{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T16:01:34Z","timestamp":1768320094160,"version":"3.49.0"},"reference-count":83,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T00:00:00Z","timestamp":1725408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Portuguese Foundation for Science and Technology (FCT), I.P.","award":["UIDP\/05913\/2020"],"award-info":[{"award-number":["UIDP\/05913\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background\/Objectives: Swimming is a popular and cost-effective way to prevent sedentary behavior and improve physical conditioning and health during early adolescence. However, information on its impact and benefits on daily life activities is lacking. This systematic review aims to summarize the chronic effects of swimming on physical conditioning and physical health outcomes in early adolescents. Methods: The PRISMA 2020 guidelines were followed and PubMed, Scopus, Web of Science, and International Symposium of Biomechanics and Medicine in Swimming proceedings databases were searched. Eligibility criteria were defined on the PICOS framework (healthy adolescents in early puberty, swimming programmes or training, passive or active control groups, general effects on physical conditioning or health, longitudinal) and risk of bias was assessed using RoBANS 2. Results: From 2365 records, 20 non-randomized studies met the defined criteria. High heterogeneity in sample size and intervention was observed. While studies related to physical conditioning (n = 5) focused on physiological variables and muscular function, the evidence regarding physical health outcomes (n = 15) explored bone accrual, haemodynamics, body composition, musculoskeletal system, and lung growth. High overall risk of bias (70%) was observed due to strict criteria. Conclusions: Swimming exercise seems to improve cardiorespiratory fitness, cardiac output, haemodynamics, heart growth, motor performance, and body composition of early adolescents. Despite clear evidence that exists on these chronic effects, research on bone health, postural deficit, motor skills, and sleep quality is still missing.<\/jats:p>","DOI":"10.3390\/jfmk9030158","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T09:57:47Z","timestamp":1725443867000},"page":"158","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effects of Swimming Exercise on Early Adolescents\u2019 Physical Conditioning and Physical Health: A Systematic Review"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2070-2064","authenticated-orcid":false,"given":"Francisco A.","family":"Ferreira","sequence":"first","affiliation":[{"name":"Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4050-450 Porto, Portugal"},{"name":"Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sport, University of Porto, 4050-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4592-8091","authenticated-orcid":false,"given":"Catarina C.","family":"Santos","sequence":"additional","affiliation":[{"name":"Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4050-450 Porto, Portugal"},{"name":"Polytechnic Institute of Coimbra, Coimbra Education School, 3030-329 Coimbra, Portugal"},{"name":"Department of Sport Sciences, Higher Institute of Educational Sciences of the Douro (ISCE-Douro), 4560-547 Penafiel, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6508-0599","authenticated-orcid":false,"given":"Ant\u00f3nio L.","family":"Palmeira","sequence":"additional","affiliation":[{"name":"Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4050-450 Porto, Portugal"},{"name":"Centro de Investiga\u00e7\u00e3o em Desporto, Educa\u00e7\u00e3o F\u00edsica, Exerc\u00edcio e Sa\u00fade (CIDEFES), Universidade Lus\u00f3fona, 1749-024 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5811-0443","authenticated-orcid":false,"given":"Ricardo J.","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4050-450 Porto, Portugal"},{"name":"Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sport, University of Porto, 4050-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5502-1202","authenticated-orcid":false,"given":"M\u00e1rio J.","family":"Costa","sequence":"additional","affiliation":[{"name":"Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4050-450 Porto, Portugal"},{"name":"Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sport, University of Porto, 4050-450 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"World Health Organization (1946). Constitution of the World Health Organization. Am. J. Public Health Nation Health, 36, 769\u2013773.","DOI":"10.2105\/AJPH.36.11.1315"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/MOP.0000000000000606","article-title":"Measurement Framework for the Environmental Influences on Child Health Outcomes Research Program","volume":"30","author":"Blackwell","year":"2018","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_3","first-page":"55","article-title":"Health, Disease, and Illness as Conceptual Tools","volume":"1","author":"Amzat","year":"2014","journal-title":"Med. Sociol. Afr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/00008480-199408000-00003","article-title":"Physical Conditioning in Adolescents","volume":"6","author":"Purcell","year":"1994","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_5","first-page":"1246","article-title":"Tracking Physical Fitness and Physical Activity from Childhood to Adolescence: The Muscatine Study","volume":"31","author":"Janz","year":"1999","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1123\/pes.20.3.251","article-title":"Longitudinal Stability of Sedentary Behaviors and Physical Activity During Early Adolescence","volume":"20","author":"Raudsepp","year":"2008","journal-title":"Pediatr. Exerc. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1080\/02640414.2011.585166","article-title":"Adolescent Physical Fitness and Activity as Predictors of Adulthood Activity","volume":"29","author":"Huotari","year":"2011","journal-title":"J. Sports Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1080\/17461391.2011.566368","article-title":"Motor Coordination, Physical Activity and Fitness as Predictors of Longitudinal Change in Adiposity during Childhood","volume":"12","author":"Lopes","year":"2012","journal-title":"Eur. J. Sport Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S2352-4642(18)30022-1","article-title":"The Age of Adolescence","volume":"2","author":"Sawyer","year":"2018","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_10","first-page":"271","article-title":"A Conceptual Framework for Early Adolescence: A Platform for Research","volume":"55","author":"Blum","year":"2014","journal-title":"J. Adolesc. Health"},{"key":"ref_11","unstructured":"OECD, and WHO (2023). Step Up! Tackling the Burden of Insufficient Physical Activity in Europe, OECD Publishing."},{"key":"ref_12","unstructured":"Inchley, J., Currie, D., Budisavljevic, S., Torsheim, T., J\u00e5stad, A., Cosma, A., Kelly, C., Arnarsson, \u00c1.M., and Samdal, O. (2020). Spotlight on Adolescent Health and Well-Being. Findings from the 2017\/2018 Health Behaviour in School-Aged Children (HBSC) Survey in Europe and Canada. International Report. Volume 2: Key Data, WHO Regional Office for Europe."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Nystoriak, M.A., and Bhatnagar, A. (2018). Cardiovascular Effects and Benefits of Exercise. Front. Cardiovasc. Med., 5.","DOI":"10.3389\/fcvm.2018.00135"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Rodriguez, A., Korzeniowska, K., Szarejko, K., Borowski, H., Brzezi\u0144ski, M., My\u015bliwiec, M., Czupryniak, L., Berggren, P.O., Radziwi\u0142\u0142, M., and Soszy\u0144ski, P. (2022). Fitness, Food, and Biomarkers: Characterizing Body Composition in 19,634 Early Adolescents. Nutrients, 14.","DOI":"10.3390\/nu14071369"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/S2213-8587(22)00047-X","article-title":"Obesity in Children and Adolescents: Epidemiology, Causes, Assessment, and Management","volume":"10","author":"Jebeile","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12966-021-01113-y","article-title":"The Effect of a One-Year Vigorous Physical Activity Intervention on Fitness, Cognitive Performance and Mental Health in Young Adolescents: The Fit to Study Cluster Randomised Controlled Trial","volume":"18","author":"Wassenaar","year":"2021","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_17","first-page":"37","article-title":"Bone Health, Activity and Sedentariness at Age 11\u201312 Years: Cross-Sectional Australian Population-Derived Study","volume":"114","author":"Osborn","year":"2018","journal-title":"Bone"},{"key":"ref_18","first-page":"578","article-title":"Adherence to 24-Hour Movement Recommendations and Health Indicators in Early Adolescence: Cross-Sectional and Longitudinal Associations in the Adolescent Brain Cognitive Development Study","volume":"73","author":"Fung","year":"2023","journal-title":"J. Adolesc. Health"},{"key":"ref_19","first-page":"100556","article-title":"Associations Between Physical Activity and Mental Health and Behaviour in Early Adolescence","volume":"28","author":"Booth","year":"2023","journal-title":"Ment. Health Phys. Act."},{"key":"ref_20","unstructured":"U.S. Department of Health and Human Services (2018). Physical Activity Guidelines for Americans, U.S. Department of Health and Human Services. [2nd ed.]."},{"key":"ref_21","first-page":"185","article-title":"Sink or Swim: Promoting Youth Development through Aquatics Programs in Baltimore, Maryland","volume":"35","author":"Storm","year":"2017","journal-title":"J. Park Recreat. Adm."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1515\/hukin-2015-0120","article-title":"Physiological Adaptations to Training in Competitive Swimming: A Systematic Review","volume":"49","author":"Costa","year":"2015","journal-title":"J. Hum. Kinet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1007\/s40279-017-0805-0","article-title":"Chronic Physiological Effects of Swim Training Interventions in Non-Elite Swimmers: A Systematic Review and Meta-Analysis","volume":"48","author":"Lahart","year":"2018","journal-title":"Sports Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zhao, K., Hohmann, A., Chang, Y., Zhang, B., Pion, J., and Gao, B. (2019). Physiological, Anthropometric, and Motor Characteristics of Elite Chinese Youth Athletes from Six Different Sports. Front. Physiol., 10.","DOI":"10.3389\/fphys.2019.00405"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Machado, E., Jannuzzi, F., Telles, S., Oliveira, C., Madeira, I., Sicuro, F., Souza, M.D.G., Monteiro, A., Bouskela, E., and Collett-Solberg, P. (2022). A Recreational Swimming Intervention During the Whole School Year Improves Fitness and Cardiometabolic Risk in Children and Adolescents with Overweight and Obesity. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192417093"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1123\/ijspp.2020-0463","article-title":"The Relationships Between Training Load, Type of Sport, and Sleep Among High-Level Adolescent Athletes","volume":"16","author":"Aloulou","year":"2021","journal-title":"Int. J. Sports Physiol. Perform."},{"key":"ref_27","first-page":"1141","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":"Sports Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Sinclair, L., and Roscoe, C.M.P. (2023). The Impact of Swimming on Fundamental Movement Skill Development in Children (3\u201311 Years): A Systematic Literature Review. Children, 10.","DOI":"10.3390\/children10081411"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Yu, S., Liu, L., Li, M., He, S., Hu, Y., Sun, S., Yan, Y., Zhao, F., Cheng, X., and Li, J. (2024). Swimming Behavior Indicates Stress and Adaptations to Exercise. Front. Physiol., 15.","DOI":"10.3389\/fphys.2024.1357120"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"Br. Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ferreira, F.A., Santos, C.C., Palmeira, A.L., Fernandes, R.J., and Costa, M.J. (2023). Effects of Swimming Exercise on Early Adolescents\u2019 Physical Conditioning and Physical Health: A Protocol for Systematic Review, INPLASY Protocol. INPLASY2023100078.","DOI":"10.3390\/jfmk9030158"},{"key":"ref_32","unstructured":"(2023, December 18). International Symposium on Biomechanics and Medicine in Swimming. International Council Biomechanics and Medicine in Swimming. Available online: https:\/\/www.iat.uni-leipzig.de\/datenbanken\/iks\/bms\/."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4082\/kjfm.23.0034","article-title":"RoBANS 2: A Revised Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions","volume":"44","author":"Seo","year":"2023","journal-title":"Korean J. Fam. Med."},{"key":"ref_34","first-page":"9","article-title":"The Effect of Swimming Training on Muscular Performance and Body Composition in Children","volume":"50","author":"Clarke","year":"1979","journal-title":"Res. Q."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1007\/s00421-014-2890-1","article-title":"Longitudinal Investigation of Training Status and Cardiopulmonary Responses in Pre- and Early-Pubertal Children","volume":"114","author":"McNarry","year":"2014","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Blume, K., and Wolfarth, B. (2019). Identification of Potential Performance-Related Predictors in Young Competitive Athletes. Front. Physiol., 10.","DOI":"10.3389\/fphys.2019.01394"},{"key":"ref_37","first-page":"21","article-title":"Investigating the Modulatory Role of Chronological and Biological Age on Performance Predictors in Youth Swimmers","volume":"2","author":"McNarry","year":"2020","journal-title":"J. Sci. Sport Exerc."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Zarzeczny, R., Kuberski, M., and Suliga, E. (2022). The Effect of Three-Year Swim Training on Cardio-Respiratory Fitness and Selected Somatic Features of Prepubertal Boys. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19127125"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1134\/S0362119709040069","article-title":"Functional Characteristics of Hemodynamics in Adolescents Under the Conditions of Different Motor Activities","volume":"35","author":"Luchitskaya","year":"2009","journal-title":"Hum. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"313","DOI":"10.3109\/01460862.2013.777818","article-title":"Do Swimming Exercises Induce Anthropometric Changes in Adolescents?","volume":"36","author":"Bielec","year":"2013","journal-title":"Issues Compr. Pediatr. Nurs."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jbspin.2012.01.006","article-title":"Bone Health during Late Adolescence: Effects of an 8-Month Training Program on Bone Geometry in Female Athletes","volume":"80","author":"Ferry","year":"2013","journal-title":"Jt. Bone Spine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1080\/17461391.2014.908957","article-title":"Does a Water-Training Macrocycle Really Create Imbalances in Swimmers\u2019 Shoulder Rotator Muscles?","volume":"15","author":"Batalha","year":"2015","journal-title":"Eur. J. Sport Sci."},{"key":"ref_43","first-page":"813","article-title":"Atrial Chamber Remodelling in Healthy Pre-Adolescent Athletes Engaged in Endurance Sports: A Study with a Longitudinal Design. The CHILD Study","volume":"222","author":"Solari","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_44","first-page":"57","article-title":"Longitudinal Effects of Swimming on Bone in Adolescents: A pQCT and DXA Study","volume":"34","author":"Casajus","year":"2017","journal-title":"Biol. Sport"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1002\/jbmr.3206","article-title":"Longitudinal Adaptations of Bone Mass, Geometry, and Metabolism in Adolescent Male Athletes: The PRO-BONE Study","volume":"32","author":"Vlachopoulos","year":"2017","journal-title":"J. Bone Miner. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e13816","DOI":"10.14814\/phy2.13816","article-title":"Does Competitive Swimming Affect Lung Growth?","volume":"6","author":"Bovard","year":"2018","journal-title":"Physiol. Rep."},{"key":"ref_47","first-page":"94","article-title":"Longitudinal Determinants of 12-Month Changes on Bone Health in Adolescent Male Athletes","volume":"13","author":"Vlachopoulos","year":"2018","journal-title":"Arch. Osteoporos."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.jsams.2017.08.018","article-title":"The Effect of 12-Month Participation in Osteogenic and Non-Osteogenic Sports on Bone Development in Adolescent Male Athletes. The PRO-BONE Study","volume":"21","author":"Vlachopoulos","year":"2018","journal-title":"J. Sci. Med. Sport"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/JSM.0000000000000484","article-title":"Bone Accrual in Children and Adolescent Nonelite Swimmers: A 2-Year Longitudinal Study","volume":"29","author":"Collins","year":"2019","journal-title":"Clin. J. Sport Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s11657-020-00727-2","article-title":"Bone Accrual over 18 Months of Participation in Different Loading Sports during Adolescence","volume":"15","author":"Agostinete","year":"2020","journal-title":"Arch. Osteoporos."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Zhao, K., Hohmann, A., Faber, I., Chang, Y., and Gao, B. (2020). A 2-Year Longitudinal Follow-Up of Performance Characteristics in Chinese Male Elite Youth Athletes from Swimming and Racket Sports. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0239155"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Bielec, G., Gozdziejewska, A., and Makar, P. (2021). Changes in Body Composition and Anthropomorphic Measurements in Children Participating in Swimming and Non-Swimming Activities. Children, 8.","DOI":"10.3390\/children8070529"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Costa, D.C., Valente-Dos-Santos, J., Sousa-E-Silva, P., Martinho, D.V., Duarte, J.P., Tavares, O.M., Castanheira, J.M., Oliveira, T.G., Abreu, S., and Leite, N. (2022). Growth, Body Composition and Bone Mineral Density among Pubertal Male Athletes: Intra-Individual 12-Month Changes and Comparisons between Soccer Players and Swimmers. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03321-2"},{"key":"ref_54","first-page":"79","article-title":"Risk-of-Bias VISualization (robvis): An R Package and Shiny Web App for Visualizing Risk-of-Bias Assessments","volume":"11","author":"McGuinness","year":"2020","journal-title":"Res. Synth. Methods"},{"key":"ref_55","first-page":"E537","article-title":"Longitudinal Studies","volume":"7","author":"Caruana","year":"2015","journal-title":"J. Thorac. Dis."},{"key":"ref_56","first-page":"365","article-title":"Propulsive Forces in Human Competitive Swimming: A Systematic Review on Direct Assessment Methods","volume":"20","author":"Santos","year":"2021","journal-title":"Sports Biomech."},{"key":"ref_57","first-page":"323","article-title":"The Relationship between Tethered Swimming, Anaerobic Critical Velocity, Dry-Land Strength, and Swimming Performance","volume":"22","author":"Gay","year":"2022","journal-title":"Int. J. Perform. Anal. Sport"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1249\/00005768-199103000-00017","article-title":"Adaptations to Swimming Training: Influence of Training Volume","volume":"23","author":"Costill","year":"1991","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1136\/bjsports-2015-095681","article-title":"Swimming in H2O: Two Parts Heart + One Part Obsession","volume":"50","author":"Mountjoy","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_60","first-page":"119","article-title":"Sedentary Patterns, Physical Activity and Health-Related Physical Fitness in Youth: A Cross-Sectional Study","volume":"14","author":"Silva","year":"2017","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_61","unstructured":"Bouchard, C. (2015). Molecular and Cellular Regulation of Adaptation to Exercise (Progress in Molecular Biology and Translational Science), Academic Press. [1st ed.]."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1249\/MSS.0000000000000580","article-title":"Exercise Modality Effect on Bioenergetical Performance at VO2max Intensity","volume":"47","author":"Sousa","year":"2015","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Tuan, S.H., Chen, G.B., Chen, C.H., Chen, Y.J., Liou, I.H., Su, Y.T., and Lin, K.L. (2021). Comparison of Peak Oxygen Consumption During Exercise Testing Between Sexes Among Children and Adolescents in Taiwan. Front. Pediatr., 9.","DOI":"10.3389\/fped.2021.657551"},{"key":"ref_64","first-page":"111","article-title":"Importance of Hemoglobin Concentration to Exercise: Acute Manipulations","volume":"144","author":"Calbet","year":"2006","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_65","first-page":"1072","article-title":"Increased Cardiac Output and Maximal Oxygen Uptake in Response to Ten Sessions of High Intensity Interval Training","volume":"58","author":"Astorino","year":"2018","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1532-429X-12-8","article-title":"Relation Between Cardiac Dimensions and Peak Oxygen Uptake","volume":"12","author":"Steding","year":"2010","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_67","unstructured":"King, J., and Lowery, D.R. (2023). Physiology, Cardiac Output, StatPearls Publishing."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1034\/j.1600-0838.2002.120104.x","article-title":"Adaptation of Cardiac Morphology and Function to Endurance and Strength Training: A Comparative Study Using MR Imaging and Echocardiography in Males and Females","volume":"12","author":"Wernstedt","year":"2002","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2165\/00007256-199724040-00003","article-title":"Cardiovascular Responses to Exercise in Children","volume":"24","author":"Turley","year":"1997","journal-title":"Sports Med."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Rafailakis, L., Deli, C.K., Fatouros, I.G., Tsiokanos, A., Draganidis, D., Poulios, A., Soulas, D., and Jamurtas, A.Z. (2023). Functional and Morphological Adaptations in the Heart of Children Aged 12\u201314 Years Following Two Different Endurance Training Protocols. Sports, 11.","DOI":"10.3390\/sports11080157"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1080\/17461391.2020.1789228","article-title":"Cardiac Adaptation to Endurance Exercise Training: Differential Impact of Swimming and Running","volume":"21","author":"Martinez","year":"2021","journal-title":"Eur. J. Sport Sci."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Elamin, A.B.A., Forsat, K., Senok, S.S., and Goswami, N. (2023). Vagus Nerve Stimulation and Its Cardioprotective Abilities: A Systematic Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12051717"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"a034173","DOI":"10.1101\/cshperspect.a034173","article-title":"Vagus Nerve Stimulation and the Cardiovascular System","volume":"10","author":"Capilupi","year":"2020","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Pinckard, K., Baskin, K.K., and Stanford, K.I. (2019). Effects of Exercise to Improve Cardiovascular Health. Front. Cardiovasc. Med., 6.","DOI":"10.3389\/fcvm.2019.00069"},{"key":"ref_75","first-page":"256","article-title":"The Effects of Aerobic Physical Activity on Adiposity in School-Aged Children and Youth: A Systematic Review of Randomized Controlled Trials","volume":"55","author":"Laframboise","year":"2011","journal-title":"J. Can. Chiropr. Assoc."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Webster, E.K., Sur, I., Stevens, A., and Robinson, L.E. (2021). Associations Between Body Composition and Fundamental Motor Skill Competency in Children. BMC Pediatr., 21.","DOI":"10.1186\/s12887-021-02912-9"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1123\/jpah.2016-0473","article-title":"Physical Activity and Motor Competence Present a Positive Reciprocal Longitudinal Relationship Across Childhood and Early Adolescence","volume":"14","author":"Lima","year":"2017","journal-title":"J. Phys. Act. Health"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40279-023-01886-1","article-title":"Associations Between Motor Competence and Physical Activity, Physical Fitness and Psychosocial Characteristics in Adolescents: A Systematic Review and Meta-Analysis","volume":"53","author":"Burton","year":"2023","journal-title":"Sports Med."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Costa, J.A., Vale, S., Rodrigues, L.P., Brito, J., and Seabra, A. (2024). A School-Based Physical Activity Intervention in Primary School: Effects on Physical Activity, Sleep, Aerobic Fitness and Motor Competence. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1365782"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s12662-022-00849-4","article-title":"Is Competitive Swimming Training a Risk Factor for Osteoporosis? A Systematic Review of the Literature and Quality of Evidence","volume":"53","author":"Freitas","year":"2023","journal-title":"Ger. J. Exerc. Sport Res."},{"key":"ref_81","first-page":"152","article-title":"Asymmetries of the Shoulder and Pelvic Girdles in Girls with Scoliosis and Scoliotic Posture","volume":"29","year":"2013","journal-title":"Med. Stud. Studia Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1152\/jappl.1972.32.2.245","article-title":"Heart and Lung Functions in Swimmers and Nonathletes During Growth","volume":"32","author":"Andrew","year":"1972","journal-title":"J. Appl. Physiol."},{"key":"ref_83","first-page":"124","article-title":"Gender Differences in Lung Growth","volume":"20","author":"Hibbert","year":"1995","journal-title":"Pediatr. Pulmonol."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/9\/3\/158\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:48:40Z","timestamp":1760111320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/9\/3\/158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,4]]},"references-count":83,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["jfmk9030158"],"URL":"https:\/\/doi.org\/10.3390\/jfmk9030158","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,4]]}}}