Skip to main content
SpringerLink
Log in

Efficacy of Exercise Intervention for Weight Loss in Overweight and Obese Adolescents: Meta-Analysis and Implications

  • Systematic Review
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Background

The global rise in obesity prevalence among children and adolescents has been linked to modifiable lifestyle factors, including lack of physical activity. However, no known meta-analysis has been conducted on the effects of exercise intervention on body composition and cardiometabolic risk factors in overweight and obese adolescents.

Objectives

The aim of this study was to (1) estimate whether exercise intervention meaningfully improves body composition and cardiometabolic risk factors in overweight and obese adolescents; and (2) discuss the implications of the findings in terms of primary healthcare provision and public health policy, using New Zealand as an exemplar context.

Data Sources

Electronic databases (PubMed, Web of Science, SPORTDiscus, Google Scholar) from inception to May 2015. The reference lists of eligible articles and relevant reviews were also checked.

Study Selection

Inclusion criteria were (1) randomized controlled trial; (2) structured exercise intervention, alone or combined with any other kind of intervention; (3) control group received no structured exercise or behavioural modification designed to increase physical activity; (4) participants overweight or obese (body mass index [BMI] ≥85th percentile); and (5) participants aged between 10 and 19 years.

Appraisal and Synthesis Methods

Initially, 1667 articles were identified. After evaluation of study characteristics, quality and validity, data from 13 articles (15 trials) involving 556 participants (176 male, 193 female, 187 unknown) were extracted for meta-analysis. Meta-analyses were completed on five body composition parameters and ten cardiometabolic parameters. Effect sizes (ESs) were calculated as mean differences, as well as standardized mean differences in order to determine effect magnitude.

Results

Exercise intervention reduced BMI (mean 2.0 kg/m2, 95 % CI 1.5–2.5; ES moderate), body weight (mean 3.7 kg, 95 % CI 1.7–5.8; ES small), body fat percentage (3.1 %, 95 % CI 2.2–4.1; ES small), waist circumference (3.0 cm, 95 % CI 1.3–4.8; ES small), but the increase (improvement) in lean mass was trivial (mean 1.6 kg, 95 % CI 0.5–2.6). The response to an oral glucose tolerance test following exercise intervention was for a decrease in the area under the curve for insulin (mean 162 μU/μl, 95 % CI 93–231; ES large) and blood glucose (mean 39 mg/dl, 95 % CI 9.4–69; ES moderate). Improvements in the homeostatic model assessment were also noted (mean 1.0, 95 % CI 0.7–1.4; ES moderate) and systolic blood pressure (mean 7.1 mmHg, 95 % CI 3.5–10.7; ES moderate). The effects of exercise on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting insulin and fasting blood glucose were inconclusive.

Limitations

Most of the included trials were short term (6–36 weeks) and 13 had methodological limitations. Additionally, the meta-analyses for some of the secondary outcomes had a small number of participants or substantial statistical heterogeneity.

Conclusions

The current evidence suggests that exercise intervention in overweight and obese adolescents improves body composition, particularly by lowering body fat. The limited available evidence further indicates that exercise intervention may improve some cardiometabolic risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Malhotra A, Noakes T, Phinney S. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med. 2015;49(15):967–8.

    Article  CAS  PubMed  Google Scholar 

  2. Triggle CR. Exercise ‘not key to obesity fight’. 2015. http://www.bbc.com/news/health/32417699. Accessed 14 May 2015.

  3. Royal Society for Public Health. Mixed messages surrounding diet and exercise risk confusing the public. 2015. https://www.rsph.org.uk/en/about-us/latest-news/index.cfm/pid/ADAA562D-5FBA-4082-A4E5F076A16EA3AB. Accessed 14 May 2015.

  4. OECD. OECD Obesity Update 2014. http://www.oecd.org/health/obesity-update.htm. Accessed 15 Apr 2016.

  5. Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352(11):1138–45.

    Article  CAS  PubMed  Google Scholar 

  6. Meeuwsen S, Horgan GW, Elia M. The relationship between BMI and percent body fat, measured by bioelectrical impedance, in a large adult sample is curvilinear and influenced by age and sex. Clin Nutr. 2010;29(5):560–6.

    Article  CAS  PubMed  Google Scholar 

  7. World Health Organization. Plan of action of the Commission on Ending Childhood Obesity. 2014. http://www.who.int/dietphysicalactivity/end-childhood-obesity/action-plan/en/. Accessed 26 May 2014.

  8. Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes Metab Syndr Obes. 2010;3:285–95.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brettschneider C, Leicht H, Bickel H, et al. Relative impact of multimorbid chronic conditions on health-related quality of life: results from the Multicare Cohort Study. PLoS One. 2013;8(6):e66742.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lal A, Moodie M, Ashton T, et al. Health care and lost productivity costs of overweight and obesity in New Zealand. Aust N Z J Public Health. 2012;36(6):550–6.

    Article  PubMed  Google Scholar 

  11. Faigenbaum AD, Myer GD. Exercise deficit disorder in youth: play now or pay later. Curr Sports Med Rep. 2012;11(4):196–200.

    Article  PubMed  Google Scholar 

  12. Lieberman D. The story of the human body: evolution, health, and disease. 1st ed. London: Pantheon; 2013.

    Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009;3(3):e123–30.

    PubMed  PubMed Central  Google Scholar 

  14. Centers for Disease Control and Prevention. Basics about childhood obesity. 2015. http://www.cdc.gov/obesity/childhood/basics.html. Accessed 12 May 2015.

  15. Higgins J, Green S, Cochrane Collaboration, editors. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley; 2008.

    Google Scholar 

  16. Crowther M, Lim W, Crowther MA. Systematic review and meta-analysis methodology. Blood. 2010;116(17):3140–6.

    Article  CAS  PubMed  Google Scholar 

  17. Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.

    Article  CAS  PubMed  Google Scholar 

  18. Borenstein M, Hedges LV, Higgins JPT. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Syn Meth. 2010;1(2):97–111.

    Article  Google Scholar 

  19. Hopkins WG. A spreadsheet for deriving a confidence interval, mechanistic inference and clinical inference from a p value. Sport Sci. 2007;11:16–20.

    Google Scholar 

  20. Hopkins WG, Marshall SW, Batterham AM, et al. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc. 2009;41(1):3–13.

    Article  PubMed  Google Scholar 

  21. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ryan R. Cochrane Consumers and Communication Review Group: meta-analysis. http://cccrg.cochrane.org. Accessed 17 May 2015.

  23. Davis JN, Kelly LA, Lane CJ, et al. Randomized control trial to improve adiposity and insulin resistance in overweight Latino adolescents. Obesity (Silver Spring). 2009;17(8):1542–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Davis JN, Tung A, Chak SS, et al. Aerobic and strength training reduces adiposity in overweight Latina adolescents. Med Sci Sports Exerc. 2009;41(7):1494–503.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Balagopal P, George D, Patton N, et al. Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. J Pediatr. 2005;146(3):342–8.

    Article  PubMed  Google Scholar 

  26. Ben Ounis O, Elloumi M, Zouhal H, et al. Effect of individualized exercise training combined with diet restriction on inflammatory markers and IGF-1/IGFBP-3 in obese children. Ann Nutr Met. 2010;56(4):260–6.

    Article  CAS  Google Scholar 

  27. Kim ES, Im JA, Kim KC, et al. Improved insulin sensitivity and adiponectin level after exercise training in obese Korean youth. Obesity (Silver Spring). 2007;15(12):3023–30.

    Article  CAS  PubMed  Google Scholar 

  28. Lee KJ, Shin YA, Lee KY, et al. Aerobic exercise training-induced decrease in plasma visfatin and insulin resistance in obese female adolescents. Int J Sport Nutr Exerc Metab. 2010;20(4):275–81.

    Article  CAS  PubMed  Google Scholar 

  29. Melnyk BM, Small L, Morrison-Beedy D, et al. The COPE Healthy Lifestyles TEEN program: feasibility, preliminary efficacy, & lessons learned from an after school group intervention with overweight adolescents. J Pediatr Health Care. 2007;21(5):315–22.

    Article  PubMed  Google Scholar 

  30. Meyer AA, Kundt G, Lenschow U, et al. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol. 2006;48(9):1865–70.

    Article  PubMed  Google Scholar 

  31. Rocchini AP, Katch V, Schork A, et al. Insulin and blood pressure during weight loss in obese adolescents. Hypertension. 1987;10(3):267–73.

    Article  CAS  PubMed  Google Scholar 

  32. Sun MX, Huang XQ, Yan Y, et al. One-hour after-school exercise ameliorates central adiposity and lipids in overweight Chinese adolescents: a randomized controlled trial. Chin Med J (Engl). 2011;124(3):323–9.

    PubMed  Google Scholar 

  33. Toulabi T, Khosh Niyat Nikoo M, Amini F, et al. The influence of a behavior modification interventional program on body mass index in obese adolescents. J Formos Med Assoc. 2012;111(3):153–9.

    Article  PubMed  Google Scholar 

  34. Tsang TW, Kohn M, Chow CM, et al. A randomised placebo-exercise controlled trial of Kung Fu training for improvements in body composition in overweight/obese adolescents: the “Martial Fitness” study. J Sports Sci Med. 2009;8(1):97–106.

    PubMed  PubMed Central  Google Scholar 

  35. Wong PC, Chia MY, Tsou IY, et al. Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity. Ann Acad Med Singapore. 2008;37(4):286–93.

    PubMed  Google Scholar 

  36. Kong AS, Sussman AL, Yahne C, et al. School-based health center intervention improves body mass index in overweight and obese adolescents. J Obes. 2013;2013:575016.

    Article  PubMed  PubMed Central  Google Scholar 

  37. de Mello MT, de Piano A, Carnier J, et al. Long-term effects of aerobic plus resistance training on the metabolic syndrome and adiponectinemia in obese adolescents. J Clin Hypertens (Greenwich). 2011;13(5):343–50.

    Article  Google Scholar 

  38. Nowicka P, Hoglund P, Pietrobelli A, et al. Family weight school treatment: 1-year results in obese adolescents. Int J Pediatr Obes. 2008;3(3):141–7.

    Article  PubMed  Google Scholar 

  39. DeBar LL, Stevens VJ, Perrin N, et al. A primary care-based, multicomponent lifestyle intervention for overweight adolescent females. Pediatrics. 2012;129(3):e611–20.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Johnston CA, Tyler C, Fullerton G, et al. Effects of a school-based weight maintenance program for Mexican-American children: results at 2 years. Obesity (Silver Spring). 2010;18(3):542–7.

    Article  PubMed  Google Scholar 

  41. Johnston CA, Tyler C, McFarlin BK, et al. Weight loss in overweight Mexican American children: a randomized, controlled trial. Pediatrics. 2007;120(6):e1450–7.

    Article  PubMed  Google Scholar 

  42. Neumark-Sztainer D, Story M, Hannan PJ, et al. New Moves: a school-based obesity prevention program for adolescent girls. Prev Med. 2003;37(1):41–51.

    Article  PubMed  Google Scholar 

  43. Savoye M, Shaw M, Dziura J, et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA. 2007;297(24):2697–704.

    Article  CAS  PubMed  Google Scholar 

  44. Ben Ounis O, Elloumi M, Ben Chiekh I, et al. Effects of two-month physical-endurance and diet-restriction programmes on lipid profiles and insulin resistance in obese adolescent boys. Diabetes Metab. 2008;34(6 Pt 1):595–600.

    Article  CAS  PubMed  Google Scholar 

  45. Davis JN, Gyllenhammer LE, Vanni AA, et al. Startup circuit training program reduces metabolic risk in Latino adolescents. Med Sci Sports Exerc. 2011;43(11):2195–203.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Buchan DS, Ollis S, Thomas NE, et al. Physical activity interventions: effects of duration and intensity. Scand J Med Sci Sports. 2011;21(6):e341–50.

    Article  CAS  PubMed  Google Scholar 

  47. Roberts CK, Lee MM, Katiraie M, et al. Strength fitness and body weight status on markers of cardiometabolic health. Med Sci Sports Exerc. 2015;47(6):1211–8.

    Article  PubMed  Google Scholar 

  48. Ho M, Garnett SP, Baur LA, et al. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr. 2013;167(8):759–68.

    Article  PubMed  Google Scholar 

  49. Stoner L, Cornwall J. Did the American Medical Association make the correct decision classifying obesity as a disease? Australas Med J. 2014;7(11):462–4.

    Article  PubMed  PubMed Central  Google Scholar 

  50. World Health Organization. The World Health report 2002. Geneva: World Health Organization; 2002.

    Google Scholar 

  51. Riley M, Bluhm B. High blood pressure in children and adolescents. Am Fam Physician. 2012;85(7):693–700.

    PubMed  Google Scholar 

  52. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Dias KA, Green DJ, Ingul CB, et al. Exercise and vascular function in child obesity: a meta-analysis. Pediatrics. 2015;136(3):e648–59.

    Article  PubMed  Google Scholar 

  54. Korner A, Wiegand S, Hungele A, et al. Longitudinal multicenter analysis on the course of glucose metabolism in obese children. Int J Obes (Lond). 2013;37(7):931–6.

    Article  CAS  Google Scholar 

  55. Alanazi A. Metformin treatment for obesity in children and adolescents: a meta-analysis and review of literature. Pharmacologia. 2013;4(8):511–8.

    Article  CAS  Google Scholar 

  56. Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000;106(4):473–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Lambrick DM, Stoner L, Faulkner J, et al. Preventive medicine needs to begin with our children. Int J Prev Med. 2014;5(1):129–31.

    PubMed  PubMed Central  Google Scholar 

  59. Schonfeld-Warden N, Warden CH. Pediatric obesity. An overview of etiology and treatment. Pediatr Clin North Am. 1997;44(2):339–61.

    Article  CAS  PubMed  Google Scholar 

  60. Rosenbaum M, Leibel RL, Hirsch J. Obesity. N Engl J Med. 1997;337(6):396–407.

    Article  CAS  PubMed  Google Scholar 

  61. World Health Organization. Global nutrition targets 2025: childhood overweight policy brief (WHO/NMH/NHD/14.6). Geneva: World Health Organisation; 2014.

    Google Scholar 

  62. LeMura LM, Maziekas MT. Factors that alter body fat, body mass, and fat-free mass in pediatric obesity. Med Sci Sports Exerc. 2002;34:487–96.

    Article  PubMed  Google Scholar 

  63. Peterson MD, Saltarelli WA, Visich PS, et al. Strength capacity and cardiometabolic risk clustering in adolescents. Pediatrics. 2014;133(4):e896–903.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Lobelo F, Stoutenberg M, Hutber A. The Exercise is Medicine global health initiative: a 2014 update. Br J Sports Med. 2014;48(22):1627–33.

    Article  PubMed  Google Scholar 

  65. Sallis RE. Exercise is medicine and physicians need to prescribe it! Br J Sports Med. 2009;43(1):3–4.

    Article  CAS  PubMed  Google Scholar 

  66. Coombes JS, Law J, Lancashire B, et al. “Exercise is Medicine”: curbing the burden of chronic disease and physical inactivity. Asia Pac J Public Health. 2015;27(2):NP600–5.

    Article  PubMed  Google Scholar 

  67. Exercise is Medicine Network: Pediatrics. http://www.exerciseismedicine.org/support_page.php?p=87. Accessed 21 May 2015.

  68. Hainer V, Toplak H, Stich V. Fat or fit: what is more important? Diabetes Care. 2009;32(Suppl 2):S392–7.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Moschonis G, Mougios V, Papandreou C, et al. “Leaner and less fit” children have a better cardiometabolic profile than their “heavier and more fit” peers: the Healthy Growth Study. Nutr Metab Cardiovasc Dis. 2013;23(11):1058–65.

    Article  CAS  PubMed  Google Scholar 

  70. Stoner L, Lambrick DM, Faulkner J. We’re not ready to encourage children to be “lean” rather than “fit”. Nutr Metab Cardiovasc Dis. 2014;24(1):e6–7.

    Article  CAS  PubMed  Google Scholar 

  71. Castro N, Faulkner J, Skidmore P, et al. Pre-adolescent cardio-metabolic associations and correlates: PACMAC methodology and study protocol. BMJ Open. 2014;4(9):e005815.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Rush E, McLennan S, Obolonkin V, et al. Beyond the randomised controlled trial and BMI: evaluation of effectiveness of through-school nutrition and physical activity programmes. Public Health Nutr. 2015;18(9):1578–81.

    Article  PubMed  Google Scholar 

  73. Cornwall J, Stoner L. School-based health interventions should be assessed with measures of fitness and fatness: comment on ‘Beyond the randomised controlled trial and BMI: evaluation of effectiveness of through-school nutrition and physical activity programmes’. Public Health Nutr. 2015;18(11):2094.

    Article  PubMed  Google Scholar 

  74. Young Y, Abdolhosseini P, Brown F, et al. Reliability of oscillometric central blood pressure and wave reflection readings: effects of posture and fasting. J Hypertens. 2015;33(8):1588–93.

    Article  CAS  PubMed  Google Scholar 

  75. Parikh P, Mochari H, Mosca L. Clinical utility of a fingerstick technology to identify individuals with abnormal blood lipids and high-sensitivity C-reactive protein levels. Am J Health Promot. 2009;23(4):279–82.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Barrett SC, Huffman FG, Johnson P. Validation of finger-prick testing of fasting blood glucose, total cholesterol, and HbA1c in adolescents. J Near-Patient Test Tech. 2011;10(2):51–8.

    Google Scholar 

  77. Ministry of Health. Healthy Families NZ. 2015. http://www.health.govt.nz/our-work/preventative-health-wellness/healthy-families-nz. Accessed 6 Jun 2015.

  78. Healthy Together Victoria. 2015. http://www.healthytogether.vic.gov.au/. Accessed 6 Jun 2015.

  79. Galea S, Riddle M, Kaplan GA. Causal thinking and complex system approaches in epidemiology. Int J Epidemiol. 2010;39(1):97–106.

    Article  PubMed  Google Scholar 

  80. Bayon V, Leger D, Gomez-Merino D, et al. Sleep debt and obesity. Ann Med. 2014;46(5):264–72.

    Article  PubMed  Google Scholar 

  81. Lucassen EA, Rother KI, Cizza G. Interacting epidemics? Sleep curtailment, insulin resistance, and obesity. Ann N Y Acad Sci. 2012;1264:110–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Lambiase MJ, Gabriel KP, Kuller LH, et al. Temporal relationships between physical activity and sleep in older women. Med Sci Sports Exerc. 2013;45(12):2362–8.

    Article  PubMed  Google Scholar 

  83. Martinez-Gomez D, Veiga OL, Gomez-Martinez S, et al. Behavioural correlates of active commuting to school in Spanish adolescents: the AFINOS (Physical Activity as a Preventive Measure Against Overweight, Obesity, Infections, Allergies, and Cardiovascular Disease Risk Factors in Adolescents) study. Public Health Nutr. 2011;14(10):1779–86.

    Article  PubMed  Google Scholar 

  84. Tricket E, Beehler S, Deutsch C, et al. Advancing the science of community-level interventions. Fram Health Matters. 2011;101(8):1410–9.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Public Health Research, Massey University, PO Box 756, Wellington, New Zealand

    Lee Stoner & Anna Matheson

  2. School of Sport and Exercise, Massey University, Wellington, New Zealand

    Lee Stoner, David Rowlands & Kim Gaffney

  3. School of Public Health, New Mexico State University, Las Cruces, NM, USA

    Ariel Morrison

  4. School of Human Performance and Recreation, University of Southern Mississippi, Hattiesburg, MS, USA

    Daniel Credeur

  5. Department of Tourism, Sport and Society, Lincoln University, Christchurch, New Zealand

    Michael Hamlin

  6. Faculty of Health Sciences, University of Southampton, Hants, UK

    Danielle Lambrick

Authors
  1. Lee Stoner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Rowlands
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ariel Morrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Credeur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Hamlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kim Gaffney
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Danielle Lambrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anna Matheson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lee Stoner.

Ethics declarations

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Lee Stoner, David Rowlands, Ariel Morrison, Daniel Credeur, Michael Hamlin, Kim Gaffney, Danielle Lambrick and Anna Matheson declare that they have no conflicts of interest relevant to the content of this review.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stoner, L., Rowlands, D., Morrison, A. et al. Efficacy of Exercise Intervention for Weight Loss in Overweight and Obese Adolescents: Meta-Analysis and Implications. Sports Med 46, 1737–1751 (2016). https://doi.org/10.1007/s40279-016-0537-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-016-0537-6

Keywords

Search

Navigation