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Physical Activity and Sports

Abstract
Positive effects from sports are achieved primarily through physical activity, but secondary effects bring health benefits such as psychosocial and personal development and less alcohol consumption. Negative effects, such as the risk of failure, injuries, eating disorders, and burnout, are also apparent. Because physical activity is increasingly conducted in an organized manner, sport’s role in society has become increasingly important over the years, not only for the individual but also for public health. In this paper, we intend to describe sport’s physiological and psychosocial health benefits, stemming both from physical activity and from sport participation per se. This narrative review summarizes research and presents health-related data from Swedish authorities. It is discussed that our daily lives are becoming less physically active, while organized exercise and training increases. sport371 Average energy intake is increasing, creating an energy surplus, and thus, we are seeing an increasing number of people who are overweight, which is a strong contributor to health problems. Physical activity and exercise have significant positive effects in preventing or alleviating mental illness, including depressive symptoms and anxiety- or stress-related disease. In conclusion, sports can be evolving, if personal capacities, social situation, and biological and psychological maturation are taken into account. Evidence suggests a dose–response relationship such that being active, even to a modest level, is superior to being inactive or sedentary. Recommendations for healthy sports are summarized.

Keywords: youth, adolescent, elderly, quality of life, relative age effect, exercise, strength and conditioning
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1. Introduction
Sport is a double-edged sword regarding effects on health. Positive effects are achieved primarily through physical activity, which is the main part of most sports. Many secondary effects of sport also bring health benefits, such as psychosocial development of both young [1] and old [2], personal development [3], later onset, and less consumption of alcohol [4,5]. Finally, those who play sports have a higher level of physical activity later in life [6], and through sport, knowledge of nutrition, exercise, and health can be developed [7]. Negative effects include the risk of failure leading to poor mental health [8,9], risk of injury [10,11], eating disorders [12], burnout [13], and exercise-induced gastrointestinal tract discomfort [14]. In sport, there are unfortunately also reports of physical and psychological abuse [15]. Negative aspects are more common in elite-level sports, where there is a fine balance between maximum performance and negative health. A somewhat unexpected effect of sport participation is that people submitting to planned training in some cases perform less physical activity compared to those who are exercising without a set schedule. One explanation can be a reduced spontaneous physical activity in the latter group [16]. Because physical activity is increasingly executed in an organized manner [17,18,19], sport’s role in society has become increasingly important over the years, not only for the individual but also for public health.

In this paper, we describe the health effects of sport from a physiological and psychological perspective, related both to physical activity and added values of sport per se. Initially, brief definitions of various concepts related to physical activity and health are given. This is then followed by: (1) A brief description of how physical activity and training affect our body from a physiological perspective; (2) a report on the health effects of physical activity and training; and (3) sport’s specific influences on the various dimensions of health. We chose to discuss the subject from an age-related perspective, separating children/adolescents, adults, and the elderly, as well as separating for sex in each age group.

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2. Definitions of Physical Activity, Exercise, Training, Sport, and Health
Definitions and terms are based on “Physical activity in the prevention and treatment of disease” (FYSS, www.fyss.se [Swedish] [20]), World Health Organization (WHO) [21] and the US Department of Human Services [22]. The definition of physical activity in FYSS is: “Physical activity is defined purely physiologically, as all body movement that increases energy use beyond resting levels”. Health is defined according to the World Health Organization (WHO) as: “[…] a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” [21].

Physical activity can occur spontaneously (leisure/work/transport) or organized and be divided according to purpose: Physical exercise is aimed primarily at improving health and physical capacity. Physical training is aimed primarily at increasing the individual’s maximum physical capacity and performance [23]. Physical inactivity is described as the absence of body movement, when energy consumption approximates resting levels. People who do not meet recommendations for physical activity are considered physically inactive and are sometimes called “sedentary”. Sport can be organized by age, sex, level of ambition, weight or other groupings [24]. Sport can also be spontaneous [7,17] and defined as a subset of exercises undertaken individually or as a part of a team, where participants have a defined goal [7]. General recommendations for physical activity are found in Table 1, not considering everyday activities. One can meet the daily recommendations for physical activity by brief, high-intensity exercise, and remaining physically inactive for the rest of the day, thereby creating a “polarization” of physical activity: Having a high dose of conscious physical training, despite having a low energy expenditure in normal life due to high volumes of sedentary time. Polarization of physical activity may lead to increased risk of poor health despite meeting the recommendations for physical activity [25,26,27]. During most of our lives, energy expenditure is greater in normal daily life than in sport, physical training, and exercise, with the exceptions of children and the elderly, where planned physical activity is more important [28].

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

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