The impact of sports participation on mental healthand social outcomes in adults: a systematic review
and the ‘Mental Health through Sport’ conceptual
modelThis is the Published version of the following publication
Eather, Narelle, Wade, Levi, Pankowiak, Aurélie and Eime, Rochelle (2023)
The impact of sports participation on mental health and social outcomes inadults: a systematic review and the ‘Mental Health through Sport’ conceptualmodel. Systematic Reviews, 12. ISSN 2046-4053

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(2023) 12:102
Eather et al. Systematic Reviews
https://doi.org/10.1186/s13643-023-02264-8

SYSTEMATIC REVIEW UPDATE

Systematic Reviews

Open Access

The impact of sports participation
on mental health and social outcomes in adults:a systematic review and the ‘Mental Healththrough Sport’ conceptual model
Narelle Eather1,2* , Levi Wade1,3 , Aurélie Pankowiak4   and Rochelle Eime4,5   

Abstract
Background Sport is a subset of physical activity that can be particularly beneficial for short-and-long-term physicaland mental health, and social outcomes in adults. This study presents the results of an updated systematic review ofthe mental health and social outcomes of community and elite-level sport participation for adults. The findings haveinformed the development of the ‘Mental Health through Sport’ conceptual model for adults.
Methods Nine electronic databases were searched, with studies published between 2012 and March 2020 screened
for inclusion. Eligible qualitative and quantitative studies reported on the relationship between sport participationand mental health and/or social outcomes in adult populations. Risk of bias (ROB) was determined using the Quality
Assessment Tool (quantitative studies) or Critical Appraisal Skills Programme (qualitative studies).
Results The search strategy located 8528 articles, of which, 29 involving adults 18–84 years were included foranalysis. Data was extracted for demographics, methodology, and study outcomes, and results presented according
to study design. The evidence indicates that participation in sport (community and elite) is related to better mental
health, including improved psychological well-being (for example, higher self-esteem and life satisfaction) and lower
psychological ill-being (for example, reduced levels of depression, anxiety, and stress), and improved social outcomes(for example, improved self-control, pro-social behavior, interpersonal communication, and fostering a sense of
belonging). Overall, adults participating in team sport had more favorable health outcomes than those participating
in individual sport, and those participating in sports more often generally report the greatest benefits; however, someevidence suggests that adults in elite sport may experience higher levels of psychological distress. Low ROB was
observed for qualitative studies, but quantitative studies demonstrated inconsistencies in methodological quality.
Conclusions The findings of this review confirm that participation in sport of any form (team or individual) is beneficial for improving mental health and social outcomes amongst adults. Team sports, however, may provide morepotent and additional benefits for mental and social outcomes across adulthood. This review also provides preliminary evidence for the Mental Health through Sport model, though further experimental and longitudinal evidence isneeded to establish the mechanisms responsible for sports effect on mental health and moderators of intervention
effects. Additional qualitative work is also required to gain a better understanding of the relationship between specificelements of the sporting environment and mental health and social outcomes in adult participants.
*Correspondence:
Narelle Eather
narelle.eather@newcastle.edu.au
Full list of author information is available at the end of the article© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to theoriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images orother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of thislicence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The Creative Commons Public Domain Dedication waiver (http://​creat​iveco​
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Eather et al. Systematic Reviews(2023) 12:102

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Keywords Adults, Review, Experimental, Observational, Psychological health, Mental health, Social health, Sport,
Model

Introduction
The organizational structure of sport and the performance demands characteristic of sport training and competition provide a unique opportunity for participants
to engage in health-enhancing physical activity of varied
intensity, duration, and mode; and the opportunity to do
so with other people as part of a team and/or club. Participation in individual and team sports have shown tobe beneficial to physical, social, psychological, and cognitive health outcomes [1–7]. Often, the social and mental
health benefits facilitated through participation in sport
exceed those achieved through participation in otherleisure-time or recreational activities [8–10]. Notably,
these benefits are observed across different sports andsub-populations (including youth, adults, older adults,
males, and females) [11]. However, the evidence regarding sports participation at the elite level is limited, withavailable research indicating that elite athletes may be
more susceptible to mental health problems, potentially
due to the intense mental and physical demands placedon elite athletes [12].
Participation in sport varies across the lifespan, withchildren representing the largest cohort to engage inorganized community sport [13]. Across adolescence andinto young adulthood, dropout from organized sport iscommon, and especially for females [14–16], and adults
are shifting from organized sports towards leisure andfitness activities, where individual activities (including
swimming, walking, and cycling) are the most popular[13, 17–19]. Despite the general decline in sport participation with age [13], the most recent (pre-COVID) global
data highlights that a range of organized team sports(such as, basketball, netball volleyball, and tennis) continue to rank highly amongst adult sport participants,
with soccer remaining a popular choice across all regionsof the world [13]. It is encouraging many adults continue
to participate in sport and physical activities throughout
their lives; however, high rates of dropout in youth sportand non-participation amongst adults means that many
individuals may be missing the opportunity to reap the
potential health benefits associated with participation in
sport.
According to the World Health Organization, mental health refers to a state of well-being and effective functioning in which an individual realizes hisor her own abilities, is resilient to the stresses of life,
and is able to make a positive contribution to his or
her community [20]. Mental health covers three main

components, including psychological, emotional andsocial health [21]. Further, psychological health has two
distinct indicators, psychological well-being (e.g., selfesteem and quality of life) and psychological ill-being(e.g., pre-clinical psychological states such as psychological difficulties and high levels of stress) [22]. Emotional well-being describes how an individual feels
about themselves (including life satisfaction, interest inlife, loneliness, and happiness); and social well–being
includes an individual’s contribution to, and integration
in society [23].
Mental illnesses are common among adults and incidence rates have remained consistently high over the
past 25 years (~ 10% of people affected globally) [24].
Recent statistics released by the World Health Organization indicate that depression and anxiety are the mostcommon mental disorders, affecting an estimated 264
million people, ranking as one of the main causes of
disability worldwide [25, 26]. Specific elements of social
health, including high levels of isolation and loneliness among adults, are now also considered a serious
public health concern due to the strong connections
with ill-health [27]. Participation in sport has shown
to positively impact mental and social health status,with a previous systematic review by Eime et al. (2013)indicated that sports participation was associated withlower levels of perceived stress, and improved vitality, social functioning, mental health, and life satisfaction [1]. Based on their findings, the authors developed
a conceptual model (health through sport) depicting
the relationship between determinants of adult sports
participation and physical, psychological, and social
health benefits of participation. In support of Eime’s
review findings, Malm and colleagues (2019) recently
described how sport aids in preventing or alleviating
mental illness, including depressive symptoms and anxiety or stress-related disease [7]. Andersen (2019) also
highlighted that team sports participation is associatedwith decreased rates of depression and anxiety [11]. In
general, these reviews report stronger effects for sports
participation compared to other types of physical activity, and a dose–response relationship between sports
participation and mental health outcomes (i.e., higher
volume and/or intensity of participation being associated with greater health benefits) when adults participate in sports they enjoy and choose [1, 7]. Sport istypically more social than other forms of physical activity, including enhanced social connectedness, social

Eather et al. Systematic Reviews(2023) 12:102

support, peer bonding, and club support, which may
provide some explanation as to why sport appears to be
especially beneficial to mental and social health [28].
Thoits (2011) proposed several potential mechanisms
through which social relationships and social support
improve physical and psychological well-being [29]; however, these mechanisms have yet to be explored in thecontext of sports participation at any level in adults. The
identification of the mechanisms responsible for such
effects may direct future research in this area and help
inform future policy and practice in the delivery of sport
to enhance mental health and social outcomes amongst
adult participants. Therefore, the primary objective of
this review was to examine and synthesize all researchfindings regarding the relationship between sports participation, mental health and social outcomes at thecommunity and elite level in adults. Based on the review
findings, the secondary objective was to develop the‘Mental Health through Sport’ conceptual model.

Methods
This review has been registered in the PROSPERO systematic review database and assigned the identifier:CRD42020185412. The conduct and reporting of this systematic review also follows the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines[30] (PRISMA flow diagram and PRISMA Checklist available in supplementary files). This review is an update of aprevious review of the same topic [31], published in 2012.
Identification of studies

Nine electronic databases (CINAHL, Cochrane Library,
Google Scholar, Informit, Medline, PsychINFO, Psychology and Behavioural Sciences Collection, Scopus, and
SPORTDiscus) were systematically searched for relevant
records published from 2012 to March 10, 2020. The following key terms were developed by all members of theresearch team (and guided by previous reviews) andentered into these databases by author LW: sport* AND
health AND value OR benefit* OR effect* OR outcome*
OR impact* AND psych* OR depress* OR stress OR anxiety OR happiness OR mood OR ‘quality of life’ OR ‘social
health’ OR ‘social relation*’ OR well* OR ‘social connect*’OR ‘social functioning’ OR ‘life satisfac*’ OR ‘mental
health’ OR social OR sociolog* OR affect* OR enjoy* OR
fun. Where possible, Medical Subject Headings (MeSH)
were also used.
Criteria for inclusion/exclusion

The titles of studies identified using this method werescreened by LW. Abstract and full text of the articles werereviewed independently by LW and NE. To be includedin the current review, each study needed to meet each ofPage 3 of 27

the following criteria: (1) published in English from 2012
to 2020; (2) full-text available online; (3) original researchor report published in a peer-reviewed journal; (4) provides data on the psychological or social effects of participation in sport (with sport defined as a subset of exercisethat can be undertaken individually or as a part of a team,
where participants adhere to a common set of rules or
expectations, and a defined goal exists); (5) the population of interest were adults (18 years and older) and wereapparently healthy. All papers retrieved in the initial
search were assessed for eligibility by title and abstract.
In cases where a study could not be included or excluded
via their title and abstract, the full text of the article wasreviewed independently by two of the authors.
Data extraction

For the included studies, the following data was extracted
independently by LW and checked by NE using a customized Google Docs spreadsheet: author name, year of publication, country, study design, aim, type of sport (e.g.,tennis, hockey, team, individual), study conditions/comparisons, sample size, where participants were recruitedfrom, mean age of participants, measure of sports participation, measure of physical activity, psychological and/or social outcome/s, measure of psychological and/or
social outcome/s, statistical method of analysis, changes
in physical activity or sports participation, and the psychological and/or social results.
Risk of bias (ROB) assessment

A risk of bias was performed by LW and AP independently using the ‘Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies’ OR the‘Quality Assessment of Controlled Intervention Studies’ for the included quantitative studies, and the ‘Critical Appraisal Skills Programme (CASP) Checklist for the
included qualitative studies [32, 33]. Any discrepancies
in the ROB assessments were discussed between the tworeviewers, and a consensus reached.

Results
The search yielded 8528 studies, with a total of 29 studies included in the systematic review (Fig. 1). Tables 1
and 2 provide a summary of the included studies. The
research included adults from 18 to 84 years old, withmost of the evidence coming from studies targeting
young adults (18–25 years). Study samples ranged from
14 to 131, 962, with the most reported psychological outcomes being self-rated mental health (n = 5) and depression (n = 5). Most studies did not investigate or report
the link between a particular sport and a specific mental
health or social outcome; instead, the authors’ focused oncomparing the impact of sport to physical activity, and/

Eather et al. Systematic Reviews(2023) 12:102

Page 4 of 27

Fig. 1 Flow of studies through the review process

or individual sports compared to team sports. The resultsof this review are summarized in the following section,with findings presented by study design (cross-sectional,
experimental, and longitudinal).
Effects of sports participation on psychological well‑being,ill‑being, and social outcomes
Cross‑sectional evidenceThis review included 14 studies reporting on the crosssectional relationship between sports participation andpsychological and/or social outcomes. Sample sizes range
from n = 414 to n = 131,962 with a total of n = 239,394
adults included across the cross-sectional studies.
The cross-sectional evidence generally supports thatparticipation in sport, and especially team sports, isassociated with greater mental health and psychologicalwellbeing in adults compared to non-participants [36,59]; and that higher frequency of sports participation
and/or sport played at a higher level of competition, arealso linked to lower levels of mental distress in adults .

This was not the case for one specific study involving
ice hockey players aged 35 and over, with Kitchen and
Chowhan (2016) Kitchen and Chowhan (2016) reporting
no relationship between participation in ice hockey andeither mental health, or perceived life stress [54]. There isalso some evidence to support that previous participationin sports (e.g., during childhood or young adulthood)is linked to better mental health outcomes later in life,
including improved mental well-being and lower mental
distress [59], even after controlling for age and current
physical activity.
Compared to published community data for adults,
elite or high-performance adult athletes demonstrated
higher levels of body satisfaction, self-esteem, and overall life satisfaction [39]; and reported reduced tendency
to respond to distress with anger and depression. However, rates of psychological distress were higher in theelite sport cohort (compared to community norms), withnearly 1 in 5 athletes reporting ‘high to very high’ distress, and 1 in 3 reporting poor mental health symptoms

Aim

To examine the impact ofparticipating in 12-week
workplace team sporton VO2 max, and of individual, social group, andorganizational healthThis study examined theassociations between
the context of physicalactivity (PA) is undertaken(team sports, informalgroup, individual PA), andpositive mental health,anxiety symptoms anddepressive symptoms. It
also investigated whethersocial connectedness or
PA volume mediate theseassociations

1. Author
2. Study design

1. Brinkley, 2017 [34]2. Quantitative Quasiexperimental
Non-randomized

1. Dore, 2018 [35]2. Quantitative-longitudinal (6 months)
cross-sectional

Social outcomes

1. Team sports
2. Team

1. Rounders, netball,basketball, soccer, cricket,
and handball
2. TeamSport
1. Mode2. Structure

Table 1 Studies on the relationship between sport and social outcomes

Team sports vs. informalgroup PA vs. individual PA

Intervention:
12 × weekly lunchtime
moderate-intensity teamsport sessions in an indoor
sports hall (10 min warmup, 40 min of sport)
Control: normal work
conditions

Conditions/comparison

1. 1446
2. 602 males: 844 females
3. mean age = 18.4 (2.4)

1. 48
2. 28 males: 20 females
aged 24 to 64
Intervention
n = 28; mean = 39.59 (9.11)
Control
1. n = 20; mean = 40.75(11.92)

1. Sample size (n)2. Sex ratio
3. Mean age (SD)/age
range

Social connectedness
in PA
Relatedness to Othersin Physical Activity Scale(ROPAS)

Social cohesion
Sub-scales from the
Copenhagen Psychosocial
Questionnaire-II
Interpersonal communication(relationships with colleagues)
Climate uniformity
Interpersonal relationships(with superiors)
Copenhagen Psychosocial
Questionnaire-II-II

Relative to those who
engaged in individual PA,
being active in informalgroup PA or sports team
was associated with higher
levels of social connectedness and higher moderatevigorous PA volume. In
mediation analysis, thehypothesis that PA context
influences mental healthindirectly through social
connectedness was notconfirmed

There were significant
improvements in interpersonal communication favoring the intervention group,though there were no othersignificant effects

Psychological
Key findings
outcome/s and measure

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Aim

The study aimed touncover how sport participation, physical activity,
social capital, and mental
health are interrelated

To study how NFL players
and their family members
characterize the impactof an NFL career on themental and emotional
health of NFL players

1. Author
2. Study design

1. Marlier, 2015 [36]2. Quantitative crosssectional

1. McGraw, 2018 [37]2. Qualitative

Social outcomes

Table 1 (continued)

1. NFL (American football)
2. Team

1. Sport participationorganized and nonorganized
2. Team and individualSport
1. Mode2. Structure

Includes both current andformer NFL players, andfamily members of theseplayers

Examined how sportparticipation, total physical activity, social capital,
and mental health areinterrelated

Conditions/comparison

1. 25 (23 former and 2
current) players, 27 family
members (88.9% wife;
3.7% parent; and 7.4%
were ’other’ (child, sibling)
2. All male
3.Age not mentioned

1. 4142. –3. age range 18 to56 years

1. Sample size (n)2. Sex ratio
3. Mean age (SD)/age
range

No direct associations were
found between sport participation and community
social capital (or individual
social capital
Individual social capital(but not community social
capital) had a direct association with mental health. A
significant indirect association of community social
capital with mental healthwas discovered throughindividual social capital (i.e.,
individual social capital partially mediates the relation
between community social
capital and mental health)The players and theirfamilies noted concerns
related to making andkeeping social connections with people outsideof the NFL; isolation due
to physical size, celebrity
status, team roster turnover;racial, socioeconomic, andcultural differences amongplayers; loss of their social
connection with the teamand teammates throughpractices and games. Of
note is the paradoxical situation that although football
is a team sport, individual
players can feel very muchalone due to the nature andstructure of the sport

Social capital (individual,
and community) evaluated using a scale basedon the ‘social capitalcommunity benchmark
survey’Thematic analysis(interview)

Social isolation
Thematic analysis (interview)

Psychological
Key findings
outcome/s and measure

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The purpose of thisstudy was to assess theprevalence and correlatesof mental health symptoms in a representative,
national sample of elite
athletes and to compare
rates against publishedcommunity norms

1. Purcell, 2020 [39]2. Quantitative crosssectional

1. Elite athletes (no singular sport)
2. Not specified

The current study sought Mixed Martial Arts (MMA)
to explore how mixed
and Brazilian Jiu-Jitsu (BJJ)
martial-arts (MMA) andBrazilian jiu-jitsu (BJJ)
affect deviant and sociallydesirable traits among
adolescents and young
adults who were new
to the sports and how
individuals predisposed tocertain traits may be more
inclined to train in one
sport than another

1. Mickelsson, 2020 [38]2. Quantitative—longitudinal (5 months)

Sport
1. Mode2. StructureAim

1. Author
2. Study design

Social outcomes

Table 1 (continued)

Community rates ofpsychological variables;’published community
norms’

Jiu-jitsu vs mixed-martial
arts

Conditions/comparison

1. 7492. 344 males
3. mean age = 24.6
(sd = 6.9)

1. 113
2. 105 males: 8 females
3. No age data

1. Sample size (n)2. Sex ratio
3. Mean age (SD)/age
range

Social dysfunction Subscale of the GHQ 28

Aggression
Buss-Perry Aggression
Questionnaire (BPAQ)
Pro-social behavior
Pro-socialness Scale for
Adults (PSA)
Self-control
Self-Control Scale (SCS)
Criminal behavior (frequency)
Total Delinquent Acts
Measure (TDAM)

There was no relationshipbetween social dysfunction
and sport participation

MMA practitioners slightly
increased their levels of
aggression, BJJ practitioners
reduced theirs. Both MMA
and BJJ increased self-control and pro-social behavior;and individuals who sought
out to practice MMA weremore predisposed to having
higher levels of aggression.
BJJ practitioners developed
more pro-social behaviour
and reduced aggression compared to MMA
practitioners; but there wasno significant interaction between self-control
and sport as self-control
improved among all practitioners. No interaction
between sport and crime
frequency was found, withboth groups reducing criminal behavior moderately(but low baseline scores)

Psychological
Key findings
outcome/s and measure

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The aim of the study was
1. Australian Rules Football –to understand the impact 2. Teamof an Aboriginal community sporting team and its
environment on the social,emotional, and physical wellbeing of young
Aboriginal men

Conditions/comparison

1. Thorpe, 2014 [40]2. QualitativeSport
1. Mode2. StructureAim

1. Author
2. Study design

Social outcomes

Table 1 (continued)

1. 14
2. All men
3. Age not provided

1. Sample size (n)2. Sex ratio
3. Mean age (SD)/age
range

Mental well-being
Social, emotional, andphysical wellbeing impact(4 semi structured interview; 3 focus groups)

Some respondents felt
social and community
aspects of participatingwere just as important toplayers as individual healthbenefits gained from participation. Participants felt
a sense of ownership andbelonging when playing
with an Aboriginal sports
team. The club was alsoa place they felt safe andcomfortable

Psychological
Key findings
outcome/s and measure

Eather et al. Systematic Reviews(2023) 12:102
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Aim

To examine whether
retrospectively assessed
sports participation (SP)and competitive sports(CS) at the age of 12 years
is associated with mental
health and health behavior in young adulthoodamong males

To examine the longitudinal associations between
sport participation duringhigh school and symptoms of panic disorder,
GAD, social phobia, andagoraphobia in young
adulthood (assessed
3 years after high school)

1. Author
2. Study design (qual/
quant)

1. Appelqvist-Schmidlechner, 2018 [41]2. Quantitative-crosssectional (retroactive)

1. Ashdown-Franks, 2017[42]
2. Quantitative—longitudinal

Psychological outcomes
Conditions/comparison

1. 18 different sports
2. Individual and team

1. 6802. 100% male
3. 26 years (4)1. Sample
Size
2. Male/female ratio
3. Mean age (SD)Years of participation in 18 1. 781
different sports (yes/no)
2. 44.8% male
3. 20.34 (0.71)

1. Structured sport partici- No participation in sportpation at age 12
at age 12
2. Not specified

Sport
1. Mode2. Structure

Table 2 Studies on the relationship between sport and mental healthAnxiety(Panic disorder, generalized anxiety disorder,social phobia, agoraphobia)
2003 Canadian Community Health Survey

Mental well-being
Warwick-Edinburgh Mental Well-Being Scale (shortversion)Mental distress
The Short Form Health
Survey (SF-36) scale (’5items’)The number of years ofsport participation in highschool was protective of
symptoms of panic andagoraphobia in young
adulthood, but not protective of symptoms of social
phobia or GAD. Participation in either type of sport(individual or team) was
protective of panic disorder
symptoms, while only teamsport was protective of agoraphobia symptoms, andonly individual sport wasprotective of social phobia
symptoms

Sports participation (SP) at
12 years is associated with
better mental health inyoung adulthood-mental
wellbeing and mental
distress. This was also thecase when controlling theimpact of age, education,and present leisure-time
physical activity. Higher
level of intensity of SP and
the level of competitive
sport in childhood wereassociated with lower levelof mental distress in adulthood

Psychological
Key findings
outcome/s and measure

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The objectives of this
1. Not specifiedstudy were to assess (1)2. Teamthe longitudinal associations of past moderate-tovigorous physical activity(MVPA) and involvementin team sports duringsecondary school withdepressive symptoms inearly adulthood, and (2)the cross-sectional associations of current MVPA
and involvement in teamsports with depressive
symptoms during young
adulthood

1. Brunet, 2013 [43]2. Longitudinal (prospective)–10 years + crosssectional

1. Rounders netball, basketball, soccer, cricket, andhandball
2. Team

To investigate the shortterm effect of regularsports team participation
on individual employee
and organizational health,including VO2 max, andindividual, social groupand organizational health

1. Brinkley, 2017 [34]2. Quantitative-quasiexperimental non-randomizedSport
1. Mode2. StructureAim

1. Author
2. Study design (qual/
quant)

Psychological outcomes

Table 2 (continued)
1. Sample
Size
2. Male/female ratio
3. Mean age (SD)-

1. 8602.(53.2% female)
3. Mean age at baseline = 12.7, SD = 0.5; meanat survey 21 (end of
study)-20.39 (sd = 0.39)

Experimental:
1. 48
12 × weekly lunchtime
2. 28 males: 20 females
moderate-intensity team 3. Aged 24 to 64
sport sessions in an indoor
sports hall (10 min warmup, 40 min of sport)
Control: normal work
conditions

Conditions/comparison

Depressive symptoms
The Major Depression
Inventory (MDI)

Vitality
Subjective vitality scale
Quality of life
Satisfaction with Life Scale
Psychological stress
Perceived Stress Scale

Longitudinal results: There
were no statistically significant associations between
the MVPA slope in secondary school and depressive symptoms in young
adulthood. In contrast,
involvement in team sports
was significantly and negatively related to depressive
symptoms in the univariate
model (P < .05)
Cross-sectional results: significant negative association
between current physicalactivity (i.e., both MVPA andinvolvement in team sports)
and depressive symptoms
during young adulthood
was observed in theunadjusted linear regression
models, but the association
between involvement inteam sports and depressive
symptoms was no longer
significant in the adjusted
model

Results indicate workplaceteam sport can improve
interpersonal communication within teams, but nosignificant findings for
subjective vitality, quality oflife, stress, communication,or relationships (with colleagues or superiors)

Psychological
Key findings
outcome/s and measure

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This study aimed toinvestigate the effects ofa 4-month judo training(1 h session, biweekly)
on physical and mental
health of older adults

This study examined thecross-sectional associations among PA volume
and context, mental
health, and symptoms ofanxiety and depression in
post-secondary students

1. Ciaccioni, 2019 [45]2. Quantitative-experimental (non-randomized)

1. Dore, 2016 [46]2. Quantitative-crosssectional

1. Team sports
2. Team

1. Judo
2. Individual

The purpose of this study 1. Brazilian jiu-jitsu
was to explore the transfer 2. Individualof life skills among adults
who participated in Brazilian jiu-jitsu

1. Chinkov, 2015 [44]2. Qualitative—interviews(semi-structured)Sport
1. Mode2. StructureAim

1. Author
2. Study design (qual/
quant)

Psychological outcomes

Table 2 (continued)

1. 1446
2. (602/844)
3. Mean age = 18.4
(sd = 2.4)

1. 30
2. (17/13)
3. Mean age = 69.7
(sd = 4.2 years)

Experimental: 2 × 60 min
sessions weekly for
4 months
Control: did not receive
any training

Team sports vs. informalgroup PA vs. individual PA

1. 14
2. (10/4)
3. Mean age = 34.6 (range
19 to 54)

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)–

Conditions/comparison

Mental health
The MHC-SF FrenchCanadian version(Emotional and social
wellbeing)
Anxiety and depressive
symptoms
Hospital Anxiety andDepression Scale (HADS)

Mental Health (includes
vitality, social functioning, role-emotional, andmental health)sf12 (v2)
Body dissatisfaction
Body Image Dimensional
Assessment

The findings indicatethat total physical activity
volume, and moderate-tovigorous physical activity
are positively associatedwith mental health. Only
moderate-to-vigorous
physical activity (not total
physical activity) wasinversely associated withsymptoms of anxiety anddepression
Considering physicalactivity context, when
adjusting for covariates
and moderate-to-vigorous
physical activity, only
participation in team sports(not individual or informalgroup physical activity) was
significantly associated with
better mental healthNo significant change inmental healthContrary to what was
expected, the 4-monthjudo program did not affectthe body image, or mental
health of novice practitioners

Self-confidence
Twelve of the particiIndividual semi-structured pants reported that theirinterviews
involvement in Brazilian
jiu-jitsu improved their selfconfidence outside of thegym. Participants reported
improved self-confidence ininteractions with others, inbeing more assertive, andin their ability to defend
themselves

Psychological
Key findings
outcome/s and measure

Eather et al. Systematic Reviews(2023) 12:102
Page 11 of 27

AimThis study examined theassociations between thecontext in which physicalactivity (PA) is undertaken(team sports, informalgroup, individual PA), andpositive mental health,anxiety symptoms anddepressive symptoms. It
also investigated whethersocial connectedness or
PA volume mediate theseassociations

To examine the dose–
response relationshipbetween physical activity
and health-related qualityof life (HRQoL) and life
satisfaction. Further, toexplore whether these
relationships depend on
type of physical activity(PA)

1. Author
2. Study design (qual/
quant)

1. Dore, 2018 [35]2. Quantitative-longitudinal (6 months) crosssectional

1. Eime, 2014 [47]2. Quantitative—crosssectional

Psychological outcomes

Table 2 (continued)

Sports club membership (netball or tennis) vsgymnasium, vs no PA

Team sports compared to
informal group PA (yoga,
running groups etc.) andto individual PA

1. Team sports
2. Team

1. Membership of a sports
club (predominantly tennis and netball)
2. TeamConditions/comparisonSport
1. Mode2. Structure

1. 793
2. All female
3. Mean ages:
club (n = 499) = 33.9
(SD = 13.7); gym(n = 185) = 38.5
(SD = 12.9) = walk(n = 109) = 44.5 (SD = 13.2)

1. 4302. 35.5% male
3. Mean age = 18.5
(SD = 2.6)

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)

Mental health36-item Short-Form
Health Survey (SF-36)—
Mental Component Summary (MCS)Life satisfaction
Life Satisfaction Score—from the AustralianLongitudinal Study on
Women’s Health

Mental health
Mental Health Continuum-Short Form (MHC-SF)
Anxiety and depressive
symptoms
Hospital Anxiety andDepressive Scale (HADS-A)

Compared to people notengaged in sport, sports
participants (tennis or netball) reported better mental
health and life satisfaction
The results showed that
there was no dose–
response relationshipbetween the level of physical activity (i.e., the amount)and either mental health orlife satisfaction, suggesting that factors other thanphysical activity are responsible for the relationship

Relative to participating inindividual physical activity,
being involved in either
team sports or informalgroup physical activity was
longitudinally associatedwith better mental healthand fewer depressive
symptoms
Further, team sports wereshown to be associatedwith positive mental healthregardless of physical activity volume, suggesting that
other qualities of the teamsport context contribute tothis effectPsychological
Key findings
outcome/s and measure

Eather et al. Systematic Reviews(2023) 12:102
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This study evaluated the
1. Handballeffects of regular participa- 2. Teamtion in small-sided teamhandball training on bodycomposition, osteogenic
response, physical performance, and cardiovascularrisk factors, as well as wellbeing and motivation, inyoung untrained women

The purpose of this study 1. Organized sport
was to identify organized 2. Team and/or individual
sport trajectories fromearly childhood to lateadolescence. Second
the authors explored theassociations of these trajectories with physical andmental health outcomesin young adulthood

1. Hornstrup, 2018 [49]2. Quantitative-RCT​

1. Howie, 2016 [50]2. Longitudinal (from age
5 to age 20)

1. Ball sports (e.g., basketball, floorball, netball,soccer, tennis, volleyball,badminton, ice-hockey
and ultimate frisbee)
2. Team

To examine the relationship between exercise
type and the stress anddepressive symptoms of
university students

1. Gerber, 2014 [48]2. Quantitative—crosssectionalSport
1. Mode2. StructureAim

1. Author
2. Study design (qual/
quant)

Psychological outcomes

Table 2 (continued)

Sports participation vs no
sports participation vs.
sports dropouts vs. sports
joiners

1. 1679
2. 855/824
3. Age at baseline = 5, age
at final assessment = 20

Mental wellbeing
Short Form 12-Item
Health Survey version 2
Depression
Depression Anxiety Stress
Scales (DASS-21)
Anxiety
Depression Anxiety Stress
Scales (DASS-21)
StressDepression Anxiety Stress
Scales (DASS-21)

Anxiety
Well-being questionnaire(Danish version)
Positive well-being
Well-being questionnaire(Danish version)
Mental energy
Well-being questionnaire(Danish version)

1. 28
2. All women
3. Mean age: Intervention(n = 14): 23.9 (sd = 2.4)
Control (n = 14): 24.1
(sd = 3.2)

Experimental: 2 × 70 min
sessions of team-based
handball per week, for
12 weeks
Control: no exercise
controlUpon examination of themultiple sports participation trajectories, despite
differences in physicalhealth outcomes, there
were minimal differences inmental health outcomes inadulthood. Of note, males
who dropped out of sportin childhood or adolescence
had higher depressive
symptoms in adulthood

There was no effect of theintervention on measures ofanxiety or well-being. Therewas, however, a significant
effect of the intervention on
mental energy

Among students with highstress (but not low stress),participation in ball sports
or dancing was associatedwith fewer depressive
symptoms. Students engaging in weightlifting reported
fewer depressive symptoms,
but only if they reported
having low levels of stress.
Aerobic exercise had nomoderating effects

Psychological
Key findings
outcome/s and measure

StressPerceived Stress Scale(German version)
Depressive symptoms
The Depression Scale

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)

Ball sports vs. aerobic
1. 451
activity vs. weightlifting vs. 2. 171 males, 280 females
dancing
3. mean age = 22.3
(sd = 2.2)

Conditions/comparison

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The present study
1. Karate-Do
investigated the influence 2. Groupof physical exercise, cognitive, or Karate training on
the cognitive functioning
and mental state of older
peopleThis study investigated
1. Karate-Do
the effects of karate versus 2. Groupa mindfulness-based
stress reduction (MBSR)
intervention on well-being
and cognitive functioningin older adults

1. Janssen, 2012 [51]2. Quantitative-experimental (non-randomized)

1. Janssen, 2017 [52]2. Quantitative-RCT (3groups)Sport
1. Mode2. StructureAim

1. Author
2. Study design (qual/
quant)

Psychological outcomes

Table 2 (continued)

The experimental groups
engaged in 2 × 60-min
sessions per week for
8 weeks
Experimental (MBSR):
included sitting and walking meditation
Experimental (Karate-Do):
karate-Do training
Control: received notraining

Each experimental condition involved 20 × 60-min
sessions held over
3–6 months
Experimental(exercise): strength, andflexibility exercises
Experimental(cognitive): problem solving activities
Experimental(Karate-Do): Karate-Do
training
Control: Received notraining

Conditions/comparison

1. 55
2. 21/33
3. Mean age = 63.5
(sd = 5.7)
n = 25 in karate group,
MBSR = 19, control = 22

Subjective well-being
Multidimensional Mood
Questionnaire (MDBF)
Anxiety
Hospital Anxiety andDepression Scale-Anxiety(HADS-A)
Depression
Hospital Anxiety andDepression Scale-Anxiety(HADS-A)
Optimism and pessimism
The Life Orientation Test–
Revised (LOT-R)
Subjective mental health
The 12-Item Short-Form
Health Survey (SF12-mental)
Perceived stress
Trier Inventory for Chronic
StressDepressive symptoms
Centre of EpidemiologicalStudies Depressions Scale
Emotional mental state
Center of EpidemiologicalStudies Depressions Scale

1. 45
2. 15/30
3. Mean age = 78.8
(sd = 7.0)

Participants in the karate
condition had significantly
greater improvements insubjective mental healthand anxiety in comparison
to the control and MBSR
groups. There were no
significant group by timeeffects for subjective
well-being, depression,
optimism, pessimism, or
perceived stress

There was an improvement
in emotional well-being
only in the Karate group
This study also showed thatthe depression score of thecontrol group increased
whereas the scoresremained the same in the
cognitive and exercisegroups and decreased in
the Karate group

Psychological
Key findings
outcome/s and measure

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)

Eather et al. Systematic Reviews(2023) 12:102
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The principal objectiveof this paper is to assess
whether participation in
ice hockey is associatedwith an additive healthbenefitTo better understand the 1. Sport participation
relations between sport
2. Not specified
consumption (i.e., sportparticipation, sport spectating, and sport media
viewing) and long- andshort-term subjective wellbeing, a study was conducted using ecologicalmomentary assessmentand multilevel structural
equation modelling

1. Kitchen, 2016 [54]2.Cross-sectional

1. Kim, 2019 [55]
2 Quantitative-ecologicalmomentary assessment(9 weeks)

Conditions/comparison

1. Ice Hockey
2. Team

Examination of the shortand long-term effects ofsports participation

Stratified by: ’did not play’,’played less than once
per week’, ’played at least
once per week’ (regular)
vs. ’did not play in the last
3 months’

1. School sport (e.g.,
Number of years in schoolbasketball, soccer, softball, sportetc.)
2. Team and individualThis longitudinal study
examined the association
between participationin school sport duringadolescence and mental
health in early adulthood

1. Jewett, 2014 [53]2. Quantitative-longitudinal (5 years)

Sport
1. Mode2. StructureAim

1. Author
2. Study design (qual/
quant)

Psychological outcomes

Table 2 (continued)

1. 242
2. 49.6% male
3. Mean age = 20.7 (no SE
or SD reported) ranging
from 18 to 37

1. 8250 (for mental health)8230 (for perceived life
stress)2. –3. Aged 35 and over

1. 853
2. 462 females
3. mean age = 20.39(sd = .75)

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)

Positive affectPositive Affect and
Negative Affect Schedule(PANAS)
Negative affectPositive Affect and
Negative Affect Schedule(PANAS)Life satisfaction
Satisfaction with Life Scale

Perceived life stress
Single item taken from
’The Community Health
Survey (2011/2012)
Mental healthSingle item taken from
’The Community Health
Survey (2011/2012)

Depressive symptoms
Major Depression Inventory (MDI)
Perceived stress
Single item, assessed on
1–5 scale
Mental healthSingle item, assessed on
1–5 scaleEngagement in sport participation led to perceptionsof short-term improvementof positive affect and life
satisfaction. There was also
evidence that regular sportparticipation contributes tolong-term improvements
in positive affect and life
satisfaction. There wasno significant interaction
between sports participation and negative affectImportantly, there was evidence that the short-term
effects of sports participation may contribute tolong-term improvements
in positive affect and life
satisfaction

The results indicate there
is no association between
playing ice hockey andperceived life stress, nor
between ice hockey andself-rated mental healthParticipation in school sport
during adolescence wassignificantly associatedwith lower perceived stress,
depressive symptoms, andhigh self-reported mental
health in young adulthood

Psychological
Key findings
outcome/s and measure

Eather et al. Systematic Reviews(2023) 12:102
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The present study aims
to uncover how sportparticipation, physicalactivity, social capital, andmental health are interrelated by examining theseoutcomes in one modelThis qualitative study
examined how NFL
players and their family
members characterized
the impact of an NFL
career on the mental andemotional health of NFL
players

The purpose of the study 1. Badminton
was to examine the health 2. Team and individual
effects of 8 weeks ofrecreational badminton in
untrained women

1. Marlier, 2015 [36]2. Quantitative-crosssectional

1. McGraw, 2018 [37]2. Qualitative-telephoneinterviews

1. Patterson, 2017 [57]2. Quantitative-RCT​

1. NFL (American football)
2. Team

1. Sport participationorganized and nonorganized
2. Team and individualThis study assessed
1. Sport (mode not specithe association of totalfied)physical activity, walking,
2. Not specified
cycling, domestic work,
sports, and gardening
with HRQL in middle-aged
and elderly adults

1. Koolhaas, 2018 [56]2. Cross-sectionalSport
1. Mode2. StructureAim

1. Author
2. Study design (qual/
quant)

Psychological outcomes

Table 2 (continued)

Experimental (Badminton):
3 1-h sessions per week for
8 weeks. One session per
week dedicated to learning skills, with the other 2
dedicated to matches
Experimental (Running):
3 × 1-h sessions per week
for 8 weeks. Sessions
involved running arounda university at approximately 75% max heart rate
Control: No exercise
control

Includes both current andformer NFL players, andfamily members of theseplayers

Examined how sportparticipation, total physical activity, social capital,
and mental health areinterrelated

Associations between
level of participation in
sport (low, moderate,high) and MH outcome.
Associations calculated
separately for 65 andunder, and over 65

Conditions/comparison

1. 33
2. All female
3. Mean age = 34.3
(sd = 6.9 years) (range
19–45 years)

1. 25 players (23 former
and 2 current), 27 family
members
2. All male
3. Age not mentioned

1. 414
2. 189/225
3. Age range: 18 to 56

1. 5554
2. 2356/3198
3. Mean age = 69

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)Physical self-esteem
Physical self-perception
profile (PSPP)

Mental health (inclusiveof depression, anxiety,loneliness /isolation, andstress)Thematic analysis (interview)Mental health (well-being,
more specifically)
Goldberg’s General Health
Questionnaire (GHQ-12)(self-report)

Health-related quality oflife (mood subscale)
Dutch version of the EuroQoL (home interview)Group by time analyses
show a significant improvement in the badminton andrunning groups’ perceptionof their physical condition.
There were no significant
group by time interaction
effects for sport competence, body attractiveness,
strength competence andphysical self-worth

Most of the players andtheir families reported
that the NFL provided
emotional benefits as wellas improvements to players’
self-esteem. Almost all theplayers experienced one ormore mental health challenge during their career(e.g., depression, anxiety, difficulty controlling temper)

There was a direct association between sports
participation, but not total
physical activity, and mental
well-being

Sports participation was
associated with bettermood in middle-aged
adults and was the physicalactivity with the most associations domains of (HRQoL)
in this age group

Psychological
Key findings
outcome/s and measure

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Aim

The purpose of thisstudy was to assess theprevalence and correlatesof mental health symptoms in a representative,
national sample of elite
athletes and to compare
rates against publishedcommunity norms

The purpose of this study
was to examine the longitudinal and unique association between numberof years of team sport andindividual sport participation during adolescenceand depressive symptoms
during early adulthood

To assess health-related
quality-of-life (HRQL)
among current and former
National Collegiate Athletic Association student–
athletes (SAs)

1. Author
2. Study design (qual/
quant)

1. Purcell, 2020 [39]2. Quantitative crosssectional

1. Sabiston, 2016 [58]2.Quantitative-longitudinal (5 years)

1. Sorenson, 2014 [59]2. Quantitative-crosssectional

Psychological outcomes

Table 2 (continued)

1. Baseball, basketball,Student athletes (SA) vs.
cross-country, American
nonathletes (NA)
football, golf, rowing, soccer, swimming and diving,
tennis, track and field,
volleyball, water polo
2. Individual and team

Number of years participating in sport; participation in team vs. individual
sportCommunity rates ofpsychological variables;’published community
norms’

1. Elite athletes (no singular sport)
2. Not specified

1. Basketball, soccer, football, swimming, baseball,volleyball, hockey, ballet/
dance, aerobics classes, skilessons, and judo/karate
2. Individual and teamConditions/comparisonSport
1. Mode2. Structure

1. 496
2. 280/215
3. Range = 17–84

1. 8602. 54% female
3. Mean age = 20.4
(sd = 0.7) at endpoint

1. 7492. 344/405
3.mean age = 24.6
(sd = 6.9)

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)

Mental healthSF-12 mental componentscore

Depressive symptoms
Major Depression Inventory (MDI)

Mental health symptoms
28-item General Health
Questionnaire (GHQ-28)
Psychological distress
Kessler 10 (K-10)
Self-esteem
Rosenberg Self-Esteem
Scale
Maladaptive responseto psychological distress(anger and aggression)
2 subscales from the Male
Depression Risk Scale(MDRS)
Body weight and shape
Dissatisfaction
weight and shapesubscales from the Eating
Disorders Examination
Questionnaire
Satisfaction with life
Satisfaction with Life Scale

Current SAs had significantly better mental healththan non-athletes. The
alumni sample reported
better mental health thancurrent students, with age
differences significantly
greater for NAs

The findings of this study
indicate adolescents who
consistently participatedin team sports duringsecondary school had lower
depression scores in early
adulthood. Conversely,
the number of years ofindividual sport participation was not related todepressive symptoms inearly adulthood

In the month prior to thesurvey, approximately 1 in
3 athletes reported mental
health symptoms at a leveltypically requiring treatment by a health professional—a rate significantly
higher than community
norms. Athletes also
reported significantly higher
psychological distressthan community norms.
However, athletes reported
greater life satisfaction, selfesteem, and body satisfaction than community norms

Psychological
Key findings
outcome/s and measure

Eather et al. Systematic Reviews(2023) 12:102
Page 17 of 27

Aim

To investigate associations between markers ofhealth and playing golf in
an Australian population

The aim of the present
study was to understandthe impact of an Aboriginal community sporting
team and its environmenton the social, emotional,
and physical wellbeing ofyoung Aboriginal men,and to identify barriers
and motivators for participation

The aim of this study was
to identify the prevalenceof specific types of sports
and exercise groups andthe association with selfrated health, depressive
symptoms, and frequencyof laughter amongcommunity-dwellingolder people

1. Author
2. Study design (qual/
quant)

1. Stenner, 2019 [60]2. Quantitative-crosssectional

1. Thorpe, 2014 [40]2. Qualitative-semi-structured interviews

1. Tsuji, 2020 [61]2. Quantitative-crosssectional

Psychological outcomes

Table 2 (continued)

Golfers vs. non-golfers

Conditions/comparison

1. Walking, running, andjogging, fitness exercises,
weight exercises, hiking,golf, gateball, dance, yoga,
aerobics, petanque, Tai
Chi, swimming, aquatics,
table tennis, bowling,
cycling, tennis, and other
2. Individual and team

1. 14
2. All men
3. –Self-rated health
1-item“How do you feel about
your current health status:
very good, good, somewhat poor, or poor?”
Depressive symptoms
15-item Geriatric Depression Scale (GDS)-GDS
Frequency of laughter
1-item “how often do you
laugh aloud in your daily
life: almost every day, 1
to 5 times a week, one to
3 × per month, or almost
none?”

Mental well-being
Interviews and group
discussion

Health-related quality oflife (HRQoL)
Question one of the
12-Item Short Form
Health Survey (SF-12)

1. n = 9307
2. –3. Mean age = 48.7
(sd = 17.6)

Playing golf in a group was
related to better self-rated
health, less experience ofdepressive symptoms, and ahigher frequency of laughter compared to not playing
golf in a group
Walking in a group was
related to better self-rated
health for females, and toless experience of depressive symptoms and a higher
frequency of laughter inmales and females
Walking in a group was also
related to a greater likelihood of reporting excellent
self-rated health for females,
and to more laughter andlower depressive symptoms
in both males and females

The players noted thatparticipation gave thema sense of purpose,enjoyment, stress relief,
and improvements in selfesteem. They further notedthat racism, community
conflicts, peer-pressure,and commitment werechallenges of playing in theteam

Golfers were more physically active andhad 83% higher odds ofreporting high HRQoL
compared to non-golfers.
HRQoL was no longer significantly different between
the groups after controllingfor physical activity

Psychological
Key findings
outcome/s and measure

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)

Odds ratios of associations 1. 131,962
between each specific
2. 63,465/68497
activity and indices of
3. Aged 65 and older
health

1. Australian Rules Football –2. Team

1. Golf
2. Not specified

Sport
1. Mode2. Structure

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Aim

The purpose of this study
was to identify the demographic and biological,
psychosocial, behavioral,social, and cultural, andenvironmental correlatesof sports group participation among Japaneseolder adults

1. Author
2. Study design (qual/
quant)

1. Yamakita, 2015 [62]2. Quantitative-crosssectional

Psychological outcomes

Table 2 (continued)

1. Sports group or club
2. Not specified

Sport
1. Mode2. Structure
Regular participation vs.
non-regular participation

Conditions/comparison

1. 78,002
2. 37,772/40230
3. Mean age = 73.5
(sd = 6.1)

1. Sample
Size
2. Male/female ratio
3. Mean age (SD)

Depression
Short version of the Geriatric Depression Scale–15

Irregular or no participationin sports was associatedwith mild to severe depression

Psychological
Key findings
outcome/s and measure

Eather et al. Systematic Reviews(2023) 12:102
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Eather et al. Systematic Reviews(2023) 12:102

at a level warranting treatment by a health professional in
one study (n = 749) [39].
Four studies focused on the associations between physical activity and sports participation and mental healthoutcomes in older adults. Physical activity was associated with greater quality of life [56], with the relationshipstrongest for those participating in sport in middle age,and for those who cycled in later life (> 65) [56]. Groupphysical activities (e.g., walking groups) and sports (e.g.,golf ) were also significantly related to excellent self-rated
health, low depressive symptoms, high health-related
quality of life (HRQoL) and a high frequency of laughterin males and females [60, 61]. No participation or irregular participation in sport was associated with symptomsof mild to severe depression in older adults [62].
Several cross-sectional studies examined whether
the effects of physical activity varied by type (e.g., total
physical activity vs. sports participation). In an analysis of 1446 young adults (mean age = 18), total physical activity, moderate-to-vigorous physical activity, andteam sport were independently associated with mental health [46]. Relative to individual physical activity,
after adjusting for covariates and moderate-to-vigorous
physical activity (MVPA), only team sport was significantly associated with improved mental health. Similarly, in a cross-sectional analysis of Australian women,
Eime, Harvey, Payne (2014) reported that women who
engaged in club and team-based sports (tennis or netball)reported better mental health and life satisfaction thanthose who engaged in individual types of physical activity [47]. Interestingly, there was no relationship between
the amount of physical activity and either of these outcomes, suggesting that other qualities of sports participation contribute to its relationship to mental health andlife satisfaction. There was also some evidence to support
a relationship between exercise type (ball sports, aerobic
activity, weightlifting, and dancing), and mental healthamongst young adults (mean age 22 years) [48], with ballsports and dancing related to fewer symptoms of depression in students with high stress; and weightlifting related
to fewer depressive symptoms in weightlifters exhibiting
low stress.
Longitudinal evidence

Eight studies examined the longitudinal relationshipbetween sports participation and either mental healthand/or social outcomes. Sample sizes range from n = 113
to n = 1679 with a total of n = 7022 adults included acrossthe longitudinal studies.
Five of the included longitudinal studies focused on
the relationship between sports participation in childhood or adolescence and mental health in young adulthood. There is evidence that participation in sport

Page 20 of 27

in high-school is protective of future symptoms ofanxiety (including panic disorder, generalised anxiety
disorder, social phobia, and agoraphobia) [42]. Specifically, after controlling for covariates (including current
physical activity), the number of years of sports participation in high school was shown to be protectiveof symptoms of panic and agoraphobia in young adulthood, but not protective of symptoms of social phobia
or generalized anxiety disorder [42]. A comparison ofindividual or team sports participation also revealed
that participation in either context was protective of
panic disorder symptoms, while only team sport wasprotective of agoraphobia symptoms, and only individual sport was protective of social phobia symptoms.
Furthermore, current and past sports team participation was shown to negatively relate to adult depressive
symptoms [43]; drop out of sport was linked to higher
depressive symptoms in adulthood compared to thosewith maintained participation [9, 22, 63]; and consistent participation in team sports (but not individual
sport) in adolescence was linked to higher self-rated
mental health, lower perceived stress and depressive
symptoms, and lower depression scores in early adulthood [53, 58].
Two longitudinal studies [35, 55], also investigated theassociation between team and individual playing context
and mental health. Dore and colleagues [35] reported
that compared to individual activities, being active in
informal groups (e.g., yoga, running groups) or teamsports was associated with better mental health, fewer
depressive symptoms and higher social connectedness –and that involvement in team sports was related to better mental health regardless of physical activity volume.
Kim and James [55] discovered that sports participation
led to both short and long-term improvements in positive affect and life satisfaction.
A study on social outcomes related to mixed martialarts (MMA) and Brazilian jiu-jitsu (BJJ) showed thatboth sports improved practitioners’ self-control and prosocial behavior, with greater improvements seen in the
BJJ group [62]. Notably, while BJJ reduced participants’reported aggression, there was a slight increase in MMA
practitioners, though it is worth mentioning that individuals who sought out MMA had higher levels of baseline
aggression.
Experimental evidenceSix of the included studies were experimental or quasiexperimental. Sample sizes ranged from n = 28 to n = 55
with a total of n = 239 adults included across six longitudinal studies. Three studies involved a form of martial
arts (such as judo and karate) [45, 51, 52], one involved
a variety of team sports (such as netball, soccer, andEather et al. Systematic Reviews(2023) 12:102

cricket) [34], and the remaining two focused on badminton [57] and handball [49].
Brinkley and colleagues [34] reported significant
effects on interpersonal communication (but not vitality, social cohesion, quality of life, stress, or interpersonal relationships) for participants (n = 40) engaging in a
12-week workplace team sports intervention. Also using
a 12-week intervention, Hornstrup et al. [49] reported asignificant improvement in mental energy (but not wellbeing or anxiety) in young women (mean age = 24; n = 28)
playing in a handball program. Patterns et al. [57] showedthat in comparison to no exercise, participation in an
8-week badminton or running program had no significant improvement on self-esteem, despite improvementsin perceived and actual fitness levels.
Three studies examined the effect of martial arts on
the mental health of older adults (mean ages 79 [52], 64[51], and 70 [45] years). Participation in Karate-Do had
positive effects on overall mental health, emotional wellbeing, depression and anxiety when compared to otheractivities (physical, cognitive, mindfulness) and a control
group [51, 52]. Ciaccioni et al. [45] found that a Judo program did not affect either the participants’ mental healthor their body satisfaction, citing a small sample size, andthe limited length of the intervention as possible contributors to the findings.
Qualitative evidence

Three studies interviewed current or former sports players regarding their experiences with sport. Chinkov andHolt [41] reported that jiu-jitsu practitioners (mean age
35 years) were more self-confident in their lives outside of the gym, including improved self-confidence intheir interactions with others because of their training.
McGraw and colleagues [37] interviewed former and current National Football League (NFL) players and theirfamilies about its impact on the emotional and mental health of the players. Most of the players reported
that their NFL career provided them with social andemotional benefits, as well as improvements to theirself-esteem even after retiring. Though, despite thesebenefits, almost all the players experienced at least one
mental health challenge during their career, including
depression, anxiety, or difficulty controlling their temper.
Some of the players and their families reported that theyfelt socially isolated from people outside of the national
football league.
Through a series of semi-structured interviews andfocus groups, Thorpe, Anders [40] investigated theimpact of an Aboriginal male community sporting teamon the health of its players. The players reported they felt
a sense of belonging when playing in the team, further

Page 21 of 27

noting that the social and community aspects were asimportant as the physical health benefits. Participatingin the club strengthened the cultural identity of the players, enhancing their well-being. The players further notedthat participation provided them with enjoyment, stressrelief, a sense of purpose, peer support, and improved
self-esteem. Though they also noted challenges, including the presence of racism, community conflict, andpeer-pressure.
Quality of studies

Full details of our risk of bias (ROB) results are provided
in Supplementary Material A. Of the three qualitative
studies assessed using the Critical Appraisal Skills Program (CASP), all three were deemed to have utilised andreported appropriate methodological standards on atleast 8 of the 10 criteria. Twenty studies were assessedusing the Quality Assessment Tool for Observational
Cohort and Cross-Sectional Studies, with all studies
clearly reporting the research question/s or objective/sand study population. However, only four studies provided a justification for sample size, and less than halfof the studies met quality criteria for items 6, 7, 9, or
10 (and items 12 and 13 were largely not applicable). Of
concern, only four of the observational or cohort studies were deemed to have used clearly defined, valid, andreliable exposure measures (independent variables) and
implemented them consistently across all study participants. Six studies were assessed using the Quality
Assessment of Controlled Intervention Studies, withthree studies described as a randomized trial (but noneof the three reported a suitable method of randomization, concealment of treatment allocation, or blinding
to treatment group assignment). Three studies showed
evidence that study groups were similar at baseline forimportant characteristics and an overall drop-out ratefrom the study < 20%. Four studies reported high adherence to intervention protocols (with two not reporting) and five demonstrated that.study outcomes wereassessed using valid and reliable measures and implemented consistently across all study participants. Importantly, researchers did not report or have access tovalidated instruments for assessing sport participationor physical activity amongst adults, though most studies
provided psychometrics for their mental health outcome
measure/s. Only one study reported that the sample
size was sufficiently powered to detect a difference inthe main outcome between groups (with ≥ 80% power)
and that all participants were included in the analysisof results (intention-to-treat analysis). In general, themethodological quality of the six randomised studies
was deemed low.

Eather et al. Systematic Reviews(2023) 12:102

Discussion
Initially, our discussion will focus on the review findings
regarding sports participation and well-being, ill-being,
and psychological health. However, the heterogeneity and methodological quality of the included research(especially controlled trials) should be considered during
the interpretation of our results. Considering our findings, the Mental Health through Sport conceptual model
for adults will then be presented and discussed and study
limitations outlined.
Sports participation and psychological well‑being

In summary, the evidence presented here indicates thatfor adults, sports participation is associated with betteroverall mental health [36, 46, 47, 59], mood [56], higher
life satisfaction [39, 47], self-esteem [39], body satisfaction [39], HRQoL [60], self-rated health [61], and frequency of laughter [61]. Sports participation has also
shown to be predictive of better psychological wellbeing
over time [35, 53], higher positive affect [55], and greater
life satisfaction [55]. Furthermore, higher frequency ofsports participation and/or sport played at a higher levelof competition, have been linked to lower levels of mental distress, higher levels of body satisfaction, self-esteem,
and overall life satisfaction in adults [39].
Despite considerable heterogeneity of sports type,cross-sectional and experimental research indicate that
team-based sports participation, compared to individual
sports and informal group physical activity, has a morepositive effect on mental energy [49], physical self-perception [57], and overall psychological health and wellbeing in adults, regardless of physical activity volume [35,46, 47]. And, karate-do benefits the subjective well-beingof elderly practitioners [51, 52]. Qualitative research inthis area has queried participants’ experiences of jiu-jitsu,
Australian football, and former and current American
footballers. Participants in these sports reported that
their participation was beneficial for psychological wellbeing [37, 40, 41], improved self-esteem [37, 40, 41], andenjoyment [37].
Sports participation and psychological ill‑being

Of the included studies, n = 19 examined the relationship between participating in sport and psychologicalill-being. In summary, there is consistent evidence thatsports participation is related to lower depression scores[43, 48, 61, 62]. There were mixed findings regarding
psychological stress, where participation in childhood(retrospectively assessed) was related to lower stress inyoung adulthood [41], but no relationship was identified
between recreational hockey in adulthood and stress [54].
Concerning the potential impact of competing at an elite

Page 22 of 27

level, there is evidence of higher stress in elite athletescompared to community norms [39]. Further, there isqualitative evidence that many current or former national
football league players experienced at least one mental
health challenge, including depression, anxiety, difficulty
controlling their temper, during their career [37].
Evidence from longitudinal research provided consistent evidence that participating in sport in adolescenceis protective of symptoms of depression in young adulthood [43, 53, 58, 63], and further evidence that participating in young adulthood is related to lower depressive
symptoms over time (6 months) [35]. Participation inadolescence was also protective of manifestations of anxiety (panic disorder and agoraphobia) and stress in young
adulthood [42], though participation in young adulthood
was not related to a more general measure of anxiety [35]nor to changes in negative affect [55]). The findings fromexperimental research were mixed. Two studies examined the effect of karate-do on markers of psychologicalill-being, demonstrating its capacity to reduce anxiety[52], with some evidence of its effectiveness on depression [51]. The other studies examined small-sided teambased games but showed no effect on stress or anxiety[34, 49]. Most studies did not differentiate between teamand individual sports, though one study found that adolescents who participated in team sports (not individual
sports) in secondary school has lower depression scoresin young adulthood [58].
Sports participation and social outcomes

Seven of the included studies examined the relationshipbetween sports participation and social outcomes. However, very few studies examined social outcomes or tested
a social outcome as a potential mediator of the relationship between sport and mental health. It should also
be noted that this body of evidence comes from a wide
range of sport types, including martial arts, professional
football, and workplace team-sport, as well as different
methodologies. Taken as a whole, the evidence showsthat participating in sport is beneficial for several social
outcomes, including self-control [50], pro-social behavior [50], interpersonal communication [34], and fosteringa sense of belonging [40]. Further, there is evidence thatgroup activity, for example team sport or informal group
activity, is related to higher social connectedness overtime, though analyses showed that social connectedness
was not a mediator for mental health [35].
There were conflicting findings regarding social effects
at the elite level, with current and former NFL players reporting that they felt socially isolated during theircareer [37], whilst another study reported no relationship between participation at the elite level and social

Eather et al. Systematic Reviews(2023) 12:102

dysfunction [39]. Conversely, interviews with a group ofindigenous men revealed that they felt as though participating in an all-indigenous Australian football teamprovided them with a sense of purpose, and they felt as
though the social aspect of the game was as important as
the physical benefits it provides [40].
Mental health through sport conceptual model for adults

The ‘Health through Sport’ model provides a depictionof the determinants and benefits of sports participation[31]. The model recognises that the physical, mental, andsocial benefits of sports participation vary by the context
of sport (e.g., individual vs. team, organized vs. informal).
To identify the elements of sport which contribute to its
effect on mental health outcomes, we describe the ‘Mental Health through Sport’ model (Fig. 2). The model proposes that the social and physical elements of sport eachprovide independent, and likely synergistic contributions
to its overall influence on mental health.
The model describes two key pathways through whichsport may influence mental health: physical activity, andFig. 2 The Mental Health through Sport conceptual model

Page 23 of 27

social relationships and support. Several likely moderators of this effect are also provided, including sport type,
intensity, frequency, context (team vs. individual), environment (e.g., indoor vs. outdoor), as well as the level ofcompetition (e.g., elite vs. amateur).
The means by which the physical activity componentof sport may influence mental health stems from thework of Lubans et al., who propose three key groupsof mechanisms: neurobiological, psychosocial, andbehavioral [64]. Processes whereby physical activity
may enhance psychological outcomes via changes inthe structural and functional composition of the brain
are referred to as neurobiological mechanisms [65, 66].
Processes whereby physical activity provides opportunities for the development of self-efficacy, opportunity
for mastery, changes in self-perceptions, the development of independence, and for interaction with theenvironment are considered psychosocial mechanisms. Lastly, processes by which physical activity
may influence behaviors which ultimately affect psychological health, including changes in sleep duration,

Eather et al. Systematic Reviews(2023) 12:102

self-regulation, and coping skills, are described as
behavioral mechanisms.
Playing sport offers the opportunity to form relationships and to develop a social support network, both ofwhich are likely to influence mental health. Thoits [29]describes 7 key mechanisms by which social relationships and support may influence mental health: social
influence/social comparison; social control; role-based
purpose and meaning (mattering); self-esteem; sense ofcontrol; belonging and companionship; and perceived
support availability [29]. These mechanisms and theirpresence within a sporting context are elaborated below.
Subjective to the attitudes and behaviors of individuals
in a group, social influence and comparison may facilitate protective or harmful effects on mental health. Participants in individual or team sport will be influenced
and perhaps steered by the behaviors, expectations, andnorms of other players and teams. When individual’s
compare their capabilities, attitudes, and values to thoseof other participants, their own behaviors and subsequent health outcomes may be affected. When others attempt to encourage or discourage an individual toadopt or reject certain health practices, social control
is displayed [29]. This may evolve as strategies between
players (or between players and coach) are discussion andimplemented. Likewise, teammates may try to motivate
each another during a match to work harder, or to engage
in specific events or routines off-field (fitness programs,
after game celebrations, attending club events) which
may impact current and future physical and mental
health.
Sport may also provide behavioral guidance, purpose,and meaning to its participants. Role identities (positions within a social structure that come with reciprocal
obligations), often formed as a consequence of social ties
formed through sport. Particularly in team sports, participants come to understand they form an integral partof the larger whole, and consequently, they hold certain
responsibility in ensuring the team’s success. They have acommitment to the team to, train and play, communicate
with the team and a potential responsibility to maintaina high level of health, perform to their capacity, and support other players. As a source of behavioral guidance
and of purpose and meaning in life, these identities arelikely to influence mental health outcomes amongst sportparticipants.
An individual’s level of self-esteem may be affectedby the social relationships and social support provided
through sport; with improved perceptions of capability(or value within a team) in the sporting domain likely tohave positive impact on global self-esteem and sense of
worth [64]. The unique opportunities provided throughparticipation in sport, also allow individuals to develop

Page 24 of 27

new skills, overcome challenges, and develop their senseof self-control or mastery. Working towards and finding
creative solutions to challenges in sport facilitates a senseof mastery in participants. This sense of mastery may
translate to other areas of life, with individual’s developing the confidence to cope with varied life challenges. For
example, developing a sense of mastery regarding capacity to formulate new / creative solutions when taking on
an opponent in sport may result in greater confidence
to be creative at work. Social relationships and social
support provided through sport may also provide participants with a source of belonging and companionship.
The development of connections (on and off the field) toothers who share common interests, can build a senseof belonging that may mediate improvements in mental
health outcomes. Social support is often provided emotionally during expressions of trust and care; instrumentally via tangible assistance; through information such asadvice and suggestions; or as appraisal such feedback. Allforms of social support provided on and off the field contribute to a more generalised sense of perceived support
that may mediate the effect of social interaction on mental health outcomes.
Participation in sport may influence mental health via
some combination of the social mechanisms identified byThoits, and the neurobiological, psychosocial, and behavioral mechanisms stemming from physical activity identified by Lubans [29, 64]. The exact mechanisms throughwhich sport may confer psychological benefit is likely tovary between sports, as each sport varies in its physical and social requirements. One must also consider thesocial effects of sports participation both on and off the
field. For instance, membership of a sporting team and/or
club may provide a sense of identity and belonging—an
effect that persists beyond the immediacy of playing the
sport and may have a persistent effect on their psychological health. Furthermore, the potential for team-based
activity to provide additional benefit to psychologicaloutcomes may not just be attributable to the differencesin social interactions, there are also physiological differences in the requirements for sport both within (teamvs. team) and between (team vs. individual) categories
that may elicit additional improvements in psychologicaloutcomes. For example, evidence supports that exercise
intensity moderates the relationship between physicalactivity and several psychological outcomes—supporting that sports performed at higher intensity will be more
beneficial for psychological health.
Limitations and recommendations

There are several limitations of this review worthy of
consideration. Firstly, amongst the included studies
there was considerable heterogeneity in study outcomesEather et al. Systematic Reviews(2023) 12:102

Page 25 of 27

and study methodology, and self-selection bias (especially in non-experimental studies) is likely to influence
study findings and reduce the likelihood that study participants and results are representative of the overall
population. Secondly, the predominately observational
evidence included in this and Eime’s prior review enabled
us to identify the positive relationship between sports
participation and social and psychological health (andexamine directionality)—but more experimental and longitudinal research is required to determine causality andexplore potential mechanisms responsible for the effectof sports participation on participant outcomes. Additional qualitative work would also help researchers gaina better understanding of the relationship between specific elements of the sporting environment and mental
health and social outcomes in adult participants. Thirdly,
there were no studies identified in the literature where
sports participation involved animals (such as equestrian
sports) or guns (such as shooting sports). Such studies
may present novel and important variables in the assessment of mental health benefits for participants whencompared to non-participants or participants in sports
not involving animals/guns—further research is neededin this area. Our proposed conceptual model also identifies several pathways through which sport may leadto improvements in mental health—but excludes somepotentially negative influences (such as poor coaching
behaviors and injury). And our model is not designed tocapture all possible mechanisms, creating the likelihoodthat other mechanisms exist but are not included in thisreview. Additionally, an interrelationship exits between
physical activity, mental health, and social relationships,
whereby changes in one area may facilitate changes in theother/s; but for the purpose of this study, we have focusedon how the physical and social elements of sport may
mediate improvements in psychological outcomes. Consequently, our conceptual model is not all-encompassing,but designed to inform and guide future research investigating the impact of sport participation on mental health.

Supplementary Information

Conclusion
The findings of this review endorse that participation in
sport is beneficial for psychological well-being, indicatorsof psychological ill-being, and social outcomes in adults.
Furthermore, participation in team sports is associatedwith better psychological and social outcomes compared
to individual sports or other physical activities. Our findings support and add to previous review findings [1]; andhave informed the development of our ‘Mental Healththrough Sport’ conceptual model for adults which presents the potential mechanisms by which participation in
sport may affect mental health.

Received: 30 August 2021 Accepted: 31 May 2023

The online version contains supplementary material available at https://​doi.​
org/​10.​1186/​s13643-​023-​02264-8.
Additional file 1: Supplementary Table A. Risk of bias.
Additional file 2: Supplementary Table B. PRISMA Checklist.  
Acknowledgements
We would like to acknowledge the work of the original systematic review
conducted by Eime, R. M., Young, J. A., Harvey, J. T., Charity, M. J., and Payne, W.
R. (2013).
Authors’ contributions
All authors contributed to the conducting of this study and reporting thefindings. The titles of studies identified were screened by LW, and abstracts
and full text articles reviewed independently by LW and NE. For the included
studies, data was extracted independently by LW and checked by NE, andthe risk of bias assessment was performed by LW and AP independently. All
authors have read and approved the final version of the manuscript and agreewith the order of presentation of the authors.
Funding
No funding associated with this study.
Availability of data and materials
The datasets used and/or analyzed during the current study are available fromthe corresponding author on reasonable request.

Declarations
Ethics approval and consent to participate
Not applicable
Consent for publication
Not applicableCompeting interests
The authors declare they have no competing interests.
Author details
1
Centre for Active Living and Learning, University of Newcastle, University
Drive, Callaghan, NSW 2308, Australia. 2 College of Human and Social Futures,
School of Education, University of Newcastle, University Drive, Callaghan,
NSW 2308, Australia. 3 College of Health, Medicine, and Wellbeing, Schoolof Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. 4 Institute for Health and Sport, Victoria University,
Ballarat Road, Footscray, VIC 3011, Australia. 5 School of Science, Psychology
and Sport, Federation University Australia, University Drive, Mount Helen, VIC
3350, Australia.

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