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Cardiovascular Benefits of Group Sport Interventions: Importance of Improved Fitness in Risk Reduction

  • Jari A. Laukkanen
    Correspondence
    Correspondence: Address to Jari A. Laukkanen, MD, PhD, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014 Jyväskylä, Finland.
    Affiliations
    Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
    Central Finland Healthcare District, Department of Internal Medicine, Jyväskylä, Finland
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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      Available evidence suggests the implementation of recreational group sports as an additional strategy in the prevention of cardiovascular disease events, with potential for broad public health impact.
      • Oja P.
      • Titze S.
      • Kokko S.
      • et al.
      Health benefits of different sport disciplines for adults: systematic review of observational and intervention studies with meta-analysis.
      • Bellissimo M.P.
      • Galaviz K.I.
      • Paskert M.C.
      • Lobelo F.
      Cardiometabolic risk reduction through recreational group sport interventions in adults: a systematic review and meta-analysis.
      • Batacan Jr., R.B.
      • Duncan M.J.
      • Dalbo V.J.
      • Tucker P.S.
      • Fenning A.S.
      Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies.
      A previous review and meta-analysis evaluating the health benefits of specific sport disciplines suggested that both running and soccer can improve cardiorespiratory fitness (CRF) and cardiovascular function.
      • Oja P.
      • Titze S.
      • Kokko S.
      • et al.
      Health benefits of different sport disciplines for adults: systematic review of observational and intervention studies with meta-analysis.
      The authors concluded that there is some conditional research evidence on benefits of running for cardiometabolic fitness parameters, body composition, and postural balance, and group sports such as soccer improve cardiometabolic fitness, muscular performance, balance, and cardiac function; however, there is less evidence from randomized controlled trials (RCTs) on health benefits of other sport disciplines.
      • Oja P.
      • Titze S.
      • Kokko S.
      • et al.
      Health benefits of different sport disciplines for adults: systematic review of observational and intervention studies with meta-analysis.
      In this issue of Mayo Clinic Proceedings, Bellissimo et al
      • Bellissimo M.P.
      • Galaviz K.I.
      • Paskert M.C.
      • Lobelo F.
      Cardiometabolic risk reduction through recreational group sport interventions in adults: a systematic review and meta-analysis.
      provide new interesting evidence of the cardiovascular health benefits of group sports in a systematic review and meta-analysis from available intervention studies.
      Previous research data have supported aerobic exercise training as an essential means to improve lipid profile and reduce blood pressure and body weight. However, high-intensity interval training (HIIT) is increasingly recognized as another common exercise mode to improve fitness and cardiovascular risk factor profile. Current evidence suggests that HIIT may increase maximum oxygen consumption (V˙O2max) and improve cardiometabolic risk factors including blood pressure and lipid levels.
      • Batacan Jr., R.B.
      • Duncan M.J.
      • Dalbo V.J.
      • Tucker P.S.
      • Fenning A.S.
      Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies.
      Physical activity with HIIT is an effective way of increasing V˙O2max and improving risk profile, compared with moderate-intensity continuous training (MICT).
      • Karlsen T.
      • Aamot I.L.
      • Haykowsky M.
      • Rognmo Ø.
      High intensity interval training for maximizing health outcomes.
      Intensive group sports could offer an alternative to traditional individual aerobic exercise options by including components of high-intensity exercise in the group with supportive emotional aspects, thereby leading to increased commitment for regular physical activity by participants of distinct ages, sex, and initial fitness levels. The positive socializing effects of physical activity in a group are benefits and incentives that may be emphasized by health care professionals in motivating patients toward regular exercise training. Exercising in a group, such as dancing, tai chi chuan, and yoga, has been reported to be beneficial in improving cardiovascular health.
      • Rodrigues-Krause J.
      • Farinha J.B.
      • Krause M.
      • Reischak-Oliveira Á
      Effects of dance interventions on cardiovascular risk with ageing: systematic review and meta-analysis.
      • Nery R.M.
      • Zanini M.
      • de Lima J.B.
      • Bühler R.P.
      • da Silveira A.D.
      • Stein R.
      Tai Chi Chuan improves functional capacity after myocardial infarction: a randomized clinical trial.
      These recreational group exercise strategies might provide useful intervention for improving CRF and reducing cardiovascular risk associated with aging; for example, dancing is an activity that is as effective as other types of exercise modes in improving CRF (V˙O2max) in the elderly.
      • Rodrigues-Krause J.
      • Farinha J.B.
      • Krause M.
      • Reischak-Oliveira Á
      Effects of dance interventions on cardiovascular risk with ageing: systematic review and meta-analysis.
      As an objective measure, the assessment of CRF has achieved considerable clinical merit and is considered to be a vital sign in patient risk assessment.
      • Ross R.
      • Blair S.N.
      • Arena R.
      • et al.
      American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic HealthCouncil on Clinical CardiologyCouncil on Epidemiology and PreventionCouncil on Cardiovascular and Stroke NursingCouncil on Functional Genomics and Translational BiologyStroke Council
      Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign; a scientific statement from the American Heart Association.
      This growing body of evidence should be a stimulus for all health care professionals to incorporate CRF improvement as a high priority in the overall clinical treatment approach to patients with chronic diseases. Although aerobic training is primarily associated with improvements in CRF level, there is some evidence that combined training with both resistance and aerobic exercise training (HIIT, MICT) components would be an effective strategy leading to positive changes in body composition, muscle strength, and CRF. A recent RCT found that a combination of aerobic and strength training was the most efficient modality for improving functional status among overweight patients.
      • Villareal D.T.
      • Aguirre L.
      • Gurney A.B.
      • et al.
      Aerobic or resistance exercise, or both, in dieting obese older adults.
      This RCT suggested that weight loss plus combined aerobic and resistance training provided greater improvement in physical function and reduction of frailty than either intervention alone and was associated with preservation of lean mass and muscle power.
      • Villareal D.T.
      • Aguirre L.
      • Gurney A.B.
      • et al.
      Aerobic or resistance exercise, or both, in dieting obese older adults.
      Cardiorespiratory fitness is related to the ability to transport oxygen from the lung to the mitochondria in exercising tissues, and the cardiovascular benefits of physical activity seem to be largely mediated by favorable modulation of CRF. Habitual exercise training produces many biological adaptations that improve CRF; such improvement may be effected by regular rhythmic contractions of large muscle groups continuously for a longer period of time at a moderate to vigorous intensity or with recovery breaks at lower intensity when the exercise period is aimed at achieving high to vigorous effort such as HIIT interventions.
      • Ross R.
      • Blair S.N.
      • Arena R.
      • et al.
      American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic HealthCouncil on Clinical CardiologyCouncil on Epidemiology and PreventionCouncil on Cardiovascular and Stroke NursingCouncil on Functional Genomics and Translational BiologyStroke Council
      Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign; a scientific statement from the American Heart Association.
      The level of CRF has been related to various characteristics, such as age, sex, heredity, body composition, and quantity and quality of physical activity.
      • Ross R.
      • Blair S.N.
      • Arena R.
      • et al.
      American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic HealthCouncil on Clinical CardiologyCouncil on Epidemiology and PreventionCouncil on Cardiovascular and Stroke NursingCouncil on Functional Genomics and Translational BiologyStroke Council
      Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign; a scientific statement from the American Heart Association.
      • Laukkanen J.A.
      • Zaccardi F.
      • Khan H.
      • Kurl S.
      • Jae S.Y.
      • Rauramaa R.
      Long-term change in cardiorespiratory fitness and all-cause mortality: a population-based follow-up study.
      As an objective measure, CRF is associated with the integration of human body function under physiologic stress conditions, and it quantifies the functional capacity of an individual, reflecting body function and general health. The relationship between the intensity and total amount physical activity and CRF has been relatively weak, and physical activity level accounts for a part of the variance of V˙O2max.
      • Ross R.
      • Blair S.N.
      • Arena R.
      • et al.
      American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic HealthCouncil on Clinical CardiologyCouncil on Epidemiology and PreventionCouncil on Cardiovascular and Stroke NursingCouncil on Functional Genomics and Translational BiologyStroke Council
      Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign; a scientific statement from the American Heart Association.
      • Laukkanen J.A.
      • Zaccardi F.
      • Khan H.
      • Kurl S.
      • Jae S.Y.
      • Rauramaa R.
      Long-term change in cardiorespiratory fitness and all-cause mortality: a population-based follow-up study.
      In addition to other determinants of V˙O2max, it is suggested that around half of the variance in CRF is attributable to heritable factors; similarly, the contribution of inherited factors to the response of CRF to aerobic or interval training approximates 45% to 50%.
      • Ross R.
      • Blair S.N.
      • Arena R.
      • et al.
      American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic HealthCouncil on Clinical CardiologyCouncil on Epidemiology and PreventionCouncil on Cardiovascular and Stroke NursingCouncil on Functional Genomics and Translational BiologyStroke Council
      Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign; a scientific statement from the American Heart Association.
      In their meta-analysis, Belissimo et al
      • Bellissimo M.P.
      • Galaviz K.I.
      • Paskert M.C.
      • Lobelo F.
      Cardiometabolic risk reduction through recreational group sport interventions in adults: a systematic review and meta-analysis.
      showed significant cardiometabolic and V˙O2max improvements following regular group sport participation. They reported that group sport participation, primarily recreational soccer, was associated with clinically important improvements in body composition, lipid profile, and CRF with decreased blood pressure levels.
      • Bellissimo M.P.
      • Galaviz K.I.
      • Paskert M.C.
      • Lobelo F.
      Cardiometabolic risk reduction through recreational group sport interventions in adults: a systematic review and meta-analysis.
      Available evidence indicates that HIIT modalities, including soccer and other group sports, are not only highly efficacious but also relatively safe, with low risk of injuries and engaging interventions for cardiometabolic risk reduction even in patients with hypertension or type 2 diabetes.
      • Bellissimo M.P.
      • Galaviz K.I.
      • Paskert M.C.
      • Lobelo F.
      Cardiometabolic risk reduction through recreational group sport interventions in adults: a systematic review and meta-analysis.
      • Karlsen T.
      • Aamot I.L.
      • Haykowsky M.
      • Rognmo Ø.
      High intensity interval training for maximizing health outcomes.
      With regard to the duration of a single exercise training, a commonly used HIIT session is shorter compared with a group sports event (<30 minutes vs 1 hour). However, there has been no direct comparison of group sports and typical HIIT interventions with cardiovascular health effects.
      • Karlsen T.
      • Aamot I.L.
      • Haykowsky M.
      • Rognmo Ø.
      High intensity interval training for maximizing health outcomes.
      The authors acknowledged some limitation with regard to published evidence on group sports and cardiovascular benefits.
      • Bellissimo M.P.
      • Galaviz K.I.
      • Paskert M.C.
      • Lobelo F.
      Cardiometabolic risk reduction through recreational group sport interventions in adults: a systematic review and meta-analysis.
      Indeed, it would be beneficial to investigate a broader range of outdoor and indoor group sports interventions, including such group sports such as volleyball, basketball, rugby, and field or ice hockey. Future studies should be conducted to compare outdoor and indoor group sports to aerobic MICT interventions (eg, running, cross-country skiing, cycling) and/or in combination with healthy diet and weight loss. In the recent meta-analysis,
      • Bellissimo M.P.
      • Galaviz K.I.
      • Paskert M.C.
      • Lobelo F.
      Cardiometabolic risk reduction through recreational group sport interventions in adults: a systematic review and meta-analysis.
      most of the included studies were based on soccer as the sport intervention, which may not represent all other potentially healthy group sports including many kinds of dance activities, tai chi chuan, and yoga training.
      It is essential to maintain good CRF levels over the long term to improve health outcomes. In a previous prospective study,
      • Laukkanen J.A.
      • Zaccardi F.
      • Khan H.
      • Kurl S.
      • Jae S.Y.
      • Rauramaa R.
      Long-term change in cardiorespiratory fitness and all-cause mortality: a population-based follow-up study.
      my collagues and I found that a smaller decrease or increase in V˙O2max over a decade was associated with a lower risk of all-cause death, although CRF tends to decrease with age. To break down barriers and to promote a positive attitude toward continuous long-term activity level with the help of various intensity exercise training modes and group sports, we need to find enjoyable activities for the general population such as recreational group sports,
      • Bellissimo M.P.
      • Galaviz K.I.
      • Paskert M.C.
      • Lobelo F.
      Cardiometabolic risk reduction through recreational group sport interventions in adults: a systematic review and meta-analysis.
      tai chi chuan,
      • Nery R.M.
      • Zanini M.
      • de Lima J.B.
      • Bühler R.P.
      • da Silveira A.D.
      • Stein R.
      Tai Chi Chuan improves functional capacity after myocardial infarction: a randomized clinical trial.
      and sauna bathing,
      • Laukkanen J.A.
      • Laukkanen T.
      • Kunutsor S.K.
      Cardiovascular and other health benefits of sauna bathing: a review of the evidence.
      which may be combined with common resistance and aerobic exercise training modes. These physical activities with social and agreeable aspects are warmly welcome. With proper orientation, soccer, dance, aerobics, tai chi chuan, and yoga activities can be easily performed by older individuals.
      In conclusion, high-quality research work is certainly needed to determine if decreased cardiovascular disease and all-cause mortality rates can be achieved by incorporating regular recreational group sports as a component of a patient’s lifestyle and following the widely acknowledged recommendations for physical activity.

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