Positive effects from sports are achieved primarily through physical activity, but secondary effects bring health benefits such as psychosocial and personal development and less alcohol consumption. Negative effects, such as the risk of failure, injuries, eating disorders, and burnout, are also apparent. Because physical activity is increasingly conducted in an organized manner, sport's role in society has become increasingly important over the years, not only for the individual but also for public health. In this paper, we intend to describe sport's physiological and psychosocial health benefits, stemming both from physical activity and from sport participation per se. This narrative review summarizes research and presents health-related data from Swedish authorities. It is discussed that our daily lives are becoming less physically active, while organized exercise and training increases. Average energy intake is increasing, creating an energy surplus, and thus, we are seeing an increasing number of people who are overweight, which is a strong contributor to health problems. Physical activity and exercise have significant positive effects in preventing or alleviating mental illness, including depressive symptoms and anxiety- or stress-related disease. In conclusion, sports can be evolving, if personal capacities, social situation, and biological and psychological maturation are taken into account. Evidence suggests a dose-response relationship such that being active, even to a modest level, is superior to being inactive or sedentary. Recommendations for healthy sports are summarized.

Introduction: The overall aim of this doctoral thesis was to identify physiological and anthropometric variables valid for prediction of competitive performance in alpine skiing (indicated by FIS points).

Method: Paper I-III in this doctoral thesis followed an experimental, hypothesis-generating design which included both junior and senior elite alpine skiers. In all papers, physiological and anthropometric test results (X-variables) were correlated with FIS points (Y-variables) in order to investigate the predictive power of physiological and anthropometric variables for competitive performance in alpine skiing. The significance of the included test results was examined using bivariate and multivariate data analysis.

Results: The results of Paper I show that included aerobic test results, neither alone nor in combination with anthropometric variables, could predict competitive performance of junior elite alpine skiers. Principal component analysis shows that male and female junior alpine skiers could be separated based on test results but that none of the included tests were important for sport-specific performance. The best multivariate models reached R² = 0.51 to 0.86 and Q² = -0.73 to 0.18. While several significant regression models could be observed, none of these met the criteria for valid models. The lack of predictive power of observed prediction models was confirmed by cross-validation. The results of Paper II show that included physiological test results from the test battery Fysprofilen could not predict competitive performance of senior elite female alpine skiers. Principal component analysis shows that there is a high correlation between individual physiological test results and their corresponding Fysprofilen score points, indicating that they can be used interchangeably. The Mann-Whitney U test was not significant neither for SL nor for GS. This suggests that Fysprofilen score points (summarized as Fysprofilen Index) and competitive performance (indicated by FIS points) are independent. The best multivariate models for SL and GS reached R² = 0.27 to 0.43 and Q² = - 0.8 to - 0.17, indicating low predictive power for competitive performance (as confirmed by cross-validation). The results of Paper III show that included physiological test results from a novel test battery could not predict competitive performance of senior elite female alpine skiers on a group level. When data were analyzed on a group level, the best models for SL and GS reached R² = 0.39 to 0.40, Q² = 0.15 to 0.21, indicating low predictive power. In contrast, when data were analyzed on an individual level, valid models with high predictive power (R² = 0.88 to 0.99 and Q² = 0.64 to 0.96) were generated. A comparative analysis between individual multivariate models shows that the relative importance of different physiological qualities for athletic performance varies between skiers.

Conclusion: When applying tests on alpine skiers, a holistic approach should be considered. This because competitive performance in alpine skiing is the result of a number of interacting dimensions. Before applying physiological tests, the validity and reliability of the test protocols must also be determined. Administering tests that do not meet these criteria will probably waste not only important resources for clubs and ski federations but also risk misleading coaches and athletes when planning and implementing preparatory training.

Background: The accumulation of myocardial triglycerides and remodeling of the left ventricle are common features in type 2 diabetes mellitus and represent potential risk factors for the development of diastolic and systolic dysfunction. A few studies have investigated the separate effects of diet and exercise training on cardiac function, but none have investigated myocardial changes in response to a combined diet and exercise intervention. This 12-week randomized study assessed the effects of a Paleolithic diet, with and without additional supervised exercise training, on cardiac fat, structure, and function.

Methods and Results: Twenty-two overweight and obese subjects with type 2 diabetes mellitus were randomized to either a Paleolithic diet and standard-care exercise recommendations ( PD ) or to a Paleolithic diet plus supervised exercise training 3 hours per week ( PD - EX ). This study includes secondary end points related to cardiac structure and function, ie, myocardial triglycerides levels, cardiac morphology, and strain were measured using cardiovascular magnetic resonance, including proton spectroscopy, at baseline and after 12 weeks. Both groups showed major favorable metabolic changes. The PD - EX group showed significant decreases in myocardial triglycerides levels (-45%, P=0.038) and left ventricle mass to end-diastolic volume ratio (-13%, P=0.008) while the left ventricle end-diastolic volume and stroke volume increased significantly (+14%, P=0.004 and +17%, P=0.008, respectively). These variables were unchanged in the PD group.

Conclusions: Exercise training plus a Paleolithic diet reduced myocardial triglycerides levels and improved left ventricle remodeling in overweight/obese subjects with type 2 diabetes mellitus.

Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01513798.