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ABSTRACT
Introduction: Sedentary habits increase the chances of developing cardiovascular disease. Physical activity
is one of the means of prevention and treatment of these diseases, thus martial arts represent a dynamic option
in promoting physical activity. Objective: The objective of the study is analyze the effects of 16 weeks of Martial
Arts (Muay Thai or judo) training on cardiovascular variables in adolescents. Methods: The sample consisted of
40 adolescents, aged 11 to 14 years, divided into two groups: Martial Arts (n=28) and control (n=12). Weight
and height measurements were taken to calculate body mass index. Systolic and diastolic blood pressure (BP),
heart rate (HR) at rest, pulse pressure (PP) and rate-pressure product (RPP), were also measured. The interven-
tion was carried out through Martial Arts (Muay Thai and judo) training held twice a week for 90 minutes,
over 16 weeks. The control group did not undergo any training. The statistical analysis was performed using
the following tests: Shapiro-Wilks, Levene’s, analysis of covariance (ANCOVA), eta-squared effect size and the
net-effect, using SPSS 15.0 software and a significance level of 5%. Results: There was no statistical difference
between the control and Martial Arts groups for the sample characterization. There was a significant difference
in systolic BP in the Martial Arts group when compared with the control group (p-value=0.049). The effect size
can be considered moderate (effect size=0.163), with a good net-effect (3.4 mmHg). Conclusion: This study
showed that 16 weeks of Martial Arts decreased systolic BP in normotensive adolescents. Level of Evidence II;
Therapeutic studies - Investigating the results of treatment.
Keywords: Heart rate; Adolescent; Blood pressure; Pulse pressure; Martial arts; Arterial pressure.
RESUMO
Introdução: Os hábitos sedentários aumentam as chances de desenvolvimento de doenças cardiovasculares. A
atividade física é um dos meios de prevenção e tratamento dessas doenças, sendo assim, as artes marciais aparecem
como uma opção de caráter dinâmico no incentivo à prática de atividades físicas. Objetivos: O objetivo do estudo
consiste em analisar os efeitos de 16 semanas de treinamento de artes marciais (Muay Thai ou Judô) sobre as va-
riáveis cardiovasculares nos adolescentes. Métodos: A amostra foi constituída por 40 adolescentes de 11 a 14 anos,
divididos em dois grupos: artes marciais (n=28) e controle (n=12). As medições de peso e altura foram realizadas
para o cálculo do índice de massa corporal. Foram medidas também a pressão arterial sistólica e diastólica (PA),
a frequência cardíaca (FC) em repouso, a pressão de pulso (PP) e o duplo produto (DP). A intervenção foi realizada
através da prática de artes marciais (Muay Thai e Judô), realizada duas vezes por semana, durante 90 minutos, por
16 semanas. O grupo controle não realizou nenhum tipo de treinamento. A análise estatística foi feita utilizando os
seguintes testes: Shapiro-Wilks, Levene, análise de covariância (ANCOVA), tamanho do efeito eta-squared e efeito
líquido, utilizando o software SPSS 15.0 e nível de significância de 5%. Resultados: Não houve diferença estatística entre
o grupo controle e o grupo de artes marciais para a caracterização da amostra. Houve diferença significativa na PA
sistólica no grupo de artes marciais quando comparado com o grupo controle (valor p=0,049). A dimensão do efeito
pode ser considerada moderada (dimensão do efeito=0,163), com um bom efeito líquido (3,4 mmHg). Conclusão:
Este estudo demonstrou que 16 semanas de artes marciais diminuíram a PA sistólica em adolescentes normotensos.
Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.
Descritores: Frequência cardíaca; Adolescente; Pressão sanguínea; Pressão de pulso; Artes marciais; Pressão arterial.
RESUMEN
Introducción: Los hábitos sedentarios aumentan las posibilidades de desarrollo de enfermedades cardiovasculares.
La actividad física es uno de los medios de prevención y tratamiento de esas enfermedades, siendo así, las artes mar-
ciales aparecen como una opción de carácter dinámico en el incentivo a la práctica de actividades físicas. Objetivos:
El objetivo del estudio es analizar los efectos de 16 semanas de entrenamiento de artes marciales (Muay Thai o Judo)
sobre las variables cardiovasculares en adolescentes. Métodos: La muestra fue constituida de 40 adolescentes de 11
a 14 años, divididos en dos grupos: artes marciales (n=28) y control (n=12). Fueron realizadas mediciones de peso y
altura para calcular el índice de masa corporal. Fueron medidas también la presión arterial sistólica y diastólica (PA),
CARDIOVASCULAR EFFECTS OF 16 WEEKS OF MARTIAL
ARTS TRAINING IN ADOLESCENTS
EFEITOS CARDIOVASCULARES DE 16 SEMANAS DE TREINAMENTO DE ARTES
MARCIAIS EM ADOLESCENTES
EFECTOS CARDIOVASCULARES DE 16 SEMANAS DE ENTRENAMIENTO DE ARTES
MARCIALES EN ADOLESCENTES
Bruna Thamyres Ciccotti Saraiva1
(Physical Education Professional)
Raphael Mendes Ritti-Dias2
(Physical Education Professional)
Breno Quintela Farah3
(Physical Education Professional)
Vinícius Yukio Botelho Suetake1
(Physical Education Professional)
Tiego Aparecido Diniz4
(Physical Education Professional)
Paulo Costa Júnior1
(Physical Education Professional)
Vinícius Flávio Milanez5
(Physical Education Professional)
Diego Giulliano Destro Christofaro1
(Physical Education Professional)
1. Universidade Estadual Paulista
(UNESP), Faculdade de Ciências e
Tecnologia, Department of Physical
Education, Presidente Prudente,
SP, Brazil.
2. Hospital Israelita Albert Einstein,
Department of Physical Education,
São Paulo, SP, Brazil.
3. Universidade de Pernambuco
(UPE), Department of Physical
Education, Pernambuco, PE, Brazil.
4. Universidade de São Paulo (USP),
Department of Physical Education,
São Paulo, SP, Brazil.
5. Universidade do Oeste Paulista
(UNOESTE), Department of Physical
Education, Presidente Prudente,
SP, Brazil.
Correspondence:
Departamento de Educação Física,
Universidade Estadual (UNESP),
Faculdade de Tecnologia e Ciências.
Rua Roberto Simonsen, 305,
Presidente Prudente, SP, Brazil.
19060-900.
brunatcsaraiva@gmail.com
Original article
Artigo originAl
Artículo originAl
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Rev Bras Med Esporte – Vol. 24, No 3 – Mai/Jun, 2018
INTRODUCTION
Cardiovascular diseases are the leading causes of deaths worldwide.
1
Blood pressure is an independent, linear and continuous risk factor for
cardiovascular disease.2,3 Alterations in blood pressure is a major risk factor
for the development of hypertension in the young population,
4
and given
that high blood pressure during adolescence tracks into adulthood,
5
early therapeutic approaches should be employed in young people.
Martial arts are a popular form of exercise for children and adoles-
cents.6 Studies have demonstrated the benefits of Martial Arts for im-
proving physical fitness,7,8 performance9-11 and bone health.12 However,
whether Martial Arts can alter the cardiovascular profile is unknown.
Given that high intensity exercise potentiates the cardiovascular effects of
exercise in young people,
13
and that martial arts usually have moderate
to high intensities,
14,15
it is possible that this mode of exercise could affect
cardiovascular function in this age-group.
Thus, the aim of the present study was to analyze the effects of
16-weeks of martial arts training (Muay-Thai or judo) on cardiovascular
variables in adolescents. We hypothesized that martial arts training
would improve cardiovascular health in adolescents.
MATERIALS AND METHODS
This study was developed in a social project in Presidente Pruden-
te-Brazil (Southeastern Brazil), carried out with low income adolescents.
This project provides various activities for young people (chess, computer
activities and practicing different sports, among others). Adolescents
were included if they: (i) were enrolled and participating in the activi-
ties of the above mentioned institution; (ii) did not present any serious
orthopedic disease that prevented them from performing Martial Arts;
(iii) were not taking medication to control blood pressure; (iv) did not
have any respiratory illness that prevented them practicing exercise. All
participants returned the Informed Consent form signed by parents or
guardians giving permission for participation and the study was approved
by the Research Ethics Committee of the Universidade Estadual Paulista
(Process number: 26702414.0.0000.5402).
Body mass was measured using an electronic scale, Filizola, accurate
to 0.1 kg, with a maximum capacity of 150 kg and height using a fixed
stadiometer, Sanny, with a precision of 0.1 cm and maximum extension
of two meters.
Systolic and diastolic blood pressure (BP) were obtained using an
automatic blood pressure monitor (brand Omron Healthcare, Inc., In-
telliSense, model HEM 742, Omron Corporation, Model HEM 742, Kyoto,
Kansai, Japan) with cuffs of appropriate size to the arm circumference of
the participants,16 obtained on the right side with the arm at a height
in line with the heart. The participant remained seated and after res
-
ting for approximately 15 minutes the blood pressure was measured.17
frecuencia cardíaca (FC) en reposo, la presión de pulso (PP) y el doble producto (DB). La intervención fue realizada a
través de la práctica de artes marciales (Judo y Muay Thai), realizada dos veces por semana durante 90 minutos, por
16 semanas. El grupo control no realizó ningún tipo de entrenamiento. El análisis estadístico fue hecho usando los
siguientes tests; Shapiro-Wilk, Levene, análisis de covarianza (ANCOVA), tamaño de efecto eta-squared y efecto neto,
usando el software SPSS 15.0 y el nivel de significación de 5%. Resultados: No hubo diferencia estadística significativa
entre el grupo control y el grupo de artes marciales para la caracterización de la muestra. Hubo diferencia significativa
en la PA sistólica en el grupo de artes marciales, cuando comparado con el grupo control ( valor p=0,049). La dimen-
sión del efecto puede ser considerada moderada (dimensión del efecto=0,163) con un buen efecto neto (3,4 mmHg).
Conclusión: Este estudio demostró que 16 semanas de artes marciales disminuyeron la PA sistólica en adolescentes
normotensos. Nivel de Evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.
Descriptores: Frecuencia cardíaca; Adolescente; Presión sanguínea; La presión del pulso; Artes marciales; Presión arterial.
Article received on 04/27/2017 accepted on 10/20/2017
DOI: http://dx.doi.org/10.1590/1517-869220182403179093
All BP measurements were performed three times in the right arm and
the mean of the final two measures was used for analysis. This blood
pressure device has been previously validated for use in adolescents.18
Pulse pressure (PP) was defined as the difference between the systolic
and diastolic BP readings.
Heart rate (HR) was obtained with a heart rate monitor (Polar FT-1
model T-31 Owncod-coded transmitter, Finland) with the cardiofrequen-
cimeter fixed at the sternum, specifically at the xiphoid process. For the
evaluation of resting heart rate the adolescents remained resting for 15
minutes until the assessment was performed. The rate pressure product
(RPP) was calculated as the product of HR and systolic BP.
The social project offered leisure activities such as: Judo, Muay-Thai,
chess, computer and music to adolescents. The adolescents were divided
into two groups: Martial Arts (Judo and Muay-Thai) and Control (chess,
computer and music). The Martial Arts group performed 16 weeks of
training, after a two week adaptation period. The training was conducted
twice a week; each session had a duration of 90 minutes, as recommended
by the American College of Sports Medicine Guidelines.19 Each session
consisted of 15 minutes of stretching, 10 minutes of warming up, 60
minutes of specific martial arts training (as detailed below) and five mi-
nutes of cooling down with stretching. Both training programs were of
moderate intensity, monitored by the perceived exertion scale.
20
All the
participants were previously familiarized with the use of the RPE scale.
The control group performed other activities twice a week during
the 16 weeks. They were instructed to maintain their usual physical
activity levels throughout the study.
The judo training was based on the principles of the sport and was
characterized as a fight for domain, aiming to grab and hold an opponent.
Initially, we developed a series of pre-sport activities. These included
games involving the field of the opponent’s footprint, conquests for
territory using the elements of judo ground fighting, crouching fights,
with the goal of unbalancing the opponent, and catching adapted to
the sport, practiced in fours and composed of guards and bearings. In
addition, specific activities for the improvement of judo techniques were
performed. First falls (forward, sideways and backward) and bearings
(for right and left) were learnt, followed by incoming blows, which
training specific to learning and the correct execution of the blows. In
addition, ground game was practiced, which is a struggle carried out
on the ground, where the practitioners enhance their immobilization
and strangulation techniques. Finally the fight itself was performed,
where the individuals used all the above techniques in a single activity.
Muay-Thai training is characterized as a percussion fight, with the aim
of striking the opponent to score points. Initially, the training included
less complex activities and low intensity for the participants who were
familiar with the sport, such as balance activities, striking parts of the
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Rev Bras Med Esporte – Vol. 24, No 3 – Mai/Jun, 2018
body, strength, agility, coordination and development of laterality. This
progressed to more specific activities, such as kicking, kneeing, punching,
elbowing, dodges and defenses, always using equipment and adequate
safeguards aimed at the safety of the students.
After learning these specific activities, the process of unification of
blows began, with sequences that always used arms and legs to impede
movement, in addition to a gradual increase in intensity. After learning
the movements and techniques, the students began performing combat
simulations with the teachers.
Statistical analysis
Normality and homogeneity of variance were verified using the Shapiro–
Wilks and Levene’s tests, respectively. Sample characterization variables were
presented as mean and standard deviation. To compare the cardiovascular
effects of the interventions, adjusting for age and sex, analysis of covariance
(ANCOVA) was used. The eta-squared effect size and net-effect (∆ Martial
Arts group - ∆ Control Group) were obtained. The statistical significance
was 5%. The statistical package used in the analyzes was SPSS 15.0
RESULTS
Seventy adolescents aged 11 to14 years were initially enrolled in the
present study. During the intervention period 30 adolescents left the study
for exceeding the number of absences or not performing the evaluations
(sample loss of 42.8%). Thus, the final sample consisted of 40 adolescents
(28 boys), divided into Martial Arts (n=28) and Control (n=12). (Figure 1)
At baseline, there were no significant differences between the
intervention groups regarding anthropometric variables, systolic BP
(p-value=0.259), diastolic BP (p-value=0.437), resting HR (p-value=0.277),
PP (p-value=0.266) or RPP (p-value=0.208). The sample characteristics
are shown in Table 1.
Figure 2 and Figure 3 presents the cardiovascular effects of the in-
terventions. There were significant decreases in systolic BP in the Martial
Arts group (p-value<0.05), while the control group presented increases
(p-value<0.05). The changes in the Martial Arts group was significantly
greater than the control group (p-value=0.049). The effect size for the
Eta-squared can be considered as large (effect size= 0.163). There were
no significant changes in diastolic BP, resting HR, PP or RPP in either the
Martial Arts or control group (p-value>0.05) with a low effect size in both.
DISCUSSION
The results of this study indicated that 16 weeks of Martial Arts
training performed twice a week decreased systolic BP in adolescents.
These results suggest that Martial Arts, including Judo and Muay-Thai,
can be used to lower BP in young people.
This is the first study to show a reduction in systolic BP following Martial
Arts training in adolescents. The strengths of the study include controlling
for various potential confounders, the homogeneity of the sample and this
being the first study to analyze the effects of martial arts on cardiovascular
variables in adolescents. In fact, previous studies
21,22
that analyzed the effects
of Martial Arts on cardiovascular variables were performed in cohorts of
either healthy adults or elderly individuals or those with cardiometabolic
diseases. In addition, only Tai Chi Chuan has been investigated.
23
thus,
the effects of other Martial Arts, such as Judo and Muay Thai, which are
confrontation Martial Arts and the most intense, are unknown.
The present study demonstrated an improvement in systolic BP after
16 weeks of Martial Arts, with a net-effect of 3.4 mmHg. These findings
demonstrated that Martial Arts, such as Judo and Muay-Thai, are an
interesting form of prevention for cardiovascular disease in adolescence,
which is interesting given that high blood pressure during adolescen-
ce tracks into adulthood
5
. In addition, it is know that a reduction of
2 mmHg in systolic BP results in a 6% decrease in the risk of stroke and
a 4% reduction in the risk of cardiac heart disease.24
Similar findings have been observed in other studies with Martial
Arts in adults and the elderly. For example, Lo et al.25 found a significant
reduction in both systolic and diastolic BP in hypertensive adults after
8 weeks of Tai Chi Chuan training (3 times a week, 60 mins per session).
Zheng et al.,26 in their meta-analytical study with 22 studies, found that
Thai Chi Chuan training reduced systolic BP in healthy adults. Similarly,
Squarcini et al.
21
analyzed the benefits of karate practice (3 times a week,
60 minutes, for 3 months) in healthy hypertensive elderly individuals and
found that, in addition to other benefits in quality of life, these women
significantly decreased systolic blood pressure.
Although it was not been aim of this study to analyze the underlying
mechanisms, it can be speculated that there was maintenance or a
small increase in cardiac output in the Martial Arts group, whereas in
the control group there was an increase in cardiac output, especially
through the increase in HR. Comparison with other studies involving
adolescents and Martial Arts is limited by the lack of studies. However, a
recent meta-analysis observed a small increase in cardiac output (small
reduction in heart rate and small increase in stroke volume) after Tai Chi
Chuan training in healthy adults. Future studies should be performed
to investigate these variables in adolescents.
The non-randomization is the main limitation of this study, which
explains in part why the groups were not matched, in addition to the
absence of physiological variables to explain the decreases in blood
pressure. In addition the analysis considering the martial arts group with
judo and muay-thai practitioners in the same group can be considered as
a limitation, since these martial arts have their specificities. However, these
groups did not differ among themselves and were treated together in com
-
parison with the control group to increase the power of statistical analysis.
Finally, this study included only normotensive adolescents; therefore, our
data need to be interpreted cautiously and may not be generalizable to
Table 1. Characteristics of the sample according to the group at baseline.
Variables Martial arts
(n=28)
Control
(n=12) p-value
Sex (%boys) 71.5 66.7 0.785
Age (years) 10.9 (1.4) 11.0 (1.4) 0.110
Weight (kg) 41.3 (13.1) 48.2 (14.3) 0.135
Height (cm) 146.9 (10.7) 151.8 (11.1) 0.197
Body mass index (kg/m2)18.8 (4.1) 20.5 (4.1) 0.233
Systolic BP (mmHg) 106.0 (7.3) 112.1 (16.4) 0.259
Diastolic BP (mmHg) 59.6 (9.4) 62.1 (8.0) 0.437
Pulse pressure (mmHg) 45.96 (8.9) 50.00 (12.6) 0.266
Heart rate (bpm) 76.8 (11.3) 81.2 (12.8) 0.277
Rate pressure product (bpm*mmHg) 8171.2 (1275.7) 9019.8 (848.1) 0.208
BP= Blood pressure, values are presented as mean (Standard deviation) or frequency.
4 Excluded non-fulfolment
inclusion criteria
46 Adolescents
Martial Arts Group 24 Adolescents
Control Group
18 Drop out 12 Drop out
28 Adolescents 12 Adolescents
74
Volunteered for the study
7 Adolescents
enrolled
Figure 1. Flow diagram of the sample.
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Rev Bras Med Esporte – Vol. 24, No 3 – Mai/Jun, 2018
all adolescents; it is possible that the results could have been better in
hypertensive adolescents.27 Finally, although the participants’ ages were
tightly controlled, we did not determine the Tanner stage.
CONCLUSION
In summary, this study showed that 16 weeks of Martial Arts decrea-
sed systolic BP in normotensive adolescents. Therefore, Martial Arts could
be an alternative mode of physical activity to improve cardiovascular
health and prevent cardiovascular diseases in young people.
ACKNOWLEDGMENTS
The author thank for the subjects who volunteered for this effort,
graduate assistants and the University participation, support, and coo-
peration that made this study possible. No external funding was obtai-
ned for this study. The author has no conflict of interest relevant to the
content of the article.
All authors declare no potential conflict of interest related to this article.
Figure 3. Comparasion of Δ% of pulse pressure (PP) and rate pressure product (RPP) in
martial arts and control group. *Adjusted by sex and body mass index (BMI).
Figure 2. Comparasion of Δ% of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate in martial arts and control group. *Adjusted by sex and body mass index (BMI).
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AUTHORS’ CONTRIBUTIONS: Each author made signicant individual contributions to this manuscript. BTCS (0000-0002-0902-0433)*: Substantial contribution in the con-
ception and design, instructor in the applied intervention, interpretation of data, writing and review; RMRD (0000-0001-7883-6746)*: and VFM (0000-0002-8121-2616)*: data
analysis, writing and review; BQF (0000-0003-2286-5892)*: statistical analysis, writing and review; VYBS (0000-0002-3981-5229)*: instructor in the applied intervention, data
collection and analysis, writing and review; TAD (0000-0002-2655-9588)*: writing and review; PCJ (0000-0002-1448-9607)*: instructor in the applied intervention, intellectual
collaboration and creation of the research project; DGDC (0000-0001-9917-9992)*: data analysis, statistical analysis, writing and review, research project coordinator. All authors
contributed to the intellectual concept of the study and approved the nal version of the manuscript. *ORCID (Open Researcher and Contributor ID).
Δ% SBP
Δ% PP
Δ% RPP
6.83
-0.17
4.16
4.25
-2.43
1.01
8
6
4
2
0
-2
5
4
3
2
1
0
6
4
2
0
-2
-4
p=0.049
p=0.923
p=0.303
Martial arts
Control
Δ% SBP Δ% Heart ratep=0.911
Martial arts
Control
Martial arts
Control
Martial arts
Control
Martial arts
Control
3.98
3.14
1.95
-0.43
5
4
3
2
1
0
2.5
2.0
1.5
1.0
0.5
0.0
-0.5
A
A
B
B C
