Original ArticleEffects of a 16-week recreational team handball intervention on aerobic performance and cardiometabolic fitness markers in postmenopausal women: A randomized controlled trial
Introduction
The population's average life expectancy is rising. Between 2000 and 2015, it increased worldwide by 5 years (from 66.5 to 71.4 years).1,2 However, in the same period, healthy life expectancy (i.e. number of years lived in full health) decreased in a similar range (from 63.1 to 58.5 years), being 11.7% lower than life expectancy.1,2 Cardiovascular (CV) diseases (CVD) are the major cause of health loss, with a reported 422 million cases, 206 million of which were in the female population.3 Postmenopausal women are at increased risk of developing CVD,4 which is the major cause of morbidity and mortality in this population,5 experiencing adverse lipid profile, and elevated serum glucose and insulin.6, 7., 8.
Conventional exercise programmes (aerobic, resistance and combined exercise) have been shown to be effective at counteracting these health risks by enhancing cardiorespiratory fitness (CRF) and metabolic fitness in postmenopausal women.9 Nonetheless, 72% of women over 55 years report never or seldomly exercising or playing sport, with lack of motivation being one of the major underlying reasons.10 Consequently, in order to overcome the high physical inactivity rates, the World Health Organization11 has made a call for innovative exercise modes that can be effective at improving the health of populations while keeping the motivational level high, thus ensuring long-term adherence to exercise. Within team sports, recreational football has shown positive physiological health effects in CV, metabolic and musculoskeletal health, both in healthy and clinical groups.12., 13, 14, 15. Recently, results from descriptive and training studies have shown that recreational team handball is also an accessible, high-adherence and high-attendance exercise mode. Team handball is an Olympic team sport played between two teams of seven players (six outfield players and one goalkeeper). Players can only manipulate the ball with their hands, except for goalkeepers, who can use any part of their body to defend throws within their own goal area, which cannot be entered by outfield players. The sport offers an alternative to conventional exercise modes, imposing a high aerobic component [mean heart rates (HRs) ~80% of maximal HR (HRmax)] associated with multiple actions performed at high intensity that stress the anaerobic metabolism and have a high impact on the musculoskeletal system.16, 17, 18, 19., 20 In fact, in these studies, CV, metabolic, body composition and well-being improvements were observed in adults of both sexes, regardless of the participants' previous experience of the sport.17, 18, 19., 20 Nevertheless, only floorball, a team sport similar to field hockey played on an indoor court with plastic sticks, has been studied in postmenopausal women, showing positive effects on aerobic performance, CRF and lipid profile.21,22 Hence, studies on the health and physical fitness effects of other team sports, such as team handball, are warranted in this population, especially taking into account its popularity with former practitioners and also fans who are attracted to this sport worldwide.23
The purpose of this study was therefore to analyse the effects of a recreational team handball-based exercise programme on aerobic performance and markers of CRF and metabolic fitness in untrained postmenopausal women with no previous experience of the sport. We expected improvements in the aerobic performance, CRF and metabolic health profile of the participants after the exercise intervention.
Section snippets
Participants and study design
Untrained postmenopausal women aged 49–79 years and in menopause for at least 3 years were invited to participate in this study. Eighty participants met the criteria to participate and did not present any contraindications for performing moderate-to-vigorous physical activity (PA) (Fig. 1). Three participants dropped out before the baseline evaluations for personal reasons. After the baseline evaluations, six participants dropped out, also for personal reasons. Thus, 71 participants with no
Training sessions
The participants attended an average of 1.9 ± 0.4 (0.9–2.9) training sessions per week. During the small-sided team handball games, mean HR was 128 ± 16 bpm, corresponding to 76 ± 6%HRmax, with peak values of 149 ± 17 bpm (88 ± 6%HRmax). HR achieved 80%–90% and >90% of HRmax for 34 ± 14% and 11 ± 9% of total match duration, respectively. Thus, for 44 ± 20% (18 ± 9 min) of total match time, the participants' HR was >80% HRmax. Average match RPE was 4.8 ± 1.9 (0.1–9.3).
Aerobic performance
A time x group interaction (
Discussion
This is the first study to show that team handball can be used to elicit moderate-to-vigorous aerobic intensities in 49–79-year-old untrained women with no previous experience of the sport, and that a training programme comprising twice-weekly 60-min recreational team handball training sessions over 16 weeks can induce positive effects on aerobic performance and markers of CRF.
Summary
To the best of our knowledge, this is the first study to analyse the training intensity of recreational team handball for postmenopausal women and the effects of a short-term training programme on markers of aerobic and metabolic fitness. The results clearly show that recreational team handball can be used to obtain moderate-to-vigorous aerobic intensities for women with no prior experience of the sport and that a short training period of recreational team handball can increase aerobic
Authors' contributions
All authors agreed with the authors' order of presentation, read and approved the final version of the manuscript. RP conducted the data curation, formal analysis, investigation and wrote the original draft. JM and CC contributed to the conceptualization, formal analysis and reviewed and edited the manuscript. SP, PK and JM performed the supervision. EC and RS contributed to formal analysis and reviewed and edited the manuscript. JTG and SM carried out the formal analysis of the metabolic
Declaration of Competing Interest
The authors have no conflicts of interest to declare.
Acknowledgments
RP is supported by a grant from the Portuguese Foundation for Science and Technology (SFRH/BD/136789/2018). This study is part of the Handball for Health project, which has the support of the Portuguese Handball Federation, the European Handball Federation and Gaia City Hall. We would like to thank all the participants for their committed participation. We would also like to express our gratitude to the students and technicians of the University Institute of Maia and Faculty of Sport,
References (47)
Global, regional, and National Burden of cardiovascular diseases for 10 causes, 1990 to 2015
J Am Coll Cardiol
(2017)To exercise, or, not to exercise, during menopause and beyond
Maturitas
(2014)Menopause and diabetes: EMAS clinical guide
Maturitas
(2018)Metabolic characterization of menopause: cross-sectional and longitudinal evidence
BMC Med
(2018)Fitness and health benefits of team handball training for young untrained women—a cross-disciplinary RCT on physiological adaptations and motivational aspects
J Sport Health Sci
(2018)- et al.
Age-predicted maximal heart rate revisited
J Am Coll Cardiol
(2001) World Health Statistics 2016: Monitoring Health for the SDGs, Sustainable Development Goals
(2016)- World Health Organization. Life Expectancy and Health Life Expectancy 6th April 2018 [cited 2019 17th October 2019];...
2016 IMS recommendations on women’s midlife health and menopause hormone therapy
Climacteric
(2016)- et al.
Menopause induces oxidative stress
Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials
Sports Med.
Special Eurobarometer 472: Sport and Physical Activity
Regional Office for Europe: Physical Activity Strategy for the WHO European Region 2016–2025
Health benefits of different sport disciplines for adults: systematic review of observational and intervention studies with meta-analysis
Br J Sports Med
Is recreational soccer effective for improving VO2max a systematic review and meta-analysis
Sports Med
The “football is medicine” platform-scientific evidence, large-scale implementation of evidence-based concepts and future perspectives
Scand J Med Sci Sports
Broad-spectrum physical fitness benefits of recreational football: a systematic review and meta-analysis
Br J Sports Med
Physical and physiological demands of recreational team handball for adult untrained men
Biomed Res Int
Effects of a short-term recreational team handball-based Programme on physical fitness and cardiovascular and metabolic health of 33-55-year-old men: a pilot study
Biomed Res Int
Cardiovascular, muscular, and skeletal adaptations to recreational team handball training: a randomized controlled trial with young adult untrained men
Eur J Appl Physiol
Cardiovascular and metabolic health effects of team handball training in overweight women: impact of prior experience
Scand J Med Sci Sports
Biomarkers of vascular function in premenopausal and recent postmenopausal women of similar age: effect of exercise training
Am J Phys Regul Integr Comp Phys
Adaptations with intermittent exercise training in post- and premenopausal women
Med Sci Sports Exerc
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