Thursday, April 29, 2010

Football (er, soccer): best for coach potatoes seeking health, fat loss, muscle?
What to do if wanting to move off the coach and into health?
If a guy - especially a guy just starting up a fitness program - wanted to do just one thing that would help drop fat, build muscle (and muscle mass), improve endurance, enhance bone mineral density, improve cholesterol levels and blood pressure, it's football (what north americans call soceer).

Really. Better than HIIT, than running, than resistance training alone, football seems to be the Big Pill solution. The only potential downside is that levels of injury may be higher than hitting the weight room or stationary bike. Overall, the cost/benefit analysis may make football the Healthy Choice. As the authors say in the abstract:
Taken together, recreational football appears to effectively stimulate musculoskeletal, metabolic and cardiovascular adaptations of importance for health and thereby reduces the risk of developing life-style diseases.
Let's take a look at the attributes the authors reviewed. To begin with, they considered studies of men who have been sedentary and then got into some kind of training protocol.

Blood Pressure and Heart Rate
Over 12 weeks, men who trained for an hour, two or three times a week, on the football pitch, comparable to endurance training of same lenght and duration. Football also showed up as better than strength training, to the level thought to have significant health benefits. Risk of death from heart attack goes down with bett blood presure too.

The footballers also have a lowered resting heart rate, and lowered heart rate during submax runs. They also have lower heart rates in intermittent exercise. Compared with groups who did resistance training alone, that didn't happne. This indicated both central and peripheral adaptations. That's great.

A quality near and dear to the hearts of many people is VO2max. Playing football over 12 weeks had the same effect (13% improvement) as "using continuous training" (eg running) for the same time, or HIIT for less time. BUT what's particularly cool is that the football group continued to have an imporvement after the first four weeks of ball play. Runners did not. It also seems that just playing some extra small sided games had the same effect as additional interval running susseions for experienced players. Playing a game is likely more enjoyable than running repeats, too.

Fat Burning (& other metabolic impacts)
Here's the kicker. How does football do for fat burning? Fat oxidation during low to moderate intensity goes up. muscle enzyme activity up, muscle fiber conversion from IIx to IIA up (good). LDL/HDL ration changed signficantly - for the good.

Now here's an interesting comparison: neither low intensity aerobics for 12 weeks, nor high intensity intermitent running or strength training lead to changes in cholesterol. What does show benefit is higher intensity work. Football vs just running seems to hit the sweet spot. Runners do have similar weight loss - just not these other perks to the same degree.

A result i find peculiar is a claim that
12 weeks of intense interval training and short-term strength training, no changes were observed in fat mass (Fig. 2b), which may be related to the fact that the total energy expenditure was limited for the interval runners and that the strength training group had no changes in metabolic fitness as indicated by unchanged fat oxidation during exercise, lipid profile, capillarization and enzyme activities (Nybo et al., 2010).
Study design is interesting, isn't it? As i've written about before, in work by Trapp, intervals on bikes were the one thing that showed fat loss - especially in the trunk - where steady state did not - even without tracking diet. So hmm. I'll go for total caloric expenditure did not exceed caloric intake in these runners/lifters, but it did in the football case, but i'm not ready to say "football is better than intervals for fat loss" -with fat loss as the single factor of interest. That said, there's more good stuff for football

Lean Body Mass
12 weeks of football, not only does fat go down, and cholesterol change, lean body mass goes up. The study authors look at related work to say heh, this should be good for glucose tolerance. Indeed, there's one study the authors site that when 12 weeks of football & dietary advice was given to a bunch of 47-49 year olds with type 2 diabetes, glucose tolerance was "markedly improved" (a similar trial without that advice showed no difference. hmm)

Musculo-Skeletal fitness
Soccer is stop and go. I've written before about how such action has been shown to be good for bone mineral density. Seems its good for muscle too. Again, comparing with interval and steady state running where there was no muscle fiber change, football does it all. The cool result is that 12 weeks of football got similar results to "14 weeks of heavy resistance training in young men" These kinds of changes just don't seem to happen in regular endurance training. But they do happen across ages in football.

Bone Mass
I admit i am partial to work on bone mineral density. It's a big deal for gals in particular, and we know that muscle size plays a not inconsiderable role for keeping the bones working. But so does the type of axial loading on the bones.

Here's the latest: go lift or do stop and start sports
[T]he increase in leg bone mass following 12 weeks of recreational football training was of a similar magnitude as the gains observed following strength training of the same duration, whereas neither recreational jogging nor high-intensity interval running induced changes in total or leg bone mass. In accordance, both male and female football players have higher hip and spine BMD than equally fit runners (Fredericson et al., 2007; Mudd et al., 2007). Furthermore, meta-analysis of cross-sectional studies reveals that participation in non-weight-bearing sports or physical activities with monotonous and stereotypic movement pattern appears to have little or no effect on bone mass or BMD, whereas strength-based and high-impact sports are associated with higher BMD (Egan et al.,2006).
In football, small sided games with lots of turns, stops and starts seems to be optimal.

Perceived Exertion
How tired are we after an activity? A lot of this experience is assessed perceptually against physiologic markers. Guess what? footballers repport lower poop'dness, despite work done. Play is good.

All good things come at a price? After last week's exegisis on ankle injuriers in sport, this question of injury level is not inconsiderable: what happens when someone gets off the coach and wants to get back int the game?

Most of the comparisons about footbal are with other on-your-feet activities like running, or very different work like lifting. Alas, no comparisons have (yet) been done with Kettlebells. The point is, when looking at injury, these are the places of comparison: how does football compare with say running?

[One study ]Parkkari et al. (2004) "have reported an injury incidence of 7.8 injuries per 1000 h of football participation, which ranks football eight in 31 recreational and competitive sports. Running ranks 20 with an injury incidence of 3.6 injuries per 1000 h of participation, but no differentiation between the types of running has been made. ... In another study involving 31 620 inhabitants in a Swedish municipality, injury rates in persons attending a physician for an acute injury sustained during sports participation were reported (de Loes & Goldie, 1988). In this study, ice hockey and handball were found to have the highest risk followed by football. For males aged 15–59 years, the ranking was ice hockey, horseback riding, handball and football. If an injury incidence of 7.8 injuries per 1000 h of football participation is valid in recreation football in general, the implication is that the players would be exposed to one injury every 1.2 years if he carried out two 1-h sessions per week all-year round and one severe injury every ∼13 years as the severity of most injuries in recreational football is mild to moderate with approximately 9% categorized as severe injuries, defined as injuries that result in missing of work or a corresponding activity for at least 1 day (Parkkari et al., 2004).

It should be emphasized that the above-mentioned injury incidences in football are the incidence for training and match play analyzed together. However, it is well known that for elite and amateur football players the injury risk per hour of activity is approximately 5–10 times higher during match-play than training (Poulsen et al., 1991; Hägglund et al., 2003; Arnason et al., 2004) with injury incidence from two to five injuries per 1000 h of participation in training sessions.

Stay away from match play and risk of injury seems to be lower.

Just to put the icing on the cake, it seems the study authors would like it to be known that runners are sucks:
In the reviewed studies dealing with the fitness and health effects of recreational football and running, around 150 subjects have been followed over 3–4 months of training performed two to three times a week. During these studies, 5% of the footballers (n=3) and distance runners (n=3) contacted the in-house medical doctor regarding injuries, whereas 33% of the interval runners did (n=5) [note the small sample size -mc]. However, further studies are required to obtain more information about injury risk, types of injury, injury severity, etc. for various age groups playing recreational football organized as small-sided games among friends.
Ok, just go play ball, already. Getting into some frienly 4 a side games, a couple times a week, seems to have so many pluses going for it's hard to imagine the down side - if everyone is rather at the same level (So great, where does one find these games?)

Field Note - General recommendation before Getting Back in the Game: get one's doctor's ok first to start a new prorgam of action, then consider getting a movement assessment to check how you're moving to reduce the risk of injury. It's also immediately beneficial to  practice some sensory-motor drills to help field awareness so as to reduce likelihood of falling on self or colleague, and so actually getting more out of the game. Such drills can start with proprioceptvie awareness work. I like z-health's r-phase and especially i phase for this (overviews).

After R- and I- phase, the drills for fast turning, fast getting up off the ground, and just moving fast in the S-Phase Complete Athlete Vol 1 dvd are awesome - as are the drills for field awareness and quickness (review here). A colleague is using a lot of the z-drills to help the kids baseball team he coaches, from proprioception to visual acuity. Injury down, performance up, much?? oh ya.

Krustrup, P., Aagaard, P., Nybo, L., Petersen, J., Mohr, M., & Bangsbo, J. (2010). Recreational football as a health promoting activity: a topical review Scandinavian Journal of Medicine & Science in Sports DOI: 10.1111/j.1600-0838.2010.01108.x


Steven Rice said...

I wrote about another soccer study (Soccer Reduces Risk of Falls and Bone Fractures, Study Finds

"Soccer is a great example of exercising the entire body in a wide variety of movements. It doesn't just require moving quickly, but changing speed and direction quickly, shifting weight, coordinating moving the body and reacting to external stimuli (the ball and other players). This is very much like the ideas of functional fitness, including exercising while standing, and doing exercises involving the entire body. Plus, it's fun and social, which is very motivational."

It is nice to see research supporting the basic precepts of what you believe.
Positive Massage Therapy

Rannoch Donald said...

Ok, First things first...

I think it's great that you want people to get "off the coach". But have you considered how the coach feels about this? If it's consensual I say leave 'em to it!

Ok, jokes aside, the issue here is, in a controlled environment whre there is a progressive approach to the training and some proper coaching involved people will make progress for sure. Sadly when it comes to sports for fitness most people want to get form a to d. By missing out b and c they fast track themselves to distress and perhpas worse, injury.

The very competitve nature of sporting activities has a habit of taking the foot off the brake when the participant has barely leraned to pull away from the kerb.

I am all for whatever gets folk motivated but from my own experience, people who take up combat sport to get fit tend not to be fit or proficient.

Baseline fitness, basic mobility and flexibility. Sports skill should be approached seperately.

Valda Redfern said...

I have always admired the physiques of footballers. I dislike the game, but it does seem to promote optimum fitness (barring injuries). Maybe solo football is the way to go?

Marc said...

As a footballer, I have a special fondness for this type of finding, thanks mc. I personally find that after a certain age (I'm in my late 30's), you learn to anticipate and play more of a 'skill' game than a 'brawn' game. As a result, the injuries I suffered as a youngster are avoided (again, just personal experience).

I do have a general joint/mobility question - it seems that the playing surface has more to do with injury for me than the nature of the sport I'm playing. When I play football on grass or a padded turf indoor field, I'm fine. If I play on a hard indoor gym floor my knees (particularly my left knee) complain loudly for at least a week or two. Same with taking my Nike Free's out for a run - pavement = pain. Is there anything in addition to general mobility work (incl. r-phase, et. al.) that would help to recover and/or prevent this joint/tendon pain?

I've been told to look into fish oil, drink more water, take arnica, try topical creams (celedrin / bio-freeze), etc. I'm going to be running in a marathon soon so I really need to sort this out - TIA for any guidance. Thanks guys!

dr. m.c. said...

Marc, thanks for your post. Sure surface can make a difference in terms of give. Football (US style) used to complain a lot about initial artificial turf.

Joint mobility is a good place to turn, but you might also want to consider your gait: if you're wearing frees for a run, and you run by hitting your heel first, that's potentially going to amplify whatever may be going on in your movement.

either take a peek at pose running or consider some vff's to encourage you to run to the forefoot.

here's a barefoot running.

These are just general points i'd share with anyone about running to improve limb life.

as for other good things like fish oil and water, well there's good anti-inflam reasons for fish oil among other things, and no harm to you in that (tho i prefer algae oil to reduce environmental harm), but it's great that you're looking at mechanics and movement.

without doing a real history, i'd be loath to say "do this"

if you can get a movement assessment that's a really great way to see specifically what may be happening for you, and what drills may be best to help focus and improve what may show up.

if there's no one near you, i do vid consults online with skype.


dr. m.c. said...

Ps marc, here's the vff/pose running link


Steven Rice said...

The solution will probably involve gait, footwear(or lack of), and surface, but for local short term treatment of inflammation of muscle and connective tissue, consider ice or contrast therapy.

Contrast therapy is alternating between cold and hot on the affected area, always ending with cold. For contrast or just ice, several times during the day for short periods is suggested.

However- reread MCs post on -itis vs -osis to consider if inflammation treatment is useful at all.

Positive Massage Therapy


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