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Published in: Sports Medicine 2/2021

01-02-2021 | Systematic Review

Which Physical Exercise Interventions Increase HDL-Cholesterol Levels? A Systematic Review of Meta-analyses of Randomized Controlled Trials

Authors: Antonio Palazón-Bru, David Hernández-Lozano, Vicente Francisco Gil-Guillén

Published in: Sports Medicine | Issue 2/2021

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Abstract

Background

Meta-analyses of randomized controlled trials (RCTs) have shown the beneficial effect of exercise on HDL-cholesterol (HDL-C) levels. However, systematic reviews are not free of bias, and this could call into question their results.

Objectives

The aim of this work was to conduct a critical assessment of meta-analyses of RCTs that analyze the association between exercise and HDL-C levels, evaluating their results and the risk of bias (RoB).

Methods

This systematic review of MEDLINE and EMBASE included meta-analyses of RCTs that studied the effects of exercise on HDL-C levels in healthy adults or patients at cardiovascular risk. The RoB was determined using AMSTAR-2, and information was obtained on exercise and the variation in HDL-C levels.

Results

Twenty-three meta-analyses were included. Great variability was found in exercise (different types, frequencies or intensities in the studied interventions). All the analyses found an improvement in HDL-C levels, ranging from 0.27 to 5.41 mg/dl, in comparison with the control group (no exercise). The RoB was very high, with 18 reviews obtaining a critically low confidence level and the remaining works obtaining the highest confidence level.

Conclusions

Only one meta-analysis showed good quality, in which HDL-C levels increased by 3.09 mg/dl in healthy adults and patients at high cardiovascular risk who practiced yoga. The rest had high RoB. Therefore, new systematic reviews with low RoB are needed to apply the results to clinical practice.
Register: CRD42020158471 (PROSPERO).
Appendix
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Literature
2.
go back to reference Allender S, Scarborough P, Peto V, et al. European cardiovascular disease statistics. Bruselas: European Heart Network; 2008. Allender S, Scarborough P, Peto V, et al. European cardiovascular disease statistics. Bruselas: European Heart Network; 2008.
3.
go back to reference Mosca L, Barrett-Connor E, Wenger NK. Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation. 2011;124:2145–54. PubMedPubMedCentral Mosca L, Barrett-Connor E, Wenger NK. Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation. 2011;124:2145–54. PubMedPubMedCentral
4.
go back to reference Goldstein JL, Brown MS. A century of cholesterol and coronaries: from plaques to genes to statins. Cell. 2015;161:161–72. PubMedPubMedCentral Goldstein JL, Brown MS. A century of cholesterol and coronaries: from plaques to genes to statins. Cell. 2015;161:161–72. PubMedPubMedCentral
5.
go back to reference Hernáez Á, Castañer O, Elosua R, et al. Mediterranean diet improves high-density lipoprotein function in high-cardiovascular-risk individuals: a randomized controlled trial. Circulation. 2017;135:633–43. PubMed Hernáez Á, Castañer O, Elosua R, et al. Mediterranean diet improves high-density lipoprotein function in high-cardiovascular-risk individuals: a randomized controlled trial. Circulation. 2017;135:633–43. PubMed
6.
go back to reference Hadi A, Pourmasoumi M, Mohammadi H, et al. The impact of pycnogenol supplementation on plasma lipids in humans: a systematic review and meta-analysis of clinical trials. Phytother Res. 2019;33:276–87. PubMed Hadi A, Pourmasoumi M, Mohammadi H, et al. The impact of pycnogenol supplementation on plasma lipids in humans: a systematic review and meta-analysis of clinical trials. Phytother Res. 2019;33:276–87. PubMed
7.
go back to reference Simental-Mendía LE, Pirro M, Gotto AM Jr, et al. Lipid-modifying activity of curcuminoids: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2019;59:1178–87. PubMed Simental-Mendía LE, Pirro M, Gotto AM Jr, et al. Lipid-modifying activity of curcuminoids: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2019;59:1178–87. PubMed
8.
go back to reference Yu L, Zhou C, Luo Z, et al. The lipid-lowering effects of Danhong and Huangqi injections: a meta-analysis of clinical controlled trials. Lipids Health Dis. 2018;17:106. PubMedPubMedCentral Yu L, Zhou C, Luo Z, et al. The lipid-lowering effects of Danhong and Huangqi injections: a meta-analysis of clinical controlled trials. Lipids Health Dis. 2018;17:106. PubMedPubMedCentral
9.
go back to reference Zou L, Zhang Y, Sasaki JE, et al. Wuqinxi Qigong as an alternative exercise for improving risk factors associated with metabolic syndrome: a meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2019;16:1396. PubMedCentral Zou L, Zhang Y, Sasaki JE, et al. Wuqinxi Qigong as an alternative exercise for improving risk factors associated with metabolic syndrome: a meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2019;16:1396. PubMedCentral
10.
go back to reference Igarashi Y, Nogami Y. Response of lipids and lipoproteins to regular aquatic endurance exercise: a meta-analysis of randomized controlled trials. J Atheroscler Thromb. 2019;26:14–30. PubMedPubMedCentral Igarashi Y, Nogami Y. Response of lipids and lipoproteins to regular aquatic endurance exercise: a meta-analysis of randomized controlled trials. J Atheroscler Thromb. 2019;26:14–30. PubMedPubMedCentral
11.
go back to reference Wewege MA, Thom JM, Rye KA, et al. Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome. Atherosclerosis. 2018;274:162–71. PubMed Wewege MA, Thom JM, Rye KA, et al. Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome. Atherosclerosis. 2018;274:162–71. PubMed
12.
go back to reference Ostman C, Smart NA, Morcos D, et al. The effect of exercise training on clinical outcomes in patients with the metabolic syndrome: a systematic review and meta-analysis. Cardiovasc Diabetol. 2017;16:110. PubMedPubMedCentral Ostman C, Smart NA, Morcos D, et al. The effect of exercise training on clinical outcomes in patients with the metabolic syndrome: a systematic review and meta-analysis. Cardiovasc Diabetol. 2017;16:110. PubMedPubMedCentral
13.
go back to reference Cui J, Yan JH, Yan LM, et al. Effects of yoga in adults with type 2 diabetes mellitus: a meta-analysis. J Diabetes Investig. 2017;8:201–9. PubMed Cui J, Yan JH, Yan LM, et al. Effects of yoga in adults with type 2 diabetes mellitus: a meta-analysis. J Diabetes Investig. 2017;8:201–9. PubMed
15.
go back to reference Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. PubMedPubMedCentral Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. PubMedPubMedCentral
16.
go back to reference Jin X, Wang J, Li X, et al. Quality assessment of systematic review of the bariatric surgery for diabetes mellitus. J Diabetes Res. 2019;2019:9541638. PubMedPubMedCentral Jin X, Wang J, Li X, et al. Quality assessment of systematic review of the bariatric surgery for diabetes mellitus. J Diabetes Res. 2019;2019:9541638. PubMedPubMedCentral
17.
go back to reference Perry R, Leach V, Davies P, et al. An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools. Syst Rev. 2017;6:97. PubMedPubMedCentral Perry R, Leach V, Davies P, et al. An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools. Syst Rev. 2017;6:97. PubMedPubMedCentral
18.
go back to reference Moher D, Liberati A, Tetzlaff J, PRISMA Group, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. PubMedPubMedCentral Moher D, Liberati A, Tetzlaff J, PRISMA Group, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. PubMedPubMedCentral
19.
go back to reference Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration; 2011. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration; 2011.
20.
go back to reference Alenazi AM, Alshehri MM, Hoover JC, et al. The effect of T’ai Chi exercise on lipid profiles: a systematic review and meta-analysis of randomized clinical trials. J Altern Complement Med. 2018;24:220–30. PubMed Alenazi AM, Alshehri MM, Hoover JC, et al. The effect of T’ai Chi exercise on lipid profiles: a systematic review and meta-analysis of randomized clinical trials. J Altern Complement Med. 2018;24:220–30. PubMed
21.
go back to reference Lemes ÍR, Turi-Lynch BC, Cavero-Redondo I, et al. Aerobic training reduces blood pressure and waist circumference and increases HDL-c in metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials. J Am Soc Hypertens. 2018;12:580–8. PubMed Lemes ÍR, Turi-Lynch BC, Cavero-Redondo I, et al. Aerobic training reduces blood pressure and waist circumference and increases HDL-c in metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials. J Am Soc Hypertens. 2018;12:580–8. PubMed
22.
go back to reference Wen J, Lin T, Cai Y, et al. Baduanjin exercise for type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Altern Med. 2017;2017:8378219. Wen J, Lin T, Cai Y, et al. Baduanjin exercise for type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Altern Med. 2017;2017:8378219.
23.
go back to reference Cai M, Zou Z. Effect of aerobic exercise on blood lipid and glucose in obese or overweight adults: a meta-analysis of randomised controlled trials. Obes Res Clin Pract. 2016;10:589–602. PubMed Cai M, Zou Z. Effect of aerobic exercise on blood lipid and glucose in obese or overweight adults: a meta-analysis of randomised controlled trials. Obes Res Clin Pract. 2016;10:589–602. PubMed
24.
go back to reference Huang XL, Pan JH, Chen D, et al. Efficacy of lifestyle interventions in patients with type 2 diabetes: a systematic review and meta-analysis. Eur J Intern Med. 2016;27:37–47. PubMed Huang XL, Pan JH, Chen D, et al. Efficacy of lifestyle interventions in patients with type 2 diabetes: a systematic review and meta-analysis. Eur J Intern Med. 2016;27:37–47. PubMed
25.
go back to reference Chu P, Gotink RA, Yeh GY, et al. The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2016;23:291–307. PubMed Chu P, Gotink RA, Yeh GY, et al. The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2016;23:291–307. PubMed
26.
go back to reference Cramer H, Lauche R, Haller H, et al. Effects of yoga on cardiovascular disease risk factors: a systematic review and meta-analysis. Int J Cardiol. 2014;173:170–83. PubMed Cramer H, Lauche R, Haller H, et al. Effects of yoga on cardiovascular disease risk factors: a systematic review and meta-analysis. Int J Cardiol. 2014;173:170–83. PubMed
27.
go back to reference Pattyn N, Cornelissen VA, Eshghi SR, et al. The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome: a meta-analysis of controlled trials. Sports Med. 2013;43:121–33. PubMed Pattyn N, Cornelissen VA, Eshghi SR, et al. The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome: a meta-analysis of controlled trials. Sports Med. 2013;43:121–33. PubMed
28.
go back to reference Malakou E, Linardakis M, Armstrong MEG, et al. The combined effect of promoting the Mediterranean diet and physical activity on metabolic risk factors in adults: a systematic review and meta-analysis of randomised controlled trials. Nutrients. 2018a;10:1577. PubMedCentral Malakou E, Linardakis M, Armstrong MEG, et al. The combined effect of promoting the Mediterranean diet and physical activity on metabolic risk factors in adults: a systematic review and meta-analysis of randomised controlled trials. Nutrients. 2018a;10:1577. PubMedCentral
29.
go back to reference Zhang X, Devlin HM, Smith B, et al. Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0176436. PubMedPubMedCentral Zhang X, Devlin HM, Smith B, et al. Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0176436. PubMedPubMedCentral
30.
go back to reference Igarashi Y, Akazawa N, Maeda S. Effects of aerobic exercise alone on lipids in healthy east Asians: a systematic review and meta-analysis. J Atheroscler Thromb. 2019;26:488–503. PubMedPubMedCentral Igarashi Y, Akazawa N, Maeda S. Effects of aerobic exercise alone on lipids in healthy east Asians: a systematic review and meta-analysis. J Atheroscler Thromb. 2019;26:488–503. PubMedPubMedCentral
31.
go back to reference Costa RR, Buttelli ACK, Vieira AF, et al. Effect of strength training on lipid and inflammatory outcomes: systematic review with meta-analysis and meta-regression. J Phys Act Health. 2019;16:477–91. PubMed Costa RR, Buttelli ACK, Vieira AF, et al. Effect of strength training on lipid and inflammatory outcomes: systematic review with meta-analysis and meta-regression. J Phys Act Health. 2019;16:477–91. PubMed
32.
go back to reference Zhang Y, Xu L, Zhang X, et al. Effects of different durations of aerobic exercise on the cardiovascular health in untrained women: a meta-analysis and meta-regression. J Sports Med Phys Fit. 2018;58:1525–36. Zhang Y, Xu L, Zhang X, et al. Effects of different durations of aerobic exercise on the cardiovascular health in untrained women: a meta-analysis and meta-regression. J Sports Med Phys Fit. 2018;58:1525–36.
33.
go back to reference Zou Z, Cai W, Cai M, et al. Influence of the intervention of exercise on obese type II diabetes mellitus: a meta-analysis. Prim Care Diabetes. 2016;10:186–201. PubMed Zou Z, Cai W, Cai M, et al. Influence of the intervention of exercise on obese type II diabetes mellitus: a meta-analysis. Prim Care Diabetes. 2016;10:186–201. PubMed
34.
go back to reference Hespanhol Junior LC, Pillay JD, van Mechelen W, et al. Meta-analyses of the effects of habitual running on indices of health in physically inactive adults. Sports Med. 2015;45:1455–68. PubMedPubMedCentral Hespanhol Junior LC, Pillay JD, van Mechelen W, et al. Meta-analyses of the effects of habitual running on indices of health in physically inactive adults. Sports Med. 2015;45:1455–68. PubMedPubMedCentral
35.
go back to reference Lin X, Zhang X, Guo J, et al. Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4:e002014. PubMedPubMedCentral Lin X, Zhang X, Guo J, et al. Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4:e002014. PubMedPubMedCentral
36.
go back to reference Hartley L, Dyakova M, Holmes J, et al. Yoga for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2014;5:010072. Hartley L, Dyakova M, Holmes J, et al. Yoga for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2014;5:010072.
37.
go back to reference Hayashino Y, Jackson JL, Fukumori N, et al. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98:349–60. PubMed Hayashino Y, Jackson JL, Fukumori N, et al. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98:349–60. PubMed
38.
go back to reference Kodama S, Tanaka S, Saito K, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med. 2007;167:999–1008. PubMed Kodama S, Tanaka S, Saito K, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med. 2007;167:999–1008. PubMed
39.
go back to reference Kelley GA, Kelley KS. Aerobic exercise and lipids and lipoproteins in men: a meta-analysis of randomized controlled trials. J Mens Health Gend. 2006;3:61–70. PubMedPubMedCentral Kelley GA, Kelley KS. Aerobic exercise and lipids and lipoproteins in men: a meta-analysis of randomized controlled trials. J Mens Health Gend. 2006;3:61–70. PubMedPubMedCentral
40.
go back to reference Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46:667–75. PubMed Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46:667–75. PubMed
41.
go back to reference Kelley GA, Kelley KS, Tran ZV. Exercise, lipids, and lipoproteins in older adults: a meta-analysis. Prev Cardiol. 2005;8:206–14. PubMedPubMedCentral Kelley GA, Kelley KS, Tran ZV. Exercise, lipids, and lipoproteins in older adults: a meta-analysis. Prev Cardiol. 2005;8:206–14. PubMedPubMedCentral
42.
go back to reference Kelley GA, Kelley KS, Tran ZV. Aerobic exercise and lipids and lipoproteins in women: a meta-analysis of randomized controlled trials. J Womens Health (Larchmt). 2004;13:1148–64. Kelley GA, Kelley KS, Tran ZV. Aerobic exercise and lipids and lipoproteins in women: a meta-analysis of randomized controlled trials. J Womens Health (Larchmt). 2004;13:1148–64.
43.
go back to reference Halbert JA, Silagy CA, Finucane P, et al. Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials. Eur J Clin Nutr. 1999;53:514–22. PubMed Halbert JA, Silagy CA, Finucane P, et al. Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials. Eur J Clin Nutr. 1999;53:514–22. PubMed
44.
go back to reference Murtagh EM, Nichols L, Mohammed MA, et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015;72:34–43. PubMed Murtagh EM, Nichols L, Mohammed MA, et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015;72:34–43. PubMed
45.
go back to reference Cramer H, Langhorst J, Dobos G, et al. Yoga for metabolic syndrome: a systematic review and meta-analysis. Eur J Prev Cardiol. 2016;23:1982–93. PubMed Cramer H, Langhorst J, Dobos G, et al. Yoga for metabolic syndrome: a systematic review and meta-analysis. Eur J Prev Cardiol. 2016;23:1982–93. PubMed
46.
go back to reference Yan JH, Gu WJ, Pan L. Lack of evidence on Tai Chi-related effects in patients with type 2 diabetes mellitus: a meta-analysis. Exp Clin Endocrinol Diabetes. 2013;121:266–71. PubMed Yan JH, Gu WJ, Pan L. Lack of evidence on Tai Chi-related effects in patients with type 2 diabetes mellitus: a meta-analysis. Exp Clin Endocrinol Diabetes. 2013;121:266–71. PubMed
47.
go back to reference Kelley GA, Kelley KS. Impact of progressive resistance training on lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials. Prev Med. 2009;48:9–19. PubMed Kelley GA, Kelley KS. Impact of progressive resistance training on lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials. Prev Med. 2009;48:9–19. PubMed
48.
go back to reference Kelley GA, Kelley KS, Vu TZ. Aerobic exercise, lipids and lipoproteins in overweight and obese adults: a meta-analysis of randomized controlled trials. Int J Obes (Lond). 2005;29:881–93. Kelley GA, Kelley KS, Vu TZ. Aerobic exercise, lipids and lipoproteins in overweight and obese adults: a meta-analysis of randomized controlled trials. Int J Obes (Lond). 2005;29:881–93.
49.
go back to reference George ES, Marshall S, Mayr HL, et al. The effect of high-polyphenol extra virgin olive oil on cardiovascular risk factors: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2019;59:2772–95. PubMed George ES, Marshall S, Mayr HL, et al. The effect of high-polyphenol extra virgin olive oil on cardiovascular risk factors: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2019;59:2772–95. PubMed
50.
go back to reference Alhassan A, Young J, Lean MEJ, et al. Consumption of fish and vascular risk factors: a systematic review and meta-analysis of intervention studies. Atherosclerosis. 2017;266:87–94. PubMed Alhassan A, Young J, Lean MEJ, et al. Consumption of fish and vascular risk factors: a systematic review and meta-analysis of intervention studies. Atherosclerosis. 2017;266:87–94. PubMed
51.
go back to reference Malakou E, Linardakis M, Armstrong MEG, et al. The combined effect of promoting the mediterranean diet and physical activity on metabolic risk factors in adults: a systematic review and meta-analysis of randomised controlled trials. Nutrients. 2018b;10:e1577. PubMed Malakou E, Linardakis M, Armstrong MEG, et al. The combined effect of promoting the mediterranean diet and physical activity on metabolic risk factors in adults: a systematic review and meta-analysis of randomised controlled trials. Nutrients. 2018b;10:e1577. PubMed
52.
53.
go back to reference Moher D. Optimal strategies to consider when peer reviewing a systematic review and meta-analysis. BMC Med. 2015;13:274. PubMedPubMedCentral Moher D. Optimal strategies to consider when peer reviewing a systematic review and meta-analysis. BMC Med. 2015;13:274. PubMedPubMedCentral
Metadata
Title
Which Physical Exercise Interventions Increase HDL-Cholesterol Levels? A Systematic Review of Meta-analyses of Randomized Controlled Trials
Authors
Antonio Palazón-Bru
David Hernández-Lozano
Vicente Francisco Gil-Guillén
Publication date
01-02-2021
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 2/2021
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-020-01364-y

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