J. Dvorak

Positive performance and health effects of a football training program over 12 weeks can be maintained over a 1-year period with reduced training frequency

We examined whether improvements in the performance and health profile of an intensive 12‐week football intervention could be maintained with a reduced training frequency. Seventeen healthy untrained males completed the study. Ten subjects trained 2.4 times/week for 12 weeks and another 52 weeks with 1.3 sessions/week [football group (FG)] and seven subjects acted as controls [control group (CG)]. For FG, fat mass (3.2 kg) and systolic blood pressure (8 mmHg) were lower (P<0.05) after 64 than 0 weeks, and VO2max (8%) and Yo‐Yo intermittent endurance level 2 test performance (49%) were higher (P<0.05), with no difference between 64 and 12 weeks. After 64 weeks, quadriceps muscle mass (11%), mean fiber area (10%) and citrate synthase activity (18%) were higher (P<0.05) than those at 0 weeks. Leg bone mass (3.5%) and density (2.0%) were higher (P<0.05) after 64 than 0 weeks, but not different between 12 and 0 weeks. Plantar jump force (17–18%), 30‐m sprinting velocity (1.3–3.0%) and muscle glycogen concentration (19–21%) were higher (P<0.05) and blood lactate during submaximal exercise was lower (27–72%, P<0.05) after 64 than after 12 and 0 weeks. The above‐mentioned variables were unaltered for CG. In conclusion, positive adaptations in cardiovascular fitness obtained over 12 weeks of regular recreational football training can be maintained over a 1‐year period with a reduced training frequency, with further development in musculo‐skeletal fitness.

Long-term musculoskeletal and cardiac health effects of recreational football and running for premenopausal women.

We examined long‐term musculoskeletal and cardiac adaptations elicited by recreational football (FG, n=9) and running (RG, n=10) in untrained premenopausal women in comparison with a control group (CG, n=9). Training was performed for 16 months (∼2 weekly 1‐h sessions). For FG, right and left ventricular end‐diastolic diameters were increased by 24% and 5% (P<0.05), respectively, after 16 months. Right ventricular systolic function measured by tricuspid annular plane systolic excursion (TAPSE) increased (P<0.05) in FG after 4 months and further (P<0.05) after 16 months (15% and 32%, respectively). In RG and CG, cardiac structure, E/A and TAPSE remained unchanged. For FG, whole‐body bone mineral density (BMD) was 2.3% and 1.3% higher (P<0.05) after 16 months, than after 4 and 0 months, respectively, with no changes for RG and CG. FG demonstrated substantial improvements (P<0.05) in fast (27% and 16%) and slow (16% and 17%) eccentric muscle strength and rapid force capacity (Imp30ms: 66% and 65%) after 16 months compared with 4 and 0 months, with RG improving Imp30ms by 64% and 46%. In conclusion, long‐term recreational football improved muscle function, postural balance and BMD in adult women with a potential favorable influence on the risk of falls and fractures. Moreover, football training induced consistent cardiac adaptations, which may have implications for long‐term cardiovascular health.

Executive summary: the health and fitness benefits of regular participation in small-sided football games.

The present special issue of Scandinavian Journal of Medicine & Science in Sports deals with health and fitness benefits of regular participation in small‐sided football games. One review article and 13 original articles were the result of a 2‐year multi‐center study in Copenhagen and Zurich and include studies of different age groups analyzed from a physiological, medical, social and psychological perspective. The main groups investigated were middle‐aged, former untrained, healthy men and women who were followed for up to 16 months. In addition, elderly, children and hypertensive patients were studied. A summary and interpretations of the main findings divided into an analysis of the physical demands during training of various groups and the effect of a period of training on performance, muscle adaptations and health profile follow. In addition, social and psychological effects on participation in recreational football are considered, the comparison of football training and endurance running is summarized and the effects of football practice on the elderly and children and youngsters are presented.

Effects of a 12-week intervention period with football and running for habitually active men with mild hypertension

The present study examined the effect of football (F, n=15) training on the health profile of habitually active 25–45‐year‐old men with mild hypertension and compared it with running (R, n=15) training and no additional activity (controls, C, n=17). The participants in F and R completed a 1‐h training session 2.4 times/week for 12 weeks. Systolic and diastolic blood pressure decreased in all groups but the decrease in diastolic blood pressure in F (−9 ± 5 (± SD) mmHg) was higher than that in C (−4 ± 6 mmHg). F was as effective as R in decreasing body mass (−1.6 ± 1.8 vs−1.5 ± 2.1 kg) and total fat mass (−2.0 ± 1.5 vs −1.6 ± 1.5 kg) and in increasing supine heart rate variability, whereas no changes were detected for C. Maximal stroke volume improved in F (+13.1%) as well as in R (+10.1%) compared with C (−4.9%). Total cholesterol decreased in F (5.8 ± 1.2 to 5.5 ± 0.9 mmol/L) but was not altered in R and C. We conclude that football training, consisting of high‐intensity intermittent exercise, results in positive effects on blood pressure, body composition, stroke volume and supine heart rate variability, and elicits at least the same cardiovascular health benefits as continuous running exercise in habitually active men with mild hypertension.

Football as a treatment for hypertension in untrained 30-55-year-old men: a prospective randomized study

The present study investigated whether football has favorable effects in the treatment of mild‐to‐moderate arterial hypertension in untrained middle‐aged men. Twenty‐five untrained males aged 31–54 year with mild‐to‐moderate hypertension were randomized to a football training group (FTG, two 1‐h sessions per week) and a control group receiving physician‐guided traditional recommendations on cardiovascular risk factor modification (doctoral advice group, DAG). After 3 months, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lowered (P<0.05) by 12 ± 3 and 7 ± 1 mmHg in FTG, respectively, whereas no significant changes were observed for DAG, with the 3 months values being lower (P<0.05) in FTG than DAG (SBP: 138 ± 2 vs 148 ± 2 mmHg; DBP: 84 ± 2 vs 92 ± 2 mmHg). The resting heart rate was lowered (P<0.05) by 12 ± 2 b.p.m. in FTG after 3 months (67 ± 3 vs 79 ± 3 b.p.m.), whereas no change was observed for DAG. After 3 months, FTG had higher (P<0.05) VO2max (8 ± 2%; 35.0 ± 1.6 vs 32.5 ± 1.3 mL/min/kg) and lower (P<0.05) fat mass (1.7 ± 0.6 kg), whereas no change was observed for DAG. In conclusion, football training is an attractive non‐pharmacological supplement to the treatment of mild‐to‐moderate arterial hypertension in untrained middle‐aged men.

Structural and functional cardiac adaptations to a 10-week school-based football intervention for 9-10-year-old children.

The present study investigated the cardiac effects of a 10‐week football training intervention for school children aged 9–10 years using comprehensive transthoracic echocardiography as a part of a larger ongoing study. A total of 97 pupils from four school classes were cluster‐randomized into a control group that maintained their usual activities (CON; two classes, n = 51, 21 boys and 30 girls) and a football training group that performed an additional 3 × 40 min of small‐sided football training per week (FT; two classes, n = 46, 23 boys and 23 girls). No baseline differences were observed in age, body composition, or echocardiographic variables between FT and CON. After the 10‐week intervention, left ventricular posterior wall diameter was increased in FT compared with CON [0.4 ± 0.7 vs −0.1 ± 0.6 (± SD) mm; P < 0.01] as was the interventricular septum thickness (0.2 ± 0.7 vs −0.2 ± 0.8 mm; P < 0.001). Global isovolumetric relaxation time increased more in FT than in CON (3.8 ± 10.4 vs −0.9 ± 6.6 ms, P < 0.05) while the change in ventricular systolic ejection fraction tended to be higher (1.4 ± 8.0 vs −1.1 ± 5.5%; P = 0.08). No changes were observed in resting heart rate or blood pressure. In conclusion, a short‐term, school‐based intervention comprising small‐sided football sessions resulted in significant structural and functional cardiac adaptations in pre‐adolescent children.

Executive summary: Football for health – prevention and treatment of non‐communicable diseases across the lifespan through football

This supplement contains 16 original articles describing how football conducted as small sided games affects fitness and health of untrained individuals across the lifespan. The intermittent nature of football and high exercise intensity result in a broad range of effects. The heart changes its structure and improves its function. Blood pressure is markedly reduced with the mean arterial blood pressure being lowered by ~10 mmHg for hypertensive men and women training 2–3 times/week for 12–26 weeks. Triglycerides and cholesterol are lowered and body fat declines, especially in middle‐aged men and women with type 2 diabetes. Furthermore, muscle mass and bone mineral density increases in a number of participant groups, including 65–75‐year‐old men. The functional capacity is elevated with increases in VO2max of 10–15%, and 50–100% improvements in the capacity to perform intermittent work within 16 weeks. These effects apply irrespective of whether the participants are young, overweight, elderly or suffering from a disease. The studies clearly show that the participants enjoy playing football and form special relationships with their team mates. Thus, football is a healthy activity, providing a unique opportunity to increase recruitment and adherence to physical activity in a hitherto underserved population, and to treat and rehabilitate patients with hypertension, type 2 diabetes and prostate cancer.

Structural and functional cardiac adaptations to 6 months of football training in untrained hypertensive men

We investigated the effects of 3 and 6 months of regular football training on cardiac structure and function in hypertensive men. Thirty‐one untrained males with mild‐to‐moderate hypertension were randomized 2:1 to a football training group (n = 20) and a control group receiving traditional recommendations on healthy lifestyle (n = 11). Cardiac measures were evaluated by echocardiography. The football group exhibited significant (P < 0.05) changes in cardiac dimensions and function after just 3 months: Left ventricular (LV) end‐diastolic volume increased from 104 ± 25 to 117 ± 29 mL. LV diastolic function improved measured as E/A ratio (1.15 ± 0.32 to 1.54 ± 0.38), early diastolic velocity, E′ (11.0 ± 2.5 to 11.9 ± 2.6 cm/s), and isovolumetric relaxation time (74 ± 13 to 62 ± 13 ms). LV systolic function improved measured as longitudinal displacement (10.7 ± 2.1 to 12.1 ± 2.3 mm). Right ventricular function improved with respect to tricuspid annular plane systolic excursion (21.8 ± 3.2 to 24.5 ± 3.7 mm). Arterial blood pressure decreased in both groups, but significantly more in the football training group. No significant changes were observed in the control group. In conclusion, short‐term football training improves LV diastolic function in untrained men with mild‐to‐moderate arterial hypertension. Furthermore, it may improve longitudinal systolic function of both ventricles. The results suggest that football training has favorable effects on cardiac function in hypertensive men.

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.

The "Football is Medicine" platform-scientific evidence, large-scale implementation of evidence-based concepts and future perspectives

Krustrup, Peter; Williams, C A; Mohr, Magni; Hansen, Peter Riis; Helge, Eva Wulff; Elbe, Anne-Marie; de Sousa, M; Dvorak, J; Junge, A; Hammami, A; Holtermann, Andreas; Larsen, Malte Nejst; Kirkendall, D; Schmidt, Jakob Friis; Andersen, Thomas Rostgaard; Buono, P; Rørth, M; Parnell, D; Ottesen, Laila; Bennike, Søren; Nielsen, Jens Jung; Mendham, A E; Zar, A; Uth, Jacob; Hornstrup, Therese; Brasso, Klaus; Nybo, Lars; Krustrup, Birgitte Rejkjær; Meyer, T; Aagaard, Per; Andersen, J L; Hubball, H; Reddy, P A; Ryom, Knud; Lobelo, F; Barene, S; Helge, Jørn Wulff; Fatouros, I G; Nassis, G P; Xu, J C; Pettersen, S A; Calbet, J A; Seabra, A; Rebelo, A N; Figueiredo, P; Póvoas, S; Castagna, C; Milanovic, Z; Bangsbo, Jens; Randers, Morten B; Brito, J