European Journal of Applied Physiology

, Volume 119, Issue 2, pp 561–573 | Cite as

Cardiovascular, muscular, and skeletal adaptations to recreational team handball training: a randomized controlled trial with young adult untrained men

  • Therese HornstrupEmail author
  • F. T. Løwenstein
  • M. A. Larsen
  • E. W. Helge
  • S. Póvoas
  • J. W. Helge
  • J. J. Nielsen
  • B. Fristrup
  • J. L. Andersen
  • L. Gliemann
  • L. Nybo
  • P. Krustrup
Original Article



The prevalence of lifestyle diseases has escalated, and effective exercise training programmes are warranted. This study tested the hypothesis that regular participation in small-sided team handball training could provide beneficial health effects on cardiovascular, skeletal, and muscular parameters in young adult untrained men.


Twenty-six untrained 20–30-year-old men were randomly allocated to either a team handball training group (HG; n = 14), which completed 1.9 ± 0.3 training sessions per week over 12 weeks, or an inactive control group (CG; n = 12). Physiological training adaptations were assessed pre- and post interventions by DXA scans, blood samples, muscle biopsies, and physical tests.


The average heart rate during training was equivalent to 84 ± 4% of maximal heart rate. Compared to CG, HG displayed significant increases in VO2max (11 ± 6%), proximal femur bone mineral density (2 ± 1%), whole-body bone mineral content (2 ± 1%), intermittent endurance performance (32 ± 16%), incremental treadmill test performance (16 ± 7%) and muscle citrate synthase activity (22 ± 28%) as well as decreases in total fat mass (7 ± 7%) and total fat percentage (6 ± 7%) (all p < 0.05). There were no significant changes in muscle mass, blood pressure, resting heart rate, muscle hydroxyl-acyl-dehydrogenase activity, or blood lipids (all p > 0.05).


Participation in regular recreational team handball training was associated with positive cardiovascular, skeletal, and muscular adaptations, including increased maximal oxygen uptake, increased muscle enzymatic activity, and improved bone mineralization as well as lower fat percentage. These findings suggest that recreational team handball training may be an effective health-promoting activity for young adult men.


Ball games Exercise training Maximal oxygen uptake Fat percentage Bone mineralization Bone markers Muscle enzyme activity 



Analysis of variance


Bone mineral density


Bone mineral content


Control group


Citrate synthase


Carboxy-terminal type-1 collagen crosslinks


Dual-energy X-ray absorptiometry


Ethylenediaminetetraacetate acid


3-hydroxacyl-CoA dehydrogenase


Glycosylated haemoglobin


High-density lipoprotein cholesterol


Handball training group


Heart rate


International Physical Activity Questionnaire


Low-density lipoprotein cholesterol


Procollagen type-1 amino-terminal propeptide


Total cholesterol




Type 2 diabetes mellitus


Maximal oxygen uptake

Yo–Yo IE1

Yo–Yo intermittent endurance level 1 test



We would like to thank Jon Egelund, Marie Hagman, Signe Hudloff Nielsen, and Nadia Quardon for their practical and technical assistance, and the participants for their committed participation. We would also like to express our gratitude for the support of TrygFonden, Nordea-fonden (Nordea-fonden 02-2011-4360), the Danish Handball Federation (Dansk Håndbold Forbund, DHF), and the European Handball Federation (EHF).

Authors’ contributions

TH conceived of the study design, applied for funding, conducted the training and testing, carried out the data collection and analysis, interpreted the study results, and drafted the manuscript; FTL and MAL conducted the training and testing and carried out the data collection and analysis; EWH, JWH, SP, JLA, and LN contributed the study design, interpreted the study results, and edited the manuscript; BF conducted the training and carried out the video analysis; JJN carried out muscle analysis and edited the manuscript; LG carried out the muscle biopsies and edited the manuscript; PK conceived of the study design, applied for funding, interpreted the study results, and edited the manuscript. All authors have read and approved the final version of the manuscript, and agree with the order of presentation of the authors.

Compliance withe thical standards

Conflict of interest

The authors declare that this study was partly funded by DHF and EHF. The authors declare that they have no conflicts of interest.


The datasets and analysis generated during the current study are available from the corresponding author upon reasonable request.


  1. Aastrand I (1960) Aerobic work capacity in men and women with special reference to age. Acta Physiol Scand Suppl 49(169):1–92Google Scholar
  2. Aspenes ST, Nilsen TIL, Skaug E–A, Bertheussen GF, Ellingsen O, Vatten L, Wisloff U (2011) Peak oxygen uptake and cardiovascular risk factors in 4631 healthy women and men. Med Sci Sports Exerc 43:1465–1473CrossRefGoogle Scholar
  3. Bangsbo J, Hansen PR, Dvorak J, Krustrup P (2015) Recreational football for disease prevention and treatment in untrained men: a narrative review examining cardiovascular health, lipid profile, body composition, muscle strength and functional capacity. Br J Sports Med 49(9):568–576CrossRefGoogle Scholar
  4. Basset DR, Howley ET (2000) Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc 32(1):70–84CrossRefGoogle Scholar
  5. Benowitz NL (2003) Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment. ProgCardiovascDis 46(1):91–111Google Scholar
  6. Bergström J (1975) Percutaneous needle biopsy of skeletal muscle in physio- logical and clinical research. Scand J Clin Lab Invest 35:609–616CrossRefGoogle Scholar
  7. Bizzini M, Dvorak J (2015) FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide-a narrative review. Br J Sports Med 49:577–579CrossRefGoogle Scholar
  8. Bozetto L, Annuzzi G, Costabile G, Costagliola L, Giorgini M, Alderisio A, Strazzullo A, Patti L, Cipriano P, Magione A, Vitelli A, Vogorito C, Riccardi G, Rivellese AA (2014) A CHO/fibre diet reduces and a MUFA diet increases postprandial lipaemia in type 2 diabetes: no supplementary effects of low-volume physical training. Acta Diabetol: 51:385–393CrossRefGoogle Scholar
  9. Conley KE (2016) Mitochondria to motion: optimizing oxidative phosphorylation to improve exercise performance. J Exp Biol 219(2):243–249CrossRefGoogle Scholar
  10. Cook S, Togni M, Schaub MC, Wenaweser P, Hess OM (2006) High heart rate: a cardiovascular risk factor? Eur Heart J 27(20):2387–2393CrossRefGoogle Scholar
  11. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395CrossRefGoogle Scholar
  12. Daussin FN, Zoll J, Dufour SP, Ponsot E, Lonsdorfer-Wolf E, Doutreleau S, Mettauer B, Piquard F, Geny B, Richard R (2008) Effect of interval training versus continuous training on cardiorespiratory and mitochondrial function: relationship to aerobic performance improvements in sedentary subjects. Am J Physiol Regul Integr Comp Physiol 295(1):R264–R272CrossRefGoogle Scholar
  13. de Sousa MV, Fukui R, Krustrup P, Pereira RM, Silva PR, Rodrigues AC et al (2014) Positive effects of football on fitness, lipid profile, and insulin resistance in Brazilian patients with type 2 diabetes. Scand J Med Sci Sports 24:57–65CrossRefGoogle Scholar
  14. Despres J-P, Moorjani S, Tremblay A, Poehlman ET, Lupien PJ, Nadeau A, Bouchard C (1998) Heredity and changes in plasma lipids and lipoproteins after short-term exercise training in men. Arteriosclerosis 8:402–409CrossRefGoogle Scholar
  15. Durstine JL, Grandjean PW, Cox CA, Thompson PD (2002) Lipids, lipoproteins and the exercise. J Cardiopulm Rehabil 22(6):385–398CrossRefGoogle Scholar
  16. Fester M (2016) Forening i forandring?— En undersøgelse af idrætsforeninger i Danmark, DIF analyseGoogle Scholar
  17. Helge EW, Andersen TR, Schmidt JF, Jørgensen NR, Hornstrup T, Krustrup P, Bangsbo J (2014) Recreational football improves bone mineral density and bone turnover marker profile in elderly men. Scand J Med Sci Sports 24:98–104CrossRefGoogle Scholar
  18. Hornstrup T, Wikman JM, Fristrup B, Póvoas S, Helge EW, Nielsen SH, Helge JW, Andersen JL, Nybo L, Krustrup P (2018) Fitness and health benefits of team handball training for young untrained women—a cross-disciplinary RCT on physiological adaptations and motivational aspects. J Health Sci 7(2):139–148Google Scholar
  19. Hu FB (2011) Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 34:1249–1257CrossRefGoogle Scholar
  20. Kelley KS, Kelley G (2006) Aerobic exercise and lipids and lipoproteinin men: a meta-analysisof randomized controlled trials. J Mens Health Gend 3:61–70CrossRefGoogle Scholar
  21. Kiens B, Beyer N, Brage S, Hyldstrup L, Ottesen LS, Overgaard K, Pedersen BK, Puggaard L, Aagaard PG (2007) Physical inactivity: consequences and correlations. Ugeskr Læger 169:2442–2445Google Scholar
  22. Krustrup P, Krustrup BR (2018) Football is medicine—it is time for patients to play! Editorial. Br J Sport Med 52(22):1412–1414CrossRefGoogle Scholar
  23. Krustrup P, Nielsen JJ, Krustrup B, Christensen JF, Pedersen H, Randers MB, Aagaard P, Petersen AM, Nybo L, Bangsbo J (2009) Recreational soccer is an effective health promoting activity for untrained men. Br J Sports Med 43:825–831CrossRefGoogle Scholar
  24. Krustrup P, Aagaard P, Nybo L, Petersen J, Mohr M, Bangsbo J (2010) Recreational football as a health promoting activity: a topical review. Scand J Med Sci Sports 20(suppl 1):1–13CrossRefGoogle Scholar
  25. Krustrup P, Randers MB, Andersen LJ, Jackman SR, Bangsbo J, Hansen PR (2013) Soccer improves fitness and attenuates cardiovascular risk factors in hypertensive men. Med Sci Sports Exerc 45:553–560CrossRefGoogle Scholar
  26. Krustrup P, Bradley PS, Christensen JS, Castagna C, Jackman S, Connolly L, Randers MB, Mohr M, Bangsbo J (2015) The Yo-Yo IE2 Test: physiological response for untrained men versus trained soccer. Med Sci Sports Exerc 47:100–108CrossRefGoogle Scholar
  27. Krustrup P, Helge EW, Hansen PR, Aagaard P, Hagman M, Randers MB, de Sousa M, Mohr M (2018) Effects of recreational football on women’s fitness and health: adaptations and mechanisms. Eur J Appl Physiol 118(1):11–32CrossRefGoogle Scholar
  28. Langevoort G, Myklebust G, Dvorak J, Junge A (2007) Handball injuries during major international tournaments. Scand J Med Sci Sports 17:400–407Google Scholar
  29. Le-Houezec J, Benowitz NL (1991) Basic and clinical psychopharmacology of nicotine. Clin Chest Med 12(4):681–699Google Scholar
  30. Loe H, Rognmo Ø, Saltin B, Wisløff U (2013) Aerobic capacity reference data in 3816 healthy men and women 20–90 years. PLoS One 8:e64319CrossRefGoogle Scholar
  31. Lowry OH, Passonneau JV (1972) A flexible system of enzymatic analysis. Academic, New York, pp 237–249Google Scholar
  32. MacInnis MJ, Gibala MJ (2016) Physiological adaptations to interval training and the role of exercise intensity. J Physiol 1;595(9):2915–2930CrossRefGoogle Scholar
  33. Middleton KR, Anton SD, Perri MG (2013) Long-term adherence to health behavior change. Am J Lifestyle Med 7(6):395–404CrossRefGoogle Scholar
  34. Milanović Z, Pantelić S, Kostić R, Trajković N, Sporiš G (2015) Soccer vs. running training effectsin young adult men:which programme is more effective in improvement of body composition? Randomized controlled trial. Biol Sport. 32(4):301–305CrossRefGoogle Scholar
  35. Milanović Z, Pantelić S, Čović N, Sporiš G, Mohr M, Krustrup P (2018) Broad-spectrum physical fitness benefits of recreational football: a systematic review and meta-analysis. Br J Sports Med. Google Scholar
  36. Mohr M, Helge EW, Petersen LF, Lindenskov A, Weihe P, Mortensen J, Jørgensen NR, Krustrup P (2015) Effects of soccer vs. swim training on bone formation in sedentary middle-aged women. Eur J Appl Physiol 115:2671–2679CrossRefGoogle Scholar
  37. Nielsen G, Wikman JM, Jensen CJ, Schmidt JF, Gliemann L, Andersen TR (2014) Health promotion: The impact of beliefs of health benefits, social relations and enjoyment on exercise continuation. Scand J Med Sci Sports 24(Suppl. 1):66–75CrossRefGoogle Scholar
  38. Nybo L, Sundstrup E, Jakobsen MD, Mohr M, Hornstrup T, Simonsen L, Bulow J, Randers MB, Nielsen JJ, Aagaard P, Krustrup P (2010) High-Intensity Training versus Traditional Exercise Interventions for Promoting Health. Med Sci Sports Exerc 42(10):1951–1958CrossRefGoogle Scholar
  39. Ottesen L, Jeppesen RS, Krustrup BR (2010) The development of social capital through football and running: studying an intervention program for inactive women. Scand J Med Sci Sports 20(suppl 1):118–131CrossRefGoogle Scholar
  40. Pedersen BK, Saltin B (2015) Exercise as medicine-evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 25(Suppl 3):1–72CrossRefGoogle Scholar
  41. Póvoas SCA, Castagna C, Resende C, Coelho EF, Silva P, Santos R, Seabra A, Tamames J, Lopes M, Randers MB, Krustrup P (2017) Physical and physiological demands of recreational team handball for adult untrained men. Biomed Res Int. 6204603Google Scholar
  42. Randers MB, Nybo L, Petersen J, Nielsen JJ, Christiansen L, Bendiksen M, Brito J, Bangsbo J, Krustrup P (2010) Activity profile and physiological response to football training for untrained males and females, elderly and youngsters: influence of the number of players. Scand J Med Sci Sports 20(Suppl):S14–S23 1)CrossRefGoogle Scholar
  43. Randers MB, Hagman M, Brix J, Christensen JF, Pedersen MT, Nielsen JJ, Krustrup P (2018) Effects of 3 months of full-court and half-court street basketball training on health profile in untrained men. Health Sci 7(2):132–138Google Scholar
  44. Reginster JY, Burlet N (2006) Osteoporosis: a still increasing prevalence. Bone 38(2 Suppl 1):S4–S9CrossRefGoogle Scholar
  45. Robling AG, Hinant FM, Burr DB, Turner CH (2002) Shorter, more frequent mechanical loading sessions enhance bone mass. Med Sci Sports Exerc 34:196–202CrossRefGoogle Scholar
  46. Rubin CT. Lanyon LE (1984) Regulation of bone formation by applied dynamic loads. J Bone Jt Surg Am: 66:397–402CrossRefGoogle Scholar
  47. Schmidt JF, Andersen TR, Horton J, Brix J, Tarnow L, Krustrup P, Andersen LJ, Bangsbo J, Hansen PR (2013) Soccer training improves cardiac function in men with type 2 diabetes. Med Sci Sports Exerc 45(12):2223–2233CrossRefGoogle Scholar
  48. Schmidt JF, Hansen PR, Andersen TR, Andersen LJ, Hornstrup T, Krustrup P, Bangsbo J (2014) Cardiovascular adaptations to 4 and 12 months of football or strength training in 65- to 75-year-old untrained men. Scand J Med Sci Sports 24(Suppl 1):86–97CrossRefGoogle Scholar
  49. Sloth M, Sloth D, Overgaard K, Dalgas U (2013) Effects of sprint interval training on VO2max and aerobic exercise performance: a systematic review and meta-analysis: Effects of sprint interval training on VO2max. Scand J Med Sci Sports 23:e341–e352CrossRefGoogle Scholar
  50. Smithline HA, Ward KR, Chiulli DA, Blake HC, Rivers EP (2003) Whole body oxygen consumption and critical oxygen delivery in response to prolonged and severe carbon monoxide poisoning. Resuscitation 56(1):97–104CrossRefGoogle Scholar
  51. Srikanthan P, Karlamangla AS (2011) Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third national health and nutrition examination survey. J Clin Endocrinol Metab Sep 96(9):2898–2903CrossRefGoogle Scholar
  52. Turner CH, Robling AG (2003) Designing exercise regimens to increase bone strength. Exerc Sport Sci Rev: 31:45–50CrossRefGoogle Scholar
  53. Uth J, Hornstrup T, Schmidt JF, Christensen JF, Frandsen C, Christensen KB, Helge EW, Brasso K, Rørth M, Midtgaard J, Krustrup P (2014) Football training improves lean body mass in men with prostate cancer undergoing androgen deprivation therapy. Scand J Med Sci Sports 24:105–112CrossRefGoogle Scholar
  54. Vorup J, Pedersen MT, Brahe LK, Melcher PS, Alstrøm JM, Bangsbo J (2017) Effect of small-sided team sport training and protein intake on muscle mass, physical function and markers of health in older untrained adults: A randomized trial. PLoS One 12(10):e0186202CrossRefGoogle Scholar
  55. Weaver CM, Gordon CM, Janz KF, Lappe JM, Lewis R, O’Karma M, Wallace TC, Zemel BS (2016) The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 27(4):1281–1386CrossRefGoogle Scholar
  56. Wikman JM, Nistrup A, Vorup J, Pedersen MT, Melcher PS, Bangsbo J, Pfister G (2017) The effect of floorball training on health status, psychological health and social capital in older men. AIMS Public Health 4(4):364–382CrossRefGoogle Scholar
  57. Wild D, Von Maltzan R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L (2007) A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient Educ Couns 68:10–15CrossRefGoogle Scholar
  58. Williams PT (1997) Relationship of distance run per week to coronary heart disease risk factors in 8283 male runners: the National Runners’ Health Study. Arch Intern Med 157:191–198CrossRefGoogle Scholar
  59. Ziogas GG, Thomas TR, Harris WS (1997) Exercise training, postprandial hypertriglyceridemia, and LDL subfraction distribution. Med Sci Sports Exerc 29:986–991CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Therese Hornstrup
    • 1
    Email author
  • F. T. Løwenstein
    • 1
  • M. A. Larsen
    • 1
  • E. W. Helge
    • 1
  • S. Póvoas
    • 2
  • J. W. Helge
    • 3
  • J. J. Nielsen
    • 1
  • B. Fristrup
    • 1
  • J. L. Andersen
    • 4
  • L. Gliemann
    • 1
  • L. Nybo
    • 1
  • P. Krustrup
    • 5
    • 6
  1. 1.Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagen NDenmark
  2. 2.Research Center in Sports Sciences, Health Sciences and Human Development, CIDESDUniversity Institute of Maia, ISMAIMaiaPortugal
  3. 3.Center for Healthy Aging, Department of Biomedical SciencesUniversity of CopenhagenCopenhagen NDenmark
  4. 4.Institute of Sports Medicine CopenhagenBispebjerg HospitalCopenhagen NVDenmark
  5. 5.Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC)University of Southern DenmarkOdenseDenmark
  6. 6.Sport and Health Sciences, Faculty of Life and Environmental SciencesUniversity of ExeterExeterUK

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