{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T06:03:18Z","timestamp":1771048998743,"version":"3.50.1"},"reference-count":59,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T00:00:00Z","timestamp":1618272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>This systematic review with meta-analysis was conducted to assess the effects of small-sided games (SSG)-based training programs on bone mineral density (BMD) in untrained adults. The data sources utilized were Cochrane, Embase, Medline (PubMed), Scopus, SPORTDiscus, and Web of Science. The study eligibility criteria were: (i) untrained adults (&gt;18 years old) of any sex, with or without a noncommunicable disease; (ii) SSG-based programs with a minimum duration of four weeks and no restrictions regarding frequency (number of sessions per week); (iii) passive or active control groups; (iv) pre-post values of BMD; (v) only randomized controlled trials; and (vi) only original and full-text studies written in English. The database search initially yielded 374 titles. From those, nine articles were eligible for the systematic review and meta-analysis. The age of included population varied from a minimum of 20 and a maximum of 71 years old. Non-significant differences between SSG and passive and active control groups on total BMD (ES = 0.14; p = 0.405 and ES = 0.28; p = 0.05, respectively). Meanwhile, significant differences in favor of SSGs vs. passive and control groups were detected, evidencing an improvement of BMD in lower limbs of the adult population for both sexes (ES = 0.26; p = 0.05 and ES = 0.28; p = 0.156, respectively). As conclusions, SSGs can be used as a non-pharmacological alternative to increase the BMD in the lower limbs despite having no significant impact on total body BMD. Careful generalization should be done of the level of heterogeneity.<\/jats:p>","DOI":"10.3390\/healthcare9040457","type":"journal-article","created":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T22:55:09Z","timestamp":1618354509000},"page":"457","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Effects of Recreational Small-Sided Soccer Games on Bone Mineral Density in Untrained Adults: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9813-2842","authenticated-orcid":false,"given":"Filipe Manuel","family":"Clemente","sequence":"first","affiliation":[{"name":"Escola Superior Desporto e Lazer, Instituto Polit\u00e9cnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun\u2019\u00c1lvares, 4900-347 Viana do Castelo, Portugal"},{"name":"Instituto de Telecomunica\u00e7\u00f5es, Delega\u00e7\u00e3o da Covilh\u00e3, 1049-001 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2035-3279","authenticated-orcid":false,"given":"Rodrigo","family":"Ramirez-Campillo","sequence":"additional","affiliation":[{"name":"Human Performance Laboratory, Department of Physical Activity Sciences, Universidad de Los Lagos, Lord Cochrane 1046, Osorno 5290000, Chile"},{"name":"Centro de Investigaci\u00f3n en Fisiolog\u00eda del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago 7500000, Chile"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8681-0642","authenticated-orcid":false,"given":"Hugo","family":"Sarmento","sequence":"additional","affiliation":[{"name":"University of Coimbra, Coimbra 3004-531, Portugal"},{"name":"Research Unit for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, 3004-531 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4159-6475","authenticated-orcid":false,"given":"Daniel","family":"Castillo","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Universidad Isabel I, 09003 Burgos, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3570-7159","authenticated-orcid":false,"given":"Javier","family":"Raya-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Universidad Isabel I, 09003 Burgos, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6436-6306","authenticated-orcid":false,"given":"Thomas","family":"Rosemann","sequence":"additional","affiliation":[{"name":"Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2412-9103","authenticated-orcid":false,"given":"Beat","family":"Knechtle","sequence":"additional","affiliation":[{"name":"Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland"},{"name":"Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.5324\/nje.v20i2.1338","article-title":"Physical activity and bone: The importance of the various mechanical stimuli for bone mineral density. A review","volume":"20","author":"Morseth","year":"2011","journal-title":"Norsk Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.csm.2017.05.006","article-title":"Osteopenia and osteoporosis in female athletes","volume":"36","author":"MacKnight","year":"2017","journal-title":"Clin. Sports Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"233002","DOI":"10.1088\/1361-6463\/aa6e18","article-title":"Review of cellular mechanotransduction","volume":"50","author":"Wang","year":"2017","journal-title":"J. Phys. D Appl. Phys."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/jor.1100130405","article-title":"Proposal for the regulatory mechanism of Wolff\u2019s law","volume":"13","author":"Mullender","year":"1995","journal-title":"J. Orthop. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1615\/CritRevEukarGeneExpr.v19.i4.50","article-title":"Mechanical signaling for bone modeling and remodeling","volume":"19","author":"Robling","year":"2009","journal-title":"Crit. Rev. Eukaryot. Gene Express."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1139\/h06-051","article-title":"Mechanisms of bone remodeling during weight-bearing exercise","volume":"31","author":"Zernicke","year":"2006","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"439","DOI":"10.2165\/00007256-200939060-00002","article-title":"Exercise and bone mass in adults","volume":"39","author":"Fuentes","year":"2009","journal-title":"Sport Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1007\/s00198-018-4482-0","article-title":"Exercise effects on bone mineral density in older men: A systematic review with special emphasis on study interventions","volume":"29","author":"Kemmler","year":"2018","journal-title":"Osteoporos. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/BF00302070","article-title":"Mechanotransduction and the functional response of bone to mechanical strain","volume":"57","author":"Duncan","year":"1995","journal-title":"Calcif. Tissue Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00198-002-1345-4","article-title":"Bone strength and its determinants","volume":"14","author":"Ammann","year":"2003","journal-title":"Osteoporos. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s001980200000","article-title":"Biomechanics of bone: Determinants of skeletal fragility and bone quality","volume":"13","author":"Turner","year":"2002","journal-title":"Osteoporos. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1359\/JBMR.050304","article-title":"Predictive value of BMD for hip and other fractures","volume":"20","author":"Johnell","year":"2005","journal-title":"J. Bone Miner. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1001\/jama.288.15.1889","article-title":"Clinical use of bone densitometry","volume":"288","author":"Cummings","year":"2002","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s00223-020-00744-w","article-title":"Effects of different types of exercise on bone mineral density in postmenopausal women: A systematic review and meta-analysis","volume":"107","author":"Kemmler","year":"2020","journal-title":"Calcif. Tissue Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.apmr.2007.02.012","article-title":"The effects of tai chi on bone mineral density in postmenopausal women: A systematic review","volume":"88","author":"Wayne","year":"2007","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s00774-009-0139-6","article-title":"Effects of different impact exercise modalities on bone mineral density in premenopausal women: A meta-analysis","volume":"28","author":"Carroll","year":"2010","journal-title":"J. Bone Miner. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.rbr.2015.09.010","article-title":"Swimming and cycling do not cause positive effects on bone mineral density: A systematic review","volume":"56","author":"Abrahin","year":"2016","journal-title":"Rev. Bras. Reumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s40279-015-0427-3","article-title":"The effect of swimming during childhood and adolescence on bone mineral density: A Systematic review and meta-analysis","volume":"46","author":"Moreno","year":"2016","journal-title":"Sport Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"103","DOI":"10.2165\/00007256-199519020-00003","article-title":"Exercise and bone mineral density","volume":"19","author":"Chilibeck","year":"1995","journal-title":"Sport Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S212","DOI":"10.1016\/S0197-2456(00)00081-7","article-title":"Exercise adherence among older adults","volume":"21","author":"Chao","year":"2000","journal-title":"Control. Clin. Trials"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.amepre.2011.05.013","article-title":"Adults\u2019 sedentary behavior","volume":"41","author":"Owen","year":"2011","journal-title":"Am. J. Prev. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"48","DOI":"10.4236\/psych.2015.61005","article-title":"Enjoyment during exercise mediates the effects of an intervention on exercise adherence","volume":"06","author":"Jekauc","year":"2015","journal-title":"Psychology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jshs.2017.12.001","article-title":"Recreational team sports: The motivational medicine","volume":"7","author":"Castagna","year":"2018","journal-title":"J. Sport Healh Sci."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Clemente, F.M., Afonso, J., and Sarmento, H. (2021). Small-sided games: An umbrella review of systematic reviews and meta-analyses. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247067"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1080\/24748668.2018.1517288","article-title":"Small sided games in soccer\u2014a systematic review","volume":"18","author":"Sarmento","year":"2018","journal-title":"Int. J. Perform. Anal. Sport"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/j.1600-0838.2010.01106.x","article-title":"Executive summary: The health and fitness benefits of regular participation in small-sided football games","volume":"20","author":"Krustrup","year":"2010","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/sms.13611","article-title":"Recreational football is medicine against non-communicable diseases: A systematic review","volume":"30","author":"Sarmento","year":"2020","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e000336","DOI":"10.1136\/bmjsem-2017-000336","article-title":"Recreational soccer as sport medicine for middle-aged and older adults: A systematic review","volume":"4","author":"Luo","year":"2018","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1136\/bjsports-2017-097885","article-title":"Broad-spectrum physical fitness benefits of recreational football: A systematic review and meta-analysis","volume":"53","author":"Mohr","year":"2019","journal-title":"Br. J. Sports Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s40279-019-01256-w","article-title":"Effects of small-sided soccer games on physical fitness, physiological responses, and health indices in untrained individuals and clinical populations: A systematic review","volume":"50","author":"Zouhal","year":"2020","journal-title":"Sport Med."},{"key":"ref_31","unstructured":"Green, S., and Higgins, J. (2005). Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_33","unstructured":"Collaboration, C. (2021, January 02). Data Extraction Template for Included Studies. Available online: https:\/\/cccrg.cochrane.org\/sites\/cccrg.cochrane.org\/files\/public\/uploads\/det_2015_revised_final_june_20_2016_nov_29_revised.doc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"215","DOI":"10.3102\/1076998609346961","article-title":"How many studies do you need?","volume":"35","author":"Valentine","year":"2010","journal-title":"J. Educ. Behav. Stat."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1080\/02640414.2020.1776002","article-title":"Power, precision, and sample size estimation in sport and exercise science research","volume":"38","author":"Abt","year":"2020","journal-title":"J. Sports Sci."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Higgins, J.P., and Green, S. (2008). Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions, The Cochrane Collaboration.","DOI":"10.1002\/9780470712184"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Kontopantelis, E., Springate, D.A., and Reeves, D. (2013). A re-analysis of the cochrane library data: The dangers of unobserved heterogeneity in meta-analyses. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0069930"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1249\/MSS.0b013e31818cb278","article-title":"Progressive statistics for studies in sports medicine and exercise science","volume":"41","author":"Hopkins","year":"2009","journal-title":"Med. Sci. Sport. Exerc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and Fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e15987","DOI":"10.1097\/MD.0000000000015987","article-title":"The trim-and-fill method for publication bias","volume":"98","author":"Shi","year":"2019","journal-title":"Medicine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1080\/02640414.2014.906043","article-title":"Soccer and Zumba as health-promoting activities among female hospital employees: A 40-weeks cluster randomised intervention study","volume":"32","author":"Barene","year":"2014","journal-title":"J. Sports Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/sms.12239","article-title":"Recreational football improves bone mineral density and bone turnover marker profile in elderly men","volume":"24","author":"Helge","year":"2014","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/j.1600-0838.2010.01107.x","article-title":"Recreational football training decreases risk factors for bone fractures in untrained premenopausal women","volume":"20","author":"Helge","year":"2010","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1111\/j.1600-0838.2010.01111.x","article-title":"Long-term musculoskeletal and cardiac health effects of recreational football and running for premenopausal women","volume":"20","author":"Krustrup","year":"2010","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1136\/bjsm.2008.053124","article-title":"Recreational soccer is an effective health-promoting activity for untrained men","volume":"43","author":"Krustrup","year":"2009","journal-title":"Br. J. Sports Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1007\/s00421-015-3231-8","article-title":"Effects of soccer vs swim training on bone formation in sedentary middle-aged women","volume":"115","author":"Mohr","year":"2015","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/j.1600-0838.2010.01091.x","article-title":"Positive performance and health effects of a football training program over 12 weeks can be maintained over a 1-year period with reduced training frequency","volume":"20","author":"Randers","year":"2010","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/sms.13252","article-title":"Osteogenic impact of football training in 55 to 70-year-old women and men with prediabetes","volume":"28","author":"Skoradal","year":"2018","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s00421-015-3301-y","article-title":"Football training in men with prostate cancer undergoing androgen deprivation therapy: Activity profile and short-term skeletal and postural balance adaptations","volume":"116","author":"Uth","year":"2016","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1002\/jbmr.3070","article-title":"Dietary inflammatory index, bone mineral density, and risk of fracture in postmenopausal women: Results from the women\u2019s health initiative","volume":"32","author":"Orchard","year":"2017","journal-title":"J. Bone Miner. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"5567","DOI":"10.3390\/ijerph110605567","article-title":"Community-based recreational football: A novel approach to promote physical activity and quality of life in prostate cancer survivors","volume":"11","author":"Bruun","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/4840531","article-title":"The effectiveness of physical exercise on bone density in osteoporotic patients","volume":"2018","author":"Benedetti","year":"2018","journal-title":"Biomed Res. Int."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Castillo, D., Raya-gonz\u00e1lez, J., Yanci, J., and Clemente, F.M. (2021). Influence of pitch size on short-term high intensity actions and body impacts in soccer sided games. J. Hum. Kinet.","DOI":"10.2478\/hukin-2021-0037"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1055\/s-0028-1105950","article-title":"Analysis of high intensity activity in premier league soccer","volume":"30","author":"Gregson","year":"2009","journal-title":"Int. J. Sports Med."},{"key":"ref_57","first-page":"8","article-title":"What do we currently know from in vivo bone strain measurements in humans?","volume":"11","author":"Yang","year":"2011","journal-title":"J. Musculoskelet. Neuronal Interact."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/00003677-200301000-00009","article-title":"Designing exercise regimens to increase bone strength","volume":"31","author":"Turner","year":"2003","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s10067-010-1648-3","article-title":"Relative value of the lumbar spine and hip bone mineral density and bone turnover markers in men with ankylosing spondylitis","volume":"30","author":"Muntean","year":"2011","journal-title":"Clin. Rheumatol."}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/9\/4\/457\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:47:41Z","timestamp":1760161661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/9\/4\/457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,13]]},"references-count":59,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["healthcare9040457"],"URL":"https:\/\/doi.org\/10.3390\/healthcare9040457","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,13]]}}}