NSC (FC: 17.5 ± 2.9; OBG: 18.4 ± 2.6; OS: 16.7 ± 2.9; NSC: 16.4 ± 2.8 kg), performed better (p<0.05) in the YYIR1C test (FC: 1083 ± 527; OBG: 968 ± 448; OS: 776 ± 398; NSC: 687 ± 378 m), and had lower (p<0.05) %HR_max after 1, 2, and 3 min of YYIR1C. Moreover, HR_rest was lower (p<0.05) for FC than for OS and NSC (FC: 68 ± 9 vs OS: 72 ± 10 and NSC: 75 ± 10 bpm), and lower (p<0.05) for OBG than for NSC (OBG: 70 ± 10 vs NSC: 75 ± 10 bpm). This study found that 10–12-year-old Danish children engaged in club-based football and other ball games had better exercise capacity, lower resting heart rate, and higher muscle mass than children not engaged in leisure-time sports. Thus, participation in club-based leisure-time ball-game activities seems to be of importance for the fitness and health profile of prepubertal children.

Comparison of the '11+ Kids' injury prevention programme and a regular warmup in children's football (soccer): a cost effectiveness analysis

OBJECTIVE

To evaluate a potential reduction in injury related healthcare costs when using the '11+ Kids' injury prevention programme compared with a usual warmup in children's football.

METHODS

This cost effectiveness analysis was based on data collected in a cluster randomised controlled trial over one season from football teams (under-9 to under-13 age groups) in Switzerland. The intervention group (INT) replaced their usual warmup with '11+ Kids', while the control group (CON) warmed up as usual. Injuries, healthcare resource use and football exposure (in hours) were collected prospectively. We calculated the mean injury related costs in Swiss Francs (CHF) per 1000 hours of football. We calculated the cost effectiveness (the direct net healthcare costs divided by the net health effects of the '11+ Kids' intervention) based on the actual data in our study (trial based) and for a countrywide implementation scenario (model based).

RESULTS

Costs per 1000 hours of exposure were CHF228.34 (95% CI 137.45, 335.77) in the INT group and CHF469.00 (95% CI 273.30, 691.11) in the CON group. The cost difference per 1000 hours of exposure was CHF-240.66 (95%CI -406.89, -74.32). A countrywide implementation would reduce healthcare costs in Switzerland by CHF1.48 million per year. 1002 players with a mean age of 10.9 (SD 1.2) years participated. During 76 373 hours of football, 99 injuries occurred.

CONCLUSION

The '11+ Kids' programme reduced the healthcare costs by 51% and was dominant (ie, the INT group had lower costs and a lower injury risk) compared with a usual warmup. This provides a compelling case for widespread implementation.

Overuse injuries are prevalent in children's competitive football: a prospective study using the OSTRC Overuse Injury Questionnaire

OBJECTIVES

To investigate the prevalence and burden of overuse injuries in children's football as well as player characteristics and their association with overuse injury risk.

METHODS

This investigation is based on the control arm (10 clubs) of a randomised controlled trial investigating prevention of injuries in youth football. We conducted a prospective 20-week follow-up study on overuse injuries among Finnish football players (n=733, aged 9-14 years). Each week, we sent a text message to players' parents to ask if the player had sustained any injury during the past week. Players with overuse problem were interviewed over the phone using an overuse injury questionnaire. The main outcome measures were prevalence of all overuse injuries and substantial overuse injuries (those leading to moderate or severe reductions in participation or performance) and injury severity.

RESULTS

The average response rate was 95%. In total, 343 players (46.8%) reported an overuse problem while in the study. The average weekly prevalence of all overuse problems and substantial overuse problems was 12.8% and 6.0%, respectively. Injuries affecting the knee had the highest weekly prevalence (5.7% and 2.4% for all and substantial knee problems, respectively). Girls had a higher likelihood of knee problems (OR 2.70; 95% CI 1.69 to 4.17), whereas boys had a higher likelihood of heel problems (OR 2.82; 95% CI 1.07 to 7.44). The likelihood of reporting an overuse problem increased with age (OR 1.21; 95% CI 1.00 to 1.47).

CONCLUSION

Overuse injuries are prevalent in children's competitive football. Knee overuse injuries represent the greatest burden on participation and performance.

TRIAL REGISTRATION NUMBER

ISRCTN14046021.

Further government measures to tackle the childhood obesity epidemic

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a recently published government report, which aspires to radically tackle rising levels of obesity in children.

Heart Rate and Perceived Experience Differ Markedly for Children in Same- versus Mixed-Gender Soccer Played as Small- and Large-Sided Games

This study examines heart rate (HR) and perceived experience during same- versus mixed-gender soccer played as small- (SSG) and large-sided (LSG) games. HR, rating of perceived exertion (RPE), and fun scores were determined in 134 pupils (50 girls, 84 boys) randomly assigned to same- and mixed-genders formats playing 2x15-min of SSG (2v2, 4v4) and LSG (12v12) in a random order (~50 m²/player). HR was lower (p≤0.03) for girls when playing together with boys than when playing alone (71±10 versus 77±7%HRmax), while being similar for boys playing mixed- or same-gender games (74±7 versus 77±4%HRmax). Boys perceived less fun when playing together with girls than when playing alone (4.4±2.3 versus 6.3±2.3, p<0.001). Irrespective of gender, higher (p<0.001) HRmean, %time>80%HRmax, and RPE were observed during 2v2 (78±9%HRmax, 43±33%, 5.5±2.5) and 4v4 (76±9%HRmax, 39±32%, 5.5±2.7) than during 12v12 (70±10%HRmax, 23±27%, 3.8±2.9). Cardiovascular strain was lower for girls when playing together with boys than when playing alone in LSG. SSG were more intense than LSG when girls played mixed-gender games and when boys played mixed- and same-gender games. When boys played mixed-gender games, SSG were considered more fun than LSG. Physical education teachers and coaches should consider gender and game format differences when using soccer.

Exercise training in overweight and obese children: Recreational football and high-intensity interval training provide similar benefits to physical fitness

This study compared the effects of recreational football and high-intensity interval training (HIIT) on body composition, muscular fitness, and cardiorespiratory fitness in overweight and obese children. Forty-two overweight/obese males aged 11-13 years [body mass index (BMI) >20.5 kg/m² ] were randomly assigned to a recreational football training group (n = 14; 157.9 ± 5.8 cm; 63.7 ± 12.6 kg), HIIT group (n = 14; 163.8 ± 9.4 cm; 71.5 ± 10.5 kg), or nontraining control group (n = 14; 162.7 ± 9.3 cm; 67.4 ± 16.1 kg). Physical fitness components were measured at baseline and after 12 weeks of training at the same time of the day and under similar conditions, including body composition, muscular fitness (lower-body power, change-of-direction speed, and flexibility), and cardiovascular fitness (Yo-Yo Intermittent Endurance test distance, resting heart rate, and blood pressure). Lean body mass (4.3%, ES = 0.40; 95% CI: -0.48, 1.29; P = .382) and muscle mass 4.4% (ES = 0.40; 95% CI: -0.48, 1.29; P = .378) very likely increased in the recreational football group, while possible improvements were observed in the HIIT group (lean body mass: 2.5%, ES = 0.22; 95% CI: -0.62, 1.06; P = .607, muscle mass: 2.8%, ES = 0.23; 95% CI: -0.61, 1.07; P = .594). Only trivial increases were observed in the control group for lean body mass (0.5%, ES = 0.05; 95% CI: -0.70, 0.79; P = .906) and muscle mass (1.1%, ES = 0.09; 95% CI: -0.65, 0.83; P = .814). Significant differences were found between the recreational football and control groups in post-training body mass (P = .034) and body mass index (P = .017). Body fat very likely decreased in the recreational football group (-7.7%, ES = -0.41; 95% CI: -1.29, 0.48; P = .376) and possibly decreased in the HIIT group (-5.2%, ES = -0.22; 95% CI: -1.05, 0.62; P = .607), with a trivial reduction in the control group (-1.1%, ES = -0.04; 95% CI: -0.78, 0.70; P = .914). Very likely increases in lower-body power were evident in the recreational football (17.0%, ES = 0.76; 95% CI: -0.15, 1.66; P = .107) and control groups (16.1%, ES = 0.55; 95% CI: -0.20, 1.31; P = .156), while small improvements were observed in the HIIT group (6.0%, ES = 0.24; 95% CI: -0.60, 1.08; P = .580, possible). Likely to most likely improvements in Yo-Yo Intermittent Endurance test performance and change-of-direction speed were noted in the recreational football group (Yo-Yo: 79.8%, ES = 1.09; 95% CI: 0.16, 2.03; P = .025, change-of-direction speed: -10.6%, ES = -1.05; 95% CI: -1.98, -0.12; P = .031) and the HIIT group (Yo-Yo: 81.2%, ES = 1.03; 95% CI: 0.15, 1.92; P = .025, change-of-direction speed: -5.4%, ES = -0.91; 95% CI: -1.79, -0.04; P = .045). Diastolic blood pressure likely decreased in the recreational football (-8.6%, ES = -0.74; 95% CI: -1.64, 0.17; P = .116) and HIIT groups (-9.8%, ES = -0.57; 95% CI: -1.40, 0.30; P = .195), with a possible increase in the control group (1.2%, ES = 0.21; 95% CI: -0.53, 0.96; P = .068). Recreational football and HIIT elicited improvements in all muscular and cardiorespiratory fitness measures. In contrast, the control group, which performed only physical education classes, increased body mass, BMI, and fat mass. Therefore, additional activities such as recreational football or HIIT might counter the prevalence of overweight and obesity in children.

"FIFA 11 for Health" for Europe in the Faroe Islands: Effects on health markers and physical fitness in 10- to 12-year-old schoolchildren

We evaluated effects of the school-based intervention "FIFA 11 for Health" for Europe on health and fitness profile in 10- to 12-year-old Faroese schoolchildren. 392 fifth-grade children were randomized into a control group (CG: n = 100, 11.1 ± 0.3 years, 149.0 ± 6.7 cm, 42.4 ± 10.2 kg) and an intervention group (IG: n = 292, 11.1 ± 0.3 years, 150.6 ± 6.9 cm, 44.2 ± 9.4 kg). IG underwent an 11-week intervention in which 2 weekly sessions of 45 minutes were included in the school curriculum focusing on health aspects, football skills, and 3v3 small-sided games. CG continued with their regular activities. Body composition, blood pressure, and resting heart rate, as well as Yo-Yo intermittent recovery children's test (YYIR1C) performance, horizontal jumping ability and postural balance were assessed pre and post intervention. Systolic blood pressure decreased more (-2.8 ± 9.9 vs 2.9 ± 8.4 mm Hg, P < .05) in IG than in CG. Lean body mass (1.0 ± 1.7 vs 0.7 ± 1.6 kg), postural balance (0.3 ± 3.9 vs -1.2 ± 5.9 seconds) and horizontal jump performance (5 ± 9 vs -5 ± 10 cm) increased more (P < .05) in IG than in CG. YYIR1C performance improved in CG (17%, 625 ± 423 to 730 ± 565 m) and IG (18%, 689 ± 412 vs 813 ± 391 m), but without between-group differences. A within-group decrease from 23.1 ± 8.4 to 22.5 ± 8.3% (P < .05) was observed in body fat percentage in IG only. In conclusion, the "FIFA 11 for Health" for Europe program had beneficial effects on SBP, body composition, jump performance and postural balance in 10- to 12-year-old Faroese schoolchildren, supporting the notion that school-based football interventions can facilitate health of children in a small-scale society and serve as an early step in the prevention of non-communicable diseases.

Physical Fitness and Body Composition in 8-10-Year-Old Danish Children Are Associated With Sports Club Participation

Larsen, MN, Nielsen, CM, Ørntoft, CØ, Randers, M, Manniche, V, Hansen, L, Hansen, PR, Bangsbo, J, and Krustrup, P. Physical fitness and body composition in 8–10-year-old Danish children are associated with sports club participation. J Strength Cond Res 31(12): 3425–3434, 2017—We investigated whether physical fitness and body composition in 8–10-year-old Danish children are associated with sports club participation. The study included 423 schoolchildren, comprising 209 girls and 214 boys, of whom 67 and 74%, respectively, were active in sports clubs. Yo-Yo intermittent recovery level 1 for children (YYIR1C), balance, jump and coordination tests, together with dual-energy X-ray absorptiometry, were used to determine exercise capacity and body composition. Children active in sports clubs had better (p < 0.05) YYIR1C (33%, 767 ± 26 vs. 575 ± 29 m), 20-m sprint (3%, 4.33 ± 0.03 vs. 4.48 ± 0.04 seconds), coordination (6%, 68 ± 1 vs. 72 ± 1 second), and balance test performances (9%, 19.3 ± 0.5 vs. 21.2 ± 0.7 falls·min⁻¹) and lower fat mass index (16%, 3.8 ± 0.1 vs. 4.5 ± 0.2 kg[fat]·m⁻²) than children not active in sports clubs. Ball game players had better (p < 0.05) YYIR1C (38%, 925 ± 39 vs. 671 ± 28 m), 20-m sprint (4%, 4.25 ± 0.03 vs. 4.42 ± 0.04 seconds), and coordination test performances (5%, 65 ± 1 vs. 69 ± 1 second), along with higher (p < 0.05) lean body mass (5%, 24.00 ± 0.22 vs. 22.83 ± 0.25 kg) and whole-body BMD (2%, 0.90 ± < 0.01 vs. 0.88 ± <0.01 g·cm⁻²) compared with children active in other sports. The study showed that 8‒10-year-old Danish children engaged in sports-club activity, especially ball game players, have better exercise capacity and superior body composition compared with children not active in sports clubs.

Perceived motivational factors for female football players during rehabilitation after sports injury - a qualitative interview study

Compliance with a rehabilitation program is significant among athletes following a sports injury. It is also one of the main factors that influence the rehabilitation process; moreover, the outcome is also influenced by the athlete’s motivation. It is primarily an autonomous motivation, resulting in rehabilitation adherence. The aim of this study was to investigate the perceived motivation of female football players during rehabilitation after a sports injury and the extent to which these motivating factors were autonomous. Qualitative interviews, based on a semistructured interview guide with injured female football players undergoing rehabilitation, were analyzed using content analysis. The motivational factors that were described were their set goals, social support as well as external and internal pressures during rehabilitation. The perceived autonomy varied somewhat but overall, they experienced external motivation; therefore, the behavior was not entirely self-determined. Results are expected to provide a better understanding of women football players’ motivation in relation to their rehabilitation; hence, physiotherapists and coaches who are part of the rehabilitation process can contribute by increasing the autonomous motivation, thus, improving the compliance and outcome of the rehabilitation.

Risk factors for football injuries in young players aged 7 to 12 years

Football (soccer) is very popular among children. Little is known about risk factors for football injuries in children. The aim was to analyze potential injury risk factors in 7- to 12-year-old players. We collected prospective data in Switzerland and the Czech Republic over two seasons. Coaches reported exposure of players (in hours), absence, and injury data via an Internet-based registration system. We analyzed time-to-injury data with extended Cox models accounting for correlations on team- and intra-person levels. We analyzed injury risk in relation to age, sex, playing position, preferred foot, and regarding age-independent body height, body mass, and BMI. Further, we analyzed injury risk in relation to playing surface. In total, 6038 player seasons with 395 295 hours of football exposure were recorded and 417 injuries occurred. Injury risk increased by 46% (Hazard Ratio 1.46 [1.35; 1.58]; P < .001) per year of life. Left-footed players had a higher injury risk (Hazard Ratio 1.53 [1.07; 2.19]; P = .02) for training injuries compared to right-footed players. Injury risk was increased in age-adjusted taller players (higher percentile rank). Higher match-training ratios were associated with a lower risk of match injuries. Injury risk was increased on artificial turf (Rate Ratio 1.39 [1.12; 1.73]; P < .001) and lower during indoor sessions (Rate Ratio 0.68 [0.52; 0.88]; P < .001) compared to natural grass. Age is known as a risk factor in older players and was confirmed to be a risk factor in children's football. Playing surface and leg dominance have also been discussed previously as risk factors. Differences in injury risks in relation to sex should be investigated in the future.

Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years

BACKGROUND

Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages.

OBJECTIVES

To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.

MAIN RESULTS

We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials.

AUTHORS' CONCLUSIONS

Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.

A Review of the Promotion of Fitness Measures and Health Outcomes in Youth

The relationship between physical fitness and health in adults is well established, yet until recently, empirical support for the impact of physical fitness levels on health markers in children has not been thoroughly documented. The aim of this review was to provide a summary of current literature that has examined the linkage between measures of health-related physical fitness (ie, cardiorespiratory fitness, musculoskeletal fitness, flexibility, and body composition) and health markers in youth. Specifically, this review focused on the findings from the recent 2012 Institutes of Medicine report on Fitness Measures in Youth as well as other subsequent review articles related to the topic. In addition, recommendations for health-related fitness assessments in youth populations are presented.

Treatment of Pediatric Obesity: An Umbrella Systematic Review

OBJECTIVE

Multiple interventions are available to reduce excess body weight in children. We appraised the quality of evidence supporting each intervention and assessed the effectiveness on different obesity-related outcomes.

METHODS

We conducted a systematic search for systematic reviews of randomized controlled trials evaluating pediatric obesity interventions applied for ≥6 months. We assessed the quality of evidence for each intervention using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach.

RESULTS

From 16 systematic reviews, we identified 133 eligible randomized controlled trials. Physical activity interventions reduced systolic blood pressure and fasting glucose (low to moderate quality of evidence). Dietary interventions with low-carbohydrate diets had a similar effect to low-fat diets in terms of body mass index (BMI) reduction (moderate quality of evidence). Educational interventions reduced waist circumference, BMI, and diastolic blood pressure (low quality of evidence). Pharmacological interventions reduced BMI (metformin, sibutramine, orlistat) and waist circumference (sibutramine, orlistat) and increased high-density lipoprotein cholesterol (sibutramine) but also raised systolic and diastolic blood pressure (sibutramine). Surgical interventions (laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) resulted in the largest BMI reduction (moderate quality of evidence). Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education significantly reduced systolic and diastolic blood pressure, BMI, and triglycerides. Combined parent-child interventions and parent-only interventions had similar effects on BMI (low quality of evidence).

CONCLUSIONS

Several childhood obesity interventions are effective in improving metabolic and anthropometric measures. A comprehensive multicomponent intervention, however, appears to have the best overall outcomes.

Blood pressure, heart rate and perceived enjoyment after small-sided soccer games and repeated sprint in untrained healthy adolescents

The purpose of this study was to examine systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), rating of perceived exertion (RPE) and perceived enjoyment responses to a repeated-sprint training session (RST) compared to a small-sided soccer game session (SSG) in untrained adolescents. Twelve healthy post-pubertal adolescent males (age 15.8±0.6 years, body mass 59.1±3.7 kg, height 1.7±0.1m) performed RST and SSG sessions in a randomized and counterbalanced order. Blood pressure and HR were measured at rest and at 10, 20 and 30 minutes after interventions, and RPE and enjoyment were assessed. RST and SSG elicited similar exercise HR (74.0% vs. 73.7% of HR peak during RST and SSG respectively, P>0.05). There was no significant change in SBP or DBP after the 2 interventions (all P>0.05, ES<0.5) with a trend to a decrease in SBP after SSG at 30 min after intervention (moderate effect, ES=0.6). Pearson’s correlation analysis revealed a significant and large correlation between baseline BP values and magnitude of decline after both RST and SSG. Heart rate during recovery was higher compared with baseline at all times after both sessions (all P<0.05), with HR values significantly lower after SSG versus RST at 30 min after interventions (82.3±3.2 versus 92.4±3.2 beats/min, respectively, P=0.04). RPE was significantly lower (P=0.02, ES=1.1) after SSG than after RST, without significant differences in enjoyment. In conclusion, repeated sprint and small-sided games elicited similar exercise intensity without a significant difference in perceived enjoyment. Post-exercise hypotension after the two forms of training may depend on resting BP of subjects.

Hip Strength as an Intrinsic Risk Factor for Lateral Ankle Sprains in Youth Soccer Players: A 3-Season Prospective Study

BACKGROUND

Numerous epidemiological studies have emphasized the burden of lateral ankle sprains in youth soccer players. However, no prospective study has identified intrinsic physical and modifiable risk factors for these injuries in this particular population. Although injury prevention programs in soccer incorporate proximal hip and core stability exercises, it is striking that the relationship between impaired proximal hip function and ankle sprains has not yet been prospectively investigated in youth soccer players.

HYPOTHESIS

This prospective study aimed to examine whether hip muscle strength is a risk factor for sustaining a lateral ankle sprain in youth soccer players. We hypothesized that decreased hip muscle strength would predispose youth soccer players to an increased risk of lateral ankle sprains.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

This study included a total of 133 male youth soccer players (age divisions U11-U17) for analysis. At the beginning of the season, anthropometric characteristics were collected and hip muscle strength was assessed using a handheld dynamometer. Injury registration was performed by the team medical staff during 3 consecutive seasons. A principal-component, multivariate Cox regression analysis was performed to identify potential risk factors for sustaining a lateral ankle sprain.

RESULTS

Twelve participants (18% of all reported injuries) sustained a lateral ankle sprain (0.36 per 1000 athletic-exposure hours). After adjustment for body size dependencies and other hip muscle forces, an increase in hip muscle extension force was associated with a significant decrease in the hazard of the injury (hazard ratio, 0.3; 95% confidence interval, 0.1-0.9; P = .028). No other study variable could be identified as a risk factor for lateral ankle sprains.

CONCLUSION

Reduced hip extension muscle strength is an independent risk factor for lateral ankle sprains in male youth soccer players. Other hip muscle strength outcomes were not identified as risk factors. Replication in larger samples with more injured cases is warranted to further ascertain the importance of this risk factor.

Technical Actions, Heart Rate, and Locomotor Activity in 7v7 and 8v8 Games for Female Youth Soccer Players

Ørntoft, C, Larsen, MN, Andersen, TB, Rasmussen, LS, Póvoas, SCA, Randers, MB, and Krustrup, P. Technical actions, heart rate, and locomotor activity in 7v7 and 8v8 games for female youth soccer players. J Strength Cond Res 30(12): 3298-3303, 2016-The purpose of this study was to evaluate technical performance, heart rate (HR), and activity profile in 7v7 and 8v8 soccer games for 9- to 10-year-old girls (U11). A total of 24 female youth players participated in the study, all playing 20-minute 7v7 and 8v8 games with 160 and 223 m per player, respectively. Technical actions, HR, and activity profile were measured during the games using video filming, HR monitors, and 5-Hz Global positioning system (GPS) units. The number of technical actions was higher in 7v7 than in 8v8 games (34 ± 19 vs. 28 ± 14; p = 0.03; d = 0.37), as was the number of successful actions (25 ± 16 vs. 20 ± 12; p = 0.01; d = 0.35), with no difference in success rate for technical actions (70 ± 13 vs. 69 ± 14%; p = 0.63; d = 0.07). No differences were found between 7v7 and 8v8 in total distance covered (1,574 ± 251 and 1,622 ± 281 m; p = 0.66; d = 0.18), peak speed (19.5 ± 2.6 and 20.7 ± 1.5 km·h; p = 0.16; d = 0.56), mean HR values (85 ± 5 and 86 ± 6%HRpeak; p = 0.85; d = 0.18), and time of >90% HRpeak (37 ± 16 and 35 ± 14% of playing time; p = 0.70; d = 0.13). Distance covered at the highest running speeds of >16 km·h was lower in 7v7 than in 8v8 games (34 ± 24 vs. 63 ± 34 m; p = 0.018; d = 0.98), as was the number of entries into this speed zone (8 ± 5 vs. 13 ± 7; p = 0.006; d = 0.82). In conclusion, more technical actions and successful actions were observed in 7v7 than in 8v8 games, but players covered more ground with high-speed running in 8v8 games. This study also revealed that HR values were high in both game formats for U11 adolescent female players, with no difference between formats.