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Peer-reviewedCC BY 4.0Frontiers in Public Health

Recreational football as medicine? A meta-analysis of its effects and feasibility in patients with chronic diseases

  • Kun Wei1,2
  • Gang Chen3
  • Tianle Wang4
  • Bo Wang5
5 affiliations
  1. 1Department of Physical Education, Henan Sport University
  2. 2School of Physical Education and Sport, Henan University
  3. 3Physical Education Department of Nanjing University
  4. 4School of Arts, Beijing Sport University
  5. 5School of Sport Science, Beijing Sport University
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Abstract

Objective: To quantitatively synthesise the effects of recreational football interventions on physiological and feasibility-related outcomes in people with chronic diseases.

Methods: PubMed, Web of Science, and the Cochrane Library were searched from inception to 6 February 2026, and additional searches of Scopus and Embase were conducted on 17 August 2026. Controlled trials of recreational football in adolescents and adults with selected chronic disease populations were eligible. Three-level random-effects meta-analyses were performed, with cluster-robust (CR2) variance estimation, clustering on the independent trial, applied to every outcome as a robustness check, and certainty of evidence was assessed using GRADE.

Results: Twenty-two study reports representing 17 unique trials (15 randomised and 2 non-randomised controlled trials; 588 unique participants) were included. Recreational football was associated with significant improvements in body fat percentage ( k = 13; SMD = −0.36, 95% CI − 0.57 to −0.14; p < 0.01), muscle mass ( k = 12; SMD = 0.22, 95% CI 0.01 to 0.44; p = 0.05), diastolic blood pressure ( k = 12; SMD = −0.53, 95% CI − 0.96 to −0.09; p = 0.02), mean arterial pressure ( k = 7; SMD = −0.89, 95% CI − 1.48 to −0.29; p = 0.01), resting heart rate ( k = 10; SMD = −1.01, 95% CI − 1.72 to −0.31; p = 0.01), VO₂peak ( k = 16; SMD = 0.70, 95% CI 0.37 to 1.03; p < 0.01), Yo-Yo Intermittent Endurance Test level 1 performance ( k = 4; SMD = 1.43, 95% CI 0.83 to 2.03; p < 0.01), triglycerides ( k = 11; SMD = −0.56, 95% CI − 0.91 to −0.22; p < 0.01), total cholesterol ( k = 11; SMD = −0.69, 95% CI − 1.08 to −0.30; p < 0.01), plasma osteocalcin ( k = 4; SMD = 1.07, 95% CI 0.53 to 1.60; p < 0.01), and P1NP ( k = 4; SMD = 1.28, 95% CI 0.22 to 2.34; p = 0.03). Borderline effects that were not retained under cluster-robust inference were observed for fat mass (SMD = −0.30; p = 0.05), systolic blood pressure (SMD = −0.60; p = 0.05) and LDL (SMD = −0.50; p = 0.05). No statistically significant pooled effects were observed for body weight (SMD = −0.29; p = 0.05), BMI (SMD = −0.06; p = 0.71), waist circumference (SMD = −0.48; p = 0.18), HbA1c (SMD = −0.28; p = 0.10), fasting glucose (SMD = −0.11; p = 0.48), fasting insulin (SMD = 0.07; p = 0.73), HDL (SMD = 0.10; p = 0.70), CRP (SMD = −0.88; p = 0.13), DXA-derived leg and whole-body bone mineral density or content (all p ≥ 0.11), or CTX-1 (SMD = 0.54; p = 0.19). Effects on body fat percentage, fat mass, muscle mass, SBP and LDL were sensitive to the assumed pre–post correlation. Under cluster-robust (CR2) inference the statistical interpretation was unchanged for 22 of the 27 outcomes; fat mass, SBP, LDL and P1NP were no longer significant (all p between 0.05 and 0.07) and whole-body bone mineral density became significant ( p = 0.03). Certainty of evidence was low to very low for most outcomes, and adverse events were summarized narratively because quantitative synthesis was not possible. Mean attendance was 82.7% across 13 independent trials, and mean attrition was 15.6% across 14 independent trials.

Conclusion: Across the selected chronic disease populations represented in the current evidence base, recreational football showed signals of potential benefit for cardiorespiratory fitness and selected cardiovascular, lipid, and bone-related outcomes, although adiposity- and bone-formation-related effects were less robust in sensitivity analyses. However, these findings should be interpreted cautiously due to heterogeneity and generally low or very low certainty of evidence. Recreational football may be considered a supervised adjunctive exercise option.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261365103 , Identifier CRD420261365103.

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Cite

BibTeXRIS
BibTeX
@article{wei2026recreational,
  title = {{Recreational football as medicine? A meta-analysis of its effects and feasibility in patients with chronic diseases}},
  author = {Kun Wei and Gang Chen and Tianle Wang and Bo Wang},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1869982},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1869982/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Recreational football as medicine? A meta-analysis of its effects and feasibility in patients with chronic diseases
AU  - Kun Wei
AU  - Gang Chen
AU  - Tianle Wang
AU  - Bo Wang
PY  - 2026
DA  - 2026/10/19
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1869982
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1869982/full
AB  - Objective: To quantitatively synthesise the effects of recreational football interventions on physiological and feasibility-related outcomes in people with chronic diseases.  Methods: PubMed, Web of Science, and the Cochrane Library were searched from inception to 6 February 2026, and additional searches of Scopus and Embase were conducted on 17 August 2026. Controlled trials of recreational football in adolescents and adults with selected chronic disease populations were eligible. Three-level random-effects meta-analyses were performed, with cluster-robust (CR2) variance estimation, clustering on the independent trial, applied to every outcome as a robustness check, and certainty of evidence was assessed using GRADE.  Results: Twenty-two study reports representing 17 unique trials (15 randomised and 2 non-randomised controlled trials; 588 unique participants) were included. Recreational football was associated with significant improvements in body fat percentage ( k = 13; SMD = −0.36, 95% CI − 0.57 to −0.14; p < 0.01), muscle mass ( k = 12; SMD = 0.22, 95% CI 0.01 to 0.44; p = 0.05), diastolic blood pressure ( k = 12; SMD = −0.53, 95% CI − 0.96 to −0.09; p = 0.02), mean arterial pressure ( k = 7; SMD = −0.89, 95% CI − 1.48 to −0.29; p = 0.01), resting heart rate ( k = 10; SMD = −1.01, 95% CI − 1.72 to −0.31; p = 0.01), VO₂peak ( k = 16; SMD = 0.70, 95% CI 0.37 to 1.03; p < 0.01), Yo-Yo Intermittent Endurance Test level 1 performance ( k = 4; SMD = 1.43, 95% CI 0.83 to 2.03; p < 0.01), triglycerides ( k = 11; SMD = −0.56, 95% CI − 0.91 to −0.22; p < 0.01), total cholesterol ( k = 11; SMD = −0.69, 95% CI − 1.08 to −0.30; p < 0.01), plasma osteocalcin ( k = 4; SMD = 1.07, 95% CI 0.53 to 1.60; p < 0.01), and P1NP ( k = 4; SMD = 1.28, 95% CI 0.22 to 2.34; p = 0.03). Borderline effects that were not retained under cluster-robust inference were observed for fat mass (SMD = −0.30; p = 0.05), systolic blood pressure (SMD = −0.60; p = 0.05) and LDL (SMD = −0.50; p = 0.05). No statistically significant pooled effects were observed for body weight (SMD = −0.29; p = 0.05), BMI (SMD = −0.06; p = 0.71), waist circumference (SMD = −0.48; p = 0.18), HbA1c (SMD = −0.28; p = 0.10), fasting glucose (SMD = −0.11; p = 0.48), fasting insulin (SMD = 0.07; p = 0.73), HDL (SMD = 0.10; p = 0.70), CRP (SMD = −0.88; p = 0.13), DXA-derived leg and whole-body bone mineral density or content (all p ≥ 0.11), or CTX-1 (SMD = 0.54; p = 0.19). Effects on body fat percentage, fat mass, muscle mass, SBP and LDL were sensitive to the assumed pre–post correlation. Under cluster-robust (CR2) inference the statistical interpretation was unchanged for 22 of the 27 outcomes; fat mass, SBP, LDL and P1NP were no longer significant (all p between 0.05 and 0.07) and whole-body bone mineral density became significant ( p = 0.03). Certainty of evidence was low to very low for most outcomes, and adverse events were summarized narratively because quantitative synthesis was not possible. Mean attendance was 82.7% across 13 independent trials, and mean attrition was 15.6% across 14 independent trials.  Conclusion: Across the selected chronic disease populations represented in the current evidence base, recreational football showed signals of potential benefit for cardiorespiratory fitness and selected cardiovascular, lipid, and bone-related outcomes, although adiposity- and bone-formation-related effects were less robust in sensitivity analyses. However, these findings should be interpreted cautiously due to heterogeneity and generally low or very low certainty of evidence. Recreational football may be considered a supervised adjunctive exercise option.  Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261365103 , Identifier CRD420261365103.
SN  - 2296-2565
ER  -