This is a sel -a chi ed e sion o an o iginal a icle. This e sion
may di e om he o iginal in pagina ion and ypog aphic de ails.
Au ho (s):
Ti le:
Yea :
Ve sion:
Copy igh :
Righ s:
Righ s u l:
Please ci e he o iginal e sion:
CC BY 4.0
h ps://c ea i ecommons.o g/licenses/by/4.0/
Heal h Bene i s o Di e en Spo s: a Sys ema ic Re iew and Me a-Analysis o
Longi udinal and In e en ion S udies Including 2.6 Million Adul Pa icipan s
© 2024 he Au ho s
Published e sion
Oja, Pekka; Memon, Aami Raoo ; Ti ze, Syl ia; Ju akic, Danijel; Chen, Si-Tong;
Sh es ha, Nipun; Em, Sowann y; Ma olic, Tena; Vasanka i, Tommi; Heinonen, A i;
G gic, Jozo; Koski, Pasi; Kokko, Sami; Kelly, Paul; Fos e , Cha lie; Podna , H oje;
Pedisic, Zeljko
Oja, P., Memon, A. R., Ti ze, S., Ju akic, D., Chen, S.-T., Sh es ha, N., Em, S., Ma olic, T.,
Vasanka i, T., Heinonen, A., G gic, J., Koski, P., Kokko, S., Kelly, P., Fos e , C., Podna , H., &
Pedisic, Z. (2024). Heal h Bene i s o Di e en Spo s: a Sys ema ic Re iew and Me a-Analysis o
Longi udinal and In e en ion S udies Including 2.6 Million Adul Pa icipan s. Spo s Medicine -
Open, 10, A icle 46. h ps://doi.o g/10.1186/s40798-024-00692-x
2024
Ojae al. Spo s Medicine - Open (2024) 10:46
h ps://doi.o g/10.1186/s40798-024-00692-x
SYSTEMATIC REVIEW Open Access
© The Au ho (s) 2024. Open Access This a icle is licensed unde a C ea i e Commons A ibu ion 4.0 In e na ional License, which
pe mi s use, sha ing, adap a ion, dis ibu ion and ep oduc ion in any medium o o ma , as long as you gi e app op ia e c edi o he
o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons licence, and indica e i changes we e made. The images o
o he hi d pa y ma e ial in his a icle a e included in he a icle’s C ea i e Commons licence, unless indica ed o he wise in a c edi line
o he ma e ial. I ma e ial is no included in he a icle’s C ea i e Commons licence and you in ended use is no pe mi ed by s a u o y
egula ion o exceeds he pe mi ed use, you will need o ob ain pe mission di ec ly om he copy igh holde . To iew a copy o his
licence, isi h p://c ea i ecommons.o g/licenses/by/4.0/.
Spo s Medicine - Open
Heal h Bene i s o Di e en Spo s:
aSys ema ic Re iew andMe a-Analysis
o Longi udinal andIn e en ion S udies
Including 2.6 Million Adul Pa icipan s
Pekka Oja1, Aami Raoo Memon2 , Syl ia Ti ze3 , Danijel Ju akic4 , Si‑Tong Chen2 , Nipun Sh es ha5 ,
Sowann y Em3, Tena Ma olic4, Tommi Vasanka i1,6 , A i Heinonen7 , Jozo G gic2 , Pasi Koski8 ,
Sami Kokko7 , Paul Kelly9, Cha lie Fos e 10 , H oje Podna 4 and Zeljko Pedisic2*
Abs ac
Backg ound Se e al e iews ha e examined he heal h bene i s o pa icipa ion in speci ic spo s, such as baseball,
c icke , c oss‑coun y skiing, cycling, downhill skiing, oo ball, gol , judo, ugby, unning and swimming. Howe e , new
p ima y s udies on he opic ha e ecen ly been published, and he espec i e me a‑analy ic e idence needs o be
upda ed.
Objec i es To sys ema ically e iew, summa ise and app aise e idence on physical heal h bene i s o pa icipa ion
in di e en ec ea ional spo s.
Me hods Sea ches o jou nal a icles we e conduc ed in PubMed/MEDLINE, Scopus, SpoLi , SPORTDiscus, Spo s
Medicine & Educa ion Index and Web o Science. We included longi udinal and in e en ion s udies in es iga ‑
ing physical heal h ou comes associa ed wi h pa icipa ion in a gi en spo among gene ally heal hy adul s
wi hou disabili y.
Resul s A o al o 136 pape s om 76 s udies conduc ed among 2.6 million pa icipan s we e included in he e iew.
Ou me a‑analyses o a ailable e idence ound ha : (1) cycling educes he isk o co ona y hea disease by 16%
(pooled haza d a io [HR] = 0.84; 95% con idence in e al [CI]: 0.80, 0.89), all‑cause mo ali y by 21% (HR = 0.79; 95% CI:
0.73, 0.84), cance mo ali y by 10% (HR = 0.90; 95% CI: 0.85, 0.96) and ca dio ascula mo ali y by 20% (HR = 0.80; 95%
CI: 0.74, 0.86); (2) oo ball has a ou able e ec s on body composi ion, blood lipids, as ing blood glucose, blood p es‑
su e, ca dio ascula unc ion a es , ca dio espi a o y i ness and bone s eng h (p < 0.050); (3) handball has a ou ‑
able e ec s on body composi ion and ca dio espi a o y i ness (p < 0.050); (4) unning educes he isk o all‑cause
mo ali y by 23% (HR = 0.77; 95% CI: 0.70, 0.85), cance mo ali y by 20% (HR = 0.80; 95% CI: 0.72, 0.89) and ca dio as‑
cula mo ali y by 27% (HR = 0.73; 95% CI: 0.57, 0.94) and imp o es body composi ion, ca dio ascula unc ion a es
and ca dio espi a o y i ness (p < 0.010); and (5) swimming educes he isk o all‑cause mo ali y by 24% (HR = 0.76;
95% CI: 0.63, 0.92) and imp o es body composi ion and blood lipids (p < 0.010).
*Co espondence:
Zeljko Pedisic
zeljko.pedisic@ u.edu.au
Full lis o au ho in o ma ion is a ailable a he end o he a icle
Page 2 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
Conclusions A ange o physical heal h bene i s a e associa ed wi h pa icipa ion in ec ea ional cycling, oo ball,
handball, unning and swimming. Mo e s udies a e needed o enable me a‑analyses o heal h bene i s o pa icipa‑
ion in o he spo s.
PROSPERO egis a ion numbe CRD42021234839.
Key Poin s
• We ound a educed isk o all‑cause mo ali y associa ed wi h cycling (–21%), unning (–23%) and swimming
(–24%).
• Running also imp o es body composi ion, ca dio ascula unc ion a es and ca dio espi a o y i ness,
while swimming also imp o es body composi ion and blood lipids.
• Foo ball imp o es body composi ion, blood lipids, as ing blood glucose, blood p essu e, ca dio ascula unc ion
a es , ca dio espi a o y i ness and bone s eng h, while handball imp o es body composi ion and ca dio espi‑
a o y i ness.
Keywo ds Exe cise, Physical ac i i y, Longe i y, Body weigh , VO2max
In oduc ion
Acco ding o he la es Eu oba ome e su ey, 55% o
Eu opean Union ci izens pa icipa e in spo s, usu-
ally wi h he aim o imp o e heal h and/o i ness [1]. A
la ge majo i y o hem do no do i egula ly [1]. S udies
ha e shown ha , by pa icipa ing in spo s, adul s can
eap a ange o heal h bene i s, such as educed isk o
p ema u e mo ali y, ype 2 diabe es and ca dio ascula
disease and imp o ed lipid p o ile, body composi ion,
muscle s eng h and unc ional capaci y [2–5]. The e o e,
ec ea ional spo s pa icipa ion has a la ge po en ial o
imp o e he heal h o he popula ion.
Speci ic ypes o spo (e.g. endu ance spo s and
s eng h spo s) may ha e dis inc heal h bene i s owing
o hei di e ences in biomechanical cha ac e is ics and
physiological demands [6, 7]. Fo example, while endu -
ance spo s a e mo e likely o imp o e ca dio ascula
unc ion and ae obic i ness, s eng h spo s a e gene -
ally mo e likely o imp o e muscle unc ion and bone
heal h [8, 9]. The e may also be di e ences in heal h
bene i s be ween speci ic spo s disciplines (e.g. ennis
and baske ball) because each spo en ails a unique se
o mo emen s ha a e pe o med in speci ic physical,
psychological, social and en i onmen al con ex s. The e-
o e, om a public heal h pe spec i e, i is impo an o
de e mine heal h ou comes associa ed wi h pa icipa ion
in speci ic spo s. Expe s a gue ha c ea ing ‘heal h p o-
iles’ o di e en spo s would also acili a e he imple-
men a ion o heal h-enhancing p og ammes in spo s
clubs [8, 9]. Such e idence may also mo i a e indi iduals
o inc ease hei pa icipa ion in spo s [1].
P e iously, we conduc ed a sys ema ic e iew and
me a-analysis o heal h bene i s associa ed wi h di e en
spo s [6]. The e iew included 47 c oss-sec ional, 9 lon-
gi udinal and 13 in e en ion s udies co e ing 26 spo s
and a ious heal h ou comes. Howe e , su icien da a
we e a ailable only o me a-analyses o he associa ions
o oo ball pa icipa ion wi h maximal oxygen up ake
(VO2max), es ing hea a e and a mass, while e idence
o o he spo s and heal h ou comes needed o be sum-
ma ised na a i ely. The me a-analyses ound ha oo -
ball is associa ed wi h inc eased VO2max and es ing hea
a e, while i s associa ion wi h a mass was no ound
o be signi ican . Mo e ecen ly, se e al e iews exam-
ined heal h bene i s o spo s pa icipa ion. They ha e
co e ed a ange o spo s, such as baseball [10], c icke
[11], c oss-coun y skiing [12], cycling [13], downhill ski-
ing [5], oo ball [14, 15], gol [3], judo [16], ugby [17],
unning [18] and swimming [19], gene ally sugges ing
a ou able heal h ou comes associa ed wi h ec ea ional
spo s pa icipa ion. Fo example, a na a i e e iew sug-
ges ed ha playing oo ball is associa ed wi h imp o ed
ca dio ascula , me abolic and musculoskele al i ness
[14], while a sys ema ic e iew showed ha unning is
associa ed wi h 27% lowe isk o all-cause mo ali y [18].
Howe e , la ge di e ences in he me hods (e.g. s udy
design, inclusion c i e ia and da a syn hesis) used in
hese e iews make he compa ison o hei indings chal-
lenging. Also, gi en ha mos o hem we e ocused on a
single spo and ha some o hem examined only spe-
ci ic ou comes, hey could no assess he o ali y o e i-
dence on heal h bene i s o spo s and comp ehensi ely
iden i y esea ch gaps in his a ea. Impo an ly, li e a u e
sea ches in mos o hese e iews we e comple ed se e al
yea s ago and new p ima y s udies on he heal h bene i s
o hese spo s ha e since been published. The e o e, he
Page 3 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
aim o his pape was o sys ema ically e iew, summa ise
and app aise he e idence on physical heal h bene i s o
pa icipa ion in di e en ec ea ional spo s.
Me hods
Sea ch S a egy
The p o ocol o his sys ema ic e iew was egis e ed
in he In e na ional P ospec i e Regis e o Sys ema ic
Re iews (PROSPERO) da abase ( egis a ion numbe :
CRD42021234839). The e iew was w i en acco ding
o he upda ed P e e ed Repo ing I ems o Sys ema ic
Re iews and Me a-Analyses (PRISMA) checklis [20].
The sea ch o ele an s udies was pe o med in
he ollowing da abases: PubMed/MEDLINE, Scopus,
SpoLi , SPORTDiscus, Spo s Medicine & Educa ion
Index and Web o Science. The keywo d ‘spo ’ was com-
bined wi h he keywo ds o ‘heal h’ and ‘ i ness’ and wi h
a ange o keywo ds desc ibing he s udy design (Addi-
ional ile 1). The ini ial sea ch was pe o med on 31
May 2020 and co e ed pee - e iewed a icles published
a e 2012. The sea ch was upda ed on 30 May 2022. Fo
s udies published be o e 2013, we e e ed o ou ea lie
sys ema ic e iew [6]. Two au ho s independen ly con-
duc ed he s udy selec ion om he e e ences ob ained
in he ini ial (PO and SE) and upda ed (ARM and STC)
sea ches. We also pe o med seconda y sea ches by
sc eening he e e ence lis s o all included pape s, lis s
o pape s ha ci ed he included pape s, ele an e iew
pape s on he associa ions be ween spo and heal h and
he au ho s’ pe sonal da abase. Two au ho s indepen-
den ly conduc ed he ini ial seconda y sea ches (NS and
TM) and upda ed seconda y sea ches (ARM and STC).
Any po en ial disag eemen s in s udy selec ion we e
esol ed by a hi d au ho (DJ).
Inclusion C i e ia
S udies we e conside ed o inclusion agains he ol-
lowing c i e ia: (i) he s udy pa icipan s we e gene ally
heal hy adul s wi hou disabili y (18 + yea s old); (ii) he
s udy design was ei he longi udinal (coho and case–
con ol s udies) o in e en ional ( andomised con olled
ials and quasi-expe imen al s udies); (iii) he s udy
included a g oup o g oups o people pa icipa ing in a
speci ic spo (o in mul iple spo s o which each was
ep esen ed by a sepa a e g oup o pa icipan s in he
analysis) and a compa ison g oup o people who did no
pa icipa e in he gi en spo ; (i ) he s udy ou comes
we e ela ed o physical heal h; and ( ) he s udy was
published in English, Ge man o Finnish. We excluded
s udies in which he pa icipan s we e op-le el/eli e/p o-
essional a hle es and indi iduals wi h disabili y, ail y o
ch onic illness. We also excluded s udies in which he
pa icipa ion in ano he spo was he only compa ison
g oup, and s udies in which he ou come a iables we e
inju ies o o he acu e heal h p oblems.
Da a Ex ac ion
The ollowing da a we e ex ac ed om he included
in e en ion s udies: (1) he ype o s udy design; (2) he
numbe , sex and age o he pa icipan s in each compa i-
son g oup; (3) he ype, leng h, in ensi y and equency
o all in e en ions; and (4) he mean and s anda d
de ia ion o each ou come a iable be o e and a e he
in e en ion in he in e en ion and con ol g oups. The
da a ex ac ion was pe o med by one au ho (PO) and
checked o accu acy by ano he au ho (ST).
The ollowing da a we e ex ac ed om he included
longi udinal s udies: (1) he ype o s udy design; (2) he
numbe , sex and age o he pa icipan s; (3) he du a-
ion o he ollow-up; (4) he ype o spo s discipline(s)
included in he analyses and he de ini ion o he com-
pa ison g oup; (5) he name and measu emen uni s o
each ou come a iable; (6) he da a analysis me hod(s)
and adjus men s o con ounding; and (7) he e ec size
(and i s s a is ical signi icance and/o con idence in e -
al [CI]) o he associa ion be ween he pa icipa ion in a
speci ic spo and he ou come a iable. The da a ex ac-
ion was pe o med by one au ho (ARM) and checked
o accu acy by ano he au ho (ZP).
Risk o Bias andCe ain y o E idence
The quali y o in e en ion s udies was assessed using he
E ec i e Public Heal h P ac ice P ojec Quali y Assess-
men Tool [21]. The ool assesses six componen s o a
s udy: (1) selec ion bias, (2) s udy design, (3) con ound-
e s, (4) blinding, (5) da a collec ion me hods and (6)
wi hd awals and d op-ou s. Two au ho s (PO and AH)
pe o med his e alua ion. Any disag eemen s we e
esol ed by a hi d au ho (SK).
The isk o bias in longi udinal s udies was assessed using
he Newcas le–O awa Quali y Assessmen Scale (NOS) o
coho s udies [22]. This scale a es he isk o bias ac oss
h ee domains: (1) selec ion, (2) compa abili y and (3) ou -
come. The e alua ion was pe o med by one au ho (ARM).
The ce ain y o e idence was assessed acco ding o he
G ading o Recommenda ions Assessmen , De elopmen
and E alua ion (GRADE) c i e ia [23]. The e alua ion
was pe o med by wo au ho s (NS and ZP) and checked
by one au ho (HP). Gi en he la ge numbe o exposu e
and ou come a iables co e ed in he me a-analyses, he
assessmen o ce ain y o e idence was pe o med only
o cycling, unning and swimming pa icipa ion in ela-
ion o all-cause mo ali y, as a key heal h indica o .
Page 4 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
S a is ical Analysis
Random-e ec s me a-analyses wi h es ic ed maxi-
mum likelihood es ima ion we e conduc ed o sum-
ma ise he e ec s o pa icipa ing in a speci ic spo
(compa ed wi h no exe cise) on a heal h ou come
epo ed in in e en ion s udies. The e ec sizes we e
p esen ed as he mean di e ence be ween he in e -
en ion and con ol g oup in changes om baseline
o ollow-up. Fo s udies ha did no epo Pea son’s
co ela ion be ween baseline and ollow-up sco es in
he ou come a iable, we used a weigh ed pooled co -
ela ion calcula ed om o he s udies on he gi en
ou come. In he me a-analyses o which less han wo
co ela ion coe icien s we e epo ed ac oss s udies (i.e.
in he analyses wi h mean a e ial p essu e, maximal
hea a e, VO2max in L/min and peak en ila ion as ou -
come a iables), we eplaced he missing co ela ions
wi h 0.50. We did he same in sensi i i y me a-analyses
o all he emaining ou comes.
To summa ise he adjus ed haza d a ios (HRs) om longi-
udinal s udies, we conduc ed andom-e ec s me a-analyses
wi h es ic ed maximum likelihood es ima ion. Fo longi-
udinal s udies ha conduc ed dose– esponse analyses (e.g.
HRs o speci ic du a ions o ac i i y) and did no epo HRs
o compa isons o ‘any’ e sus ‘no’ pa icipa ion in a gi en
spo , in he me a-analysis we included he HR o he lowes
dose o ac i i y. We also conduc ed sensi i i y me a-analyses
in which we included HRs o he highes dose o ac i i y.
We used he I2, τ2, Coch an’s Q es and p edic ion
in e als o assess he he e ogenei y o e ec sizes. Low,
mode a e, subs an ial and high deg ee o he e ogenei y
was indica ed by I2 alues o 0–40%, 30–60%, 50–90% and
75–100%, espec i ely [24]. Fo he me a-analyses ha
included 10 o mo e e ec sizes, we assessed he publi-
ca ion bias using he con ou -enhanced unnel plo and
he Egge ’s asymme y es [25]. We also calcula ed he
pooled mean di e ences using he ‘ im and ill’ me hod
and ail-sa e N using he ‘gene al me hod’ [26].
The me a-analyses we e conduc ed in R (R Founda ion
o S a is ical Compu ing, Vienna, Aus ia), using he
‘me a o ’ package [26].
Resul s
Sea ch Resul s
The da abase sea ch yielded 27,429 pape s and an addi-
ional 32,250 pape s we e iden i ied h ough second-
a y sea ches. Following emo al o duplica es, and i le
Fig. 1 Flowcha o he sea ch and s udy selec ion p ocess

Page 5 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
and abs ac sc eening, 199 pape s we e le o ull- ex
sc eening. A o al o 80 pape s [27–106] om 46 in e -
en ion s udies and 56 pape s [7, 107–161] om 30 lon-
gi udinal s udies we e included in he analysis (Fig.1).
S udy Cha ac e is ics
The in e en ion s udies included ~ 2400 pa icipan s and
co e ed he ollowing 19 di e en spo disciplines: oo -
ball/socce (he ea e e e ed o as ‘ oo ball’), unning,
swimming, alpine skiing, handball, cycling, climbing,
olleyball, ka a e, ugby, baske ball, loo ball, badmin-
on, ennis, able ennis, judo, gol , eques ian spo s and
aekwondo. In o al, 29 pape s om in e en ion s ud-
ies included men only, 27 included women only and 24
included bo h men and women. The heal h ou comes
co e ed in he in e en ion s udies we e: (1) ca dio as-
cula unc ion a es ; (2) ca dio espi a o y i ness; (3)
body composi ion; (4) me abolic i ness; (5) muscula
i ness; (6) bone s eng h; and (7) physical pe o mance.
A desc ip i e summa y o he in e en ion s udies is p e-
sen ed in Addi ional ile2.
The longi udinal s udies included ~ 2.64 million pa -
icipan s and co e ed 18 di e en spo disciplines,
including: badmin on, baske ball, cycling, boxing/ka a e,
oo ball, gol , hockey, ice ska ing, acque ball, owing,
unning, baseball, skiing, swimming, able ennis, en-
nis and olleyball. In o al, 9 pape s om he longi udi-
nal s udies e e ed o men only, 5 e e ed o women
only and 42 e e ed o bo h men and women. One o
he included longi udinal s udies was in e na ional, wi h
pa icipan s om Aus ia, Belgium, England, I aly, Spain,
Sweden and Swi ze land. O e all, 2 included pape s om
longi udinal s udies we e om Aus alia, 1 om Canada,
4 om China, 13 om Denma k, 6 om Finland, 1 om
F ance, 5 om he Ne he lands, 1 om Russia, 5 om
Sweden, 6 om he UK and 11 om he USA. The ol-
lowing heal h ou comes we e co e ed in he included
longi udinal s udies: (1) all-cause mo ali y, (2) ca dio-
ascula mo ali y, (3) espi a o y mo ali y, (4) diabe es
mo ali y, (5) cance mo ali y, (6) mo ali y om o he
causes, (7) cance , (8) colon cance , (9) b eas cance ,
(10) enous h omboembolism, (11) a ial ib illa ion,
(12) ao ic s i ness, (13) ca dio ascula disease, (14)
co ona y hea disease, (15) ischemic hea disease, (16)
myoca dial in a c ion, (17) s oke, (18) hype ension, (19)
obesi y o change in body composi ion, (20) hype iglyc-
e idemia, (21) impai ed glucose ole ance, (22) diabe es,
(23) espi a o y diseases, (24) ch onic obs uc i e pul-
mona y disease, (25) as hma, (26) join diseases, (27) eye
diseases, (28) ch onic kidney disease, (29) alle gies, (30)
a icose eins and (31) diseases o he u ogeni al sys em.
A desc ip i e summa y o longi udinal s udies is p e-
sen ed in Addi ional ile3.
Risk o Bias
The o e all me hodological quali y was a ed as mode -
a e o 8 and weak o 72 pape s om in e en ion s ud-
ies (Addi ional ile4). The o e all me hodological quali y
was a ed as ai o 15 and good o 41 pape s om lon-
gi udinal s udies (Addi ional ile5).
Me a‑Analyses o In e en ion S udies
E ec s o Cycling onHeal h
We did no ind signi ican e ec s o cycling on body
mass, body mass index (BMI), sys olic blood p essu e
and dias olic blood p essu e (p > 0.05 o all; Table1 and
Addi ional ile6). The e was high he e ogenei y be ween
he s udies on body mass. We did no ind signi ican
Table 1 The e ec s o cycling on heal h ou comes: esul s o ou me a‑analyses
* Pooled sample size (numbe o s udies)
† Pooled mean di e ence be ween he p e-pos e ec s ound in he in e en ion and con ol g oups. A posi i e alue indica es a la ge inc ease in he a e age sco e
in a gi en es as a esul o cycling pa icipa ion, compa ed wi h con ols
‡ 95% con idence in e al o d
§ p- alue o d
∥I2 measu e o he e ogenei y be ween s udies exp essed as pe cen age
¶ Tau-squa ed measu e o he e ogenei y be ween s udies
** Coch an’s Q
†† p- alue om he Coch an’s Q es o he e ogenei y be ween s udies
‡‡ 95% p edic ion in e al o d
Heal h ou come n*d†95% CI‡p§I2 (%)∥τ2¶ Q** p†† 95% PI‡‡
Body mass (kg) 180 (4) −1.15 –3.92, 1.62 0.415 85.5 6.73 19.36 < 0.001 –6.94, 4.64
Body mass index (kg/m2) 141 (3) 0.15 –0.18, 0.47 0.372 0.0 0.00 1.36 0.506 –0.18, 0.47
Sys olic blood p essu e (mmHg) 161 (3) –1.35 –5.02, 2.32 0.471 0.0 0.00 0.84 0.657 –5.02, 2.32
Dias olic blood p essu e (mmHg) 161 (3) –0.38 –3.55, 2.80 0.817 0.0 0.00 0.53 0.765 –3.55, 2.80
Page 6 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
he e ogenei y among he s udies on he emaining heal h
ou comes (p > 0.05). The sensi i i y analyses con i med
he indings (Addi ional ile7).
E ec s o Foo ball onHeal h
We ound a ou able e ec s o oo ball on body mass,
BMI, body a mass, body a pe cen age, o al and low-
densi y lipop o ein (LDL) choles e ol, as ing blood glu-
cose, sys olic and dias olic blood p essu e, mean a e ial
p essu e, es ing hea a e, VO2max, peak en ila ion,
absolu e measu es o bone mine al con en ( o al and
in legs) and os eocalcin (p < 0.050 o all; Table2). The
sensi i i y analyses con i med he indings o all ou -
comes excep o o al choles e ol and LDL choles e ol
(Addi ional ile 8). In he main me a-analyses, we did
no ind signi ican e ec s o oo ball on he emaining
se en heal h ou comes (p > 0.05 o all). Howe e , in he
sensi i i y analysis, we ound a a ou able e ec o oo -
ball on pe o mance in he coun e mo emen jump es
(p = 0.031). The e was high he e ogenei y be ween he
s udies on all measu es o body composi ion excep o
lean mass o legs. High he e ogenei y was also ound
be ween he s udies on high-densi y lipop o ein (HDL)
choles e ol, VO2max (ml/kg/min) and coun e mo emen
Table 2 The e ec s o oo ball on heal h ou comes: esul s o 24 me a‑analyses
* Pooled sample size (numbe o s udies)
† Pooled mean di e ence be ween he p e-pos e ec s ound in he in e en ion and con ol g oups. A posi i e alue indica es a la ge inc ease in he a e age sco e
in a gi en es as a esul o oo ball pa icipa ion, compa ed wi h con ols
‡ 95% con idence in e al o d
§ p- alue o d
∥I2 measu e o he e ogenei y be ween s udies exp essed as pe cen age
¶ Tau-squa ed measu e o he e ogenei y be ween s udies
** Coch an’s Q
†† p- alue om he Coch an’s Q es o he e ogenei y be ween s udies
‡‡ 95% p edic ion in e al o d
§§ Numbe o in e en ion g oups p esen ed ins ead o numbe o s udies, whe e numbe o s udies = numbe o in e en ion g oups−1
∥∥Pe o med wi h hands on hips (i.e. wi hou a m swing)
Heal h ou come n*d†95% CI‡p§I2 (%)∥τ2¶ Q** p†† 95% PI‡‡
Body mass (kg) 298 (11§§) –3.64 –5.74, –1.54 < 0.001 93.9 11.20 175.90 < 0.001 –10.53, 3.25
Body mass index (kg/m2)236 (8§§) –0.83 –1.53, –0.14 0.018 93.0 0.85 131.98 < 0.001 –2.77, 1.10
Body a mass (kg) 195 (6) –2.15 –3.43, –0.87 < 0.001 84.2 1.88 47.21 < 0.001 –5.13, 0.83
Body a pe cen age 281 (10§§) –1.98 –2.68, –1.28 < 0.001 80.6 0.88 81.14 < 0.001 –3.94, –0.01
Lean body mass (kg) 164 (6) –0.10 –1.58, 1.38 0.891 82.4 2.77 21.32 < 0.001 –3.69, 3.48
Lean mass o legs (kg) 103 (3) 0.09 –0.43, 0.62 0.728 37.3 0.09 3.20 0.201 –0.69, 0.88
To al choles e ol (mmol/L) 232 (8§§) –0.15 –0.29, –0.01 0.031 12.7 0.01 6.40 0.494 –0.35, 0.04
HDL choles e ol (mmol/L) 263 (9§§) 0.07 –0.02, 0.17 0.129 81.8 0.02 39.66 < 0.001 –0.20, 0.34
LDL choles e ol (mmol/L) 232 (8§§) –0.15 –0.28, –0.02 0.025 14.5 0.01 7.43 0.385 –0.35, 0.04
T iglyce ides (mmol/L) 200 (7§§) –0.16 –0.31, 0.00 0.056 45.1 0.02 10.54 0.104 –0.46, 0.15
Fas ing blood glucose (mmol/L) 114 (6§§) –0.22 –0.41, –0.03 0.025 55.2 0.03 10.50 0.062 –0.59, 0.15
Sys olic blood p essu e (mmHg) 303 (10§§) –4.44 –6.78, –2.09 < 0.001 63.1 8.64 23.53 0.005 –10.66, 1.79
Dias olic blood p essu e (mmHg) 303 (10§§) –2.59 –4.28, –0.91 0.003 57.9 3.83 20.82 0.013 –6.78, 1.59
Mean a e ial p essu e (mmHg) 79 (3) –2.93 –5.32, –0.54 0.016 0.0 0.00 0.70 0.705 –5.32, –0.54
Res ing hea a e (bpm) 154 (8§§) –5.41 –7.57, –3.26 < 0.001 49.6 4.34 12.59 0.083 –10.03, –0.80
Maximal hea a e (bpm) 87 (3) 2.42 –2.45, 7.29 0.330 59.6 10.60 4.98 0.083 –5.60, 10.45
VO2max (ml/kg/min) 222 (7) 4.00 1.76, 6.24 < 0.001 91.8 7.89 38.04 < 0.001 –1.95, 9.94
VO2max (L/min) 97 (3) 0.38 0.18, 0.59 < 0.001 0.0 0.00 1.54 0.463 0.18, 0.59
Peak en ila ion (L/min) 96 (4) 15.43 8.79, 22.07 < 0.001 0.0 0.00 0.92 0.822 8.79, 22.07
Bone mine al densi y – o al body (g/cm2) 192 (5) 0.01 –0.01, 0.03 0.210 71.6 0.00 12.19 0.016 –0.02, 0.04
Bone mine al con en – o al body (g) 194 (5) 30.82 5.71, 55.93 0.016 0.0 0.00 0.87 0.929 5.71, 55.93
Bone mine al con en – legs (g) 103 (3) 26.33 13.54, 39.12 < 0.001 1.7 3.89 1.75 0.417 12.97, 39.69
Os eocalcin (μg/L) 154 (4) 9.61 5.40, 13.83 < 0.001 40.9 7.54 5.31 0.150 2.78, 16.45
Coun e mo emen jump∥∥ (cm) 54 (3) 2.11 –0.08, 4.29 0.059 84.6 3.13 14.57 < 0.001 –1.99, 6.21
Page 7 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
jump. Fo mos o he emaining heal h ou comes, he -
e ogenei y be ween he s udies was no ound o be sig-
ni ican (p < 0.05). Howe e , in mos o he me a-analyses,
p edic ion in e als we e ela i ely wide.
E ec s o Handball onHeal h
We ound a ou able e ec s o handball on body a
mass, body a pe cen age and VO2max (p < 0.050 o all;
Table 3). The sensi i i y analyses did no con i m he
indings o body a mass and body a pe cen age (Addi-
ional ile9). We did no ind signi ican e ec s o hand-
ball on he emaining nine heal h ou comes (p > 0.05 o
all). The e was subs an ial he e ogenei y be ween he
s udies on HDL choles e ol and VO2max and high he e o-
genei y be ween he s udies on es ing hea a e. Fo he
emaining heal h ou comes, he e ogenei y be ween he
s udies was no ound o be signi ican (p < 0.05).
E ec s o Running onHeal h
We ound a ou able e ec s o unning on body a mass,
body a pe cen age, es ing hea a e, VO2max and peak
en ila ion (p < 0.010 o all; Table4). In he main me a-
analyses, we did no ind signi ican e ec s o unning
on he emaining nine heal h ou comes (p > 0.05 o all).
Howe e , in he sensi i i y analysis, we ound a a ou -
able e ec o unning on BMI (p = 0.003; Addi ional
ile10). The e was high he e ogenei y be ween he s ud-
ies on body mass, BMI, body a mass, lean body mass
and VO2max. Fo he emaining heal h ou comes, he -
e ogenei y be ween he s udies was no ound o be sig-
ni ican (p < 0.05). Howe e , in mos o he me a-analyses,
p edic ion in e als we e ela i ely wide.
E ec s o Swimming onHeal h
We ound a ou able e ec s o swimming on body
a pe cen age, o al choles e ol and HDL choles e ol
(p < 0.010 o all; Table5). The sensi i i y analysis did no
con i m he indings o body a mass and o al choles-
e ol (Addi ional ile11). In he main me a-analyses, we
did no ind signi ican e ec s o swimming on LDL cho-
les e ol (p = 0.120) and iglyce ides (p = 0.007). Howe e ,
in he sensi i i y analysis, we ound a a ou able e ec
o swimming on LDL choles e ol (p = 0.002). The e was
subs an ial he e ogenei y be ween he s udies on body a
pe cen age. Fo he emaining heal h ou comes, he e o-
genei y be ween he s udies was no ound o be signi i-
can (p < 0.050).
Table 3 The e ec s o handball on heal h ou comes: esul s o 12 me a‑analyses
* Pooled sample size (numbe o s udies)
† Pooled mean di e ence be ween he p e-pos e ec s ound in he in e en ion and con ol g oups. A posi i e alue indica es a la ge inc ease in he a e age sco e
in a gi en es as a esul o handball pa icipa ion, compa ed wi h con ols
‡ 95% con idence in e al o d
§ p- alue o d
∥I2 measu e o he e ogenei y be ween s udies exp essed as pe cen age
¶ Tau-squa ed measu e o he e ogenei y be ween s udies
** Coch an’s Q
†† p- alue om he Coch an’s Q es o he e ogenei y be ween s udies
‡‡ 95% p edic ion in e al o d
Heal h ou come n*d†95% CI‡p§I2 (%)∥τ2¶ Q** p†† 95% PI‡‡
Body mass (kg) 117 (3) –0.34 –1.05, 0.37 0.350 0.0 0.00 0.69 0.707 –1.05, 0.37
Body a mass (kg) 76 (3) –1.11 –2.20, –0.03 0.045 8.5 0.09 1.78 0.412 –2.35, 0.12
Body a pe cen age 195 (5) –0.85 –1.38, –0.33 0.001 27.3 0.10 4.98 0.289 –1.66, –0.04
Lean body mass (kg) 147 (3) 0.06 –0.44, 0.55 0.820 0.8 0.00 1.27 0.531 –0.45, 0.56
To al choles e ol (mmol/L) 167 (5) 0.05 –0.10, 0.21 0.478 0.0 0.00 2.36 0.670 –0.10, 0.21
HDL choles e ol (mmol/L) 167 (5) 0.07 –0.02, 0.16 0.143 65.2 0.01 13.24 0.010 –0.12, 0.25
LDL choles e ol (mmol/L) 167 (5) –0.03 –0.16, 0.10 0.622 0.0 0.00 0.98 0.913 –0.16, 0.10
T iglyce ides (mmol/L) 167 (5) –0.12 –0.26, 0.03 0.107 22.4 0.01 4.73 0.316 –0.33, 0.09
Sys olic blood p essu e (mmHg) 96 (4) 1.89 –0.89, 4.66 0.183 0.0 0.00 2.08 0.557 –0.89, 4.66
Dias olic blood p essu e (mmHg) 96 (4) –0.44 –3.54, 2.66 0.782 35.6 3.55 4.51 0.211 –5.26, 4.39
Res ing hea a e (bpm) 163 (5) –3.56 –7.84, 0.72 0.103 79.2 18.53 15.05 0.005 –13.02, 5.90
VO2max (ml/kg/min) 191 (6) 2.26 1.03, 3.50 < 0.001 69.8 1.55 13.99 0.016 –0.47, 5.00
Page 8 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
Me a‑Analyses o Longi udinal S udies
Heal h Ou comes Associa ed wi hCycling
Cycling was associa ed wi h 21%, 10% and 20% lowe
isk o all-cause, cance and ca dio ascula mo ali y,
espec i ely, o e he ollow-up pe iods (p ≤ 0.001
o all; Table6). Cycling was also associa ed wi h 16%
lowe isk o co ona y hea disease o e he ollow-
up pe iods (p < 0.001). We did no ind a signi ican
Table 4 The e ec s o unning on heal h ou comes: esul s o 14 me a‑analyses
* Pooled sample size (numbe o s udies)
† Pooled mean di e ence be ween he p e-pos e ec s ound in he in e en ion and con ol g oups. A posi i e alue indica es a la ge inc ease in he a e age sco e
in a gi en es as a esul o unning pa icipa ion, compa ed wi h con ols
‡ 95% con idence in e al o d
§ p- alue o d
∥I2 measu e o he e ogenei y be ween s udies exp essed as pe cen age
¶ Tau-squa ed measu e o he e ogenei y be ween s udies
** Coch an’s Q
†† p- alue om he Coch an’s Q es o he e ogenei y be ween s udies
‡‡ 95% p edic ion in e al o d
Heal h ou come n*d†95% CI‡p§I2 (%)∥τ2¶ Q** p†† 95% PI‡‡
Body mass (kg) 128 (5) –2.47 –5.65, 0.71 0.128 92.2 11.96 80.06 < 0.001 –9.96, 5.02
Body mass index (kg/m2) 116 (5) –0.82 –1.83, 0.19 0.111 89.7 1.16 69.24 < 0.001 –3.16, 1.52
Body a mass (kg) 128 (5) –2.10 –3.44, –0.77 0.002 77.8 1.69 26.05 < 0.001 –4.98, 0.77
Body a pe cen age 128 (5) –1.89 –2.67, –1.12 < 0.001 35.7 0.27 5.51 0.239 –3.18, –0.61
Lean body mass (kg) 128 (5) –0.39 –2.28, 1.50 0.686 89.8 4.15 34.30 < 0.001 –4.80, 4.03
Lean mass o legs (kg) 52 (3) 0.03 –0.82, 0.87 0.951 60.9 0.34 5.11 0.078 –1.40, 1.45
To al choles e ol (mmol/L) 120 (5) –0.10 –0.25, 0.06 0.227 0.0 0.00 3.24 0.518 –0.25, 0.06
HDL choles e ol (mmol/L) 120 (5) 0.01 –0.04, 0.05 0.780 0.1 0.00 7.23 0.124 –0.04, 0.05
LDL choles e ol (mmol/L) 119 (5) –0.03 –0.17, 0.12 0.718 0.0 0.00 1.40 0.844 –0.17, 0.12
Sys olic blood p essu e (mmHg) 87 (4) –2.29 –5.27, 0.68 0.130 12.6 1.26 3.14 0.371 –5.99, 1.41
Dias olic blood p essu e (mmHg) 87 (4) –2.17 –6.09, 1.75 0.278 56.2 8.73 6.59 0.086 –9.17, 4.82
Res ing hea a e (bpm) 55 (3) –7.06 –10.79, –3.32 < 0.001 0.0 0.00 0.15 0.928 –10.79, –3.32
VO2max (ml/kg/min) 111 (4) 5.75 2.59, 8.91 < 0.001 81.1 8.28 14.09 0.003 –0.72, 12.21
Peak en ila ion (L/min) 79 (3) 12.97 6.44, 19.50 < 0.001 0.0 0.00 0.00 > 0.999 6.44, 19.50
Table 5 The e ec s o swimming on heal h ou comes: esul s o i e me a‑analyses
* Pooled sample size (numbe o in e en ion g oups), whe e numbe o s udies = numbe o in e en ion g oups – 1
† Pooled mean di e ence be ween he p e-pos e ec s ound in he in e en ion and con ol g oups. A posi i e alue indica es a la ge inc ease in he a e age sco e
in a gi en es as a esul o swimming pa icipa ion, compa ed wi h con ols
‡ 95% con idence in e al o d
§ p- alue o d
∥I2 measu e o he e ogenei y be ween s udies exp essed as pe cen age
¶ Tau-squa ed measu e o he e ogenei y be ween s udies
** Coch an’s Q
†† p- alue om he Coch an’s Q es o he e ogenei y be ween s udies
‡‡ 95% p edic ion in e al o d
Heal h ou come n*d†95% CI‡p§I2 (%)∥τ2¶ Q** p†† 95% PI‡‡
Body a pe cen age 86 (3) –2.98 –4.30, –1.67 < 0.001 70.6 0.95 6.33 0.042 –5.30, –0.66
To al choles e ol (mmol/L) 86 (3) –0.31 –0.52, –0.10 0.004 0.0 0.00 0.55 0.759 –0.52, –0.10
HDL choles e ol (mmol/L) 86 (3) 0.15 0.07, 0.24 < 0.001 0.0 0.00 0.67 0.715 0.07, 0.24
LDL choles e ol (mmol/L) 86 (3) –0.17 –0.39, 0.05 0.120 40.8 0.02 3.08 0.214 –0.52, 0.17
T iglyce ides (mmol/L) 86 (3) –0.20 –0.34, –0.05 0.007 12.3 0.00 1.68 0.433 –0.39, 0.00
Page 15 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
80. Niede see D, Ledl‑Ku kowski E, K i a K, Pa sch W, Dela F, Muelle E,
e al. Salzbu g Skiing o he Elde ly S udy: changes in ca dio ascu‑
la isk ac o s h ough skiing in he elde ly. Scand J Med Sci Spo s.
2011;21(S1):47–55. h ps:// doi. o g/ 10. 1111/j. 1600‑ 0838. 2011. 01341.x.
81. Niede see D, S eidle‑Kloc E, May M, Mülle EE, Cadamu o J, Pa sch
W, e al. E ec s o a 12‑week alpine skiing in e en ion on endo helial
p ogeni o cells, pe iphe al a e ial one and endo helial bioma ke s
in he elde ly. In J Ca diol. 2016;214:343–7. h ps:// doi. o g/ 10. 1016/j.
ijca d. 2016. 03. 229.
82. No dsbo g NB, Connolly L, Weihe P, Iuliano E, K us up P, Sal in B, e al.
Oxida i e capaci y and glycogen con en inc ease mo e in a m han
leg muscle in seden a y women a e in ense aining. J Appl Physiol.
2015;119(2):116–23. h ps:// doi. o g/ 10. 1152/ jappl physi ol. 00101. 2015.
83. Nybo L, Sunds up E, Jakobsen MD, Moh M, Ho ns up T, Simonsen L,
e al. High‑in ensi y aining e sus adi ional exe cise in e en ions o
p omo ing heal h. Med Sci Spo s Exe c. 2010;42(10):1951–8. h ps://
doi. o g/ 10. 1249/ MSS. 0b013 e3181 d99203.
84. Pa e son S, Pa ison J, Legg H, Gibson A‑M, B own N. The impac
o badmin on on heal h ma ke s in un ained emales. J Spo s Sci.
2017;35(11):1098–106. h ps:// doi. o g/ 10. 1080/ 02640 414. 2016. 12108
19.
85. Pede sen MT, Vo up J, Bangsbo J. E ec o a 26‑mon h loo ball aining
on male elde ly’s ca dio ascula i ness, glucose con ol, body composi‑
ion, and unc ional capaci y. J Spo Heal h Sci. 2018;7(2):149–58.
h ps:// doi. o g/ 10. 1016/j. jshs. 2017. 12. 002.
86. Pe ei a R, K us up P, Cas agna C, Coelho E, San os R, Helge EW, e al.
E ec s o ec ea ional eam handball on bone heal h, pos u al bal‑
ance and body composi ion in inac i e pos menopausal women—a
andomised con olled ial. Bone. 2021;145: 115847. h ps:// doi. o g/ 10.
1016/j. bone. 2021. 115847.
87. Pe ei a R, K us up P, Cas agna C, Coelho E, San os R, Ma ins S, e al.
E ec s o a 16‑week ec ea ional eam handball in e en ion on ae obic
pe o mance and ca diome abolic i ness ma ke s in pos meno‑
pausal women: a andomized con olled ial. P og Ca dio asc Dis.
2020;63(6):800–6. h ps:// doi. o g/ 10. 1016/j. pcad. 2020. 10. 005.
88. Pó oas SC, Cas agna C, Resende C, Coelho EF, Sil a P, San os R, e al.
E ec s o a sho ‑ e m ec ea ional eam handball‑based p og amme
on physical i ness and ca dio ascula and me abolic heal h o
33–55‑yea ‑old men: a pilo s udy. BioMed Res In . 2018:4109796.
h ps:// doi. o g/ 10. 1155/ 2018/ 41097 96.
89. Quis JS, Rosenkilde M, Pe e sen M, G am A, Sjödin A, S allknech B.
E ec s o ac i e commu ing and leisu e‑ ime exe cise on a loss in
women and men wi h o e weigh and obesi y: a andomized con‑
olled ial. In J Obes. 2018;42(3):469–78. h ps:// doi. o g/ 10. 1038/ ijo.
2017. 253.
90. Raja ajan S, Anandhan P. E ec o walking cycling and swimming on
physiological changes among o e weigh men. In J Yogic Hum Mo
Spo s Sci. 2018;3(2):798–800.
91. Rande s MB, Hagman M, B ix J, Ch is ensen JF, Pede sen MT, Nielsen JJ,
e al. E ec s o 3 mon hs o ull‑cou and hal ‑cou s ee baske ‑
ball aining on heal h p o ile in un ained men. J Spo Heal h Sci.
2018;7(2):132–8. h ps:// doi. o g/ 10. 1016/j. jshs. 2017. 09. 004.
92. Rande s MB, Nielsen JJ, K us up BR, Sunds up E, Jakobsen MD, Nybo
L, e al. Posi i e pe o mance and heal h e ec s o a oo ball aining
p og am o e 12 weeks can be main ained o e a 1‑yea pe iod wi h
educed aining equency. Scand J Med Sci Spo s. 2010;20(S1):80–9.
h ps:// doi. o g/ 10. 1111/j. 1600‑ 0838. 2010. 01091.x.
93. Sa eban M, Fe nandez La Puen e de Ba e MD, Reich B, Schmied C,
Loidl M, Niede see D, e al. E ec s o ac i e commu ing o wo k o 12
mon hs on ca dio ascula isk ac o s and body composi ion. Scand J
Med Sci Spo s. 2020;30(S1):24–30. h ps:// doi. o g/ 10. 1111/ sms. 13695.
94. Schmid JF, Hansen PR, Ande sen TR, Ande sen L, Ho ns up T, K us up
P, e al. Ca dio ascula adap a ions o 4 and 12 mon hs o oo ball o
s eng h aining in 65‑ o 75‑yea ‑old un ained men. Scand J Med Sci
Spo s. 2014;24(S1):86–97. h ps:// doi. o g/ 10. 1111/ sms. 12217.
95. Seynnes O, Koes e s A, Gimpl M, Rei be ge A, Niede see D, Niebaue J,
e al. E ec o alpine skiing aining on endon mechanical p ope ies in
olde men and women. Scand J Med Sci Spo s. 2011;21:39–46. h ps://
doi. o g/ 10. 1111/j. 1600‑ 0838. 2011. 01340.x.
96. Shimada H, Lee S, Akishi a M, Kozaki K, Iijima K, Nagai K, e al. E ec s o
gol aining on cogni ion in olde adul s: a andomised con olled ial.
J Epidemiol Communi y Heal h. 2018;72(10):944–50. h ps:// doi. o g/ 10.
1136/ jech‑ 2017‑ 210052.
97. Sko adal MB, Helge EW, Jø gensen NR, Mo ensen J, Weihe P, K us up
P, e al. Os eogenic impac o oo ball aining in 55‑ o 70‑yea ‑
old women and men wi h p ediabe es. Scand J Med Sci Spo s.
2018;28:52–60. h ps:// doi. o g/ 10. 1111/ sms. 13252.
98. Sunds up E, Jakobsen MD, Ande sen LL, Ande sen TR, Rande s MB,
Helge JW, e al. Posi i e e ec s o 1‑yea oo ball and s eng h aining
on mechanical muscle unc ion and unc ional capaci y in elde ly
men. Eu J Appl Physiol. 2016;116(6):1127–38. h ps:// doi. o g/ 10. 1007/
s00421‑ 016‑ 3368‑0.
99. Tibe iu ȘR, Iacob H. Tennis as a ec ea ional physical ac i i y o adul s:
he e ec on physical i ness. S udia Uni e si a is Babes‑Bolyai, Educa io
A is Gymnas icae. 2019;64(2):47–56. h ps:// doi. o g/ 10. 24193/ subbe ag.
64(2). 14.
100. Toma R, Allen JA. Physical and physiological bene i s o small sided
ec ea ional handball in un ained males: ela ionship o body a wi h
ae obic capaci y. Phys Educ S ud. 2021;25(6):339–44. h ps:// doi. o g/ 10.
15561/ 20755 279. 2021. 0601.
101. Toma R, An ony VC. E ec o small‑sided ec ea ional socce on me a‑
bolic con ols, lipid p o ile and physical cha ac e is ics in un ained
males. Med Sci. 2019;23(100):835–42.
102. Toma R, An ony VC. Linkage o ae obic capaci y and body a pe cen :
e ec s o ec ea ional ac i i y on ae obic capaci y, body composi ion,
blood p essu e and es ing hea a e in Uni e si y s uden s. Med Sci.
2019;23(98):557–64.
103. T ajko ić N, Spo iš G, K is iče ić T, Boga aj Š. E ec s o small‑sided
ec ea ional olleyball on heal h ma ke s and physical i ness in middle‑
aged men. In J En i on Res Public Heal h. 2020;17(9):3021. h ps:// doi.
o g/ 10. 3390/ ije p h1709 3021.
104. an Ginkel S, Amami M, Dela F, Niede see D, Na ici M, Niebaue J, e al.
Adjus men s o muscle capilla i y bu no mi ochond ial p o ein wi h
skiing in he elde ly. Scand J Med Sci Spo s. 2015;25(4):e360–7. h ps://
doi. o g/ 10. 1111/ sms. 12324.
105. Wi e K, Emme mache P, Pliske G. Imp o emen o balance and gene al
physical i ness in olde adul s by ka a e: a andomized con olled ial.
Complemen Med Res. 2017;24(6):390–3. h ps:// doi. o g/ 10. 1159/
00047 9151.
106. Yoshimu a Y, Imamu a H. E ec s o basic ka a e exe cises on maxi‑
mal oxygen up ake in seden a y collegia e women. J Heal h Sci.
2010;56(6):721–6. h ps:// doi. o g/ 10. 1248/ jhs. 56. 721.
107. Ahmadi‑Abha i S, Sabia S, Shipley MJ, Ki imäki M, Singh‑Manoux A,
Tabak A, e al. Physical ac i i y, seden a y beha io , and long‑ e m
changes in ao ic s i ness: he Whi ehall II s udy. J Am Hea Assoc.
2017;6(8): e005974. h ps:// doi. o g/ 10. 1161/ jaha. 117. 005974.
108. Alb ech M, Koolhaas CM, Schou ou JD, an Rooij FJ, Ka ousi M,
Ik am MA, e al. Physical ac i i y ypes and a ial ib illa ion isk in he
middle‑aged and elde ly: he Ro e dam S udy. Eu J P e Ca diol.
2018;25(12):1316–23. h ps:// doi. o g/ 10. 1177/ 20474 87318 780031.
109. Ande sen K, Hållma ke U, James S, Sunds öm J. Long‑dis ance
skiing and incidence o hype ension: a coho s udy o 206 889
pa icipan s in a long‑dis ance c oss‑coun y skiing e en . Ci cula ion.
2020;141(9):743–50. h ps:// doi. o g/ 10. 1161/ CIRCU LATIO NAHA. 119.
042208.
110. Ande sen ZJ, De Nazelle A, Mendez MA, Ga cia‑Ayme ich J, He el
O, Tjønneland A, e al. A s udy o he combined e ec s o physical
ac i i y and ai pollu ion on mo ali y in elde ly u ban esiden s: he
Danish Die , Cance , and Heal h Coho . En i on Heal h Pe spec .
2015;123(6):557–63. h ps:// doi. o g/ 10. 1289/ ehp. 14086 98.
111. A ms ong ME, G een J, Ree es GK, Be al V, Cai ns BJ. F equen physical
ac i i y may no educe ascula disease isk as much as mode a e
ac i i y: la ge p ospec i e s udy o women in he Uni ed Kingdom.
Ci cula ion. 2015;131(8):721–9. h ps:// doi. o g/ 10. 1161/ CIRCU LATIO
NAHA. 114. 010296.
112. Be en zen T, Pe e sen L, Schnoh P, Sø ensen T. Physical ac i i y in
leisu e‑ ime is no associa ed wi h 10‑yea changes in wais ci cum e ‑
ence. Scand J Med Sci Spo s. 2008;18(6):719–27. h ps:// doi. o g/ 10.
1111/j. 1600‑ 0838. 2007. 00761.x.
113. Besson H, Ekelund U, B age S, Luben R, Bingham S, Khaw K‑T, e al. Rela‑
ionship be ween subdomains o o al physical ac i i y and mo ali y.

Page 16 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
Med Sci Spo s Exe c. 2008;40(11):1909–15. h ps:// doi. o g/ 10. 1249/
MSS. 0b013 e3181 80bcad.
114. Blond K, Jensen MK, Rasmussen MG, O e ad K, Tjønneland A, Øs e ‑
gaa d L, e al. P ospec i e s udy o bicycling and isk o co ona y hea
disease in Danish men and women. Ci cula ion. 2016;134(18):1409–11.
h ps:// doi. o g/ 10. 1161/ CIRCU LATIO NAHA. 116. 024651.
115. Chak a a y EF, Hube HB, Lingala VB, F ies JF. Reduced disabili y and
mo ali y among aging unne s: a 21‑yea longi udinal s udy. A ch
In e n Med. 2008;168(15):1638–46. h ps:// doi. o g/ 10. 1001/ a chi n e.
168. 15. 1638.
116. Chase NL, Sui X, Blai SN. Swimming and all‑cause mo ali y isk com‑
pa ed wi h unning, walking, and seden a y habi s in men. In J Aqua
Res Educ. 2008;2(3):213–23. h ps:// doi. o g/ 10. 25035/ ija e. 02. 03. 03.
117. Chomis ek AK, Cook NR, Flin AJ, Rimm EB. Vigo ous‑in ensi y leisu e‑
ime physical ac i i y and isk o majo ch onic disease in men. Med Sci
Spo s Exe c. 2012;44(10):1898–905. h ps:// doi. o g/ 10. 1249/ MSS. 0b013
e3182 5a68 3.
118. Dhana K, Koolhaas CM, Be ghou MA, Pee e s A, Ik am MA, Tiemeie
H, e al. Physical ac i i y ypes and li e expec ancy wi h and wi hou
ca dio ascula disease: he Ro e dam S udy. J Public Heal h (Ox ).
2017;39(4):e209–18. h ps:// doi. o g/ 10. 1093/ pubmed/ dw110.
119. Dons E, Rojas‑Rueda D, Anaya‑Boig E, A ila‑Palencia I, B and C,
Cole‑Hun e T, e al. T anspo mode choice and body mass index:
c oss‑sec ional and longi udinal e idence om a Eu opean‑wide s udy.
En i on In . 2018;119:109–16. h ps:// doi. o g/ 10. 1016/j. en in . 2018. 06.
023.
120. Fan M, L J, Yu C, Guo Y, Bian Z, Yang S, e al. Associa ion be ween ac i e
commu ing and inciden ca dio ascula diseases in Chinese: a p ospec‑
i e coho s udy. J Am Hea Assoc. 2019;8(20): e012556. h ps:// doi.
o g/ 10. 1161/ JAHA. 119. 012556.
121. Fa ahmand B, B oman G, De Fai e U, Våge ö D, Ahlbom A. Gol : a game
o li e and dea h– educed mo ali y in Swedish gol playe s. Scand J
Med Sci Spo s. 2009;19(3):419–24. h ps:// doi. o g/ 10. 1111/j. 1600‑ 0838.
2008. 00814.x.
122. Fishe JE, Lo S, Ul ik CS, Raaschou‑Nielsen O, He el O, Tjønneland
A, e al. Physical ac i i y, ai pollu ion, and he isk o as hma and
ch onic obs uc i e pulmona y disease. Am J Respi C i Ca e Med.
2016;194(7):855–65. h ps:// doi. o g/ 10. 1164/ ccm. 201510‑ 2036OC.
123. Fulle D, Pabayo R. The ela ionship be ween u ili a ian walking, u ili a ‑
ian cycling, and body mass index in a popula ion based coho s udy
o adul s: compa ing andom in e cep s and ixed e ec s models. P e
Med. 2014;69:261–6. h ps:// doi. o g/ 10. 1016/j. ypmed. 2014. 10. 022.
124. G øn ed A, Koi ula RW, Johansson I, Wennbe g P, Øs e gaa d L, Hall‑
mans G, e al. Bicycling o wo k and p imo dial p e en ion o ca dio as‑
cula isk: a coho s udy among Swedish men and women. J Am Hea
Assoc. 2016;5(11): e004413. h ps:// doi. o g/ 10. 1161/ JAHA. 116. 004413.
125. Hållma ke U, Lindbäck J, Michaelsson K, Ä nlö J, Åsbe g S, Wes e P,
e al. Su i al and incidence o ca dio ascula diseases in pa icipan s
in a long‑dis ance ski ace (Vasaloppe , Sweden) compa ed wi h
he backg ound popula ion. Eu Hea J Qual Ca e Clin Ou comes.
2018;4(2):91–7. h ps:// doi. o g/ 10. 1093/ ehjqc co/ qcy005.
126. Hoe enaa ‑Blom MP, Wendel‑Vos GW, Spijke man AM, K omhou D,
Ve schu en WM. Cycling and spo s, bu no walking, a e associa ed
wi h 10‑yea ca dio ascula disease incidence: he MORGEN s udy. Eu J
P e Ca diol. 2011;18(1):41–7. h ps:// doi. o g/ 10. 1097/ HJR. 0b013 e3283
3b c87.
127. Johnsen NF, Ch is ensen J, Thomsen BL, Olsen A, Lo S, O e ad K, e al.
Physical ac i i y and isk o colon cance in a coho o Danish middle‑
aged men and women. Eu J Epidemiol. 2006;21(12):877–84. h ps://
doi. o g/ 10. 1007/ s10654‑ 006‑ 9076‑z.
128. Johnsen NF, Ekblond A, Thomsen BL, O e ad K, Tjønneland A. Leisu e
ime physical ac i i y and mo ali y. Epidemiology. 2013;24(5):717–25.
h ps:// doi. o g/ 10. 1097/ EDE. 0b013 e3182 9e3dda.
129. Koolhaas CM, Dhana K, Golubic R, Schou ou JD, Ho man A, an Rooij FJ,
e al. Physical ac i i y ypes and co ona y hea disease isk in middle‑
aged and elde ly pe sons: he Ro e dam s udy. Am J Epidemiol.
2016;183(8):729–38. h ps:// doi. o g/ 10. 1093/ aje/ kw 244.
130. Koolhaas CM, Dhana K, Schou ou JD, Lahousse L, an Rooij FJ, Ik am
MA, e al. Physical ac i i y and cause‑speci ic mo ali y: he Ro e dam
s udy. In J Epidemiol. 2018;47(5):1705–13. h ps:// doi. o g/ 10. 1093/ ije/
dyy058.
131. Kubesch NJ, The ming Jø gensen J, Ho mann B, Lo S, Nieuwenhuijsen
MJ, Raaschou‑Nielsen O, e al. E ec s o leisu e‑ ime and anspo ‑
ela ed physical ac i i ies on he isk o inciden and ecu en myoca ‑
dial in a c ion and in e ac ion wi h a ic‑ ela ed ai pollu ion: a coho
s udy. J Am Hea Assoc. 2018;7(15): e009554. h ps:// doi. o g/ 10. 1161/
JAHA. 118. 009554.
132. Kunu so SK, Lakka TA, Ku l S, Mäkikallio TH, Jae SY, Laukkanen JA. Lei‑
su e‑ ime c oss‑coun y skiing and he isk o enous h omboembo‑
lism: a p ospec i e coho s udy. Eu J P e Ca diol. 2021;28(10):1138–
41. h ps:// doi. o g/ 10. 1177/ 20474 87320 908978.
133. Kunu so SK, Laukkanen JA, Ku l S, Mäkikallio TH, Khan H. Leisu e‑ ime
c oss‑coun y skiing and isk o a ial ib illa ion and s oke: a p ospec‑
i e coho s udy. Eu J P e Ca diol. 2020;27(19):2354–7. h ps:// doi.
o g/ 10. 1177/ 20474 87319 901040.
134. Kunu so SK, Mäkikallio TH, Kauhanen J, Vou ilainen A, Jae SY, Dey RS,
e al. Leisu e‑ ime c oss‑coun y skiing is associa ed wi h lowe inci‑
dence o ype 2 diabe es: a p ospec i e coho s udy. Diabe es Me ab
Res Re . 2020;36(1): e3216. h ps:// doi. o g/ 10. 1002/ dm . 3216.
135. Kunu so SK, Mäkikallio TH, Kauhanen J, Vou ilainen A, Jae SY, Ku l
S, e al. Leisu e‑ ime c oss‑coun y skiing is associa ed wi h lowe
incidence o hype ension: a p ospec i e coho s udy. J Hype ens.
2019;37(8):1624–32. h ps:// doi. o g/ 10. 1097/ hjh. 00000 00000 002110.
136. Laukkanen JA, Lakka TA, Ogunjesa BA, Ku l S, Kunu so SK. C oss‑
coun y skiing and he isk o acu e myoca dial in a c ion: a p ospec i e
coho s udy. Eu J P e Ca diol. 2020;27(10):1108–11. h ps:// doi. o g/
10. 1177/ 20474 87319 869696.
137. Laukkanen JA, Laukkanen T, Kunu so SK. C oss‑coun y skiing is associ‑
a ed wi h lowe all‑cause mo ali y: a popula ion‑based ollow‑up
s udy. Scand J Med Sci Spo s. 2018;28(3):1064–72. h ps:// doi. o g/ 10.
1111/ sms. 12980.
138. Lee D‑C, Pa e RR, La ie CJ, Sui X, Chu ch TS, Blai SN. Leisu e‑ ime
unning educes all‑cause and ca dio ascula mo ali y isk. J Am Coll
Ca diol. 2014;64(5):472–81. h ps:// doi. o g/ 10. 1016/j. jacc. 2014. 04. 058.
139. Li man A, K is al A, Whi e E. E ec s o physical ac i i y in ensi y, e‑
quency, and ac i i y ype on 10‑y weigh change in middle‑aged men
and women. In J Obes. 2005;29(5):524–33. h ps:// doi. o g/ 10. 1038/ sj.
ijo. 08028 86.
140. MacDonald CJ, Madika AL, Lajous M, Laouali N, A aud F, Bonne F,
e al. Associa ions be ween physical ac i i y and inciden hype en‑
sion ac oss s a a o body mass index: a p ospec i e in es iga ion in a
la ge coho o F ench women. J Am Hea Assoc. 2020;9(23): e015121.
h ps:// doi. o g/ 10. 1161/ JAHA. 119. 015121.
141. Ma hews CE, Ju j AL, Shu X‑O, Li H‑L, Yang G, Li Q, e al. In luence o
exe cise, walking, cycling, and o e all nonexe cise physical ac i i y on
mo ali y in Chinese women. Am J Epidemiol. 2007;165(12):1343–50.
h ps:// doi. o g/ 10. 1093/ aje/ kwm088.
142. Meka y RA, Feskanich D, Malspeis S, Hu FB, Wille WC, Field AE. Physical
ac i i y pa e ns and p e en ion o weigh gain in p emenopausal
women. In J Obes. 2009;33(9):1039–47. h ps:// doi. o g/ 10. 1038/ ijo.
2009. 127.
143. Mielke GI, Bailey TG, Bu on NW, B own WJ. Pa icipa ion in spo s/ ec‑
ea ional ac i i ies and incidence o hype ension, diabe es, and obesi y
in adul s. Scand J Med Sci Spo s. 2020;30(12):2390–8. h ps:// doi. o g/
10. 1111/ SMS. 13795.
144. Øs e gaa d L, Jensen MK, O e ad K, Tjønneland A, G øn ed A. Asso‑
cia ions be ween changes in cycling and all‑cause mo ali y isk. Am J
P e Med. 2018;55(5):615–23. h ps:// doi. o g/ 10. 1016/j. amep e. 2018. 06.
009.
145. Pa e son R, Pan e J, Vamos EP, Cummins S, Mille C, La e y AA. Asso‑
cia ions be ween commu e mode and ca dio ascula disease, cance ,
and all‑cause mo ali y, and cance incidence, using linked Census
da a o e 25 yea s in England and Wales: a coho s udy. Lance Plane
Heal h. 2020;4(5):e186–94. h ps:// doi. o g/ 10. 1016/ S2542‑ 5196(20)
30079‑6.
146. Po e AK, Cu hbe son CC, E enson KR. Pa icipa ion in speci ic leisu e‑
ime ac i i ies and mo ali y isk among US adul s. Ann Epidemiol.
2020;50:27–34. h ps:// doi. o g/ 10. 1016/j. annep idem. 2020. 06. 006.
147. Po e AK, Schilsky S, E enson KR, Flo ido R, Pal a P, Holliday KM, e al.
The associa ion o spo and exe cise ac i i ies wi h ca dio ascula
disease isk: he A he oscle osis Risk in Communi ies (ARIC) s udy. J
Page 17 o 17
Ojae al. Spo s Medicine - Open (2024) 10:46
Phys Ac Heal h. 2019;16(9):698–705. h ps:// doi. o g/ 10. 1123/ jpah.
2018‑ 0671.
148. P onk A, Ji B, Shu X, Chow W, Xue S, Yang G, e al. Physical ac i i y and
b eas cance isk in Chinese women. B J Cance . 2011;105(9):1443–50.
h ps:// doi. o g/ 10. 1038/ bjc. 2011. 370.
149. Rasmussen MG, G øn ed A, Blond K, O e ad K, Tjønneland A, Jensen
MK, e al. Associa ions be ween ec ea ional and commu e cycling,
changes in cycling, and ype 2 diabe es isk: a coho s udy o Danish
men and women. PLoS Med. 2016;13(7): e1002076. h ps:// doi. o g/ 10.
1371/ jou n al. pmed. 10020 76.
150. Rasmussen MG, O e ad K, Tjønneland A, Jensen MK, Øs e gaa d
L, G øn ed A. Changes in cycling and incidence o o e weigh
and obesi y among Danish men and women. Med Sci Spo s Exe c.
2018;50(7):1413–21. h ps:// doi. o g/ 10. 1249/ MSS. 00000 00000 001577.
151. Sahlq is S, Goodman A, Simmons RK, Khaw K‑T, Ca ill N, Fos e C, e al.
The associa ion o cycling wi h all‑cause, ca dio ascula and cance
mo ali y: indings om he popula ion‑based EPIC‑No olk coho . BMJ
Open. 2013;3(11): e003797. h ps:// doi. o g/ 10. 1136/ bmjop en. 2013.
003797.
152. Schnoh P, Ma o JL, Lange P, Jensen GB. Longe i y in male and
emale jogge s: he Copenhagen Ci y Hea S udy. Am J Epidemiol.
2013;177(7):683–9. h ps:// doi. o g/ 10. 1093/ aje/ kws301.
153. Schnoh P, O’Kee e JH, Hol e mann A, La ie CJ, Lange P, Jensen GB, e al.
Va ious leisu e‑ ime physical ac i i ies associa ed wi h widely di e gen
li e expec ancies: he Copenhagen Ci y Hea S udy. Mayo Clin P oc.
2018;93(12):1775–85. h ps:// doi. o g/ 10. 1016/j. mayocp. 2018. 06. 025.
154. Schnoh P, O’Kee e JH, Ma o JL, Lange P, Jensen GB. Dose o jogging
and long‑ e m mo ali y: he Copenhagen Ci y Hea S udy. J Am Coll
Ca diol. 2015;65(5):411–9. h ps:// doi. o g/ 10. 1016/j. jacc. 2014. 11. 023.
155. Sheehan CM, Li L. Associa ions o exe cise ypes wi h all‑cause mo ali y
among US adul s. Med Sci Spo s Exe c. 2020;52(12):2554–62. h ps://
doi. o g/ 10. 1249/ MSS. 00000 00000 002406.
156. S edbe g N, Sunds öm J, James S, Hållma ke U, Hamb aeus K,
Ande sen K. Long‑ e m incidence o a ial ib illa ion and s oke among
c oss‑coun y skie s: coho s udy o endu ance‑ ained male and
emale a hle es. Ci cula ion. 2019;140(11):910–20. h ps:// doi. o g/ 10.
1161/ CIRCU LATIO NAHA. 118. 039461.
157. To a ‑Ga cía ED. The associa ions o di e en ypes o spo s and exe ‑
cise wi h heal h s a us and diseases: e idence om Russian longi udi‑
nal da a. Spo s Sci Heal h. 2021;17(3):687–97. h ps:// doi. o g/ 10. 1007/
s11332‑ 021‑ 00734‑x.
158. Tu ell G, Hewi BA, Rachele JN, Giles‑Co i B, Busija L, B own WJ. Do
ac i e modes o anspo cause lowe body mass index? Findings
om he HABITAT longi udinal s udy. J Epidemiol Communi y Heal h.
2018;72(4):294–301. h ps:// doi. o g/ 10. 1136/ jech‑ 2017‑ 209957.
159. Wang N, Zhang X, Xiang Y‑B, Li H, Yang G, Gao J, e al. Associa ions
o Tai Chi, walking, and jogging wi h mo ali y in Chinese men. Am J
Epidemiol. 2013;178(5):791–6. h ps:// doi. o g/ 10. 1093/ aje/ kw 050.
160. Wang Y, Lee D‑C, B ellen hin AG, Eijs ogels TM, Sui X, Chu ch TS, e al.
Leisu e‑ ime unning educes he isk o inciden ype 2 diabe es. Am J
Med. 2019;132(10):1225–32. h ps:// doi. o g/ 10. 1016/j. amjmed. 2019. 04.
035.
161. Wa s EL, Ma hews CE, F eeman JR, Go zeli z JS, Hong HG, Liao LM,
e al. Associa ion o leisu e ime physical ac i i y ypes and isks o all‑
cause, ca dio ascula , and cance mo ali y among olde adul s. JAMA
Ne w Open. 2022;5(8): e2228510. h ps:// doi. o g/ 10. 1001/ jaman e wo
kopen. 2022. 28510.
162. No dengen S, Ande sen LB, Solb aa AK, Riise A. Cycling is associa ed
wi h a lowe incidence o ca dio ascula diseases and dea h: pa 1—
sys ema ic e iew o coho s udies wi h me a‑analysis. B J Spo s Med.
2019;53(14):870–8. h ps:// doi. o g/ 10. 1136/ bjspo s‑ 2018‑ 099099.
163. Zhao Y, Hu F, Feng Y, Yang X, Li Y, Guo C, e al. Associa ion o cycling
wi h isk o all‑cause and ca dio ascula disease mo ali y: a sys em‑
a ic e iew and dose‑ esponse me a‑analysis o p ospec i e coho
s udies. Spo s Med. 2021;51(7):1439–48. h ps:// doi. o g/ 10. 1007/
s40279‑ 021‑ 01452‑7.
164. No dengen S, Ande sen LB, Solb aa AK, Riise A. Cycling and ca dio as‑
cula disease isk ac o s including body composi ion, blood lipids and
ca dio espi a o y i ness analysed as con inuous a iables: pa 2‑sys‑
ema ic e iew wi h me a‑analysis. B J Spo s Med. 2019;53(14):879–85.
h ps:// doi. o g/ 10. 1136/ bjspo s‑ 2018‑ 099778.
165. Milano ić Z, Pan elić S, Čo ić N, Spo iš G, Moh M, K us up P. B oad‑
spec um physical i ness bene i s o ec ea ional oo ball: a sys ema ic
e iew and me a‑analysis. B J Spo s Med. 2019;53(15):926–39. h ps://
doi. o g/ 10. 1136/ bjspo s‑ 2017‑ 097885.
166. Zouhal H, Hammami A, Tijani JM, Jaya el A, de Sousa M, K us up P, e al.
E ec s o small‑sided socce games on physical i ness, physiologi‑
cal esponses, and heal h indices in un ained indi iduals and clinical
popula ions: a sys ema ic e iew. Spo s Med. 2020;50(5):987–1007.
h ps:// doi. o g/ 10. 1007/ s40279‑ 019‑ 01256‑w.
167. Laha IM, Me sios GS. Ch onic physiological e ec s o swim aining
in e en ions in non‑eli e swimme s: a sys ema ic e iew and me a‑
analysis. Spo s Med. 2018;48(2):337–59. h ps:// doi. o g/ 10. 1007/
s40279‑ 017‑ 0805‑0.
168. Chia L, De Oli ei a SD, Whalan M, McKay MJ, Sulli an J, Fulle CW, e al.
Non‑con ac an e io c ucia e ligamen inju y epidemiology in eam‑
ball spo s: a sys ema ic e iew wi h me a‑analysis by sex, age, spo ,
pa icipa ion le el, and exposu e ype. Spo s Med. 2022;52(10):2447–
67. h ps:// doi. o g/ 10. 1007/ s40279‑ 022‑ 01697‑w.
169. Leppänen M, Aal onen S, Pa kka i J, Heinonen A, Kujala UM. In e en‑
ions o p e en spo s ela ed inju ies: a sys ema ic e iew and me a‑
analysis o andomised con olled ials. Spo s Med. 2014;44(4):473–86.
h ps:// doi. o g/ 10. 1007/ s40279‑ 013‑ 0136‑8.
170. Khan KM, Thompson AM, Blai SN, Sallis JF, Powell KE, Bull FC, e al.
Spo and exe cise as con ibu o s o he heal h o na ions. Lance .
2012;380(9836):59–64. h ps:// doi. o g/ 10. 1016/ s0140‑ 6736(12) 60865‑4.
171. Moun joy M, Junge A, Budge R, Doe D, Leglise M, Mille S, e al.
Heal h p omo ion by In e na ional Olympic Spo Fede a ions: p io i ies
and ba ie s. B J Spo s Med. 2019;53(17):1117–25. h ps:// doi. o g/ 10.
1136/ bjspo s‑ 2018‑ 100202.
172. Kelly P, Kahlmeie S, Gö schi T, O sini N, Richa ds J, Robe s N, e al.
Sys ema ic e iew and me a‑analysis o educ ion in all‑cause mo al‑
i y om walking and cycling and shape o dose esponse ela ion‑
ship. In J Beha Nu Phys Ac . 2014;11:132. h ps:// doi. o g/ 10. 1186/
s12966‑ 014‑ 0132‑x.
Publishe ’s No e
Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in pub‑
lished maps and ins i u ional a ilia ions.