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



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.

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Fig. 5



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

VO2max :

Maximal oxygen uptake

Yo–Yo IE1:

Yo–Yo intermittent endurance level 1 test


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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).

Author information




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.

Corresponding author

Correspondence to Therese Hornstrup.

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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.

Additional information

Communicated by I. Mark Olfert.

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Hornstrup, T., Løwenstein, F.T., Larsen, M.A. et al. Cardiovascular, muscular, and skeletal adaptations to recreational team handball training: a randomized controlled trial with young adult untrained men. Eur J Appl Physiol 119, 561–573 (2019).

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