Combat sports and wellbeing: advancing health and inclusion in athletes and practitioners. An opinion paper

This is not an original experiment but an opinion paper that synthesises findings from multiple systematic reviews, meta-analyses, and individual studies. The authors examined:

**Physical outcomes:** Cardiovascular fitness, muscular strength, neuromuscular control, motor coordination, injury rates (especially concussion and repetitive head trauma)

**Psychological outcomes:** Anxiety, depression, self-efficacy, emotional regulation, resilience, stress management, executive function, neuropsychological impairment

**Social outcomes:** Social integration, community belonging, self-perception, quality of life — particularly for individuals with disabilities (physical impairments, intellectual disabilities, autism spectrum disorders, emotional disorders)

**Risks:** Injury, hypercompetitive environments, disordered eating/eating disorders, low energy availability, sexual harassment, psychological stressors from high-intensity training and competition

The paper does not test a single intervention. Instead, it reviews the existing literature and provides a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of combat sports research.

Because this is a synthesis paper, there is no single sample. The authors draw on studies covering:

Elite and recreational combat sports athletes (ages ~15–50+)

Children and adolescents in school-based programmes

Individuals with physical disabilities (e.g., visual impairments, hearing impairments, mobility limitations)

Individuals with intellectual disabilities

Individuals with mental health conditions (autism spectrum disorder, oppositional defiant disorder, anxiety, depression)

Marginalised communities (refugees, low-income populations)

Both male and female participants, though the authors note male-dominated samples in many studies

No specific sample size is reported because this is not a primary study.

The paper does not report original measurements. However, the authors reference studies that used:

**Physical fitness tests:** Aerobic capacity (VO₂max), anaerobic power (Wingate test), muscular strength (1-repetition maximum, grip strength), neuromuscular control (balance tests, reaction time)

**Cardiovascular measures:** Heart rate variability (HRV), resting heart rate, blood pressure

**Biochemical markers:** Salivary cortisol (stress hormone), blood lactate

**Neurocognitive assessments:** Functional MRI (fMRI), executive function tests (Stroop test, Wisconsin Card Sorting Test), reaction time tasks

**Psychological scales:** Anxiety (State-Trait Anxiety Inventory, STAI), depression (Beck Depression Inventory, BDI), self-efficacy (General Self-Efficacy Scale), emotional regulation (Emotion Regulation Questionnaire), resilience (Connor-Davidson Resilience Scale), quality of life (WHOQOL-BREF)

**Social measures:** Social integration scales, self-perception profiles, community belonging questionnaires

**Injury surveillance:** Concussion rates, head trauma incidence, injury location/type (via medical records or self-report)

### Study design

This is an **opinion paper** — not a systematic review, meta-analysis, or original experiment. The authors state they conducted "a synthesis of contemporary empirical findings, theoretical paradigms, and applied insights." They do not describe a systematic search strategy, inclusion/exclusion criteria, quality assessment of included studies, or quantitative synthesis (meta-analysis). The paper includes a SWOT analysis (Figure 1) but no formal evidence grading.

### What this design can and cannot prove

**What it can do:**

Identify broad themes across a body of literature

Highlight gaps in current research

Propose future directions for investigation

Offer expert interpretation of existing evidence

**What it cannot do:**

Establish causality (no experimental manipulation)

Provide precise effect sizes (no meta-analysis)

Quantify the strength of evidence (no systematic quality assessment)

Rule out publication bias (no systematic search)

Compare interventions head-to-head (no controlled comparison)

### Major methodological weaknesses

1. **No systematic search strategy:** The authors do not report databases searched, search terms, date ranges, or inclusion/exclusion criteria. This means the evidence presented is selective and may reflect author bias.

2. **No quality assessment:** The authors do not evaluate the methodological quality of the studies they cite. Studies with weak designs (small samples, no control groups, no blinding) are given equal weight to rigorous RCTs.

3. **No quantitative synthesis:** Effect sizes, confidence intervals, and p-values are not reported for the claims made. Statements like "reductions in anxiety and depression" are not accompanied by specific statistics.

4. **Opinion, not evidence:** The paper is explicitly labelled an "opinion paper." While it cites empirical studies, the conclusions are the authors' interpretations, not the result of a systematic evidence review.

5. **Confounding by population:** The authors discuss benefits across diverse populations (elite athletes, children, disabled individuals, mental health patients) without distinguishing which findings apply to which group. A benefit seen in recreational adult judo practitioners may not generalise to children with autism or elite boxers.

Because this is an opinion paper with no systematic synthesis, the "findings" below are the authors' claims based on selected literature. No effect sizes, confidence intervals, or p-values are reported for any outcome.

### Physical health claims

Combat sports training improves aerobic and anaerobic endurance, muscular strength, and neuromuscular control — attributed to the high-intensity, intermittent nature of training

Injury risk is elevated in striking disciplines (boxing, taekwondo, MMA), particularly for concussion and repetitive head trauma

Reduced-contact styles (e.g., French "boxe éducative," kata in judo) may lower injury risk while maintaining benefits

### Psychological health claims

Participation is associated with reduced anxiety and depressive symptomatology

Improvements in self-efficacy, emotional regulation, resilience, and stress management are reported

Mindfulness techniques integrated into combat sports training may benefit individuals with autism spectrum disorder and oppositional defiant disorder

However, some combat sport athletes show symptoms of low energy availability, high competition-related anxiety, executive function deficits, and neuropsychological impairments associated with concussions

### Social inclusion claims

Adapted judo and para-taekwondo programmes improve social integration, self-perception, and quality of life for individuals with intellectual disabilities

Programmes for marginalised communities (refugees, low-income groups) show promise for fostering community belonging

Longitudinal data on retention and sustainability of these benefits are lacking

### Risks identified

Injury (especially concussion and head trauma in striking sports)

Disordered eating and eating disorders associated with weight-cutting practices

Sexual harassment and psychological abuse in hypercompetitive environments

Psychological stress from competition and injury-related pressures

**No effect sizes are reported.** The paper makes qualitative claims (e.g., "reductions in anxiety and depression," "improvements in self-efficacy") without quantifying the magnitude of change. For someone running a self-experiment, this means you cannot estimate how much improvement to expect.

The only quantitative reference is to a systematic review on judo interventions for intellectual disabilities (Pečnikar Oblak et al., 2020), which reportedly showed "improved social integration and self-perception and enhanced participants' quality of life" — but no numbers are given.

### What the authors acknowledge

Variability in study designs, participant demographics, and intervention protocols limits external validity

Many studies rely on observational designs susceptible to confounding variables and biases

Longitudinal research is needed to assess long-term retention rates and sustainability of benefits

There is a need for studies on appropriate adapted rules for fair competition in para-sports

Ethical concerns and logistical challenges constrain the use of RCTs in combat sports research

Qualitative studies have limitations in reproducibility and generalisability

### What a critical reader would note

1. **No systematic review methodology:** The paper cannot be considered a reliable synthesis of evidence. Claims may reflect selective citation.

2. **No effect sizes:** Without numbers, you cannot assess whether benefits are clinically meaningful or trivial.

3. **Confounding by population:** Benefits claimed for "combat sports" may not apply to all disciplines, all populations, or all training contexts.

4. **Publication bias ignored:** Studies showing null or negative effects may be under-represented in the cited literature.

5. **No discussion of dose-response:** The paper does not specify how much training (frequency, intensity, duration) is needed to produce benefits.

6. **Conflict of interest:** Several authors have published extensively on combat sports benefits, which may introduce confirmation bias.

7. **No comparison to other exercise modalities:** The paper does not compare combat sports to running, swimming, team sports, or yoga — so you cannot know if combat sports are superior, equivalent, or inferior to other forms of exercise.

8. **Risks downplayed:** While risks are mentioned, the overall tone emphasises benefits. The paper does not provide risk-benefit ratios or incidence rates for adverse outcomes.

For someone running their own n=1 experiment:

### What to test (specific intervention and dose)

**Option A: Judo or Brazilian Jiu-Jitsu (grappling, lower head trauma risk)**

Dose: 2–3 sessions per week, 60–90 minutes each

Include: Warm-up (10 min), technique drilling (20 min), sparring/rolling (20 min), cool-down/stretching (10 min)

Duration: Minimum 8 weeks, ideally 12 weeks

**Option B: Karate or Taekwondo (striking, but can be non-contact)**

Dose: 2–3 sessions per week, 60 minutes each

Include: Kata/forms (20 min), pad work (20 min), sparring (10 min, optional), cool-down (10 min)

Duration: Minimum 8 weeks, ideally 12 weeks

**Option C: Boxing (high contact risk — use only non-sparring format)**

Dose: 2–3 sessions per week, 45–60 minutes

Include: Bag work, pad work, footwork drills, shadow boxing — NO sparring

Duration: Minimum 8 weeks

### Minimum meaningful duration

**Physical fitness changes:** 4–6 weeks for initial improvements, 8–12 weeks for meaningful changes in aerobic capacity or strength

**Psychological changes:** 8–12 weeks minimum; some studies suggest 16+ weeks for anxiety/depression improvements

**Social inclusion/quality of life:** 12+ weeks, possibly longer for marginalised populations

### What to measure (specific metrics)

**Primary outcomes (choose 2–3 maximum):**

1. **General wellbeing:** WHO-5 Well-Being Index (0–100, higher = better) — weekly

2. **Anxiety:** Generalized Anxiety Disorder-7 (GAD-7, 0–21, lower = better) — weekly

3. **Depression:** Patient Health Questionnaire-9 (PHQ-9, 0–27, lower = better) — weekly

4. **Self-efficacy:** General Self-Efficacy Scale (GSE, 10–40, higher = better) — every 2 weeks

5. **Sleep quality:** Pittsburgh Sleep Quality Index (PSQI, 0–21, lower = better) — every 2 weeks

6. **Physical fitness:** Resting heart rate (measured upon waking), grip strength (hand dynamometer), push-ups in 60 seconds — every 4 weeks

**Secondary outcomes:**

**Stress:** Perceived Stress Scale (PSS-10, 0–40, lower = better) — every 2 weeks

**Emotional regulation:** Emotion Regulation Questionnaire (ERQ, two subscales: cognitive reappraisal and expressive suppression) — every 4 weeks

**Social connectedness:** Social Connectedness Scale (SCS-R, 8–48, higher = better) — every 4 weeks

**Injury log:** Daily log of any injuries, pain, or missed sessions due to injury

### Key confounds to control for

1. **Baseline fitness level:** Measure all outcomes for 2 weeks BEFORE starting combat sports

2. **Other exercise:** Keep all other physical activity constant during the experiment

3. **Sleep:** Track sleep duration and quality (use a sleep diary or wearable)

4. **Diet:** Keep diet consistent; note any weight-cutting attempts

5. **Stressors:** Log major life events (work stress, relationship changes, illness)

6. **Medication:** Note any changes in medication or supplements

7. **Social support:** Training with a partner vs. alone may affect outcomes

8. **Instructor quality:** Different coaching styles may produce different psychological effects

9. **Contact level:** Sparring vs. non-sparring dramatically changes injury risk and psychological experience

### What a positive result would look like

**For wellbeing (WHO-5):** An increase of ≥10 points from baseline (e.g., from 50 to 60) sustained for at least 4 consecutive weeks

**For anxiety (GAD-7):** A decrease of ≥4 points (e.g., from 10 to 6), moving from "moderate" to "mild" anxiety range

**For depression (PHQ-9):** A decrease of ≥5 points (e.g., from 12 to 7), moving from "moderate" to "mild" depression range

**For self-efficacy (GSE):** An increase of ≥5 points (e.g., from 28 to 33)

**For physical fitness:** Resting heart rate decrease of ≥5 bpm; grip strength increase of ≥5 kg (dominant hand); push-up count increase of ≥5 repetitions

**Important caveat:** Because this paper provides no effect sizes, these thresholds are based on general clinical guidelines for these instruments, not on combat sports-specific data. Your individual results may vary substantially. A "positive result" in an n=1 experiment means a consistent change in the expected direction that exceeds your normal day-to-day variability (measure for 2 weeks at baseline to establish your personal variability).