A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport
International Journal of Behavioral Nutrition and Physical Activity
A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport
Rochelle M Eime 0 1
Janet A Young 1
Jack T Harvey 0
Melanie J Charity 0 1
Warren R Payne 1
0 School of Health Sciences, University of Ballarat , PO Box 663, Ballarat, Victoria 3353 , Australia
1 Institute of Sport, Exercise and Active Living, Victoria University , PO Box 14428, Melbourne, Victoria 8001 , Australia
Background: There are specific guidelines regarding the level of physical activity (PA) required to provide health benefits. However, the research underpinning these PA guidelines does not address the element of 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 children and adolescents. Secondly, the information arising from the systematic review has been used to develop a conceptual model. 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 30 met the selection criteria. There were many different psychological and social health benefits reported, with the most commonly being improved self-esteem, social interaction followed by fewer depressive symptoms. Sport may be associated with improved psychosocial health above and beyond improvements attributable to participation in PA. Specifically, team sport seems to be associated with improved health outcomes compared to individual activities, due to the social nature of the participation. 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 fact that the majority of studies identified (n=21) were cross-sectional. Conclusion: It is recommended that community sport participation is advocated as a form of leisure time PA for children and adolescents, in an effort to not only improve physical health in relation to such matters as the obesity crisis, but also to enhance psychological and social health outcomes. It is also recommended that the causal link between participation in sport and psychosocial health be further investigated and the conceptual model of Health through Sport tested.
Sport; Health; Psychological; Psychosocial; Social
Regular participation in physical activity (PA) is imperative
for good health. Active people benefit from higher levels
of health-related fitness and are at lower risk of developing
many different disabling medical conditions than inactive
people [1,2]. It is widely acknowledged that the health
benefits of participation in PA are not limited to physical
health but also incorporate mental components [1,2].
Extensive research has resulted in clear
recommendations of the level of PA required to produce health
benefits [1,3]. There are specific health-related
recommendations for children and adolescents distinct from
those for adults. For people aged 5–17 years it is
recommended that they undertake moderate or vigorous
activities for at least 60 minutes per day . Regular
maintenance of this level of activity by children and
adolescents can result in increased physical fitness, reduced
body fat, favourable cardiovascular and metabolic
disease risk profiles, enhanced bone health and reduced
symptoms of depression and anxiety . Whilst many
different health benefits of participation in PA are
acknowledged, the vast majority of research has focused
on the physical health benefits of participation in PA,
with less research focused on the mental and social
health aspects. Although mental health benefits have
been referenced in recent guidelines, to date ”insufficient
evidence precludes conclusions about the minimal or
optimal types or amounts of physical activity for mental
health”  (Part G Section 8 p39).
Even though the World Health Organisation definition
of health (2006) incorporates physical, mental and social
health domains, the research providing evidence to the PA
guidelines does not specifically address social health.
However, the literature informing PA guidelines does suggest
that aspects such as social support may contribute to
some of the explanations of mental health outcomes .
Leisure-time PA is one domain of PA. Sport is one
type of leisure-time PA which is organised and usually
competitive and played in a team or as an individual .
Participation in sport is very popular among children.
However there is evidence that participation in sport
peaks at around 11–13 years before declining through
adolescence [6,7]. Conversely, there is research indicating
that children who are active through sport are more likely
to be physically active in adulthood than those who do not
participate in childhood sport [8,9]. Further, substantial
public investment in sport development has been justified
in terms of a range of health benefits , but without a
clear understanding of the best way to achieve maximum
health benefits - both mental and physical.
Extensive research has been conducted on the
determinants of participation in PA [6,11] and on
interventions that attempt to increase PA participation , with
relatively little research focusing more specifically on
sport [9,13]. Also, with regard to the health benefits of
PA, the research has generally not extended to the
mental and social health benefits of sport participation in
A conceptual model in the public health area has been
defined as “diagram of proposed causal linkages among
a set of concepts believed to be related to a specific
public health problem”  (p163). Determinants of PA are
increasingly being understood using socio-ecological
models, whereby intrapersonal, interpersonal,
organisational, environmental and policy variables are identified
as influences on participation [15-18]. As Earp and
Ennett (1991) explain, conceptual models in health do
take an ecological perspective, implying that behaviours
or health outcomes result from the interaction of both
individual and environmental determinants [14,19]. In
terms of the sport and health nexus, we are not aware of
a conceptual model that depicts the specific mental and
social health outcomes of sport participation.
Conceptual models have been developed which show the
relationship between different types of PA, including sport,
and the intensity and context of participation ,
however they do not extend to the health benefits of
participation. In one systematic review of the effectiveness of
interventions to increase physical activity, a conceptual
model of the relationship between interventions,
modifiable determinants, immediate outcomes and health
outcomes was developed . However, this study did not
specifically identify sport. Furthermore, there are many
clinical conceptual models depicting health outcomes of
clinical conditions, however they do not focus on the
general population or on preventive health or health
Firstly, this paper presents the results of a systematic
review investigating the psychological and social benefits
of participation in sport for children and adolescents.
Secondly, the information obtained in the systematic
review has been used to develop a conceptual model: the
conceptual model of Health through Sport, for children
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 that 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” . ‘health’ – “a state of complete physical,
mental and social well-being and not merely the
absence of disease and infirmity” ; ‘mental’ - “of
or referring to the mind or to the processes of the
mind, such as thinking, feeling, sensing, and the like”
 (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 WHO's definition of health…It is
related to the promotion of well-being, the
prevention of mental disorders, and the treatment
and rehabilitation of people affected by mental
disorders” [26,27] ‘social’: “Relating to the
interactions of individuals, particularly as members
of a group or a community ”  (p475); ‘social
health’: “That dimension of an individual’s well-being
that concerns how he gets along with other people,
how other people react to him, and how he interacts
with social institutions and societal mores.” 
(p 152). In this study, we also used the following
terms: ‘psychological’ – as a synonym for ‘mental’;
and ‘psychosocial’ - “…any situation in which both
psychological and social factors are assumed to play
a role”  (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’, or ‘recreation’, and not
sport. Definitions of these terms are: ‘Exercise’
–“physical activity that is planned, structured,
repetitive, and purposive in the sense that
improvement or maintenance of one or more
components of physical fitness is an objective” 
(p128); ‘Physical activity’ - “bodily movement
produced by skeletal muscles that results in energy
expenditure”  (p126); ‘Physical education’
“a sequential, developmentally appropriate
educational experience that engages students in
learning and understanding movement activities that
are personally and socially meaningful, with the goal
of promoting healthy living”  (p8); ‘Recreation’ –
“pleasurable activity”  (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
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 administrators.
6. Research/reports that addressed elite sports
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
A systematic search of 14 electronic databases (AU
SPORT, AusportMed, CINAHL, Cochrane Library,
EBSCHOHost Research Databases, Health Collection,
Informit, Medline Fulltext, PsycARTICLES, Psychology
and Behavioral Sciences Collection, PsycINFO, PubMed,
Scopus, SPORTDiscus 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 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 most basic word stem for each
keyword to ensure all associated terms were included in
Figure 1 provides a summary of the stages of study
selection. Titles and abstracts of potentially relevant
articles were screened by JY. Authors, JY and RE examined
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 reviewers.
Consensus was obtained for all included articles. After
reviewing the selected studies it was decided, given the
breadth and complexity of the research domain, that
studies focusing on children and adolescents should be
reviewed separately from studies focusing on adults, This
review focuses on children and adolescents only; studies
that stated that they specifically investigated children and/
or adolescents, but not adults (18 or above), were included.
Data collection and analysis
Data extracted from each of the studies included: study
design and methodology; sample size; country of origin;
age of participants; cohort of participants; gender of
participants; study aim; sport variable; other PA variables;
theoretical construct; key findings in relation to
psychological and social health outcomes.
Assessment of study quality
Study quality was objectively appraised using the Downs
and Black checklist . This checklist has been used in
other systematic reviews within the physical activity and
health field [33,34]. This checklist includes 27 items
grouped into categories: reporting (10), external validity
(3), internal validity - bias (7), internal validity –
confounding (6), and power (1). Twenty five items are
scored as 1 (compliance) or 0 (non-compliance or inability
to determine 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
complex algorithm) on a scale of 0–5.
Because most of the studies we reviewed did not
involve interventions, a number of the items on the
Downs and Black checklist were not generally applicable.
We substituted a simpler power item (presence or
absence 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
applicable) by expressing the number of compliant
items as a percentage of the number of applicable
items. We included these scores (ranging from 33%
to 88%) in Table 1, and used the insights we gained
through the scoring process in our discussion of
Screening for duplicates and full
Screening of titles and abstracts
Full-text articles assessed for
eligibility n= 99
Figure 1 Stages of study selection.
Ref. & Year Design* Method Sample
Cohort** Sex*** Aim
quality of life
or club sports)
School or club Non-school or
sport club sport
7-8 & Child. &
Youth involved in
sport in both
middle & high
school had lower
odds of suicidal
Athletes (school or
mental health &
sports & clubs had
children who did
relative risk of
not participate in
any sports or clubs
outside of school
account for some
of the differences
between types of
8-11 & Child. &
Less or no
Less sport or
Playing on sport
5th-8th Child. &
team sport to
higher levels of
related to reduced
was related to
their inactive peers.
perceived health &
Playing on team
with greater life
No team sport
Recreation sport participation Other
Less or no
associated with a
lower frequency of
involved in sports
resilient” or able to
bounce back from
Psychological resilience 60 67
Less or no
Socialization theory & Ecologyoriented
nervous or anxious,
more often full of
energy & happy
sports club &
in motor ability
strength of the
sport & health
last 2 years of
Sport Less or no sport
about their life, &
less often sad,
desperate, & less
outcomes of social
Conceptual model development
Based upon the literature presented in this review, 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 inclusion criterion 3 above.
The determinants are represented as per the
SocioEcological Model [19,65]. Upon reviewing the studies,
two dimensions of sport participation were identified, and
it became evident that some reported 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
participation and the different strengths of association
between different contexts 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 evidence 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
Figure 2 Health through Sport conceptual model.
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
nature 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
terminology in reviewing these studies.
Results and discussion
A total of 3668 publications were initially identified.
Table 1 provides a summary of the 30 studies that met the
inclusion criteria. Since the studies were generally
conducted within schools, they included school age
children and adolescents, generally 18 years or less. Most
studies were quantitative (n=26) rather than qualitative
(n=3), with one study incorporating both quantitative and
qualitative methods. There were no randomised controlled
trials, and the majority of studies were cross-sectional and
observational (n=21). Of the longitudinal studies (n=9),
the time between data collection was generally between 1
and 3 years (n=7), with one study reporting 12 years
between data collection periods. The sample sizes ranged
considerably, from 22 participants to large national
surveys of over 50,000 participants. The United States of
America was the country where most studies were
conducted (n=21), followed by Canada (n=4), Switzerland
(n=3), and Germany, United Kingdom and Puerto Rica
(n=1). One study was conducted with participants across
two countries, the USA and Puerto Rica. The age ranges
of the children and adolescents differed considerably
across studies. Six studies incorporated data from both the
child or adolescent and their parent(s).
Most studies scored highly on the modified Downs
and Black scale of study quality (median 75 percent;
range 33–88 percent). Those studies within the highest
tertile score range were all cross-sectional quantitative
studies [39,41-43,46,49,51-53,62]. Only one of the 10
studies in the highest tertile score range incorporated a
theoretical approach - the Theory of Youth Development
. Half of these 10 studies investigated differences in
health measures between participants in sport/club sport
and either other organised activities or no sport
[41,43,49,53,62]; the other half more specifically
investigated team sport participation in comparison to less or
no team sport [39,42,46,51,52]. There was no clear
distinction between the key findings of higher and lower
ranked studies; both high and lower quality studies
reported similar associations between sport participation
and the psychological and social health domains.
Prima facie, longitudinal studies can provide greater
strength of evidence regarding causality than can
crosssectional research. However, all of the longitudinal
studies reviewed [35,40,44,50,58] had other methodological
limitations, and as a consequence were not represented
in the highest tertile of study quality scores. The results
of these studies were consistent with those of the
There were few (n=2) qualitative studies, and similar
health benefits of participation in sport were also
reported in the quantitative studies. The study by Holt
et al., (2011) provided more depth than was captured in
the other studies reviewed. Interviews with parents and
children unearthed a wide range of developmental
benefits, both personal and social benefits . Psychological
aspects of emotional control and exploration were
reportedly related to sport participation. In addition, social
benefits of relationships with coaches and friends were
reported in this study .
The investigation of health benefits through
participation in physical activity mainly involved cross-sectional
surveys conducted through schools. In most cases the
students were not allocated to a participation group
prior to the study, and as such there were no control
groups. This limits the capacity to attribute causality of
participation on health outcomes.
The psychological and social health measures in each
study were diverse (Tables 1 and 2). The most common
variables related to psychosocial functioning and
emotional wellbeing (n=6), followed by risk of depression
and mental ill health (n=5), developmental
aspects/behaviour (n=4), social anxiety and shyness (n=3),
selfesteem (n=3) and suicidal behaviour (n=3). Some studies
(n=15) investigated the differences between sports and
non-sports participants, but many did not distinguish
between sport and other categories of PA. In the studies
involving adolescents, it was common to investigate
differences in youth behaviour and development according
to their participation (or not) in out-of-school
extracurricular activities. Sport was sometimes defined as ‘school
sport’, ‘club sport’ or ‘team sport’; however no studies
investigated associations between specific types of sport
and psychological or social health domains.
Table 2 provides a broad overview of the health
outcomes found to be significantly and positively associated
with sports participation, and lists the studies that
reported each health outcome. The most common
positive outcomes were higher self-esteem (n=6 studies),
better social skills (n=5 studies), fewer depressive symptoms
(n=4 studies), higher confidence (n=3 studies) and
higher competence (n=3 studies) amongst sport
participants than non-sport participants. In total 40 different
psychological and social health factors were reportedly
associated with participation in sport.
In general, there were few theoretical constructs used
to frame or explain the research findings. Only six
Table 2 Summary of the psychosocial health aspects associated with sport participation for children and/or
Category Specific health aspect
Psychological Emotional control, exploration,
Psychological Emotional regulation
Psychological Emotional self-efficacy
Psychological Emotional wellbeing
Psychological Fewer depressive symptoms
studies (20%) incorporated theoretical or conceptual
constructs. The most frequently adopted construct
(n=3) was the theory of Positive Youth Development
[36,40,41], which propounds the notion that children are
‘resources to be developed’ rather than ‘problems to be
solved’, and that all youth have the potential for positive
One study that incorporated the theory of Positive
Youth Development  also utilised an ecological
approach, whereby the study was exploratory and not
guided by one specific theory. In this case these
researchers investigated the intrapersonal and interpersonal
benefits of participation in sport. Similarly, an ecological
approach has been combined with other theories such as
the Socialisation Theory . Brettschneider (2001)
proposed that there are many contributing factors to the
relationship between sports club participation and adolescent
development . As such, a multivariate structure, as
well as cumulative and interactive effects, needs to be
taken into account. Secondly, within his theoretical
framework Brettschneider proposes that each individual is
assumed to be the creator of his/her development. Whilst
studies often discussed theories underpinning the
research, it was not always clear how particular theories
were incorporated into the methodology. For example
Holt et al., introduced the Positive Youth Development
theory in their introduction, but there was no mention of
how this was applied in the methodology of data
collection or in the analysis and interpretation . On the
other hand, Zarrett et al. clearly defined how they
measured and indexed Positive Youth Development .
A recent study  incorporated Antonovsky’s
Salutogenesis model  and Bandura’s theory of Social
Learning . The foundation of Antonovsky’s model is that
heterostasis, ageing and progressive entropy are core
characteristics of all living organisms. The model focuses
on what makes a person maintain good health rather
than focusing on the aetiology of sickness. In terms of
the Social Learning theory, it is suggested that organised
sport, particularly in teams, could be an important factor
in a child’s social development . However, this was a
general discussion comment, and it is not clear how the
Social Learning Theory was applied in the methodology
of this study .
The theoretical perspective of Marsh  was adopted
from Coleman’s  seminal work which “implies a
zero-sum model in which greater involvement in
extracurricular activities necessitates a decreased involvement
in more narrowly defined academic pursuits” (p.19) in a
way that is complementary rather than multiple roles
being in conflict . Stemming from Coleman’s earlier
work, Marsh discussed Snyder et al. (1995) Multiple
Role theory  which proposes that adolescents take
on multiple roles as both a student and an athlete.
Marsh suggests that “multiple roles may create
psychological stress based in part on time and energy limitations,
multiple roles may be complementary and may lead to
energy expansion” (p19). In essence Marsh attempts to
capsulate the perspective that sport participation as an
additional extracurricular activity can have positive
outcomes, rather than sport being seen, as depicted in earlier
theoretical perspectives, as a burden, taking time away
from academic pursuits. However, as with a number of
other studies reviewed, it was not clear how the particular
behavioural theory was applied in the study .
Few differences were evident between the conclusions
of studies of higher and lower quality or of different
study design. There were however, clear differences in
the reported health outcomes associated with different
contexts of participation. Therefore the following
presents and discusses the reported psychological and social
health benefits of participation in sport in the different
contexts of: extracurricular activities; team sport; school
or club sport; and sport in general. These categories,
which are not mutually exclusive, were based upon the
definitions or categorisation made within each individual
study. Furthermore, the health benefits according to
different types of participation are discussed. Lastly,
given the greater strength of evidence regarding causality
in longitudinal versus cross-sectional research, the key
findings from the longitudinal studies are summarised.
Several studies have investigated the influence of sport, as
one type of extracurricular activity, on positive youth
development [36,40,41] general behaviours  and personal
development . Other extracurricular activity categories
considered were school-based activities, religious activities,
youth groups, performing arts, volunteering, paid work,
band and music lessons [40,41,52]. The definition of
‘sport’ as an extracurricular activity varied considerably.
Sport was sometimes defined as including both team and
individual sports [40,53] or encompassing different
categorical groups for both team and individual sports
participants , whilst others categorised groups as structured
versus unstructured activities . Howie et al. (2010)
investigated extracurricular (outside school) activities
sports teams/lessons, sports clubs/organisations, or both
in the previous year .
While the qualitative study of Holt et al. (2011) did not
compare sports participation with other activities, parents
reported benefits for their children in personal and social
development from sport participation. Social benefits
included positive relationships with coaches, making new
friends, and developing teamwork and social skills.
Personal benefits included children being emotionally
controlled, enjoying exploration, having confidence and
discipline, performing well academically, managing their
weight and being ‘kept busy’ .
Similarly, Bartko and Eccles (2003) reported that
structured activities (sport being one of them) led
to higher positive functioning for participants .
Howie et al. (2010) reported that children participating
in both sports and clubs had higher social skill scores
compared with children who did not participate in any
outside-school activity . Concurring with these
findings, Linver et al. (2009) found that participation in sport
and other organised activities had the greatest youth
development outcomes, and low involvement in organised
activities outside school was associated with less positive
development across the board . Sports participation
alone had more developmental benefits than
nonparticipation or other types of extracurricular activities,
however the greatest benefits were seen for those involved
with both sport and other activities [39,41].
Whilst positive social aspects of participation in sport
have been consistently reported, it has also been found
that young people involved with sport had higher rates
of negative peer interaction . These researchers
concluded that this may be due to the competitive nature of
sports activities compared to other activities. Even so,
they found that, in addition to physical benefits, those
involved with sport had higher rates of self-knowledge
and emotional regulation than those involved with other
activities . While Harrison et al. (2003) defined team
sport separately from other activities, their results were
collated as sports only, activities only and sports and
activities . Contrary to some other findings, they found that
sports alone (and also in combination with other activities)
were associated with significantly better health outcomes,
including higher healthy self-image and lower risk of
emotional distress, suicidal behaviour and substance abuse.
Two longitudinal studies, one with a year between
measurements and another three years, investigated the
effects of participation in extracurricular activity on
youth development  and social anxiety . Dimech
and Seiler (2011) investigated sport only, categorised as
non-participation, individual or team involvement ,
whereas Zarrett et al. (2009) investigated team or
individual sport participation in comparison to participation
in development programs, performing arts, arts and
crafts, school clubs, volunteering, religious groups, and
paid work . Consistent with the cross-sectional
results of Linver et al. (2009) and Howie et al. (2010),
Zarrett et al. (2009) concluded that a combination of
sport plus other youth development programs was
related to positive youth development, even after
controlling for total time spent in the activities and the
duration of sport participation.
Dimech and Seiler (2011) measured the effects of
extracurricular participation in sport on social anxiety .
Comparing team sport, individual sport and no sport,
they reported an interaction between sport mode and
time, with team sport participants having reductions in
social anxiety scores over time, whilst anxiety scores in
the no-sport and individual-sport groups actually
increased. Dimech and Seiler concluded that sport practice
had a positive effect as a buffer against anxiety, but only
team sport and not individual sport.
Whilst some studies highlighted the benefits of
extracurricular sport, the focus was more commonly on ‘team
sport’ in general, without distinguishing between in-school
and out-of-school settings [42,43,46,50,51,58,59,61].
The psychological and social health aspects measured
included mental health benefits , social isolation
, depressed mood and symptoms of depression
[46,58], self-esteem , life satisfaction ,
hopelessness and suicidality  and emotional self-efficacy .
Cross-sectional studies included a survey of US high
school students, in which participation in team sport
was associated with lower general risk-taking and fewer
mental health and general health problems compared
with non-participation . In another cross-sectional
survey, team sport involvement was positively associated
with social acceptance and negatively associated with
depressive symptoms . Boone and Leadbeater
concluded that benefits from team sport may be related to
the effect of positive experiences (in coaching, skill
development, peer support) in enhancing perceived social
acceptance and reducing body dissatisfaction . Team
sport participation has also been reported to protect
against feelings of hopelessness and suicidality, even
after controlling for levels of physical activity .
Another reported health benefit of participation in team
sport (both school and extracurricular participation) is
life satisfaction . A study investigated the
relationship between different physical activity behaviours,
distinguishing between vigorous and moderate levels as
well as strength/toning and team participation contexts,
and found that meeting recommended levels of PA and
participation in sports teams was significantly associated
with better emotional self-efficacy .
In a longitudinal study of adolescents with measurements
one year apart, team sport participation was found to be
protective against depressed mood associated with school
performance levels . In a longitudinal study of females,
team sport achievement experiences in early adolescence
were positively associated with self-esteem three years later
in middle adolescence . Another longitudinal study
spanning 12 years found that participation in team sport
(specifically school teams) was associated with lower social
isolation later in life, compared with other activities
categorised as pro-social, arts, and school-based .
School and/or club sport
Some studies distinguished between participation in
‘school sport’ and ‘club sport’ [38,54,56,57,62]. Snyder et al.
(2010) while reporting school and club participation, then
combined them into a single ‘athletes’ category and
compared them to non-athletes on health-related quality of life
measures. The athletes reported higher scores on physical
functioning, general health, social functioning and mental
health scales and a mental composite score, and lower on
a bodily pain scale, than non-athletes . Similarly, in a
Swiss study, Ferron and colleagues classified adolescents
as ‘athletes’ or ‘non-athletic’ on the basis of sports club
participation. The athletes had superior well-being,
including being better adjusted, feeling less nervous or anxious,
being more often full or energy and happy about their life,
feeling sad or depressed less often and having higher body
image and fewer suicide attempts .
One longitudinal study of club sport participation over
a three year period during adolescence in Germany, as
well as identifying physical benefits, showed that sport
club activities had a positive influence on the
development of self-esteem, with girls discovering sports as a
source of self-esteem earlier than boys . In terms of
relationships with peers and parents, club sport
members did not differ significantly from non-members.
Brettschneider and colleagues concluded that although
sports club participants had better health outcomes,
these benefits were due to self-selection bias rather than
a sport club effect . These researchers also
acknowledged that research into the impact of sports by
discipline, and studies of longer duration, are required.
In relation to school sport specifically, participation
was found to be significantly associated with self-esteem
in Latino subgroups of students living in the United
States of America . This was true for Mexican girls
and boys, Puerto Rican girls and Cuban boys but not
Puerto Rican boys and Cuban girls. Pyle and colleagues
investigated participation in school sports defined as
being high or low intensity. Participation in competitive
sports was found to be associated with lower frequency
of mental health problems .
Level of sport involvement
Most studies defined sport participation as a binary
categorical variable without further information regarding
level of involvement. However, a few studies have
investigated psychological and social health outcomes in
relation to different levels of intensity of sport activities
(low, moderate, vigorous, or high) [60,63] or frequency
of participation and number of sport activities .
Steptoe and Butler (1996) assessed the association
between extent of participation in sport or vigorous
recreational PA and emotional wellbeing in adolescents .
Without distinguishing between sport and other vigorous
PA, Steptoe and Butler reported that greater participation
in vigorous activities was associated with lower risk of
emotional distress . Sanders and colleagues found that
for high school senior students moderate sport
participation (3–6 hours per week) was associated with lower
depression scores than low sport involvement (0–2 hours)
. Donaldson and Ronan (2006) investigated
participation in both “formal” and “informal” sports and reported
that greater participation was related to enhanced
emotional and behavioural well-being. Those participating in
more formal sports reported significantly lower levels of
emotional and social problems compared to those
participating in fewer formal sports . Another study
investigated frequency of extracurricular sport and perceived
health, health attitudes and behaviour . Those with
greater frequency of participation (at least twice per week)
had better feelings of well-being compared to those who
participated less than once per week . One study
looked at number of sports, type of sport, and years
participating in sport, and found that sport participation was
positively related to self-assessments of physical
appearance and physical competence, physical self-esteem and
general self-esteem . Furthermore, these researchers
found that differences between competitive and
noncompetitive sports was minimal, and suggested that for
young adolescents, it is more important to consider the
total number of sports and total number of years in
sports-related activities .
Sport in general
A few studies used a broad definition of sport without
providing further context of participation [35,44,64].
Sport participation versus no sport participation was
found to be significantly associated with enhanced
selfconcept . A longitudinal study also reported benefits
of participation in sport compared to no participation, in
relation to lower rates of suicidal ideation including both
thoughts and intentions . In terms of the effect of
sport participation on shyness, a longitudinal study with
measurement at baseline and one year later found that
sport was positively associated with positive adjustment
(e.g. social skills and self-esteem) and that sport played a
uniquely protective role for shy children, with shy children
who participated in sport over time reporting significant
decreases in anxiety . Similarly, in a qualitative study
of focus groups of parents of young people participating in
sport, social factors as well as life skills and self-concept
were stated as benefits of participation .
Longitudinal studies can provide stronger evidence of
causality than cross-sectional studies. However, the
longitudinal studies reviewed were generally short in
duration, usually with only two measurement points, one or
two years apart [35,40,44,50,58]. They were all
observational in nature, with no control groups, and with
limited measurement of the level of participation and
frequency or duration of sport activities. All studies were
based on surveys conducted through schools, with
participation in sport and other extracurricular activities
reported mainly in binary categories.
The main findings were that, after controlling for
factors such as income, parents’ education, age and
ethnicity, compared to no participation or participation
in individual sports, participation in team sport had
resulted in benefits such as lower social anxiety ,
lower social isolation , better social self-concept ,
and improved self-esteem . Sport in general has also
been associated with positive youth development ;
the young people who were highly engaged in general,
and those who participated primarily in sports and youth
development programs, had the highest positive youth
In a recent study undertaken longitudinally over a
one-year period, where sport participation was generally
reported to be of 1–2 hour duration per week, there was
no effect of weekly hours of sport on social anxiety .
Similarly, Findlay and Coplan (2008) in a longitudinal
analysis over a one-year period, did not find significant
effects of sport participation over the year (neither main
effects of time or participation-time interactions) on
social skills, self-esteem, positive adjustment or
externalising problem behaviours . However, shy children
who participated in sport over a one-year period
demonstrated a decrease in anxiety over time. Sport was
associated with positive psychological and social outcomes,
including higher positive affect and well-being and
greater social skills. Shy and aggressive children who
participated in sport reported higher self-esteem . A
study of club sport members compared to non-club
members also did not show a systematic effect of club
membership on most measures of psychological and
social health in adolescents over three years .
Notwithstanding, clubs had a positive effect on
adolescent self-esteem and were reported, on the basis of
high membership rates, to be a highly integrative social
A US study in which high school students were
interviewed at two time points one year apart, showed
that for females, but not for males, team sport
involvement was protective against depressed mood state
associated with poor school performance . Another US
study of female adolescents over three years found that
sports achievement experiences in early adolescence
were positively associated with self-esteem in middle
adolescence . Team sports achievements, team
sports self-evaluations and individual sports
selfevaluations tended to be significantly and positively
associated both cross-sectionally and longitudinally.
Team sport achievement in early adolescence was
related to girls’ global self-esteem in middle adolescence,
and team sport self-evaluations mediated the relation
between achievement and self-esteem. In addition, the
relationship between achievement and self-esteem was
partially mediated by girls’ perceptions of competence
and interest in team sport, and mastery in team sport
contributed to global self-esteem development .
Another longitudinal study showed that adolescents
involved with team sport had lower suicide ideation with
regard to both contemplation and intention . These
researchers suggested that when young people
discontinue playing sport they lose the protective social
networks, as well as connections to caring adults and
pro-social peers, that help to promote healthy youth
development and reduce the risk of suicide.
A conceptual model of Health through Sport is proposed
that is based on three primary categories of outcome:
physical, psychological and social, and two secondary
categories: physical/psychological – aspects involving
both the physical and psychological elements, and
psychosocial – aspects involving both psychological and
While our model incorporates all five categories and
thus depicts the full range of health aspects, the
‘physical’ aspects have been well reviewed elsewhere , and
so this paper in focused on the psychological and social
aspects, as defined above. Furthermore, while the
present review was limited to research into children and
adolescents, the general form of the Health through
Sport model is believed to also apply to adults, although
it is likely there would be some change in the specific
elements of each component.
The model includes three major elements:
determinants of sports participation, sport itself, and health
outcomes of sport participation. The ‘determinants’ element
is based on the well-established social ecological model
[19,65] and is represented as concentric rings spreading
out from the individual’s 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, running in an informal group, running
for a club team, running 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 interactions and interrelationships
between physical and psychological aspects and between
psychological and social health aspects. For example,
there are relationships between physical fitness and
mental state; and interpersonal relationships may satisfy
needs for belongingness and, as such, influence
psychological health. Another example is resilience, whereby
psychological health may influence an individual’s
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
physical health, but that while organised and/or team
forms also contribute strongly to psychological and
social outcomes, informal and/or individual forms
contribute somewhat less to psychological outcomes and
relatively little to social outcomes. Finally, we have noted
the limited evidence 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 represented it by ‘feedback loops’
from the three outputs to the intrapersonal and
This systematic review has some limitations. Whilst the
search strategy, based on a-priori inclusion and exclusion
criteria, was comprehensive and encompassed grey
literature 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
crosssectional and used self-report measures. Therefore results
should be interpreted with caution, and any conclusions
regarding causation are conjectural.
There is substantive evidence of many different
psychological and social health benefits of participation in sport
by children and adolescents. Furthermore, there is a
general consensus that participation in sport for children
and adolescence is associated with improved
psychological and social health, above and beyond other forms
of leisure-time PA. More specifically, there are reports
that participation in team sports rather than individual
activities is associated with better health. It is conjectured
that this is due to the social nature of team sport, and that
the health benefits are enhanced through positive
involvement of peers and adults. However, the research is
predominantly based on cross-sectional studies.
In light of the research evidence, acknowledging that
research to date is predominantly based on
crosssectional studies, it is recommended that community
sport participation is advocated as a form of leisure time
PA for children and adolescents; in an effort to not only
improve the obesity crisis associated with low PA levels,
but to enhance other psychological and social health
outcomes. It is also recommended that the causal link
between participation in sport and health be further
investigated and the conceptual model of health through
sport tested. Furthermore, in light of the fact that our
assessment of the quality of the studies to date has
revealed considerable variation in study quality, it is
recommended that researchers should give more
attention to protocols such as CONSORT  and STROBE
 in order to ensure high levels of methodological
rigor in future studies.
PA: Physical activity.
The authors declare that they have no competing interests.
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.
RME is supported by a VicHealth Research Practice Fellowship.
1. US Department of Health and Human Services: Physical activity guidelines advisory Committee report; 2008 . Available from http://www.health. gov/ paguidelines/report/.
2. Janssen I : Physical activity guidelines for children and youth . Appl Physiol Nutr Metab 2007 , 32 : S109 - S121 .
3. Oja P , Bull F , Fogelholm M , Martin B : Physical activity recommendations for health: what should Europe do ? BMC Public Health 2010 , 10 : 10 .
4. US Department of Health and Human Services: Physical Activity Guidelines for Americans ; 2008 . Available from: http://www.health.gov/paguidelines/ guidelines/.
5. Eime R , Harvey J , Sawyer N , Craike M , Symons C , Polman R , Payne W : Understanding the contexts of adolescent female participation in sport and physical activity . Res Q Exerc Sport 2013 , 84 ( 2 ): 157 - 166 .
6. Zimmermann-Sloutskis D , Wanner M , Zimmermann E , Martin B : Physical activity levels and determinants of change in young adults: a longitudinal panel study . Int J Behav Nutr Phys Act 2010 , 7 : 2 .
7. Department of Health and Ageing: Australian National Children's Nutrition and Physical Activity Survey: Main Findings , 2008 . Department of Health and Ageing : Canberra ; 2007 .
8. Tammelin T , Nayha S , Hills A , Javelin MR : Adolescent participation in sports and adult physical activity . Am J Prev Med 2003 , 24 ( 1 ): 22 - 28 .
9. Dunn A , Madhukar H , Kampert J , Clark C , Chambliss H : Exercise treatment for depression: efficacy and dose response . Am J Prev Med 2005 , 28 ( 1 ): 1 - 8 .
10. VicHealth: Building health through sport . VicHealth action plan 2010 - 2013 . Melbourne: VicHealth; 2010 .
11. Brunton G , Harden A , Rees R , Kavanagh J , Oliver S , Oakley A : Children and physical activity: A systematic review of barriers and facilitators . London: University of London: EPPI Centre ; 2003 .
12. Kriemler S , Meyer U , Martin E , van Sluijs EMF , Andersen LB , Martin BW : Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update . Br J Sports Med 2011 , 45 ( 11 ): 923 - 930 .
13. Calfas K , Long B , Sallis J , Wooten W , Pratt M , Patrick K : A controlled trial of physician counseling to promote the adoption of physical activity . Prev Med 1996 , 25 : 225 - 233 .
14. Earp J , Ennett S : Conceptual models for health education research and practice . Health Educ Res 1991 , 6 ( 2 ): 163 - 171 .
15. Toftegaard-Støckel J , Nielsen GA , Ibsen B , Andersen LB : Parental, socio and cultural factors associated with adolescents' sports participation in four Danish municipalities . Scand J Med Sci Sports 2010 , 21 ( 4 ): 606 - 611 .
16. Casey M , Eime R , Payne W , Harvey J : Using a socioecological approach to examine participation in sport and physical activity among rural adolescent girls . Qual Health Res 2009 , 19 ( 7 ): 881 - 893 .
17. Eime R , Payne W , Casey M , Harvey J : Transition in participation in sport and unstructured physical activity for rural living adolescent girls . Health Educ Res 2010 , 25 ( 2 ): 282 - 293 .
18. Cleland V , Ball K , Hume C , Timperio A , King A , Crawford D : Individual, social and environmental correlates of physical activity among women living in socioeconomically disadvantaged neighbourhoods . Soc Sci Med 2010 , 70 ( 12 ): 2011 - 2018 .
19. McLeroy K , Bibeau D , Steckler A , Glanz K : An ecological perspective on health promotion programs . Health Educ Q 1988 , 15 ( 4 ): 351 - 377 .
20. Australian Bureau of Statistics: Defining sport and physical activity, a conceptual model . Canberra: Australian Bureau of Statistics; 2008.
21. Kahn EB , Ramsey LT , Brownson RC , Heath GW , Howze EH , Powell KE , Stone EJ , Rajab MW , Corso P : The effectiveness of interventions to increase physical activity: a systematic review and . Am J Prev Med 2002 , 22 ( 4 , Supplement 1 ): 73 - 107 .
22. Wilson I , Cleary P : Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes . J Am Med Assoc 1995 , 4 ( 273 ): 59 - 65 .
23. Australian Sports Commission : What is defined as a sport . n.d [cited 2012 July]. Available from: https://ausport.gov.au/supporting/nso/asc_recognition.
24. World Health Organisation: Constitution of the World Health Organisation . 2006 August 2012 ]. Available from: http://apps.who.int/gb/bd/PDF/bd47/EN/ constitution-en.pdf.
25. APA Concise dictionary of psychology . Edited by Vandenbos R. Washington: American Psychology Association ; 2009 .
26. Gill T , Baur L , Bauman A , Steinbeck K , Storlien L , Singh M , Brand-Miller J , Colagiun S , Caterson I : Childhood obesity in Australia remains a widespread health concern that warrants population-wide prevention programs . MJA 2009 , 190 : 146 - 148 .
27. Caspersen C , Powell K , Christenson G : Physical activity, exercise and physical fitness: definitions and distinctions for health-related research . Public Health Rep 1985 , 100 ( 2 ): 129 .
28. McDowell I , Newell C (Eds): Measuring health: A guide to rating scales and questionnaires . New York : University Press ; 1987 .
29. Reber A , Allen R , Reber E (Eds): Penguin Dictionary of Psychology. London: Penguin; 2009 .
30. Department of Education and Early Childhood Development: Improving school sport and physical education in your school . Melbourne: Department of Education and Early Childhood Development ; 2009 .
31. The Australian Concise Oxford Dictionary (Ed): 2011 . Melbourne: Oxford.
32. Downs S , Black N : The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions . J Epidemiol Community Health 1998 , 52 : 377 - 384 .
33. Tremblay M , LeBlanc A , Kho M , Saunders T , Larouche R , Colley R , Goldfield G , Gorber S : Systematic review of sedentary behaviour and health indicators in school-aged children and youth . Int J Behav Nutr Phys Act 2011 , 8 : 98 .
34. Janssen I , LeBlanc A : 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 .
35. Taliaferro LA , Eisenberg ME , Johnson KE , Nelson TF , Neumark-Sztainer D : Sport participation during adolescence and suicide ideation and attempts . Int J Adolesc Med Health 2011 , 23 ( 1 ): 3 - 10 .
36. Holt N , Kingsley B , Tink L , Scherer J : Benefits and challenges associated with sport participation by children and parents from low-income families . Psychol Sport Exerc 2011 , 12 : 490 - 499 .
37. Dimech A , Seiler R : Extra-curricular sport participation: a potential buffer against social anxiety symptoms in primary school children . Psychol Sport Exerc 2011 , 12 : 347 - 3554 .
38. Snyder A , Martinez J , Bay R , Parsons J , Sauers E , McLeod T : Health-related quality of life differs between adolescent athletes and adoloscent nonathletes . J Sport Rehabil 2010 , 19 : 237 - 248 .
39. Howie L , Lukacs S , Pastor P , Reuban C , Mendola P : Participation in activities outside of school hours in relation to problem behavior and social skills in middle childhood . J School Health 2010 , 80 ( 3 ): 119 - 125 .
40. Zarrett N , Fay K , Li Y , Carrano J , Phelps E , Lerner R : More than child's play: Variable- and pattern-centered approaches for examining effects of sport participation in youth development . Dev Psychol 2009 , 45 ( 2 ): 368 - 382 .
41. Linver M , Roth J , Brooks-Gunn J : Patterns of adolescents' participation in organized activities: Are sports best when combined with other activities ? Dev Psychol 2009 , 45 ( 2 ): 354 - 367 .
42. Taliaferro L , Rienzo B , Miller M , Pigg R , Dodd V : High school youth and suicide risk: exploring protection afforded through physical activity and sport participation . J School Health 2008 , 78 ( 10 ): 545 - 553 .
43. Valois R , Umstattd M , Zullig K , Paxton R : Physical activity behaviors and emotional self-efficacy: is there a relationship for adolescents ? J School Health 2008 , 78 ( 6 ): 321 - 327 .
44. Findlay L , Coplan R : Come out and play: Shyness in childhood and the beneftis of organized sports participation . Can J Behav Sci 2008 , 40 ( 3 ): 153 - 161 .
45. Wiersma L , Fifer A : "The schedule has been tough but we think it's worth it": the joys, challenges, and recommendations of youth sport parents . J Leis ×Res 2008 , 40 ( 4 ): 505 - 530 .
46. Boone E , Leadbeater B : Game on: diminishing risks for depressive symptoms in ealry adolescence through positive involvement in team sports . J Res Adolesc 2006 , 16 ( 1 ): 79 - 90 .
47. Donaldson S , Ronan K : The effects of sports participation on young adolescents' emotional well-being . Adoelscence 2006 , 41 ( 162 ): 369 - 389 .
48. Bowker A : The relationship between sprots participation and self-esteem during early adoelscence . Can J Behav Sci 2006 , 38 ( 3 ): 214 - 229 .
49. Michaed P , Jeannin A , Suris J : Correlates of extracurricular sport participation among Swiss adolescents . Eur J Pediatr 2006 , 165 : 546 - 555 .
50. Pedersen S , Siedman E : Team sports achievement and self-esteem development among urban adolescent girls . Psychol Women Q 2004 , 28 : 412 - 422 .
51. Valois R , Zullig K , NHuebner E , Crane J : Physical activity behaviors and perceived life satisfaction among public high school adolescents . J School Health 2004 , 74 ( 2 ): 59 - 65 .
52. Harrison P : Differences in behavior, psychological factors, and environmental factors associated with participation in school sports and other activities in adolescence . J School Health 2003 , 73 ( 3 ): 113 - 120 .
53. Hansen D , Larson R , Dworkin J : What adolescents learn in organized youth activities: a survey of self-reported developmental experiences . J Res Adolesc 2003 , 13 ( 1 ): 25 - 55 .
54. Pyle R , McQuivey R , Brassington G , Steiner H : High school student athletes: Associations between intensity of participation and health factors . Clin Pediatr 2003 , 42 : 697 - 701 .
55. Bartko W , Eccles J : Adolescent participation in structured and unstructured activities: a person-oriented analysis . J Youth Adolesc 2003 , 32 ( 4 ): 233 - 241 .
56. Erkut S , Tracy A : Predicting adolescent self-esteem from participation in school sports among latino subgroups . Hispanic J Behav Sci 2002 , 4 : 409 - 429 .
57. Brettschneider W-D : Effects of sport club activities on adolescent development in Germany . Eur J Sport Sci 2001 , 1 ( 2 ): 1 - 11 .
58. Gore S , Farrell F , Gordon J : Sports involvement as protection against depressed mood . J Res Adolesc 2001 , 11 ( 1 ): 119 - 130 .
59. Barber B , Eccles J , Stone M : Whatever happened to the jock, the brain, and the princess? young adult pathways linked to adolescent activity involvement and social identity . J Adolesc Res 2001 , 16 ( 5 ): 429 - 455 .
60. Sanders C , Field T , Diego M , Kaplan M : Moderate involvement in sports is related to lower depression levels among adolescents . Adoelscence 2000 , 35 ( 140 ): 793 - 798 .
61. Steiner H , McQuivey R , Pavelski R , Pitts T , Kraemer H : Adolescents and sports: risk or benefit? Clin Pediatr 2000 , 39 : 161 - 166 .
62. Ferron C , Narring F , Cauderay M , Michaud P : Sport activity in adolescence: associations with health perceptions and experimental behaviors . Health Educ Res 1999 , 14 ( 2 ): 225 - 233 .
63. Steptoe A , Butler N : Sports participation and emotional wellbeing in adolescents . Lancet 1996 , 347 ( 9018 ): 1789 - 1792 .
64. Marsh H : The effects of participation in sport during the last two years of high school . Sociol Sport J 1993 , 10 : 18 - 43 .
65. Sallis J , Owen N : Ecological models of health behavior . In Health Behavior and Health Education: Theory , research, and practice. Edited by Glanz K, Rimer B , Lewis F . San Francisco: Jossey-Bass ; 2002 : 462 - 485 .
66. Roth J , Brooks-Gunn J , Murrary L , Foster W : Promoting healthy adolescents: synthesis of youth development program evaluations . J Res Adolesc 1998 , 8 : 423 - 459 .
67. Antonovsky A (Ed): Salutogenesis: Unravelling the mystery of health . Tubingen: DGVT Verlag ; 1997 .
68. Bandura A (Ed): Social learning theory. Englewood Cliffs , NJ: Prentice-Hall ; 1977 .
69. Coleman J : Academic achievement and the structure of competition . Harvard Ed Rev 1959 , 29 : 330 - 351 .
70. Snyder E : A theoretical analysis of academic and athletic roles . Sociol Sport J 1985 , 3 : 210 - 217 .
71. Schulz K , Altman D , Moher D : CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials . BMJ 2010 , 340 : 698 - 702 .
72. von Elm E , Altman D , Egger M , Pocock S , Gotzsche P , Vandenbroucke J : The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidlines for reporting observational studies . Bull World Health Organ 2007 , 85 ( 11 ): 867 - 872 .