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A systematic review of the psychological and social benefits of participation in sport for adults: Informing development of a conceptual model of health through sport

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Background The definition of health incorporates the physical, social and mental domains, however the Physical Activity (PA) guidelines do not address social health. Furthermore, there is insufficient evidence about the levels or types of PA associated specifically with psychological health. This paper first presents the results of a systematic review of the psychological and social health benefits of participation in sport by adults. Secondly, the information arising from the systematic review has been used to develop a conceptual model of Health through Sport. Methods A systematic review of 14 electronic databases was conducted in June 2012, and studies published since 1990 were considered for inclusion. Studies that addressed mental and/or social health benefits from participation in sport were included. Results A total of 3668 publications were initially identified, of which 11 met the selection criteria. There were many different psychological and social health benefits reported, with the most commonly being wellbeing and reduced distress and stress. Sport may be associated with improved psychosocial health in addition to improvements attributable to participation in PA. Specifically, club-based or team-based sport seems to be associated with improved health outcomes compared to individual activities, due to the social nature of the participation. Notwithstanding this, individuals who prefer to participate in sport by themselves can still derive mental health benefits which can enhance the development of true-self-awareness and personal growth which is essential for social health. A conceptual model, Health through Sport, is proposed. The model depicts the relationship between psychological, psychosocial and social health domains, and their positive associations with sport participation, as reported in the literature. However, it is acknowledged that the capacity to determine the existence and direction of causal links between participation and health is limited by the cross-sectional nature of studies to date. Conclusion It is recommended that participation in sport is advocated as a form of leisure-time PA for adults which can produce a range of health benefits. It is also recommended that the causal link between participation in sport and psycho-social health be further investigated and the conceptual model of Health through Sport tested.
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RES E AR C H Open Access
A systematic review of the psychological and
social benefits of participation in sport for adults:
informing development of a conceptual model of
health through sport
Rochelle M Eime
1,2*
, Janet A Young
1
, Jack T Harvey
2
, Melanie J Charity
1,2
and Warren R Payne
1
Abstract
Background: The definition of health incorporates the physical, social and mental domains, however the Physical
Activity (PA) guidelines do not address social health. Furthermore, there is insufficient evidence about the levels or
types of PA associated specifically with psychological health. This paper first presents the results of a systematic
review of the psychological and social health benefits of participation in sport by adults. Secondly, the information
arising from the systematic review has been used to develop a conceptual model of Health through Sport.
Methods: A systematic review of 14 electronic databases was conducted in June 2012, and studies published since
1990 were considered for inclusion. Studies that addressed mental and/or social health benefits from participation
in sport were included.
Results: A total of 3668 publications were initially identified, of which 11 met the selection criteria. There were
many different psychological and social health benefits reported, with the most commonly being wellbeing and
reduced distress and stress. Sport may be associated with improved psychosocial health in addition to improvements
attributable to participation in PA. Specifically, club-based or team-based sport seems to be associated with improved
health outcomes compared to individual activities, due to the social nature of the participation. Notwithstanding this,
individuals who prefer to participate in sport by themselves can still derive mental health benefits which can enhance
the development of true-self-awareness and personal growth which is essential for social health. A conceptual model,
Health through Sport, is proposed. The model depicts the relationship between psychological, psychosocial and social
health domains, and their positive associations with sport participation, as reported in the literature. However, it is
acknowledged that the capacity to determine the existence and direction of causal links between participation and
health is limited by the cross-sectional nature of studies to date.
Conclusion: It is recommended that participation in sport is advocated as a form of leisure-time PA for adults which
can produce a range of health benefits. It is also recommended that the causal link between participation in sport and
psycho-social health be further investigated and the conceptual model of Health through Sport tested.
Keywords: Sport, Health, Psychological, Psychosocial, Social
* Correspondence: Rochelle.eime@vu.edu.au
1
Institute of Sport, Exercise and Active Living, Victoria University, PO Box
14428, Melbourne, Victoria 8001, Australia
2
School of Health Sciences, University of Ballarat, PO Box 663, Ballarat,
Victoria 3353, Australia
© 2013 Eime et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Eime et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:135
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Introduction
It is important to participate regularly in physical activity
(PA) to improve the likelihood of living a healthy life. To
assist people living a healthy life, there are specific PA
guidelines [1]. These guidelines include recommenda-
tions to avoid inactivity given any activity is better than
being sedentary and even low levels of participation are
associated with some health gains. However for a sub-
stantial health gain to be realised it is recommended that
adults participate in PA for at least 150 minutes per
week of moderate-intensity, or 75 minutes a week of
vigorous-intensity aerobic PA or an equivalent combin-
ation of both moderate and vigorous PA [1].
Recommended minimum levels of PA were historically
based on identified quantitative relationships between
PA and physical health benefits [2]. Although mental
health benefits have been referenced in more recent
guidelines, to date insufficient evidence precludes con-
clusions about the minimal or optimal types or amounts
of physical activity for mental health [2] (Part G Section
8 p39). Instead of specifying a recommended level of PA
for mental health benefits, mental health is often
assessed in relation to the existing PA recommendations
based on physical health benefits [ 3-7].
The World Health Organisations (2006) definition of
health incorporates three domains, physical, mental, and
social [8]. However, social health is not incorporated into
the PA guidelines. Notwithstanding this, the literature
informing the PA guidelines does suggest that social
support through participation in PA can contribute to
positive mental health aspects [2].
There are many different ways that people can be
physically active. During peoples leisure-time is one way.
Within the context of leisure-time PA there are different
participation modes, settings and types of PA [9]. Eime
et al., (2013) have distinguished four modes of leisure-
time PA: team sport, individual sport, organi sed but
non-competitive PA; and non-organised PA [9]. Sport is
a popular form of leisu re-time PA. Participation in sport
is often in a social context. Because of this social nature,
it is conjectured that sport participation may be associ-
ated with greater psychosocial health benefits than other
forms of PA [10].
In a previous study, a Health through Sport model was
developed for children and adolescents [11]. This study
concluded that there were many different psychological
and social health benefits reported, with the most com-
mon being improved self-esteem and improved social
interaction/integration, followed by fewer depressive
symptoms [11]. The authors concluded that for children
and adolescents, sport may be associated with improved
psychosocial health benefits above and beyond improve-
ments attributed to participation in general PA [11]. The
aim of this systematic review was to investigate the
psychological and social benefits of participation in sport
for adults, and to investigate the applicability of the
Health through Sport model to adults.
Methods
The criteria for considering studies for this review were
as follows, and as reported in [11].
Inclusion criteria were
1. Studies published in English between Jan 1990 and
May 2012 inclusive.
2. Original research or reports published in peer review
journals or government or other organisational
publications which reported primary data.
3. Studies which presented data that addressed mental
and/or social health benefits from participation in
sport. In this context, the following definitions were
adopted: sport - a human activity of achieving a
result requiring physical exertion and/or physical skill
which, by its nature and organisation, is competitive
and is generally accepted as being a sport [12]. health
–“a state of complete physical, mental and social
well-being and not merely the absence of disease and
infirmity [8]; mental - of or referring to the mind or
to the processes of the mind, such as thinking, feeling,
sensing, and the like [13](p475)mental health’–
Mental Health refers to a broad array of activities
directly or indirectly related to the mental well-being
component included in the WHOsdefinitionof
healthIt is related to the promotion of well-being,
the prevention of mental disorders, and the treatment
and rehabilitation of people affected by mental disor-
ders [14,15] social: Relating to the interactions of in-
dividuals, particularly as members of a group or a
community [13](p475);social health: That dimen-
sion of an individuals well-being that concerns how
he gets along with other people, how other people
react to him, and how he interacts with social institu-
tions and societal mores. [16] (p 152). In this study,
we also used the following terms: psychological’–
synonymous with those aspects of
mental that do
not include the treatment and rehabilitation of people
affected by mental disorders;andpsychosocial -
“…any situation in which both psychological and
social factors are assumed to play a role [17](p638).
4. Studies where the data pertained to the individual level
(i.e. for persons versus communal or national level).
Exclusion criteria were:
1. Studies or reports that addressed exercise, physical
activity, physical education,orrecreation, and not
sport. Definitions of these terms are: Exercise’–
physical activity that is planned, structured,
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repetitive, and purposive in the sense that
improvement or maintenance of one or more
components of physical fitness is an objective [15]
(p128); Physical activity - bodily movement
produced by skeletal muscles that results in energy
expenditure [15] (p126); Physical education - a
sequential, developmentally appropriate educational
experience that engages students in learning and
understanding movement activities that are person-
ally and socially meaningful, with the goal of
promoting healthy living [18] (p8); Recre ation’–
pleasurable activity [19] (p. 915).
2. Research/reports that addressed participation in
adapted sports (i.e. sport participation for persons
with a physical and/or intellectual disability, such as
wheelchair tennis).
3. Research/reports that addressed sub-populations
subject to specific risks (i.e. studies with heroin
users, at risk individuals etc.).
4. Research/reports that addressed rehabilitation from,
or management of, injury or illness.
5. Research/reports that addressed spectators, coaches
or sports administrat ors.
6. Research/reports that addressed elite sports
participants.
7. Research/reports that addressed sport development
programs that have an educational objective.
8. Book chapters, abstracts, dissertations and
conference proceedings.
Search methods for identification of studies, reports
and publications
A systematic search of 14 electronic databases (AUSPORT,
AusportMed, CINAHL, Cochrane Library, EBSCHOHost
Research Databases, Health Collection, Informit, Medline
Fulltext, PsycARTICLES, Psychology and Behavioral Sci-
ences Collection, PsycINFO, PubMed, Scopus, SPORT-
Discus Fulltext) was conducted in June 2012. We also
consulted with the Australian Sports Commission to
search the National Sports Information Centre records in
order to identify relevant reports, publications and
research not located through the search of the electronic
databases cited above. Further, we conducted an internet
search using the Google Scholar search engine (www.
googlescholar.com) to locate additional studies in the
Medicine, Social Sciences, Arts and Humanities subject
areas. The Google Scholar search engine was also used
to search for recognised International, National and State
reports and publications that directly addressed the topic
under consideration.
To search the electronic databases a combination of
keywords and search terms was adopted. These key
words and search terms were formulated by the authors
of this systematic review as those they considered
directly addressed the topic under consideration. These
keywords and search terms constituted four groups,
namely:
Group 1: sport
Group 2: health
Group 3: value, benefit, effect, outcome
Group 4: psychology, depression, stress, anxiety,
happiness, mood, quality of life, social health,
social relations, well, social connect, social
functioning, life satisfaction, mental health,
sociology, social.
Accordingly where possible, the database searches
consisted of key words from Group 1 AND Group 2
AND Group 3 AND Group 4. The truncation symbol
was added to the mos t basic word stem for each key-
word to ensure all associated terms were included in the
search.
Study selection
Figure 1 provides a summary of the stages of study se-
lection. Titles and abstracts of potentially relevant arti-
cles were screened by JY. Authors, JY and RE exam ined
all full-text articles, and assessed the studies to ensure
that they met the inclusion criteria . Any discrepancies
were resolved through discussion between the two re-
viewers. Consensus was obtained for all included articles.
After reviewing the selected studies it was decided that,
given the breadth and complexity of the research do-
main, that studies focusing on children and adolescent
would be further reviewed separately from studies focus-
ing on adults. This review focuses on adults only. Stud-
ies that stated that they investigated adults sport
participation were included. A separate systematic re-
view focusing on child ren and adolescents has been
published [11].
Data collection and analysis
Data extracted from each of the studies included: study
design an d methodology; sample size; country of origin;
age of participants; cohort of participant s; gender of par-
ticipants; study aim; sport variable; other PA variables;
theoretical construct; key findings in relation to psycho-
logical an d social health outcomes.
Assessment of study quality
Study quality was objectively appraised using the Downs
and Black checklist [20] This checklist has been used in
other systematic reviews within the physical activity and
health field [21,22]. This checklist includes 27 items
grouped into categories: reporting (10), external validity
(3), internal validity - bias (7), internal validity con-
founding (6), and power (1). Twenty five items are scored
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as 1 (compliance) or 0 (non-compliance or inability to de-
termine compliance); one item about confounding is
scored as 2 (full compliance), 1 (partial compliance) or 0
(non-compliance or inability to determine compliance);
and the item concerning power is scored (via a more com-
plex algorithm) on a scale of 05.
Because most of the studies we reviewed did not in-
volve interventions, a numbe r of the items on the
Downs and Black checklist were not generally applicable.
We substituted a simpler power item (presence or ab-
sence of reference to a power analysis), and scored all
items as 0, 1 or NA (not applicable). We calculated a
summary quality score for each paper (except the two
qualitative papers for which only five items were applic-
able) by expressing the number of compliant items as a
percentage of the number of applicable items. We in-
cluded these scores (ranging from 44% to 93%) in
Table 1, and used the insights we gained through the
scoring process in our discussion of study quality.
Conceptual model development
Based upon the literature presented in this review, and
an accompanying review of literature regarding children
and adolescents [11], a conceptual model of Health
through Sport has been developed (Figure 2). The model
depicts the relationship between determinants driving
sport participation and the reported psychological and
social health benefits of participation. The terminology
used in this conceptual model is as defined in the inclu-
sion criterion 3 above. The determinants are represented
as per the Socio-Ecological Model [33,34]. Upon review-
ing the studies, two dimensions of sport participation
were identified, and it became evident that some re-
ported health benefits were more likely to be associated
with some contexts of sport participation than others.
Therefore, a model was developed to represent the two
contextual dimensions of sport participatio n and the dif-
ferent strengths of association between different con-
texts of sport participation and the three health aspects
(physical, psychological and social).
With regard to causality, we note that most studies
have been cross-sectional and observational in nature,
and hence do not provide strong eviden ce of causality.
The literature suggests that sport can have positive
health benefits; however it is also the case that better
health may predispose people to initiate and maintain
participation in sport. A few longitudinal studies provide
stronger evidence of causality. However, in the absence
of randomised and controlled experimental studies,
which are challenging to implement in this domain, it
will remain difficult to unequivocally determine the na-
ture and direction of causality. Notwithstanding this,
terms like outcome and benefit of sport participation
have been used to describe the results of many of the
studies reviewed, and we have used the same termin-
ology in reviewing these studies.
Screening
Screening of titles and abstracts
Eligibility
Included
Studies included in the review n=11
Excluded n=58
Full-text articles assessed for
eligibility n= 99
Excluded n=1453
Excluded n=2116
Screening of titles and abstracts
n=1552
Screening for duplicates and full
publications n=1552
References identified n=3668
Children and adolescent
studies excluded n=30
Figure 1 Stages of study selection.
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Table 1 Studies investigating the psychological and social health benefits of participation in sport for adults
Reference Design* Method** Sample
(n)
Country Age
(yrs)
Cohort*** Sex**** Aim Sport Other PA Theory Key Finding(s) Psychosocial
Outcomes
Score
(%)
[23] Quant. Cross. 1427 Belgium 20-65 Adult B Analysis of the
relationship
between sports
participation
and stress
Favourite
sports
no sport,
other
sports/PA
Mindful
Movement
theory
Little difference
in perceived
stress and
emotional
distress existed
in men and
women across
different sports.
Significant
associations
were found
between
participation
in walking
and meditation
sports with
stress appraisal
and emotional
distress among
women.
Less stress
and distress,
less emotional
distress (males)
and increased
social support
69
[24] Quant. Pros.
Cross.
6751 Germany 18-45 Adult B Analysis of the
effects of sport
participation
in long-term
labour market
variables, health
and subjective
well-being
Sport at
least
monthly
Less than
monthly
participation
in sport
Nil Positive mental
health effects
of sports
participation
included vitality,
social functioning
and role emotion.
Sport has
positive effects
on health
and subjective
well-being.
Vitality, social
functioning,
role emotion,
subjective
well-being
87
[25] Qual. Cross. 14 Australia 16-25 Adol. and
adult
M Explore
connections
between sport
and civic
engagement
Sport Nil Phenomenological
framework
Grounded theory
Sport participants
reported mental
and health
benefits including
feeling good,
confident, ability
to cope with
hard times and
a sense of
belonging.
Feeling good,
confidence,
coping with
hard times,
sense of
belonging,
resilience
67
[26] Quant. Cross. 16,627 England 16 yrs
and
older
Adol. and
adult
B Investigate
impact of sports
participation
on subjective
well-being
Sport No sport and
non-social
interaction
sports
Subjective
wellbeing
Sports
participation
positively
associated
with subjective
well-being.
Well-being/
happiness
56
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Table 1 Studies investigating the psychological and social health benefits of participation in sport for adults (Continued)
[27] Qual. Cross. 20 USA 17-23 Adol. and
adult
B Investigate
mechanisms
for creating
sense of
community
within a
sport setting
College
athletes
Nil Sense of
community.
Grounded theory,
Phenomenoligcal
approach
Five key factors
(leadership
opportunities,
social spaces,
competition,
equity in
administrative
decisions,
administrative
consideration)
were identified
that fostered
a sense of
community
within a
collegiate
sport context.
Sense of
community went
beyond their
sporting
experience.
Sense of
community
71
[10] Quant. Cross. 818 Australia M 34-
47
Adult F Examine
health-related
quality of life
and life
satisfaction
in different
forms of PA
Club sport Walking and
gymnasium
Nil Women involved
in club sport
reported higher
levels of mental
well-being and
life satisfaction
compared
with women
engaged in the
individual-based
activities of
walking and
going to a
gymnasium
(ie participation
in sport is
associated with
better mental
well-being
than other
forms of PA).
Club sport
participants
had better
physical role
functioning,
vitality, social
functioning and
mental health.
Mental health,
life satisfaction,
vitality, social
functioning
81
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Table 1 Studies investigating the psychological and social health benefits of participation in sport for adults (Continued)
[28] Quant. Long. 30 Australia M 24 Adult M Monitor
changes
in stress
and recovery
for Rugby
League players
Rugby
League
nil Nil Significant
decreases in
social stress
were reported
between weeks
1 and 4.
Less social
stress
56
[29] Quant. Cross. 19,842 UK M 45 Adult B Examine
association
between
mental health
and PA
behaviours
Leisure Time
Sport
Walking,
Domestic PA
Nil All types of PA
associated with
lower risk of
psychological
distress, with
strongest effect
observed
for sport.
Less
psychological
distress
93
[30] Quant. Cross. 791 USA M 20 Adult B Examined
relationships
among
dimensions
of athletic
involvement
(team sport,
individual
sport, athlete
identity, jock
identity)
Team sport Individual
sport and
no sport
Nil Participation in
a team sport
was associated
with lower
depression
scores. Athlete
identify mediated
the relationship
between team
sport participation
and depression.
Lower
depression
score
73
[31] Quant. Cross. 1919 Belgium 20-65 Adult B Examine
associations
between
5 types
of PA with
different
contents:
housework,
leisure active
transport,
biking to/
from work,
walking to/from
work and sports
participation
and mental
health
Sport Housework,
leisure transport,
walking and
bike to work
Nil Sports
participation
was the only
type of PA
inversely
associcated
with both stress
and distress.
Less stress
and distress
75
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Table 1 Studies investigating the psychological and social health benefits of participation in sport for adults (Continued)
[32] Quant. Pros. 118 UK M 21 Adult B Test hypotheses
that importance
of ratings of
life aspirations
would mediate
the effects of
participation
in sport on
psychological
well-being
Competitive
sport
participation
Recreation
sport
participation
Self-Determination
Theory
Recreational
athletes
reported higher
psychological
well-being than
competitive
athletes. The
moral worth of
sport does not
reside so much
in the frequency
with which
individuals
engage in sport
but in the
goals and values
people express
through their
participation.
Hedonic
enjoyment and
eudemonia
wellbeing
44
*Quant. (Quantitative): Qual (Qualitative).
**Cross. (Cross-sectional): Pros. (Prospective): Long: (Longitudinal).
***Adol (Adolescent).
****M (Male): F (Female): B (Both Male and Female).
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Results
A total of 3668 publications were initially identified.
Table 1 provides a summary of the 11 studies that met
the inclusion criteria. The majority of studies were quan-
titative (n = 8) rather than qualitative (n = 3). There were
no randomised-controlled trials in the identified studies,
with the majority being cross-sectional (n = 8). Two were
classified as prospective. One of these was a study using
cross-sectional sample data over a 22 year period [24]
and the other states it is prospective withou t providing
details of waves of mea surement time [32]. Whilst one
study is classified as longitudinal, it only covers a single
Rugby League season with multiple measurement pe-
riods within the season [28].
The sample sizes in the studies that met the inclusion
criteria ranged from 14 to 19,842 participants. The ma-
jority of studies (n = 8) had over 100 participants. The
majority of studies were conducted in Australia (n = 3)
and United Kingdom (n = 3), followed by United States
of America (n = 2), Belgium (n = 2), and Germany (n = 1).
The age of study participants was generally adult exclu-
sively (n = 7) with four studies including older adolescents
too. Nearly all (n = 8) included both males and females.
The three Australian studies focused exclusively on males
[25,28] or females [10].
Most studies scored highly on the modified Downs
and Black scale of study quality (median 71 percent;
range 4493 percent). Those studies scored above the
median value (higher quality) were all cross-sectional
quantitative studies [10,24,29-31]. None of the studies of
higher quality incorporated a theoretical approach.
Within the studies of higher quality, there was no
consistency regarding the components of sport and
other PA investigated. Instead, these included: sport at
least monthly [24], club sport [10], leisure time sport
[29], team sport [3], and sport [31]. As a consequence of
the varied study designs, low number of studies, and dif-
fering aspects of sport investigated, there was no clear
Intrapersonal
OrganisedIndividual
Informal
Team
SPORT
Policy
Environmental
Organisational
Interpersonal
Physical
SocialPsychological
Figure 2 Health through sport conceptual model.
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distinction between the key findings of the higher and
lower ranked studies in terms of the psychological and
social health benefits of participation in sport.
Thirteen different psychosocial health aspects were
identified in the ten studies (Table 2). The most com-
mon positive health benefit was improved well-being
[24,25,28,32], followed by reduced stress [23,28,31], re-
duced distress [23,29,32] and increased social function-
ing [10,24] and vitality [10,24].
The definitions and measurement of sport participa-
tion varied considerably. Several studies classifi ed sport
participation by frequency only [24,26,29,31], whilst
others classified measurement by favourite sport [23],
club sport [10], team sport [30] or context of participa-
tion such a s competitive versus recreational [32]. The
types of sport activities were generally not defined, how-
ever Eime et al. [10] defined club participants as partici-
pating in netball and/or tennis, and King et al. [28]
measured stress and recovery in Rugby League. The
measurement was often in binary terms whe re those
participating in sport were compared to those participat-
ing in other activities or to those not participating in any
activity. Sport was not always the focus of each paper
and in some instances sport was measured as one con-
text of PA participation [31].
Half of the studies incorporated a theoretical perspec-
tive. Two incorporated a Grounded theory theoretical
perspective to their enquiry [25,27], whilst others utilised
specific theories such as the Mindful Movement theory
and Self-Determination theory to explain behaviours.
Few differences were evident between the conclusions
of studies of higher and lower quality or of different
study design. Although the total number of studies
reviewed was relatively small, there were some differences
in the reported health outcomes associated with different
contexts of participation. Therefore the following presents
a summary of the psychological and social health benefits
of participation in sport according to the different con-
texts of sport participation/definition.
Sport participation in general
A study by Asztalos et al. [31] compared sport to other
forms of PA with regard to mental health. As these au-
thors explain, the relationship between physical activity
and mental health may change across different domains
of activity. In their study Asztalos et al. examined the as-
sociations between participatio n in five domains of PA:
housework leisure active transportation, biking to/from
work, walking to/from work, and sports participation
[31]. The a spects of mental health measured were per-
ceived stress and psychological distress. The mean fre-
quency of sports participation in the sample of 1919
adults was once per week, averaging 2.75 hours/week.
Sport participation was based upon this mean, and spe-
cifically the adults had to participate weekly for at lea st
2.75 hours. Whilst the data was controlled for gender,
age and occupation, they did not do so for level of PA.
Nonetheless, sports participation was the only type of
PA inversely associated with both stress and distress. On
the other hand, housework was associated with more
stress and distress for women with blue-collar jobs. Bik-
ing to work was associated with more stress for men
with blue-collar jobs. The authors provided some rea-
sons why they believe that sport participation, and not
other types of activities, had better mental health out-
comes. They explained that sport represents a chosen
leisure-time activity and aims for recreation, enjoym ent
and social interaction whic h promotes well-being. Fur-
thermore, these improved levels of well-being are not as-
sociated with PA that implies compulsion which to an
extent, housework and active transport do. Similarly,
Harmer et al. [29] investigated PA in different domains
of sport, walkin g and domestic PA. They found signifi-
cant benefits of participation on reduced psychological
distress for all types of activ ity with participants only
needing a minimum of 20 per week to have significant
differences in mental health measures [29]. The stron-
gest effects were observed for sport participation. A
doseresponse pattern was reported, which demon-
strated greater risk reduction with higher volume and/or
intensity of participation.
Club sport participation
A recent study investigated sport participation more spe-
cifically. Eime et al. [10] hypothesised that sports club
participants would have improved health related quality
of life (HRQoL) and life satisfaction given the social na-
ture of their participation, compared to more individual
Table 2 Summary of the psychosocial health aspects
associated with sport participation for adults
Category Specific health aspect Study
Psychological Well-being [24,25,28,32]
Psychological Reduced stress [23,28,31]
Psychological Reduced distress [23,29,31]
Social Social functioning [10,24]
Psychological Vitality [10,24]
Psychological Hedonic enjoyment [32]
Psychological Subjective wellbeing [26]
Psychosocial Belonging [25]
Psychological Life satisfaction [10]
Psychological Lower depression [30]
Psychological Mental health [10]
Psychosocial Role emotion [24]
Psychosocial Sense of community [27]
Eime et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:135 Page 10 of 14
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PA activities such as walking and going to the gymna-
sium [10]. These authors also compared these contexts
of participation with a normative reference group of par-
ticipants, which measured the same health aspects. Even
after adjusting for differences in levels of PA, club partic-
ipants had better physical role functioning, vitality, social
functioning, mental health and life satisfaction than
gymnasium and walking participants. These results sup-
port the notion that participation in a socially engaged
manner can contribute to mental health and life-
satisfaction. The authors concluded that the improved
health benefits in the sport club group compared to in-
dividual based PA may result from enhanced social con-
nectedness, social support, peer bonding and self-esteem
which may be provided by club support [10].
Similarly, Miller et al. investigated group (defined as
team in the literature) compared to individual sport par-
ticipation in terms of depression and suicidal behaviour
[30]. Team sport was defined as requiring two or more
people on the same side to coordinate their movements.
Miller et al. found that both participation in team sport
and athlete identify were associated with lower depres-
sion scores. Specifically, athletic identify mediated the
relationship between sport participation and depression.
Recreational and competitive sport
Within club and/or team sport participation there can be
different contexts of play, including competitive and recre-
ation participation. One study investigated the contribu-
tions of recreational sport and competitive sport to life
aspirations and psychological well-being [32]. The pro-
spective design meant that demographic characteristics
and participation in recreational versus competitive sport
were collected at baseline, and after two weeks, and gen-
eral psychological well-being was assessed. The life aspira-
tions had a mediating effect on the relationship between
participation in recreational and competitive sport and
psychological well-being. Furthermore, recreational partic-
ipants showed a preference for intrinsic life aspirations
compared with competitive participants and reported
higher psychological well-being [32]. The researchers con-
cluded that the relative importance of intrinsic over ex-
trinsic aspirations is a key dimension in predicting
psychological well-being. They proposed that their find-
ings are in line with the Self-Determination theory [35]
given intrinsic motivation is related to personal growth,
community contributions, health and meaningful relation-
ships and is far more rewarding and enhances eudemonia
and enjoyment compared with extrinsic life aspirations.
Furthermore, Chatzisarantis and Hagger argued that, be-
cause the focus of recreational participation is not so
much on winning compared to competitive sport struc-
tures, participants in recreational sport place greater em-
phasis on intrinsic versus extrinsic life aspirations.
Only one study investigated a single sport being Rugby
League [28]. These researchers investigated Rugby League
participation across a season and changes in social stress,
and how this related to fatigue and injury. There were sig-
nificant differences observed in social stress between
weeks 1 and 4. On the recovery scales significant differ-
ences were observed for social recovery between weeks 1
and 5 and general well-being between weeks 2 and 3 [28].
Other sport participation
Warner and Dixon (2011) interviewed former college
athletes and asked them about mechanisms for creating
a sense of community within a sport setting. The study
found that sense of community was mainly fostered by
administrative consideration, leadership opportunities,
equity in administrative decisions, competition and so-
cial spaces [27].
Two studies had a less defined measure of sport, with
favourite sport [23] and frequency of participation [24]
being used. In the more recent study, sport participation
was defined as how often individuals participated in
their favourite sport per week [23]. The authors pre-
sented results of frequency of participation to demo-
graphics but not to the health outcomes of stress
appraisal and emotional distress. However, they did pro-
vide detailed information on the types of sports and the
associated health outcomes. Sport type-related differ-
ences relative to stress appraisal and emotional distress
were scarce. However, sport versus no sport participa-
tion was associated with significantly less stress and dis-
tress. Therefore the differences in the PA to mental
health relationship are insignificant as long as the indi-
viduals participation is in the personally favoured types
of sport. The authors concluded that, in trying to explain
the PA - mental health relationship, previous research
has narrowed the spectrum of PA domains down to
sport participation. As a result Asztalsos et al. proposed
that no one activity fits all recomme ndations in relation
to stress appraisal and emotional distress. However they
did emphasise the fact that there is an association be-
tween specific types of sports and individual preferences,
and that it is important for people to choose a sport that
suits them best [23]. In particular, individuals who prefer
to participate in sport in solitary modes can experience
mental health benefits from this chosen form of partici-
pation. Specifically, they concluded that such modes of
participation can enhance the development of true-self-
awareness and personal growth, which is important to
social health [23].
Lastly, Lechner conducted a micro econometric study
analysing the effects of sport participation on long-term
labour market variables, as well a s health and subjective
well-being indicators [24]. In addition to the sizeable
positive long-term labour market effects in terms of
Eime et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:135 Page 11 of 14
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earnings and wages, there were positive effects on health
and subjective well-being. The researchers measured
sport participation in terms of frequency ranging from
at least every week to none. The health measures in-
cluded the degree of disability, perceived health status
and general satisfaction with their health status. Sport
was positively associated with all health outcomes.
Conceptual model
A conceptual model of Health through Sport is proposed
(Figure 2) that is based on three primary categories of
outcome as per [11]: physical, psych ological and social;
and two secondary categories: physical/psychological as-
pects involving both the physical and psychological ele-
ments, and psychosocial aspects involving both
psychological and social elements.
While our model incorporates all five categories and
thus depicts the full range of health aspects, the phys-
ical aspects have been well reviewed elsewhere [2] and
so this paper in focused on the psychological and social
aspects, as defined above.
As previously described [11], the model includes three
major elements: (a) determinants of sports participation,
(b) sport itself, and (c) health outcomes of sport partici-
pation. The determinants element is based on the
well-established social ecological model [33,34] and is
represented as concentric rings spreading out from the
individuals intrapersonal characteristics to widening
spheres of influence. The sport element incorporates two
dimensions of context: individual team and informal
organised, each of which is almost dichotomous, but also
has some intermediate variants (e.g. running alone, run-
ning in an informal group, running for a club team, run-
ning in a club relay team). The three types of health
outcomes - physical, psychological and social - are shown
as overlapping, representing the fact that there may be in-
teractions and interrelationships between physical and
psychological aspects and between psychological and so-
cial health aspects. For example, there are relationships
between physical fitness and mental state; and interper-
sonal relationships may satisfy needs for belongingness
and, as such, influence psychological health. Another ex-
ample is resilience, whereby psychological health may in-
fluence an individuals capacity to engage in interpersonal
relationships.
The different strengths of the various linkages between
the sport element and the health outcomes represent the
notion that all forms of sport contribute strongly to phys-
ical health. However, while organised and/or team forms
also contribute strongly to psychological and social out-
comes, informal and/or individual forms contribute some-
what less to psychological outcomes and relatively little to
social outcomes. Finally, we have noted the limited evi-
dence of causality in the literature reviewed. This
ambiguity or reciprocity could perhaps be represented by
double-headed arrows linking the physical, psychological
and social elements to the sport element, but we have rep-
resented it by feedback loops from the three outputs to
the intrapersonal and interpersonal determinants.
The structure of the model proposed is sufficiently
general to be applicable both in the adult context and in
the context of children and adolescents [11]. Each elem-
ent and each link shown in Figure 2 is applicable in both
contexts. However, the specific details of each element
or link may differ between the adult and child/adoles-
cent contexts. The relative importance of specific deter-
minants of participation (within the five social-ecological
domains) is not the same for children/adolescents and
adults; for example, schools are important organisational
settings for sport part icipation among children and ado-
lescents, but not for adults. The mechanisms of the links
between sport participation and psychological and social
health also differ at different stages of life; for example,
developmental issues are important aspects of the psy-
chological and social health domains for children and
adolescents, but not for adults. Also, the feedback loops
whereby health status affects intrapersonal and interper-
sonal determinants of participation are different in detail
at different life stages. The main differences between the
health outcomes of the children and adolescent com-
pared to adults were that the children and adolescent
studies highlighted mainly social health aspe cts and the
adults more psychological. Improved social interaction/
integration and social skills and improved self-esteem
were the most common health aspects reported in the
systematic review for children and adolescents [11].
Whereas the most common health aspects reported in
this study related to psychological health aspects of well-
being, and reduced stress and distress.
Limitations
This systematic review has some limitations. Whilst the
search strategy, based on a-priori inclusion and exclusion
criteria, was comprehensive and encompassed grey litera-
ture which reported primary data, conference proceedings
were not included. Nor were non-English language articles
included. The studies reviewed included a wide range of
aims, focuses, measurement tools and indicators of both
sport participation and health outcomes. This diversity of
focus and methodology limited the extent of synthesis and
precluded meta-analysis. Most studies were cross-
sectional and used self-report measures. Therefore results
should be interpreted with caution, and any conclusions
regarding causation are conjectural.
Conclusion
Whilst the number of studies investigating the psycho-
logical and social health benefits of sport participation
Eime et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:135 Page 12 of 14
http://www.ijbnpa.org/content/10/1/135
for adults was not large, there wa s a general consensus
that there are many psychological and social health ben-
efits associated with participation in sport for adult s.
Furthermore, there is consistent evidence that club-
based and team-based sport participation, when com-
pared to other individual forms of PA, is associated with
better psychological and social health outcomes. It is
generally concluded that it is the social nature of this
participation that is the factor mediating the relationship
between participation and improved health. Further-
more, the concept of choice and fun seems to be a con-
tributing factor to improved health. When people play a
sport of their choice, it is fun and enjoyable in the social
context and they are often intrinsically motivated to par-
ticipate. In saying this, it is important for each individual
to choose their sport so tha t it suits their preferences.
Some individuals prefer to participate in sport in solitary
modes and this participation can enhance their mental
health. This in turn can contribute to the development
of true-self-awareness and personal growth which is also
significant for social health. In contrast to sport partici-
pation, other forms of PA, such as domestic chores and
transport, are not necessarily enjoyable. The improved
health aspects from sport participation were also often
associated with recreational play rather than with
competition.
In light of the research evidence, and acknowledging
that research to date is predominantly based on cross-
sectional studies, it is recommended that participation in
sport is advocated as a form of leisure-time PA for adults
which can produce a range of health benefits. It is also
recommended that the causal link between participation
in sport and psy cho-social health be further investigated
and the conceptual model of Health through Sport
tested.
Abbreviations
PA: Physical activity.
Competing interests
The authors declare that they have no competing interests.
Authors contributions
RME contributed to the study design, the review of literature, analysis of
literature, model conceptualisation, manuscript conceptualisation and
preparation. JAY contributed to the study design, the review of literature,
analysis of literature, model conceptualisation, manuscript conceptualisation
and preparation. JTH contributed to analysis of literature, model
conceptualisation and representation, and manuscript preparation. MJC
contributed to analysis of study quality and critical review of the manuscript.
WRP contributed to the study design and critical review of the manuscript.
All authors read and approved the final manuscript.
Acknowledgements
RME is supported by a VicHealth Research Practice Fellowship.
Received: 12 March 2013 Accepted: 2 December 2013
Published: 7 December 2013
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doi:10.1186/1479-5868-10-135
Cite this article as: Eime et al.: A systematic review of the psychological
and social benefits of participation in sport for adults: informing
development of a conceptual model of health through sport.
International Journal of Behavioral Nutrition and Physical Activity
2013 10:135.
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... This in turn could be protective for their mental health. Our findings are in agreement with earlier studies that also found an association between OLTAs and mental health in children and adolescents [14,19,20,22,24,39]. In our study sample, 32% was not participating in any OLTA. ...
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