martial art research paper

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The effects of martial arts participation on mental and psychosocial health outcomes: a randomised controlled trial of a secondary school-based mental health promotion program

Brian Moore ORCID: orcid.org/0000-0001-8377-8579 1 ,
Dean Dudley 2 &
Stuart Woodcock 3

BMC Psychology volume 7 , Article number: 60 ( 2019 ) Cite this article

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Mental health problems are a significant social issue that have multiple consequences, including broad social and economic impacts. However, many individuals do not seek assistance for mental health problems. Limited research suggests martial arts training may be an efficacious sports-based mental health intervention that potentially provides an inexpensive alternative to psychological therapy. Unfortunately, the small number of relevant studies and other methodological problems lead to uncertainty regarding the validity and reliability of existing research. This study aims to examine the efficacy of a martial arts based therapeutic intervention to improve mental health outcomes.

Methods/design

The study is a 10-week secondary school-based intervention and will be evaluated using a randomised controlled trial. Data will be collected at baseline, post-intervention, and 12-week follow-up. Power calculations indicate a maximum sample size of n = 293 is required. The target age range of participants is 11–14 years, who will be recruited from government and catholic secondary schools in New South Wales, Australia. The intervention will be delivered in a face-to-face group format onsite at participating schools and consists of 10 × 50–60 min sessions, once per week for 10 weeks. Quantitative outcomes will be measured using standardised psychometric instruments.

The current study utilises a robust design and rigorous evaluation process to explore the intervention’s potential efficacy. As previous research examining the training effects of martial arts participation on mental health outcomes has not exhibited comparable scale or rigour, the findings of the study will provide valuable evidence regarding the efficacy of martial arts training to improve mental health outcomes.

Trial registration

Australian New Zealand Clinical Trials Register ACTR N12618001405202 . Registered 21st August 2018.

Peer Review reports

Mental health problems are a significant social issue that have multiple consequences; ranging from personal distress, disability, and reduced labour force participation; to wider social and economic impacts. The annual global cost of mental health problems was estimated as $USD 2.5 trillion by the World Health Organisation [ 1 ]; and the annual cost of mental illness in Australia has been estimated as $AUD 60 billion [ 2 ]. These costs are projected to increase 240% by 2030 [ 1 ].

However, for a variety of reasons including stigmatisation of mental health and the cost and poor availability of mental health treatment, many individuals do not seek assistance for mental health problems [ 3 ]. Consequently, it is important to consider the application of alternative and complimentary therapies regarding mental health treatment. Martial arts training may be a suitable alternative, as it incorporates unique characteristics including an emphasis on respect, self-regulation and health promotion. Due to this, martial arts training could be viewed as a sports-based mental health intervention that potentially provides an inexpensive alternative to psychological therapy [ 4 ]. However, the efficacy of this approach has received little research attention [ 5 ].

Existing martial arts research has mostly focused on the physical aspects of martial arts, including physical health benefits and injuries resulting from martial arts practice [ 6 ], while few studies have examined whether martial arts training addressed mental health problems or promoted mental health and wellbeing. Several studies report that martial arts training had a positive effect reducing symptoms associated with anxiety and depression. For example: (a) training in tai-chi reduced anxiety and depression compared to a non-treatment condition [ 7 ], (b) karate students were less prone to depression compared to reported norms for male college students [ 8 ], and (c) a study examining a six-month taekwondo program reported significantly reduced anxiety [ 9 ]. Similarly, several studies report martial arts training promotes characteristics associated with wellbeing including: (a) a group of female participants reported higher self-concept compared to a comparison group after studying taekwondo for 8 weeks [ 10 ], and (b) a six-month taekwondo program found increased self-esteem following the intervention [ 9 ].

A recent meta-analysis examining the effects of martial arts training on mental health examined 14 studies and found that martial arts training had a positive effect on mental health outcomes (Moore, B., Dudley, D. & Woodcock, S. The effect of martial arts training on mental health outcomes: a systematic review and metaanalysis, Under review). The study found that martial arts training had a medium effect size regarding reducing internalising mental health problems, such as anxiety and depression; and a small effect size regarding increasing wellbeing.

However, despite generally positive findings the research base examining the psychological effects of the martial arts training exhibits significant methodological problems [ 11 , 12 ]. These include definitional and conceptual issues, a reliance on cross-sectional research designs, small sample sizes, self-selection effects, the use of self-report measures without third party corroboration, absence of follow-up measures, not accounting for demographic differences such as gender, and issues controlling for the role of the instructor. These issues may limit the generalisability of findings and suggest uncertainty regarding the validity and reliability of previous research.

This study seeks to examine the relationship between martial arts training and mental health outcomes, while addressing the methodological limitations of previous studies. The intervention examined by the study is a bespoke programme based primarily on the martial art taekwondo and incorporating psycho-education developed for the intervention. Importantly, this study aims to examine the efficacy of a martial arts based therapeutic intervention to improve mental health outcomes.

Study design

This study is a 10-week secondary school-based intervention and will be evaluated using a randomised controlled trial. Ethics approval has been sought and obtained from an Australian University Human Research Ethics Committee, the New South Wales (NSW) Department of Education, and the Catholic Education Diocese of Parramatta. The study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618001405202). The study protocol was also reviewed externally by school psychologists employed by the NSW Department of Education.

Researchers will conduct baseline assessments at participating schools after the initial recruitment processes. Following baseline assessments and randomisation, the intervention group will receive the intervention after which post-intervention assessment will be conducted. A 12-week post-intervention (follow-up) assessment will also be conducted. The control group will receive the same intervention program after the first post-intervention assessment and will not be measured at follow-up. The design, conduct and reporting of this study will adhere to the Consolidation Standards of Reporting Trials (CONSORT) guidelines for a randomised controlled trial [ 13 ]. Participants and caregivers will provide written informed consent.

Sample size calculation

Power calculations were conducted to determine the sample size required to detect changes in mental health related outcomes resulting from martial arts training. Statistical power calculations assumed baseline-post-test expected effect size gains of d = 0.3, and were based on 90% power with alpha levels set at p < 0.05. The minimum completion sample size was calculated as n = 234 (intervention group: n = 117, control group: n = 117). As participant drop-out rates of 20% are common in randomised controlled trials [ 14 ], the maximum proposed sample size was n = 293 (intervention group: n = 147, control group: n = 146).

Recruitment and study participants

To be eligible to participate in the study, schools must be government or catholic secondary schools in NSW, Australia. All eligible schools ( n = 140) will be sent an initial email with an invitation to participate in the study. Schools that respond to the initial email will be pooled and receive a follow up call in random order from the project researchers to discuss whether they would like to participate in the study. The first five schools that demonstrate interest will then be recruited into the study.

Inclusion criteria for participation in the study includes: (a) participants are currently enrolled in grades 7 or 8, and (b) participants are within an age range 11–14 years. Exclusion criteria: concurrent martial arts training will exclude participation in the study, however prior experience of martial arts training is not an exclusion criteria. All students at participating schools who meet these criteria will be invited to participate in the study. Participant and caregiver information and consent forms will be provided to students. Two follow-up letters will be sent subsequently at 2 week intervals. Students who respond to the invitation will be pooled and randomly allocated into the study, or not included in the study.

Randomisation into intervention and control group will occur after baseline assessments. A simple computer algorithm will be used to randomly allocate participants into intervention or control groups. This will be performed by a researcher not directly involved in the study. Figure 1 provides a flowchart of the timeline for the study.

Flowchart of study

Intervention design

Intervention description.

The intervention will be delivered in a face to face group format onsite at participating schools. The intervention will be 10 × 50–60 min sessions, once per week for 10 weeks. Each intervention session will include:

Psycho-education – guided group based discussion. Topics include respect, goal-setting, self-concept and self-esteem, courage, resilience, bullying and peer pressure, self-care and caring for others, values, and, optimism and hope;

Warm up – including jogging, star jumps, push ups, and sit ups;

Stretching – including hamstring stretch, triceps stretch, figure four stretch, butterfly stretch, lunging hip flexor stretch, knee to chest stretch, and standing quad stretch; and,

Technical practice – including stances, blocks, punching, and kicking.

Additionally, intervention sessions intermittently include (alternated throughout the program):

Patterns practice – a pattern is a choreographed sequence of movements consisting of combinations of blocks, kicks, and punches performed as though defending against one or more imaginary opponents;

Sparring – based on tai-chi sticking hands exercise (which has been included as an alternative to traditional martial arts sparring); and

Meditation – based on breath focusing exercise.

In the final session the intervention will conclude with a formal martial arts grading where participants will be awarded a yellow belt subject to demonstration of martial arts techniques (stances, blocks, punching, and kicking) and the pattern learnt during the program. While it is desirable for participants to attend all 10 sessions to achieve intervention dose, it is unrealistic to assume all sessions will be attended. Research has suggested that determining an adequate intervention dose in health promotion programmes can be based on level of participation and whether participants did well [ 15 ]. In the current study intervention dose will be assumed if participants successfully complete the formal grading and are awarded a yellow belt. It is important to note that aggressive physical contact is not part of the intervention program. The intervention will be delivered by a (1) registered psychologist with minimum 6 years’ experience, and (2) 2nd Dan/level black-belt taekwondo instructor with minimum 5 years’ experience. Materials used during the intervention will include martial arts belts (white and yellow), and martial arts training equipment (for example strike paddles, strike shields).

Theoretical framework

The intervention development and implementation will be based on a traditional martial arts model, dichotomous health model, and social cognitive theory. Research examining the relationship between the martial arts and mental health has typically used a bipartite model [ 16 ] which distinguishes between traditional and modern martial arts. The intervention is based on a traditional martial arts perspective, which emphasizes the non-aggressive aspects of martial arts including psychological and philosophical development [ 17 ].

The absence of an explicit health model is a significant methodological limitation of previous research examining the mental health outcomes of martial arts training. The dominant models of mental health are based on the homeostatic assumption that normal health reflects the tendency towards a relatively stable equilibrium; and that the dysregulation of homeostatic processes causes ill-health [ 18 ]. These models can be defined dichotomously as having a: (1) pathological basis (deficit model) which refers to the presence or absence of disease based symptoms such as depression or anxiety; and (2) wellbeing basis (strengths model) which refers to the presence or absence of beneficial mental health characteristics such as resilience or self-efficacy. While considering both aspects of the mental health continuum, this study was particularly interested in the strengths model and examined the wellbeing characteristics of resilience and self-efficacy.

Social cognitive theory suggests that knowledge can be acquired through the observation of others in the context of social interactions, experiences, and media influences; and explains human behaviour in terms of continuous reciprocal interaction between personal cognitive, behavioural, and environmental influences [ 19 ]. The theory is useful for explaining the learning processes in the martial arts, which include: (a) modelling – where learning occurs through the observation of models; (b) outcome expectancies – to learn a modelled behaviour the potential outcome of that behaviour must be understood (for example, the anticipation of rewards or punishment); and (c) self-efficacy – the extent to which an individual believes that they can perform a behaviour required to produce a particular outcome [ 19 ].

The study’s theoretical framework incorporating a traditional martial arts model, dichotomous health model and social cognitive theory facilitates examination of the effects of martial arts training on mental health, ranging from mental health problems to factors associated with wellbeing such as resilience and self-efficacy. Further, the framework may determine the efficacy of martial arts training as an alternative mental health intervention that improves mental health outcomes.

Evaluation of the intervention program will involve a variety of standardised psychometric instruments to report on mental health related outcomes. Instruments include the Strengths and Difficulties Questionnaire (SDQ) [ 20 ], Child and Youth Resilience Measure (CYRM) [ 21 ], and Self-Efficacy Questionnaire for Children (SEQ-C) [ 22 ]. All outcome time-points will be examined 1 week pre-intervention, 1 week post-intervention, and 12-week post-intervention (follow-up).

Behavioural and emotional difficulties

The primary outcome measured by the SDQ will be mean total difficulties. Additionally, the SDQ will measure the following secondary outcomes: emotional difficulties, conduct difficulties, hyperactivity difficulties, peer difficulties, and pro-social behaviour.

Total difficulties was selected as a primary outcome as it provides an overview of participants’ psychological problems. The SDQ scale is a commonly used psychometric screening tool recommended for use by the Australian Psychological Society [ 23 ] and has been normed for the Australian population.

The primary outcome measured by the CYRM will be mean total resilience. Additionally, the CYRM will measure the following secondary outcomes: individual capacities and resources, relationships with primary caregivers, and contextual factors.

Resilience was selected as a primary outcome as it is a current focus of research regarding psychological strengths, but has not been examined regarding the effect of martial arts training. The CYRM-28 was used in the study as it efficiently operationalises the theoretical aspects of resilience in a valid and reliable manner, but is shorter than comparable scales (for example the Resilience Scale for Children and Adolescents [ 24 ]).

Self-efficacy

The primary outcome measured by the SEQ-C will be mean total self-efficacy. Additionally, the SEQ-C will measure the following secondary outcomes: academic self-efficacy, social self-efficacy, and emotional self-efficacy.

Self-efficacy was selected as a primary outcome as this operationalised a relevant component of social cognitive theory, which is important regarding the hypothesised learning processes in the intervention. The SEQ-C was used in the study as it operationalises self-efficacy for adolescents in an educationally relevant context.

Statistical methods

Statistical analysis of the primary and secondary outcomes will be conducted using SPSS statistics version 25 (IBM SPSS Statistics, 2017) and alpha levels will be set at p < 0.05.

The collected psychometric test data will be consolidated into subscale variables using factor analysis and the internal consistency of each variable will be examined to determine reliability. Items to be included in the scale variables will be added and computed to create composite scores. Repeated measures univariate analysis of variance (ANOVA), and multivariate analysis of variance (MANOVA) will primarily be used to analyse test data. Ordinal regression will be used to analyse test data based on psychometric measures using a 3-point Likert scale. Interpretation of effect sizes will reflect Cohen’s suggested small, medium, and large effect sizes, where partial eta squared sizes are equal to 0.10, 0.25, and 0.40 respectively [ 25 ].

Age, school grade level, sex, socio-economic status and cultural background will be included as covariates in the analysis.

The primary aim of this study is to evaluate the training effects of martial arts participation on mental health outcomes. The study will use a randomised controlled trial of secondary school aged participants.

Previous studies examining the impact of martial arts training on mental health and wellbeing have found positive results, which has also been confirmed by a systematic review and meta-analysis. Results have included martial arts training reducing symptoms associated with anxiety and depression; and promoting characteristics associated with wellbeing. However, the small number of relevant studies and noted methodological problems lead to uncertainty regarding the validity and reliability of existing research.

The current study utilises a robust design with baseline, post-test and follow-up measures to examine the views of participants and includes a rigorous evaluation process using quantitative data to explore the program’s potential efficacy. This is a clear strength of this study and is important due to the study’s multi-site delivery. The current study has not used a qualitative approach which is a limitation of the research. Qualitative work is planned for future research to explore issues such as mechanism of impact.

The findings of this study will provide valuable evidence regarding the training effects of martial arts participation on mental health outcomes, and information for research groups looking for alternative or complementary psychological interventions. To our knowledge, no previous studies have reported the training effects of martial arts participation on mental health outcomes on a scale comparable to the current study while maintaining a similarly robust design and rigorous evaluation process. This study has the potential to change public health policy, and school-based policy and practice regarding management of mental health outcomes and enhance a range of health promoting behaviours in schools.

Availability of data and materials

The datasets used and/or analysed during the current study will be available from the corresponding author on reasonable request.

Abbreviations

Australian dollar

United States dollar

Australian New Zealand Clinical Trials Registry Number

Analysis of variance

Consolidation standards of reporting trials

Child and youth resilience measure

Multivariate analysis of variance

New South Wales

Strengths and difficulties questionnaire

Self-efficacy questionnaire for children

Statistical packages for the social sciences

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Charles Sturt University, School of Teacher Education Faculty of Arts and Education, Panorama Avenue, Bathurst, NSW, 2795, Australia

Brian Moore

Macquarie University, Department of Educational Studies Faculty of Human Sciences, Balaclava Road, Macquarie, NSW, 2109, Australia

Dean Dudley

Griffith University, School of Education and Professional Studies Faculty of Arts, Education, and Law, Brisbane, QLD, 4122, Australia

Stuart Woodcock

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BM conceived the research aims, conducted the literature search, primarily wrote the manuscript and had primary responsibility for the final content. DD and SW reviewed and approved the final manuscript. All authors read and approved the final manuscript.

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Correspondence to Stuart Woodcock .

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Ethics approval has been sought and obtained from an Australian University Human Research Ethics Committee (Reference No: 5201700901), the NSW Department of Education (Reference No: DOC18/257488), and Catholic Education Diocese of Parramatta (Reference No: 28032018).

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Moore, B., Dudley, D. & Woodcock, S. The effects of martial arts participation on mental and psychosocial health outcomes: a randomised controlled trial of a secondary school-based mental health promotion program. BMC Psychol 7 , 60 (2019). https://doi.org/10.1186/s40359-019-0329-5

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DOI : https://doi.org/10.1186/s40359-019-0329-5

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The effect of martial arts training on mental health outcomes: A systematic review and meta-analysis

Affiliations.

1 School of Teacher Education, Charles Sturt University, Panorama Avenue, BATHURST, NSW, 2795, Australia. Electronic address: [email protected].
2 Macquarie University, Australia.
3 Griffith University, Australia.
PMID: 33218541
DOI: 10.1016/j.jbmt.2020.06.017

Objective: Mental health issues are of increasing public concern, however are often untreated for a variety of reasons. While limited, the research examining the relationship between mental health and martial arts training is generally positive. This systematic review and meta-analysis explored whether martial arts training may be an efficacious sports-based mental health intervention.

Design: The meta-analysis used a random effects model and examined three mental health outcomes: wellbeing, internalising mental health, and aggression.

Data sources: During January to July 2018 the following electronic databases were searched: CENTRAL, EBSCO, Embase, ERIC, MEDLINE, PUBMED, and ScienceDirect.

Eligibility criteria: Eligibility criteria included: (1) martial arts was examined as an intervention or activity resulting in a psychological outcome, (2) the study reported descriptive quantitative results measured using standardised scales that compared results between groups and (3) studies were published as full-length articles in peer reviewed scientific or medical journals.

Results: More than 500,000 citations were identified and screened to determine eligibility. Data was extracted from 14 eligible studies. Martial arts training had a significant but small positive effect on wellbeing (d = 0.346, 95% CI = 0.106 to 0.585, I 2 = 59.51%) and a medium effect on internalising mental health (d = 0.620, 95% CI = 0.006 to 1.23, I 2 = 84.84%). Martial arts training had a minimal non-significant positive effect in reducing aggression (d = 0.022, 95% CI = -0.191 to 0.236, I 2 = 58.12%).

Summary/conclusion: Whilst there is considerable variance across the studies included in the meta-analyses, there is support for martial arts training as an efficacious sports-based mental health intervention for improving wellbeing and reducing symptoms associated with internalising mental health.

Keywords: Aggression; Martial arts; Mental health; Mental illness; Wellbeing.

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ORIGINAL RESEARCH article

The effects of martial arts training on attentional networks in typical adults.

$\r\nAshleigh Johnstone*$

School of Psychology, Bangor University, Bangor, United Kingdom

There is substantial evidence that training in Martial Arts is associated with improvements in cognitive function in children; but little has been studied in healthy adults. Here, we studied the impact of extensive training in Martial Arts on cognitive control in adults. To do so, we used the Attention Network Test (ANT) to test two different groups of participants: with at least 2 years of Martial Arts experience, and with no experience with the sport. Participants were screened from a wider sample of over 500 participants who volunteered to participate. 48 participants were selected: 21 in the Martial Arts group (mean age = 19.68) and 27 in the Non-Martial Arts group (mean age = 19.63). The two groups were matched on a number of demographic variables that included Age and BMI, following the results of a previous pilot study where these factors were found to significantly impact the ANT measures. An effect of Martial Arts experience was found on the Alert network, but not the Orienting or Executive ones. More specifically, Martial Artists showed improved performance when alert had to be sustained endogenously, performing more like the control group when an exogenous cue was provided. This result was further confirmed by a negative correlation between number of years of Martial Arts experience and the costs due to the lack of an exogenous cue suggesting that the longer a person takes part in the sport, the better their endogenous alert is. Results are interpreted in the context of the impact of training a particular attentional state in specific neurocognitive pathways.

Introduction

Being able to attentionally focus on a task, and therefore avoid distraction, is fundamental to achieving our goals. Despite its central role in human adaptation to life, it is one of the most vulnerable cognitive functions. This is evidenced by the level of research showing the number of variables that deficits in attention can be attributed to, such as genetics ( Durston et al., 2006 ), mental illness ( Clark et al., 2002 ), and traumatic brain injury ( Shah et al., 2017 ), among others. Age has perhaps the biggest influence on attentional control with a large amount of research discussing the decline in this function in older adults ( Milham et al., 2002 ; Kray et al., 2004 ; Jennings et al., 2007 ; Deary et al., 2009 ; Carriere et al., 2010 ; Dorbath et al., 2011 ). Deterioration of attentional control is variable but generally progressive, establishing it as the best predictor of cognitive dysfunction in older people. In neural terms, attentional control is achieved by the coordinated activation of a number of attentional networks with various specialities depending on the type of control required, although not all of these networks are affected by age in the same manner ( Jennings et al., 2007 ).

Compared to how easily attentional control seemingly declines, little is known about whether we can enhance this function, and if so, how. In this paper, we evaluate the impact of Martial Arts experience on three different attentional networks: Alert, Orienting, and Executive. These networks have been neuroanatomically validated and reported as being largely independent of one another ( Fan et al., 2002 ). The results provided in this paper are important in aiding understanding of the impact of experience on these networks, whilst also highlighting potential intervention strategies.

Attentional Control in Martial Arts

Tang and Posner (2009) suggested that there are two different ways to improve attentional control: Attention Training (AT, also called Network Training; Voelker et al., 2017 ) and Attention State Training (AST). AT comes from Western cultures and is mostly based on specific task practice; over the past decade it has become popularized and marketed as ‘brain training’ games ( Boot et al., 2008 ; Bavelier and Davidson, 2013 ). This means that much research into AT focuses on training participants on a certain task to improve a specific cognitive skill, yet these improvements often are not transferable to tasks measuring other skills ( Rueda et al., 2005 ). For example, training at an attentional task will only improve the skills required for attentional tasks similar in nature ( Thorell et al., 2009 ). Despite this, improvements are often found in this type of AT research. Participants given training in playing an action video game were shown to present an increase in visual attention, in comparison to those given training in playing Tetris ( Green and Bavelier, 2003 ). This is possibly due to the need to stay vigilant whilst also scanning the screen for targets or enemies during this type of game. In addition to the improvement not being transferable, this improvement seems to be short-term, rather than the long-term improvement researchers are striving for Tang and Posner (2009) .

On the other hand, AST is based on Eastern cultures and aims to improve attention through a change in state of mind and body, also claiming to provide a better transference to other tasks not specifically trained by the activity ( Tang and Posner, 2009 ). AST can be found in activities such as yoga, mindfulness, meditation, and Martial Arts. Gothe et al. (2013) used healthy, adult participants to investigate the effects of yoga on cognitive control. Participants were asked to visit the laboratory on three occasions to complete some computerized behavioral tasks after a different activity on each day: (1) a 20-min yoga session; (2) a 20-min exercise routine on a treadmill; (3) no activity in order to collect baseline data. The order of the three activities was randomized. A flanker task and an n-back task were used to provide measures of attentional control, and results indicated that the yoga session provided an improvement across both of these tasks. Interestingly, these benefits were not seen after the aerobic exercise condition, perhaps suggesting that the exercise element of yoga is not the sole force behind the effects. Similarly, Moore and Malinowski (2009) found a correlation between mindfulness experience and improved performance in attention and response inhibition tasks. However, unlike the Gothe et al. (2013) experiment, this was a cross-sectional design using the amount of mindfulness experience as a variable rather than results after a single session.

Martial Arts includes similar aspects to mindfulness and yoga, and could potentially produce similar improvements in attentional control, although much of the research with Martial Arts has been conducted with school aged children ( Diamond and Lee, 2011 ). For example, during an academic year, an average of three sessions of Taekwondo per week showed improvements in working memory and attention, as well as parentally-reported benefits in concentration and behavioral inhibition ( Lakes et al., 2013 ). Additionally, a recent large-scale review of 84 studies conducted by Diamond and Ling (2016) found that Martial Arts, mindfulness, and Montessori Teaching produced the widest range of benefits in executive control tasks in children when compared with other interventions such as team sports, aerobic exercises, board games, or adaptations to the school curriculum. This review also raised an important point, noting that the greatest benefits were found in the children with the lowest starting scores in cognitive tests, and those from lower socio-economic backgrounds. This observation indicates that the greatest benefits from this type of intervention should be observed in those who display poor cognitive control and that neurotypical populations composed of developed young adults may already be at a ceiling in their attentional performance. Indeed, reports of improved cognitive abilities in younger adults are rare. Most of the benefits have been found in the sensorymotor system, involving corticospinal excitability due to long term training in Karate ( Moscatelli et al., 2016b ), or in the excitability of the motor cortex in Taekwondo athletes ( Moscatelli et al., 2016c ). Interestingly, some of these pathways coexist with more cognitive networks, such as attentional networks (as reviewed further on), raising the possibility of successfully finding changes in cognition with neurotypical adults despite the lack of previous reports.

Conversely, one would expect some improvements in older adults due to the evidence suggesting an age-related decline in cognitive control. Kray et al. (2004) suggested that if cognitive control was plotted on a graph along the lifespan, then it would take the shape of an inverted ‘U,’ with performance improving as a person ages, remaining relatively stable during early adulthood, and then declining again as a person grows older. Studies using older populations to investigate the effects of Martial Arts on attentional control remain elusive, possibly due to the physical demands the sport requires, however that is not to say that this type of research is impossible. Jansen and Dahmen-Zimmer (2012) recruited participants aged 67–93 to compare the effects of Karate training in comparison to general physical exercise training, and cognitive training. This training took place over 20 sessions over 3–6 months, yet despite an increase in well-being reported by those in the Karate training group, there were no significant effects on cognitive speed or working memory across any of the groups.

However, it is important to note that outside laboratories, Martial Artists usually measure their differences in training in terms of years, rather than weeks or months, so it is conceivable that short interventions would not achieve the state of mind characteristic of the discipline. Witte et al. (2015) built on previous research and studied three different groups of participants, with an age range of 63–83. They compared a group training in Karate, with another training in fitness and with a passive control group that did not complete any sports intervention. The results showed that the Karate group displayed small improvements in each of the four tasks performed. In a test of divided attention, for example, this improvement was not quite significant ( p = 0.063) after 5 months but, after another 5 months of extra training, the level of improvement further increased, reaching more reliable effects ( p = 0.002). These results clearly suggest that, at least in adults, potential benefits may need a longer time of training to emerge than those normally used in pre–post intervention studies.

To sum up, much of the research into the effects of Martial Arts on attentional and cognitive control has used either school-aged children or older adults. There appears to be a lack research focusing on healthy, neurotypical, adult participants. This population seems to need longer periods of training to show any improvement in other transference tasks, and this is the gap that we aim to fill with our current research.

The Attention Network Test

A limitation of comparing much of the previous research is the wide range of measures used to assess attentional control, potentially leading to inconsistency across studies. One way to reduce this problem is to avoid using general measures (such as academic results or IQ) that result in difficulties isolating the core mechanisms behind the benefits. The problem could also be countered by using tasks which have been validated as measuring specific functions that have been localized to neuroanatomical locations.

Petersen and Posner (2012) discussed recent literature in attentional control and confirmed the existence of three core networks of attention in the human brain: Alert, Orienting, and Executive ( Posner and Petersen, 1990 ). They suggested that these networks are independent of each other, each having distinct neuroanatomical structures, and responsible for a different aspect of attention. The alert index is related to optimal vigilance, Orienting has associations with the spatial location of targets, and executive has been linked with conflict resolution. Measures of these indexes can be collected using the Attention Network Test (ANT; Fan et al., 2002 ), which utilizes a modified flanker task with four cues types to produce various trial types. The Alert index gives a measure of how well a person is able to respond to targets appearing at unpredictable intervals (uncued) compared to a predictable one (time cued). The Orienting index assesses how well-participants can orient to a target that appears in an unpredictable location (uncued) compared to a certain one (spatially cued). Finally, the executive index evaluates how well-participants can resolve response conflict in a flanker task, where distractors evoke the same response as the target (congruent) or the opposite one (incongruent). Behaviorally, all these three indexes are interpreted as costs, where large differences in RTs or accuracy reflect poor control ( Fan et al., 2002 ; Jennings et al., 2007 ; Petersen and Posner, 2012 ).

Functional magnetic resonance imaging (fMRI) has been used to assess the neural activity related to the three attentional networks measured by the ANT. It has been suggested that these three networks are independent of each other, and while there is some overlap, the functional response for each network has a distinct anatomical location ( Fan et al., 2005 ). The Alert index seems to involve norepinephrine circuits connecting the locus coruleus with the right frontal and parietal cortices. The Orienting index is mostly driven by acetylcholine areas engaging the superior parietal cortex, temporoparietal junction frontal eye fields and superior colliculus. Finally, the Executive network activates dopamine based areas including the anterior cingulate, lateral and ventral prefrontal cortices, and the basal ganglia. When a particular sensory event is presented, it is believed that the coordinated activation of these three networks makes it possible to react to them with fast and accurate responses.

Training in Martial Arts is a wide-reaching experience involving not only a great level of motor training but also a mental state of concentration and reactivity to targets with a strong social context. Because of this, it is difficult to confidently predict where the improvements, if any, should be observed. There are, however, different aspects of the training that could impact directly these indexes. For example, during sparring, Martial Artists need to continuously scan the body of the opponent for an opening where they can score. As this may happen at any particular time, training in sparring may transfer to other tests involving target detection at random intervals, as measured by the Alert index. In addition to scoring, the Martial Artist needs to avoid and block any incoming hit from the opponent. This requires not only good timing (also linked to the alert system) but enhanced spatial orienting to the exact location where the hit comes from. Following the example of sparring, Martial Artists also throw feigned punches and kicks to distract the opponent’s attention in order to score with an unexpected move. Not reacting to these in order to better respond to the real ones should require response conflict control of the type measured by the Executive index. Of course, it is not just sparring that is involved in Martial Arts training. Equally, these aspects are not exclusive of Martial Arts and can be shared with many other activities such as tennis, fencing, dancing, etc. But they at least represent a context of repetitive training on specific skills that are comparable to those used in AT studies, such as brain training. With the added element of concentration, meditation, and discipline (as is typical in AST research), it provides a promising strategy for training in attentional control.

In this study, we compared two groups of participants screened from a wider sample of 500 young adults. One group was composed of Martial Artists with at least 2 years of experience while the others had no previous experience with Martial Arts. Because of the requirements of extensive training, assignation to the groups could not be random, so special care was taken during the matching process to eliminate the most relevant potential confounds. As there is no previous literature of the influence of different demographics on ANT, we previously ran a pilot where these confounds were detected.

The aim of this study was to assess the performance of Martial Artists and Non-Martial Artists on the three indexes of attention, as measured by the ANT. We hypothesized that smaller indexes, reflecting improved performance, would be observed in the Martial Arts group in comparison to Non-Martial Artists.

Materials and Methods

Participants and screening procedure.

An unpublished pilot study using an unbiased random sample of 41 undergraduate students of Psychology at Bangor University was used to test the ANT in the general population according to different demographic and lifestyle factors. This pilot showed that Age and Body Mass Index (BMI) both had significant effects on ANT performance, and so based on this we decided to match the Martial Arts and Non-Martial Arts groups mainly on these two variables among others.

Using G ∗ Power 3.0.10, an a priori calculation of optimal sample size was calculated based on parameters taken from the pilot study. When using stringent criteria such as a correlation of 0.6 between measures, a desired power of 0.95, and an alpha level set to 0.05, it was estimated that a minimum sample size of 30 participants would be needed to reach an effect size of 0.25 from the required 2x2x2 ANOVA (see section “Design and Procedure”). This would result in 15 participants in each of the two participant groups.

A screening questionnaire was introduced and distributed online to over 500 new people including Bangor University undergraduates and non-students from the local community. These responses then made up a participant pool which was used to create two experimental groups matched on the aforementioned variables: one group with no Martial Arts experience ( n = 27, five males), and the second with those who had undertaken Martial Arts practice during the last 2 years ( n = 21, six males). The Martial Arts group was made up of participants with experience in Karate (5), Taekwondo (3), Kickboxing (3), Jujitsu (3), Tai Chi (2), Judo (2), Thai Boxing (2), and Kung Fu (1). This sample exceeded the minimum sample size estimated by the power calculation. The participants from these groups were invited to participate in the ANT phase. The Non-Martial Arts group reported taking part in activities such as going to the gym, playing team sports, meditating, praying, and playing musical instruments.

Students from Bangor University were reimbursed for their time with course credits, and those from the community were given a monetary token of £6. All participants were neurotypical, had normal or corrected to normal vision, and normal hearing. This study gained approval from the Bangor University Ethics and Governance Committee (Ethics Approval #2015-15553) and have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. As a condition of this approval, all participants provided fully informed consent prior to taking part. Information regarding the demographics of the selected participants can be found in Table 1 .

TABLE 1. Descriptive data for key participant demographics.

Stimuli and Apparatus

This experiment was presented using EPrime 2.0 [Psychology Software Tools (PST)]. Responses were recorded using a QWERTY keyboard, with the ‘C’ and ‘M’ keys as the response keys. Target stimuli consisted of a row of five black arrows on a white background, facing to either the left or right side of the screen; each arrow subtended 0.53° of a visual angle, with a gap of 0.09°. The complete series of arrows subtended 2.73°. Participants were required to press the left key (C) or the right key (M) in response to the direction of the central arrow. This could be in either a congruent position (facing the same way) to the other arrows, or in an incongruent one (facing the opposite way). These were displayed either 0.71° of a visual angle above or below a fixation cross in the center of the screen (see Figure 1 ).

FIGURE 1. Diagram showing (A) all possible cue types, (B) the target types, and (C) trial timings and procedure.

The target stimulus was preceded by one of four cue configurations (Figure 1 ): no cue, center cue, double cue, and spatial cue. Each cue was made up of a black asterisk the same size as the fixation cross (0.44° of a visual angle tall; 0.44° wide) and appeared for 100 ms before the target (Figure 1 ). During the no cue condition, an asterisk did not appear, instead, the fixation cross remained on screen. For the center cue conditions, the asterisk simply replaced the fixation cross. Double cue conditions consisted of an asterisk appearing both above and below the fixation cross. Finally, during spatial cue conditions, the asterisk appeared either above or below the fixation cross, and always provided a true indication of the location in which the target would appear.

Each trial began with a fixation cross presented during variable intervals (400–1600 ms) and ended with another fixation cross appearing just after the response to the target also with a variable duration to make the total interval time 1600 ms per trial. After the first interval, the cue appeared on screen for 100 ms, followed by another fixation cross for a fixed duration of 400 ms. The target then appeared and remained on screen until the participant responded, or until 1700 ms had passed. Responses exceeding this limit were recorded as errors.

Design and Procedure

The study took a 2 (participant group) × 2 (trial type) × 2 design (target congruency – executive) design. For the Alert index this would look like 2 (Martial Arts vs. Non-Martial Arts) × 2 (no cue vs. double cue) × 2 (congruent target vs. incongruent target). Whereas for Orienting it would take the form of 2 (Martial Arts vs. Non-Martial Arts) × 2 (center cue vs. spatial cues) × 2 (congruent target vs. incongruent target). The Alert and Orienting networks come from cue manipulations, and are independent due to them using different trial types in their calculations, however the Executive network comes from a target manipulation and is therefore not independent of the Alert and Orienting networks. As a result, we will analyze this as an interaction.

Upon arrival in the laboratory, participants were provided with information about the experiment, given the opportunity to ask questions, and provided with a consent form. After receiving fully informed consent, participants were presented with the demographics questionnaire, before being asked to complete the ANT by responding to the direction of a central arrow as described earlier.

A practice block of 24 trials was presented to participants to ensure all instructions were understood; no feedback was provided. Once completed, participants moved onto the experimental block of 128 trials, before having a break of a length determined by the participant, which was then followed by another 128 trials. Again, no feedback was provided.

Data Analysis

All data was pre-processed within EPrime 2.0 (PST). Incorrect trials were removed from the analysis, as were those with a response time greater than 1000 ms. Once the filtering in EPrime was complete, the data was moved over to SPSS v.22 for statistical analysis, and split into the two participant groups based on the criteria mentioned above for Martial Arts experience. The significance level was set at p ≤ 0.05. Descriptive statistics are presented as mean averages, ± standard deviation for continuous variables, and frequencies for categorical variables (see Table 1 ). Differences between the groups were estimated using independent samples t -tests, whilst differences in frequencies were assessed using chi square. The three indexes, Alert, Orienting, and Executive, were then created using the calculations described by Fan et al. (2002) . These are expressed as mean cost indexes. Mean RT averages per participant, per condition were analyzed through three different general linear models (see Table 2 ). Effect sizes for these effects are estimated through partial eta squared. When Martial Arts group differences were found, correlations were conducted with years of experience using the Pearson’s coefficient.

TABLE 2. F -values, probability values ( p ) and effect sizes ( η p 2 ), for all conducted general linear models.

Data were separately analyzed for each of the attentional indexes.

When the Executive index was analyzed in isolation, we found an overall increase of 36 ms for incongruent trials compared to congruent ones [ F (1,46) = 1013.92; p < 0.001; η p 2 = 0.1]. This effect was almost identical for the Martial Arts group (36 ms) compared to the Non-Martial Arts one (35 ms, F < 1) (see Figure 2 ).

FIGURE 2. Graph depicting the mean cost for each of the three attentional network, for both participant groups. Error bars represent Standard Error. ∗ p < 0.05.

Executive vs. Alert

Mean RTs per participant per condition were submitted to a mixed factor analysis of variance (ANOVA) with the Martial/Non-Martial Arts variable as a grouping factor and the Type of Cue (Double Cue, no Cue) and Congruency (Congruent, Incongruent) as repeated measures. Results indicated no overall differences in RTs across the groups ( p = 0.31). Responses to targets preceded by the double cue were 32 ms faster than those without a cue as would be expected as a measure of Alert. More importantly, this benefit from the double cue was 18 ms smaller in the Martial Arts group compared to the Non-Martial arts group [ F (1,46) = 5.64; p = 0.022; η p 2 = 0.642] (see Figure 2 ). Although group differences did not reach significance in any of the conditions, Non-Martial Artists were found to be particularly slower than the Martial Artists when no cue was presented (24 ms), while both groups seemed more similar with the double cue (6 ms) (see Figure 3 ). Congruent trials were overall 32 ms faster than incongruent ones [ F (1,46) = 52.59; p < 0.001; η p 2 = 0.1], but this effect did not change with the group ( F < 1). Interestingly, the executive congruency effects were more evident in the double cue trials (38 ms) than with no cue (27 ms) [ F (1,46) = 4.18; p = 0.047; η p 2 = 0.516]; but this was found in general for all participants and did not change across the groups ( p = 0.57).

FIGURE 3. Graph depicting the mean RT for the trial types that make up the Alert index, no cue trials and double cue trials. Mean RTs are displayed for both participant groups. Error bars represent Standard Error. ∗ p < 0.05.

Executive vs. Orienting

Mean RTs per participant per condition were also submitted to a mixed factor analysis of variance (ANOVA) with the Martial/Non-Martial Arts variable as a grouping factor and the Type of Cue (Spatial, Center Cue) and Congruency (Congruent, Incongruent) as repeated measures. As before, no overall differences were found between the Martial Arts and the Non-Martial Arts groups ( p = 0.22) (see Figure 2 ). Congruent trials were found to be 38 ms faster than the incongruent ones [ F (1,46) = 160.93; p < 0.0001; η p 2 = 1]. Also, spatial cues produced responses that were 41 ms faster than the single central cue [ F (1,46) = 111.14; p < 0.0001; η p 2 = 1]. Interestingly, the congruency effects changed depending on the type of spatial cueing [ F (1,46) = 10.52; p = 0.002; η p 2 = 0.89], with a flanker congruency effect of 47 ms in the center cue condition congruent trials that was reduced to 29 ms with the spatial cue.

Attentional Networks Correlations

We analyzed whether there were any interactions across attentional networks by calculating the correlations across the three indexes. Results demonstrated a marginally significant correlation between the Alert and Executive indexes only ( r = -0.262; p = 0.072).

A correlation was also done on the three indexes of attention and the number of years of Martial Arts practice. No significant correlation between Orienting and number of years was found, r = 0.121, n = 46, p = 0.421, nor between Executive and number of years, r = 0.039, n = 46, p = 0.798. However, a correlation nearing significance was found between the Alert index and the number of years of practice, r = -0.274, n = 46, p = 0.065.

Finally, a series of analyses were run on the accuracy of responses to each trial type. For each participant, a percentage (%) accuracy score was calculated for each type of trial (cue type and congruency type), and these were then compared between groups. There were no significant differences between the two participant groups for any trial type for the ANT, suggesting that all trials were equally as difficult. Less than 16% of overall responses were recorded as errors.

In this paper, we provide evidence that training in Martial Arts is associated with improvements in the Alert attentional network. This appears to be a specific benefit that boosts endogenous preparation for uncertain targets, as suggested by the increased benefits in the uncued conditions in comparison to a lack of improvement in the cued conditions. This means that when an upcoming target had no cue, the Martial Artists performed at a higher level, however when the target had a reliable cue, these group differences disappeared. Importantly, the Alert benefits observed in the MA group was further supported by the negative correlation found between the Alert index and the number of years of training.

The use of ANT allows us to speculate on the nature of these benefits, as explained in the introduction. Previous research with this task using neuroimaging techniques found that the Alert index is linked to the activation of a norepinephrine based network connecting the locus coeruleus with the right frontal and parietal cortices, as well as the anterior cingulate cortex (ACC) and orbitofrontal cortex (OFC; Nieuwenhuis et al., 2005 ; Raz and Buhle, 2006 ; Petersen and Posner, 2012 ). The locus coeruleus is a nucleus in the brainstem in charge of producing norepinephrine, which has an excitatory effect on the rest of the brain, resulting in an increased level of arousal. As a result of this activation, different parts of the brain involved in perceptual and motor processing get primed to enable faster responses to stimuli ( Moscatelli et al., 2016a , b ; Monda et al., 2017 ).

It is not yet clear which aspect of Martial Arts training may be driving the effect on the alert index, or indeed where the effect is coming from. Further work using neuroimaging techniques may allow us to gain an insight into these details. For example, Fan and Posner (2004) suggested the use of diffusion tensor imaging (DTI) to look at the attentional networks’ functional connectivity; by understanding how these circuits work in a typical group of participants, we could then begin to investigate whether Martial Arts experience has any effect, which would then be able to show us where the effect on alert is observed at a neural level. Of course, it is conceivable that Martial Artists who trained for years on fast reactions to stimuli may have modeled their brains to lower the activation threshold of areas involved in perceptual processing and motor control ( Moscatelli et al., 2016c ). However, we would expect this influence to appear across all conditions, for both predictable and unpredictable targets, simply inducing faster reaction times, rather than any exclusive benefits. This idea is not supported by the results which suggested no significant differences in overall RTs in the Martial Arts group in comparison to the Non-Martial Arts controls.

An interesting aspect of our results is that the strongest benefits seem to appear more specifically in the unpredictable condition. Somehow, our Martial Artists seem to be more capable of inducing these increases in arousal to improve sensorimotor processing endogenously without the aid of external cues. Indeed, there is evidence that endogenous time allocation of attention to the particular moment when a target appears improves identification of masked targets that otherwise would have been unconsciously processed ( Naccache et al., 2002 ). More importantly, it has also been found that identifications were better for targets closer to the expected time frame than for more distant ones in time. When this is considered in relation to our findings, it raises the possibility that Martial Artists may endogenously hold the level of vigilance for longer periods of time reaching the unpredictable target in a more efficient way than controls.

This interpretation is supported by recent findings of increased excitability of the corticospinal motor system in Karate athletes ( Moscatelli et al., 2016a , b ; Monda et al., 2017 ). In this study, the authors found that this greater excitability from the Karate group was evidenced in faster reaction times to targets appearing in variable intervals (as is standard in the Reaction Time [RTI] test from the Cambridge Neuropsychological Test Automated Battery [CANTAB ® ]). Related findings from this team have also found excitability of the motor cortex in Taekwondo athletes ( Moscatelli et al., 2016c ), suggesting that this effect may be found in other types of Martial Arts. In the current study, when the target appeared in a predictable interval, no group differences were found. Our Martial Arts group were faster than the Non-Martial Arts group only with unpredictable targets, thereby supporting Moscatelli colleagues findings. Interestingly this RTI task was also described as a vigilance task. Our results can be seen as a step forward, further suggesting that the excitability of this corticospinal motor system may be linked to the improved activity in the Alert network due to Martial Arts practice.

Although previous research seems to assume that the three attentional networks studied here largely independent, there is some evidence of influences across them. For example, spatial orienting seems to have a fundamental role in the activation of competing responses during a flanker task in what it would seem like a modulation of the Orienting network over the Executive one ( Vivas and Fuentes, 2001 ). Also, when testing neglect patients, increased alert can be used to improve target detection in the hemifield contralateral to the site of the lesion ( Robertson et al., 1995 ), demonstrating an influence of the Alert network over the Orienting one. In our data, we did not find any correlation between Alert and Orienting, neither Orienting with Executive. However, we did find a strong correlation between Alert and Executive, since greater congruency effects were found in the predictable condition. Further support may come from studies finding that increases in norepinephrine improve executive response selection ( Chamberlain et al., 2006 ). This also fits well with results described earlier in which response congruency effects were only found at the spatially cued location ( Vivas and Fuentes, 2001 ). Basically, the executive resolution of conflict elicit by incongruent flankers requires first the selection of the target, both spatially and temporally. Although this is an interesting aspect of the data, it nevertheless did not change with the group, not being affected by training in Martial Arts.

The benefits associated with MA training in our study seem to be exclusive to the Alert system, mostly with regards to endogenous alert. Importantly, this improvement increases with years of practice extending up to 18 years. These results are important because it highlights the potential difficulties of getting significant results from studies of using randomized groups with a training intervention of only a few months. Nevertheless, one of the biggest disadvantages of using cross-sectional samples is the lack of control of group variables. In order to improve the control over the current study, participants were carefully matched on various variables. To find two homogeneous participant groups, demographic information for over 500 people was collected and then filtered based on age, BMI, lifestyle, and health factors such as smoking status, and level of education. To avoid ending up with an active participant group and a passive participant group, we ensured that control participants were only recruited if they reported taking part in several hours of activity per week. The activities reported included gym time, football, and basketball among others, suggesting that the control participants were just as active as the Martial Artists. We believe that this is an important variable to use with regards to matching the groups to ensure a similar level of fitness due to previous research suggesting a link between fitness and cognitive control. Our estimation, however, has been based on a non-validated self-report measure so should be considered with caution. In any case, the descriptive data showed no significant differences in terms of hours of participating in other activities per week between the two groups.

A further consideration comes from the heterogeneity of participants in the Martial Arts group, specifically in relation to the styles of Martial Arts. In the current paper, different styles of Martial Arts with variations in both training and philosophy are used. This was done under the assumption that all of them would contain elements of physical and mental training in line with Tang and Posner (2009) AST classification, found to cause improvements in executive control ( Moore and Malinowski, 2009 ; Gothe et al., 2013 ). However, Weiser et al. (1995) suggested that Martial Arts exist on a continuum with more meditative styles on one end, and more combative styles on the other. This suggests that it may be important to consider potential differences in style in various forms of Martial Arts. Further research intends to assess these possible differences, in the hope that it could lead to a greater understanding of the underlying drivers behind the cognitive improvements associated with Martial Arts.

The current research suggests that the alert network of attention differs between people with Martial Arts experience and those without this experience. Whilst this effect was only found in one of the three known attentional networks, it supports previous work which suggests changes in control as a result of taking part in Martial Arts, whilst also extending the research field into populations of neurotypical adults. Further research should seek to replicate this finding, and discover the underlying reasons for the effect solely appearing in the Alert network and not Orienting or Executive. This may help improve our understanding of how activity in different attentional networks can be ‘trainable’ or able to be improved through Martial Arts.

Data Availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Author Contributions

AJ and PM-B equally contributed to the development, data collection, analysis and interpretation, and manuscript write- up of this research.

This research was funded by the Economic and Social Research Council Doctoral Training Center (ESRC DTC) from United Kingdom, grant number ES/J500197/1.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The reviewer DG and handling Editor declared their shared affiliation.

Acknowledgments

The authors would like to thank Alexander Kelly and Lauren Green for their help collecting data. They would also like to thank the reviewers for their insightful comments on the manuscript.

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Keywords : Martial Arts, attention training, attention, cognitive control, typical adults, alerting, cross-sectional

Citation: Johnstone A and Marí -Beffa P (2018) The Effects of Martial Arts Training on Attentional Networks in Typical Adults. Front. Psychol. 9:80. doi: 10.3389/fpsyg.2018.00080

Received: 31 October 2017; Accepted: 18 January 2018; Published: 08 February 2018.

Reviewed by:

Copyright © 2018 Johnstone and Marí-Beffa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ashleigh Johnstone, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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The Influence of Gender Dynamics on Women’s Experiences in Martial Arts: A Scoping Review

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Published: 01 August 2023
Volume 6 , pages 297–325, ( 2023 )

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Rosie Lindsay ORCID: orcid.org/0000-0002-9176-4828 1 ,
Jo Horne 2 ,
Jill Shaw 3 ,
Nichola Kentzer 4 &
Wendi Bacon 5

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Women are underrepresented in martial arts participation compared to men. The aim of this scoping review was to understand how gender dynamics influence women’s experiences of martial arts, in order to inform future interventions and policies which could increase the participation of women in martial arts. Fifty-three studies were eligible for inclusion and thematic analysis was used to identify they key themes across the literature. The seven themes identified included: martial arts as a tool for improving gender relations, use of martial arts to challenge societal gender norms, women’s empowerment through martial arts training, problematic mixed-gender contact, expectation for women to conform to gender norms, martial arts as men’s space, and patriarchy in martial arts. Overall whilst there was evidence some women had positive experiences of gender dynamics in martial arts, and that women’s experiences are improving over time, the review highlighted that women can be excluded from martial arts as a result of traditional hierarchies, gender norms and problems associated with mixed-gender contact.

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Velija, P., Mierzwinski, M., & Fortune, L. (2013b). It made me feel powerful’: Women’s gendered embodiment and physical empowerment in the martial arts. Leisure Studies, 32(5), 524–541.

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Acknowledgments

We would like to thank the Better Martial arts and Combat Sports research group for their support and suggestions throughout this process.

Rosie Lindsay received financial support from The Open University to write the manuscript.

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Lindsay, R., Horne, J., Shaw, J. et al. The Influence of Gender Dynamics on Women’s Experiences in Martial Arts: A Scoping Review. Int J Sociol Leis 6 , 297–325 (2023). https://doi.org/10.1007/s41978-023-00140-2

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Dear Colleagues,

The martial arts have been practiced for thousands of years and today mixed martial arts remains the fastest growing sport in the world. Yet, despite its current popularity and enduring cultural importance, relatively little scientific and philosophical research exists on martial arts. The purpose of this Special Issue of Philosophies is to contribute to the advancement of research in the philosophy and science of martial arts. I am delighted to invite you to submit your best empirical and theoretical work on martial arts to this Special Issue.

The goal for this Special Issue is to showcase exemplary work on martial arts from multiple disciplinary perspectives. For example, philosophers of mind and ethics may submit work on martial arts and the cultivation of virtues, and experimental philosophers and psychologists may submit work on the influence of martial arts on psychological well-being. Other topics of interest include the use of mental simulation during shadowboxing, flow experience during training or competition, weapons as extensions of the self, qualities of exemplary martial artists, the ethics and aesthetics of martial arts, and in general, what the study of martial arts may reveal about the nature of the human mind and human society. Integrative review articles, focused philosophical arguments, and original empirical research that is philosophically relevant will all be warmly received.

If you would like to extend upon or offer a critical response to my own work on martial arts and the mind, you may find several empirical and theoretical articles available here: https://wp.me/Pb4nZT-1Lm .

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Martial arts of the world: An Encyclopedia of History and innovation

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Acta Periodica Duellatorum

Eric Burkart

The paper is organised around the notion of embodied technique. The recent attempts to formulate scientific methodologies for the reconstruction of medieval fighting techniques based on a study of premodern fight books raise questions about the epistemological status of these (re)constructed techniques developed by modern practitioners of Historical European Martial Arts (HEMA). Approaching the subject from a perspective of cultural history and martial arts studies, the following questions are discussed: What is technique and how is it related to practice? How is technique acquired and transmitted? How can technique be recorded? And finally, how can historical records of technique be understood, interpreted and converted into practice? Following Ben Spatz, technique is defined as the knowledge content of specific practices and the semiotic references between practice, technique, and symbols referring to embodied technique are discussed. By looking at the intersubjective communication of subjective fighting skills and relying on the work of Michael Polanyi, the possibility to record the “tacit knowing” of these skills as explicit knowledge is questioned. Given the low knowledge content of the fight books in regard to the execution of the referenced techniques, modern HEMA techniques therefore are to be addressed as purely modern constructions based on modern fighting practices instead of as reconstructions of medieval technique. The discourses in HEMA are also compared to a similar debate in musicology, where the status and the “authenticity” of attempts to recreate the sound of medieval music based on interpretations of early musical notation systems was vividly discussed until the early 2000s. Fighting techniques are furthermore addressed as elements of complex fighting systems that only exist within a given historical culture of fighting and are transformed when transferred to another societal context.

Sean Wauters

Introduction: Martial arts and combat sports are a wide spectrum of sports and disciplines. The spectrum can be divided in several clusters, by origin and geography, content (Striking arts, grappling arts, armed arts, armored arts and others), by contact (non, limited, full) and goal (recreative, competitive, self-development, self-defense, etc.) Aim: The aim is to investigate the place of Historical European Martial Arts in the broad spectrum of Martial Arts and how it relates to other martial arts. Methods: A scoping narrative review of martial arts and Historical European Martial Arts. Results and Conclusion: Historical European Martial Arts is defined by its own properties and aspects that are defined by its origin, content, impact forms and goals. They are a cluster of martial systems developed in Europe and can be seen as the European counterpart of many comparable eastern martial arts such as a.o. the Japanese Budo and Chinese Wushu/kung fu with sometimes comparable techniques and with a variety of (often comparable) weapons. They can consist of grappling arts, striking arts, armed arts, armored arts and any combination thereof, depending on the discipline. Comparable to Budo, Wushu or other (Eastern) martial arts, some European martial arts also incorporate Kata-like drills, exercises, and plays. There are different contact forms ranging from non-contact with no protective equipment to full contact sparring and tournaments with a full set of protective equipment. Due to its own properties, it also has a specific injury profile. It deserves its proper place in the spectrum of martial arts and more research in the field of injury prevention is required.

Introduction: Medieval and early modern sword and buckler fencing treatises of the "German" tradition or systems are often vague and incomplete. Few treatises are fully dedicated to it. Often they combine many different weapons such as grappling, dagger, onehanded or two-handed sword and pole arms. Methods: Scoping narrative review of medieval and the first period of the early modern age (renaissance) treatises in the "German" style of fencing, mainly Liechtenauer Tradition combining and reviewing different sword and buckler sources. Results: Several fencing treatises and manuscripts deal with the use of the sword and buckler, yet none of them explain the complete system. Fecht1 is the only one that is fully dedicated to the subject (100%). Others like the Liechtenauer treatises (Ms.3227a, Cod44.a.8,

George Jennings , Benjamin Judkins

Xilam is a modern Mexican martial art that is inspired by pre-Hispanic warrior cultures of ancient Mesoamerica, namely the Aztecs (Mexica), Maya and Zapotec cultures. It provides a noteworthy case study of a Latin American fighting system that has been recently invented, but aspires to rescue, rediscover and relive the warrior philosophies that existed before the Spanish Conquest and subsequent movements beginning in 1521. Using the thought-provoking work of anthropologist Guillermo Bonfil Batalla, México Profundo, I aim to analyse the Xilam Martial Arts Association through the way that they represent themselves in their three main media outlets: The official webpage, the Facebook group and the YouTube channel. I argue that their portrayal of the art as a form of Mesoamerican culture and wisdom for current and future generations of Mexicans is contrasted to contemporary Mexico, a Western (Occidental) project that is far removed from the foundations of this diverse country. Overall, the data suggests that certain elements of Mesoamerican civilisation may be transmitted to young Mexicans through a mind-body discipline, which in turn acts as a form of physical (re)education. Overall, xilam is both an invented tradition (in a technical sense) and a reinvented tradition (in a cultural sense) that provides lessons on the timeless issues of transformation, transmission and transcendence. Keywords: Mexico Profundo; Mesoamerica; pre-Hispanic; martial arts cultures; warrior philosophies.

Anthropology and Humanism

Derek Sheridan

In a Tanzanian seaside dojo, Sempai Ali Issa Hassan, a Swahili martial artist, filmmaker, and healer, offers an alternative history claiming the East Asian martial arts originate in the Afro-Islamic world. Starting from his reaction to a visit by a Chinese Shaolin master, we trace the contours of our experience making sense of claims which both challenge and recast assumptions about Afro-Asian cultural exchange.

Abel Figueiredo

Martial Arts Studies

Daniel Jaquet

Journal of the Philosophy of Sport

Irena Martinkova , Jim Parry

George Jennings

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Exploratory Systematic Review of Mixed Martial Arts: An Overview of Performance of Importance Factors with over 20,000 Athletes

João c. a. bueno.

1 Research Group on Metabolism, Nutrition and Strength Training, Department of Physical Education, Jardim Botânico Campus, Federal University of Paraná, Curitiba 80210-132, PR, Brazil; moc.liamtoh@9002rjoticat

2 Sciences Center of Health and Sport, Laboratory of Sport and Exercise Psychology, Physical Education Department, State University of Santa, Catarina 88080-350, FLN, Brazil; moc.liamtoh@aa2d

Heloiana Faro

3 Associate Graduate Program in Physical Education, Federal University of Paraíba, João Pessoa 58059-900, PB, Brazil; moc.liamg@orafanaioleh

Seth Lenetsky

4 Sport Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland 1010, New Zealand; moc.liamg@ykstenel

5 Canadian Sport Institute Pacific, Victoria, BC V9E 2C5, Canada; moc.liamtoh@reingvamanurb

Aleksandro F. Gonçalves

6 Laboratory of Psychophysiology and Performance in Sports & Combats, School of Physical Education and Sport, Federal University of Rio de Janeiro, Rio de Janeiro 21941-599, RDJ, Brazil; moc.liamg@gfordnaskela

Stefane B. C. D. Dias

7 Exercise and Sport Science Laboratory, Keiser University Orlando, Sports Medicine & Fitness Tech/Exercise Science, 5600 Lake Underhill Road Orlando, Florida, FL 32807, USA; ude.ytisrevinuresiek@saids

André L. B. Ribeiro

8 Department of Physiology and Product Development Limber Software, Balsam 15140-000, SP, Brazil; moc.liamg@oriebiritozrebla

Bruno V. C. da Silva

9 Department of Physical Education, University of Itaúna, Highway MG 431-Km 45, Itaúna 35680-142, MG, Brazil; moc.liamg@hbjjbonurb

Carlos A. Cardoso Filho

10 Laboratory of Biomechanics, School of Physical Education and Sport, Campus São Paulo, Universidade de São Paulo, São Paulo 05508-030, SAO, Brazil; [email protected] (C.A.C.F.); rb.psu@oarrescj (J.C.S.); or moc.liamg@onidualcovatsugoaoj (J.G.C.)

11 Research and Development Department, LOAD CONTROL, Contagem 32000-000, MG, Brazil

Bruna M. de Vasconcelos

Júlio c. serrão, alexandro andrade, tácito p. souza-junior, joão g. claudino.

12 Center for Health Sciences, Group of Research, Innovation and Technology Applied to Sport (GSporTech), Department of Physical Education, Federal University of Piauí, Teresina 64000-850, PI, Brazil

Associated Data

This review aimed to analyze the findings in the literature related to Mixed Martial Arts (MMA) through an exploratory systematic review and to present the state of the art from a multifactorial perspective. The review was conducted in accordance with the PRISMA statement, with a search performed in the Scopus, PubMed, and Web of Science databases. Participants were competitive athletes (amateurs or professionals) of regional, national, or international levels. Of the 2763 registries identified, 112 studies met the eligibility criteria. The pooled sample size and age were 20,784 participants, with a mean age of 27.7 ± 6 years for male and 28.9 ± 3 years for female, with the vast majority of athletes being male (94.9%). MMA athletes were 17.2% amateurs, 73.8% professionals, and 9% were not reported. The scientific literature related to MMA reported injuries ( n = 28), weight loss ( n = 21), technical and tactical analysis ( n = 23), physical fitness ( n = 8), physiological responses and training characteristics ( n = 13), psychobiological parameters ( n = 12), and interventions applied to MMA athletes ( n = 7). Therefore, this exploratory systematic review presents practitioners and researchers with seven broad summaries of each facet of performance of importance in this population of athletes.

1. Introduction

Mixed Martial Arts (MMA) is a full contact combat sport characterized by its high degree of freedom in offensive and defensive approaches, resulting in the inclusion of techniques and tactics from multiple combat sport styles [ 1 ]. MMA has gained legitimacy and uniformity of rule sets after a tumultuous and unregulated introduction in North America [ 2 , 3 , 4 ]. Victory in a bout can occur through submission, knockout (rendering an opponent unconscious), technical knockout (rendering an opponent unable to continue fighting), stoppage by the ringside doctor, or a decision by judges. A judges’ decision is based on the quality and effectiveness of the strikes and grappling techniques [ 5 ]. Judges’ decisions can result in the following scores: 10–10 round even between fighters, 10–9 round win by a very small margin by one of the fighters, 10–8 round won by a wide margin by one of the fighters, or 10–7 round won overwhelmingly and dominantly by one of the fighters [ 5 ]. MMA is one of the fastest growing sports in the world [ 6 ]. In 26 years, since its rebranding for Western audiences in 1993, the number of fights per year have increased by more than 100 times. In 1993 there were 72 fights, in 2019 there were 19,877 fights, in 2020 there were only 8884 fights at the expense of the COVID-19 pandemic [ 7 ], and in 2021 there were 13,779 fights [ 7 ]. As this sport has become more regulated and accepted globally, research into MMA has increased, particularly in the last decade [ 7 , 8 ].

Due to the nature of combat sports, early research in the topic had focused on injury risk in the sport [ 9 , 10 ]. As one of the most explored areas in MMA literature, these studies have established many of the epidemiological factors resulting from participation [ 11 , 12 ]. This research has highlighted neurological, musculoskeletal, and endocrine system risks related to preparation for, and competition in, MMA [ 12 , 13 , 14 , 15 , 16 ]. Scientific literature on athletic performance in MMA emerged in the early 2010s, with researchers examining athlete profiling, time–motion analysis, weight-cutting strategies, psychological factors, and intervention studies [ 1 , 14 , 17 , 18 , 19 ]. The most recent published reviews on MMA cover specific approaches such as muscle injuries [ 12 ], magnitude of rapid weight loss and rapid weight gain [ 20 ], physical and training characteristics [ 21 ], quantification of typical training loads and periodization practices [ 22 ], and application of sport psychology [ 19 ]. Furthermore, Spanias et al. [ 23 ], in a brief review, reported that anthropometric and physiological profiles of MMA athletes may not vary among high-level athletes. Based on the Applied Research Model for the Sport Sciences implementation studies (i.e., last stage: studies to determine how effective at improving performance the previously identified interventions are when used in a real-world scenario) were not found in the MMA literature [ 22 ]. Furthermore, we observed that there is a lack of systematic reviews using different databases (e.g., Web of Science, Scopus). As a result of these approaches performed (i.e., brief reviews and narratives), a large difference was found in the number of studies selected, 19 and 70 studies, [ 22 , 23 ] respectively, and additional studies may be found in the scientific literature. To the best of our knowledge, there are still no methodical, comprehensive, transparent, and replicable studies that have summarized the overall perspective of MMA athletes, resulting in an integrated analysis for a better scientific understanding and more efficient practical applications. Therefore, the objective of the present study was to analyze the findings of the scientific literature related to MMA through an exploratory systematic review on the subject and to present the state of the art of the sport from a multifactorial perspective.

2. Materials and Methods

We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 24 ]. The registration was published on the INPLASY website with the registration number: INPLASY202240158 and the DOI number: 10.37766/inplasy2022.4.0158.

2.1. Procedure

The selection process and data extraction methods were completed by three authors (A.F.G., S.L. and J.C.A.B). A fourth author (J.G.C.) supported this team and aided them in the methodological process. The quality appraisal was completed by three other authors (A.F.G., C.A.C.F. and A.B.).

2.2. Search Strategy

Three electronic databases (PubMed, Scopus, and Web of Science) were systematically searched until January 2022. The command line “Mixed Martial Arts” or “Combat Sport” was used during the electronic search.

2.3. Eligibility Criteria

The titles and abstracts were reviewed based on the following inclusion criteria: (1) the study was written in English, (2) the study was published as original research in a peer-reviewed journal as a full text article, (3) data were reported for the MMA athletes, and (4) the participants were competitive athletes (defined as regional, national, and international). After this first screening, the eligibility criteria according to PECO were applied to the remaining full manuscripts. (P)articipants: healthy, MMA athletes of any age, sex and level. (E)xposure: exposure to the MMA training and/or competition. (C)omparators: control groups are acceptable, but not mandatory. (O)utcomes: data reported from the MMA athletes. Based on the title, main objective of the study and according to the main findings of each study, categories were created for analysis. When necessary, the first and last author (JCA and JGC) entered into an agreement to decide if one study could be added in more than one category. For example: study title = “Repeat Effort Performance is Reduced 24 Hours After Acute Dehydration in Mixed Martial Arts Athletes” and study purpose = “This study sought to determine the influence of acute dehydration on physical performance and physiology in mixed martial arts.” Thus, the referred study could be added in the “weight loss” and “physical fitness and performance” categories. However, because of the main findings found (i.e., “Acute dehydration of 4.8% body mass results in reduced physical performance 3 and 24 h after a dehydration protocol”), this study was added just in the “weight loss” category.

2.4. Quality Assessment

The quality of all studies was evaluated by three authors (S.L., C.A.C.F., and A.B.) using evaluation criteria ( Table S1 : Risk of bias assessment criteria) based on the study by Saw et al. [ 25 ], which has been used in previous systematic reviews [ 26 , 27 ]. Scores were allocated based on how well each criterion was met, assuming a maximum possible score of 8 (low risk of bias). Studies with a risk of bias score of 4 or less were considered poor and were excluded. Risk of bias was assessed independently of study appraisal using the GRADE guidelines [ 28 ]. This takes into account randomization, concealment of allocation, blinding of outcomes assessment, incomplete outcome data, selective reporting, and other biases, such as stopping early for benefit or the use of non-validated outcome measures.

3. Results and Discussion

The initial search returned 2763 articles ( Figure 1 ). After the removal of duplicate articles ( n = 1835), a total of 1570 studies were retained for full text screening. Following eligibility assessment, 153 studies were excluded as they did not meet the inclusion criteria. Thus, 112 studies were included in this systematic review.

An external file that holds a picture, illustration, etc.
Object name is sports-10-00080-g001.jpg

Study selection PRISMA flow diagram.

3.1. Characteristics of the Studies and Risk of Bias

The grouped sample size was 20,784 participants, with mean age of 27.7 ± 6 years for male athletes and 28.9 ± 3 years for female athletes, with the vast majority being male athletes (94.9%). MMA athletes were amateurs (17.2%), professionals (73.8%), and undefined (9%). All studies included had a low risk of bias, with scores > 4. The scientific literature related to MMA reported studies on the topics of injuries (25%), weight loss (18.8%), technical and tactical analysis (20.5%), physical fitness (7%), physiological responses and training characteristics (11.6%), psychobiological parameters (10.7%), and interventions applied to MMA athletes (6.3%). The mean bias score of the studies was 7 ± 1 (see Table S2 : risk of bias score).

3.2. Main Findings

The 112 studies included in the systematic review are described in detail in Tables S3 and S4 .

3.2.1. Injuries

As MMA includes grappling, striking and throwing techniques, in addition to those that aim to damage joints resulting in bruises, sprains, and even fractures [ 10 ]. Due to these inherent characteristics of MMA, studies exploring injuries in the sport have received substantial attention in the scientific literature. In this present study, investigations of injury comprise 25% of all manuscripts. Injuries were reported with different methodologies, such as athlete exposure (AE) [ 13 , 29 , 30 ], time exposure [ 29 ], combat time exposure [ 30 ], fight participation [ 30 , 31 , 32 , 33 ], and competitor rounds [ 31 , 33 ]. The overall injury prevalence in MMA fighters was 8.5% of fight participations or 5.6% per rounds fought [ 33 ], values that are lower than those reported in Olympic combat sports during training (58%) compared to with the competition (42%) [ 34 ], still on MMA, 4.1 injuries (95% CI = 3.48 to 4.70) per 100 min of exposure [ 29 ], 64.9 injuries per 1000 combat minutes [ 30 ], 23.6 to 28.6 injures per fight participations [ 30 , 31 ], 12.5 injuries per 100 competitor rounds [ 31 ], and 23.6 (95% CI 20.5 to 27.0) [ 29 ] to 51 injuries per 100 AE [ 13 ].

There are some inconsistences about the relationship of athlete’s characteristics (i.e., age and weight) and the risk of injuries [ 30 , 31 ]. Some authors suggest that older athletes were associated with a higher risk of injury [ 30 ]. However, others showed that age did not statistically increase the likelihood of injuries [ 31 ]. When analyzed by weight class, some authors suggested that heavier athletes had the highest injury incidence (75 injuries per 100 AE) [ 13 ], while the strawweight athletes had the lowest injury incidence (39 injuries per 100 AE) [ 13 ]. Alternatively, others showed that athletes’ weight did not statistically increase the likelihood of injuries [ 30 ]. There are inconsistent data about injury incidence and injury rates across genders also. Some studies suggested that the incidence of injuries is higher in men than woman [ 4 , 30 ], with an average of 3.9 injuries per subject in male fighters and 2.3 injuries per subject in female fighters [ 4 ], and 54 injuries per 100 athlete exposures in males and 30 injuries per 100 athlete exposure in females [ 13 ], while others suggested that there are similar injury rates between men and women [ 33 ]. Figure 2 presents the main findings regarding injuries in MMA athletes.

An external file that holds a picture, illustration, etc.
Object name is sports-10-00080-g002.jpg

Main findings regarding injuries in MMA athletes.

The relationship between competitive level and fight experience has also been investigated in several studies, but inconsistent results were found again [ 4 , 30 , 33 ]. It is suggested that professional fighters suffer more injuries than amateur fighters [ 4 , 33 ], resulting in three times higher injury rates [ 4 ]. Moreover, it has been shown that lower ranked fighters had more than two times higher injury rates than those higher ranked [ 4 ]. However, others showed that fight experience did not statistically influence the likelihood of injuries [ 4 ]. Most MMA injuries were sustained during competition [ 35 , 36 ]. Regarding fight results, a losing fighter is 2.53 times more likely to be injured than a winning fighter (OR = 2.53, 95% CI 1.88 to 3.42, p < 0.01) [ 30 , 31 ].

In summary, injury incidence and injury rates in MMA seem to vary according to the evaluation method. Five differing methods of measuring MMA related injuries were found in the literature. This inconsistency makes it difficult to identify the exact number of injuries among MMA fighters, as well as to compare injury data across different studies or different sports modalities. Therefore, future studies should consider adopting a standard method to assess and report MMA related injuries.

The most common injury locations reported for MMA athletes were the head, face, and neck, followed by upper extremities, trunk, lower extremities, and all other body locations [ 4 , 13 , 29 , 36 , 37 ]. It has been shown that some differences on injury location between men and women exist, with upper limb injuries being more frequent in females [ 13 ] and lower limbs injuries being more frequently in males [ 13 ].

The higher frequency of head, neck, and face injuries reported seems plausible, and it is likely because attacking the head increases the chance to win by knockout or technical knockout (KO/TKO) [ 38 ]. Researchers found that the rate of fights finished by KO was 6.4 per 100 athletes-exposures, by TKO was 9.5 per 100 athletes-exposures, and combined incidence of match-ending head trauma of 15.9 per 100 athletes-exposures, which represents a higher rate when compared to other combat sports [ 39 ]. It is well established that head impacts can results in concussion and similar symptoms [ 29 , 38 , 40 ], especially when MMA athletes are finished via KO/TKO [ 29 , 38 ], with a higher risk of head trauma in heavier fighters [ 38 , 41 , 42 ]. The chance of a fight stopping by KO/TKO is 80%, 100%, and 206% higher in middleweight, light heavyweight, and heavyweight, respectively, when compared to the lightweight class [ 38 ].

Regarding injury type, injuries that occur near to the head, such as facial laceration [ 30 , 31 , 43 , 44 ], which is one of the most common reported reason of doctor stoppage in MMA (~90% of cases), and concussions [ 29 , 37 , 38 , 45 ], were the most common reported. Other types of injuries such as abrasion, contusion, fractures, strains, and sprains were also observed between MMA athletes [ 4 , 31 , 35 , 36 ]. Head traumas are a major concern due to the negative effects that this injury leads to, such as headaches, loss of balance, visual impairments, emotional disturbance, and neurocognitive deficits [ 38 , 39 , 46 , 47 , 48 ]. At professional events, such as the UFC, a head injury rate of 35 injuries per 100AE is reported [ 43 ]. This value is higher than that proposed by the systematic review of injuries by Thomas and Thomas [ 12 ]. A possible explanation for this divergence would be the inclusion of other promotions that demonstrate lower values in injury rates [ 43 ]. In addition, male athletes have higher rates of head trauma than women, making it the most observed injury with traumatic brain injury TCE [ 43 ].

Among MMA fighters, a common practice is to rest for two days after a head injury before returning to the sport or competitive practice. It is suggested to avoid physical exertion until athletes become asymptomatic, as early return can potentially worsen head injuries and increase the chance of developing neuronal diseases such as Alzheimer’s disease and chronic traumatic encephalopathy [ 40 ]. However, current data show that after a serious injury, which prevents an athlete from returning to combat, only 94% of fighters tend to return to sport after injury [ 49 ]. Additionally, a decrease in performance was observed after injury associated with age. Athletes > 35 years who had suffered injuries are more likely to not return to sport [ 49 ].

Regarding brain injuries, a longitudinal study demonstrated temporal trends in structure and cognition—positive and neuropsychiatric outcomes that diverged when investigated by weight category and type of combat sport [ 48 ]. This evidence suggests that, although weight category has not been preliminarily identified as a determinant of early brain health among professional athletes, it modifies the course of neurodegenerative transformations over time, as the similar neurological effects of repetitive impacts on the head (RHIs) are concentrated [ 48 ]. Currently, few studies have investigated the effects of head accelerations and its outcomes. Lota et al. [ 50 ] reported that rotational acceleration (RA) is greater after direct attacks to the head. Consequently, a possible increase in rotational acceleration (RA) is a strong predictor for traumatic brain injury (TBI) [ 50 ]. Tiernan et al. [ 51 ] reported 541 impacts confirmed over 30 events and found that striking the opponent on the side of the head was associated with concussive injuries [ 45 ]. Seeking to improve the prevention of neural damage, whether pre- or post-fight, Matuk et al. [ 52 ] explored the feasibility of analysing extracellular vesicles as an analysis tool, finding that the method was able to differentiate more severe injury mechanisms and methods (knockout or technical knockout by punches or kicks) through gene expression [ 52 ]. Furthermore, evidence has been found that analysing salivary and serum microRNAs (miRNAs) have been promising in predicting mTBI after head impact in MMA bouts [ 53 ]. Finally, other common type of injuries in MMA is ophthalmic injuries caused by lacerations of structures around the eye, commonly resulting in fight-loss by those that receive such injuries [ 44 ]. As such, it is recommended that boxing gloves should be used during training, as these reduce the intensities of the impact on the head, minimizing injuries in the facial or eye areas [ 46 ].

3.2.2. Weight Loss

Rapid weight loss (RWL) is a common strategy used by MMA athletes to reduce their body mass (BM), aiming to reach the limit of weight division. The process of RWL usually starts one/two weeks before competition, and the athletes lose 2–10% of their BM [ 54 , 55 ]. The prevalence of RWL among MMA athletes is between 88% [ 56 ] and 95% [ 57 ], with greater predominance among professional athletes compared to amateurs [ 58 ]. In contrast to grappling modalities, such as judo, Malliaropoulos et al. [ 59 ] reported in their study with British judo athletes a prevalence of RWL of 84%. Moreover, the RWL incidence in MMA is higher than other combat sports [ 55 , 57 ]. Barley et al. [ 54 ] reported a reduction of 9.8 ± 7.9 kg of BM, while Santos-Junior et al. [ 60 ] reported a reduction of ~10%. Many methods were self-reported by the athletes to induce RWL. For instance, Andreato et al. [ 56 ] found the use of diuretics, saunas, and exercise in hot rooms as main methods used to cut weight, while Santos-Junior et al. [ 60 ] reported the use of a combination of gradual diet (64.2%), restricting fluid intake (62.6%), and sweat suits (55.9%). Moreover, athletes reported the use of more aggressive methods such as diuretics (~49%) and laxatives (~32%) [ 60 ]. Recently, Connor and Egan [ 55 ] also reported using water loading and hot clothing alternative baths as a common method to perform RWL by amateur and professional Irish athletes. The frequencies of “always” or “sometimes” in surveys were reported as 90% for water loading and 76% for hot salt baths [ 61 ]. Interestingly, Connor et al. [ 55 ] compare the use of hot baths with and without salt, but no differences in the magnitude of weight lost as found. Subsequently, Connor and Egan reported no differences between a hot freshwater bath (FWB) and a hot bath with ~1.6% Epsom salt added (SWB) for body mass loss. The authors state that hot baths lasting 2 h are an effective method of losing ~2.0% RWL body mass [ 62 ]. Some authors also investigated the source of information to induce RWL. The athletes cited magazines, social networks, coaches, training partners, friends, and physical trainers as sources, although some mentioned a nutritionist service [ 16 , 60 , 61 ].

The inducement of hypohydration is the primary reported method to provoke RWL and has significant adverse effects, as it can cause psychology [ 63 , 64 ], physical, or health decline [ 65 ]. The reduction in bodily fluids resulting from exercising in hot environments, using plastic clothing, laxatives, and diuretics, might generate electrolyte imbalances, especially calcium, which might lead to less bone mineralization and cause stress fractures [ 66 ]. Additionally, the use of diuretics produces hypokalemia, which is the reduction in body potassium in the blood, altering the activity of the sodium–potassium pump, which can lead to death [ 66 ]. Physiological disturbances on hydration status, hormonal balance, and markers of muscle damage were also reported [ 14 , 65 , 67 ]. In addition, a decrease on performance [ 14 , 18 , 54 , 57 ], emotional and mood disturbances [ 64 ], and cognitive impairment [ 68 ]. The literature has reported reductions in muscle strength levels, aerobic fitness, reduced plasma and blood volume, decreased myocardial efficiency and maximal oxygen consumption, reductions in blood fluid, renal function and the volume of fluid filtered by the kidneys, reductions in glycogen stores, impairment of thermoregulatory processes, and electrolyte balance [ 16 , 54 , 57 , 66 , 67 , 69 , 70 ]. Additionally, RWL is reported to cause physiological damage to mental function by generating deficits in concentration, memory, cognitive processing speed, and an increased risk of developing eating disorders [ 66 , 71 , 72 ].

The negative influence on physiological, physical performance, or psychological markers due to RWL remains, even after 24 h of recovery [ 73 ]. These problems might occur regardless of the time interval between weigh-in and the fight itself, as physiological parameters such as hydration status, salivary nitrate, and energy availability may not be restored enough [ 3 , 65 , 68 , 74 ]. Possibly, this behaviour is encouraged by the time between the official weigh-in and the fight (i.e., 12 to 32 h), which allows for weight recovery so that an athlete fights one to two categories above the official weigh-in [ 3 , 74 ].

There is no consensus on the effect of BM recovery on the fight outcome [ 35 ]. The act of weight regain (WR) after weigh-in is reported as a common act among wrestlers of both genders with no differences ( p < 0.005) between relative values of BM gains between genders [ 75 ]. Kirk et al. [ 76 ] showed that the magnitude of the WR does not predict victory or defeat in a professional cohort of MMA athletes. Alternatively, Coswig et al. [ 63 ] found that the magnitude of WG was greater in winners than losers, which was more important than the magnitude of RWL. It is important to highlight that the winners showed higher total caloric intake and absolute intake (g) of carbohydrates, proteins, and lipids during the WG than losers, which might partially explain the result. Faro et al. [ 77 ] demonstrated that regardless of gender, fighting category, or competitive level, the percentage of WG can be used as a predictor of competitive success in the fight; every 1% of additional WG increases the probability of competitive victory by 4.5%. Figure 3 presents the main findings regarding weight loss in MMA athletes.

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Main findings regarding weight loss in MMA Athletes.

3.2.3. Technical and Tactical Analysis

MMA bouts are characterized by a variety of actions (e.g., grappling, striking, clinching, etc.) that give the sport an intermittent activity characteristic, with reported effort-pause ratio between 1:1 and 1:4 [ 78 , 79 ]. The MMA rule set also influences the characteristic of technical–tactical behaviour, as the athletes choose their combat strategies based on what types of attacks are allowed [ 80 ]. Hence, changes in the rules might lead to differences in technical–tactical actions, such as strikes landed and injures [ 80 ]. Moreover, age seems to be an essential influent component on technical–tactical actions in MMA. Dos Santos et al. [ 80 ] demonstrated a reduction in technical quality after ten years of competitive performance ( n = 45 professional athletes; age: 34–54 years). These results suggest that technical aspects are susceptible to age.

Technical–tactical and time research was conducted in this review using retrospective data from UFC fights. The most common characteristics observed were the frequency of spatiotemporal work (keeping distance, clinch, groundwork, etc.), motor actions (strikes attempted and landed, submissions, chocks, locks attempted, etc.), technical–tactical actions (preparatory actions and fighting in both standing and groundwork), and effort-pause (i.e., high and low intensities in both standing and groundwork), following a previously established protocol [ 78 , 81 , 82 , 83 , 84 , 85 , 86 ]. Miarka and colleagues analysed these data through comparison between weight divisions [ 78 , 86 ], sexes [ 87 ], fight outcomes [ 82 , 87 ], type of fight outcome [ 87 , 88 ], actions during the rounds [ 84 ], and home advantage [ 85 ], using technical–tactical, time–motion, and/or motor action analysis as an outcome. The aim and main findings of these studies are summarized in Tables S3 and S4 . Furthermore, Antoniêtto et al. [ 89 ] compared the pacing strategy and technical–tactical actions during individual rounds (first, second, and/or third rounds). The analysis identified a shorter duration of “standing preparatory activity”, groundwork, and fewer attempted and landed strikes to all parts of the body in the first round of fights which also ended in the first round. Moreover, a similar pattern was found in the second round of fights that ended in the second or third rounds [ 89 ]. Additionally, reduced groundwork was found in the third round of fights that ended in the third round. The authors argue that this information might help the coaches strategize pacing strategies in training and consequently improve performance. Likewise, these pacing strategies could be used to distribute offensive and defensive efforts to efficiently distribute the athlete’s exertion, in respect to their individual strengths and weaknesses [ 88 , 89 ]. Finally, Miarka et al. [ 90 ] calculated how spatiotemporal and technical–tactical actions increased a fighter’s probability of winning. The authors found that “keeping distance”, “head strike landed”, “offensive passes”, and “effective takedowns” were the most significant actions related to the probability of victory [ 76 ]. More recently, an investigation based on more than 900 successful submissions by UFC athletes found that 15.5% of the fights ended up by strangulation, with the rear naked choke used in 49.1% of those fight finishes, and that 76.2 % of total submissions were used by grappling-style fighters [ 91 , 92 ].

The aforementioned characteristics are important for the training process, providing insight into opponent’s potential actions, identifying winners’ frequent actions, sex differences, and weight category characteristics [ 84 , 87 , 88 , 89 ]. For example, females who won their fights by KO/TKO/Submission presented a high number of attacking and grappling actions, while those who won by decision had a high number of standing strike actions [ 82 ]. These differences were observed at a rate of ~0.5 strike attempts per second of fight in the first round and ~1.0 strike attempts per second of fight in the second and third rounds [ 93 ]. Alternatively, male winners maintained a high frequency of actions and increased the number of strikes to the head and body throughout all rounds, with a high frequency of takedowns in fights that end in a judge’s decision [ 86 , 88 , 89 , 94 ] ( Table 1 ).

Compare technical–tactical, time–motion, motor action, and spatiotemporal characteristics among weight divisions, sex, and fight outcomes.

Study	Objective	Main Findings
Miarka et al. [ ]	Comparison of time–motion between male weight divisions and rounds in 2097 bouts of UFC events.	Heavyweight athletes presented a shorter high effort time in the first and third rounds. Fly- and lightweight divisions also spent more time in low-intensity in the first round. In the second round, bantamweight spent a shorter time performing lower-intensity actions than fly- and lightweight division. Featherweight spent more time performing high-intensity groundwork than fly-, light-, and middleweight divisions. In the third round, bantamweight spent more time executing groundwork at high intensity than the four other divisions.
Miarka et al. [ ]	Comparison of time–motion and technical–tactical analysis between sexes and weight categories (light- and middleweight) in UFC fights.	Male middleweight athletes spent a longer time in standing activity (striking or standing in preparatory activity) than other sex/divisions and longer time on groundwork than male lightweight. Male lightweight presented longer standing fight activity than the other sex/divisions and spend more time between actions in both standing and on groundwork when compared to female middleweight.
Miarka et al. [ ]	Comparison of time–motion and technical–tactical analysis between rounds and between winners and losers.	Winners presented higher total strikes and takedown attempts in the first round. Furthermore, the winners performed a higher total of head and body strike attempts in the first and second rounds than in the third round. Submission attempts were more frequent in the first round, while advances in the mount and half-guard were more frequent in the second round. Regarding combat phases, in the third quartile of the first round, the time spent in low-intensity activity was higher than in the third round. In the third quartile of the third round, the time spend on low-intensity activity was higher than in the second round.
Brito et al. [ ]	Comparison of the motor actions of winners and losers with consideration of doping status.	Athletes who tested positive for doping had a higher physical performance, such as effort and pause time, however, doping did not reflect better technical performance.
Miarka et al. [ ]	Comparison of-motion and technical–tactical analysis between rounds of female combats in the UFC.	The total strike attempts, head strike attempts while standing, and total leg strike attempts while standing were higher in bouts finished by judges’ decision. Total body strike attempts were more frequent in fights ended by split decision. Total head strike attempts in groundwork position and advances to half guard were higher in bouts finished by KO/TKO than by decision. Passes to side control were higher in fights ended vis submission than decision. Advance to mount was higher in bouts finished by unanimous decision than by KO/TKO. Submission attempts were greater in bouts finished by submission than all others.
Dal Bello et al. [ ]	Comparison of grappling actions to fight outcomes.	Takedown attempts were more frequent in fights finished by judges’ decision than by KO/TKO. Takedown success was more frequent in decision and KO/TKO finished bouts than those finished by submission. Total submission attempts were more frequent in decision and KO/TKO than in bouts won by submission. All type choke attempts were more frequent in bouts finished by decision than those by submission.
Miarka et al. [ ]	Comparison of time–motion and technical–tactical analysis between rounds.	The percentage of low-intensity activity was more prevalent in the fifth round, while the percentage of high-intensity activities was more prevalent in the fourth round. In the first and fourth rounds, strikes attempts were less frequent than in the first and second rounds.
Miarka et al. [ ]	Comparison of home advantage effect on time–motion and technical–tactical analysis	Total strikes landed and attempted and head and body strike attempts were lower when the athletes were in home advantage.

Figure 4 presents the main finding regarding technical and tactical analysis in MMA athletes.

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Main findings regarding technical and tactical analysis in MMA Athletes.

3.2.4. Physical Fitness and Performance

Given the growth of MMA, a greater understanding of the attributes possessed by fighters is needed to inform future research and training. Somatotype and body composition results indicate that MMA athletes have a predominantly mesomorph body type (6.4 ± 0.8) [ 97 ], with variation in body fat percentage ranging from 8.5 to 14.9 ± 7.2 [ 21 ]. Furthermore, the average values of body fat percentage observed were 13.4 ± 5.6. These somatotype and fat percentage values were similar to those found in other combat sports [ 23 ].

Cardiorespiratory endurance, expressed by maximal oxygen uptake (VO 2max ), has been found to range in MMA athletes from 44.2 ± 6.7 to 62.8 ± 4.9 mL/min/kg −1 in testing using the lower body and from 45.8 ± 2.9 to 55.0 mL/min/kg −1 in testing of the upper body, with mean of 45.5 mL/min/kg −1 [ 23 ] ( Figure 5 ). These values were higher than the general population, equivalent to other combat sports, but lower than those seen in traditional endurance athletes [ 23 ]. MMA bouts most commonly have three to five rounds consisting of three or five minutes each, with one minute of rest in between each round [ 98 ]. Under these circumstances, the active energy system is primarily oxidative metabolism [ 82 ]. Therefore, the development of the aerobic system is key for MMA athletes maintain intensity throughout the fight and to accelerate recovery between high intensity actions [ 21 ].

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Main findings regarding physical fitness and performance in MMA Athletes.

While the physiological demands of MMA are primarily derived from the aerobic energy system, anaerobic metabolism still supplies key energetic demands during commonly occurring high intensity efforts [ 98 ]. In the literature, the most commonly used tool to measure anaerobic power and capacity is the Wingate test. Reported absolute and relative values of peak and mean power, as well as fatigue index results in MMA athletes, were similar to athletes of other combat sports [ 99 ].

Neuromuscular testing of MMA athletes has demonstrated intriguing and contradictory results. Marinho et al. [ 97 ] reported poor performance on the horizontal jump and maximum strength tests, while James et al. [ 15 ] reported good performance for 1RM squat and vertical jump. A possible explanation for this discrepancy between the results is the difference in the test used to analyse lower body power (i.e., horizontal. in Marinho et al. [ 97 ] and vertical jumps in James et al. [ 98 ]), and the data collection period (i.e., preparatory period in Marinho et al. [ 97 ] and not described in James et al. [ 98 ]). Despite the contradiction in the literature, lower-body neuromuscular capabilities have been found to distinguish between the high- and low-level MMA competitor, specifically using 1RM squat strength, reactive strength index (RSI), and peak power, force, and velocity in incrementally loaded jump tests [ 15 ]. Likewise, comparisons between semi-professionals and amateur MMA athletes found that sprint performance and repeated sprint ability were higher in semi-professionals than amateurs [ 98 ]. Comparisons of countermovement jump kinetics further identified that differences between amateur and professional athletes could be identified by higher values in power and RSI and lower eccentric time and impulse, suggesting a higher lower-body neuromuscular control in the higher levels in MMA [ 99 , 100 ]. Thus, the performance on neuromuscular tests might help distinguish the level of MMA athletes, an important factor to be considered during strength and conditioning programming. Figure 5 presents the main findings regarding physical fitness and performance in MMA athletes.

3.2.5. Physiological Responses and Training Characteristics

The intermittent nature of MMA fights induces high metabolic demand [ 101 , 102 ], reflected by an increase in blood lactate (LAC) after training (0.00197 mmol·L −1 ) and official matches (0.00272.7 mmol·L −1 ) [ 103 ]. De Souza et al. [ 104 ] report similar values between winners and losers during different time periods: −24 h pre-competition (0.00132 ± 0.00047 and 0.00144 ± 0.00027 mmol·L −1 ), 1 h (0.00202 ± 0.00061 and 0.00222 ± 000042 mmol·L −1 ), 0 h (0.00237 ± 0.00318 and 0.00388 ± 0.0013 mmol·L −1 ), and 24 h after competition (0.00172 ± 0.00068 and 0.00182 ± 000047 mmol·L −1 ).

A significant effect was observed in some phases (−24 h to +24 h) between hormonal and biochemical markers. In the hormonal profiles, the behaviour of testosterone (T), cortisol (C), and the testosterone/cortisol ratio (T/C) were observed with a decrease in the T and T/C ratio regardless of performance (gain/defeat) between moments. Initials were (−24 h to 0h; and −24 h to −1 h and −1 h to 0 h) (see Tables S3 and S4 ) [ 104 ]. At a later time, increases ( p < 0.0001) occurred between 0 h and +24 h for T and T/C (see Table 2 ) [ 104 ].

Mean ± SD of testosterone and cortisol values in MMA fighters at selected moments.

Testosterone (nmol·L )
	(−24 h)	(−1 h)	0 h	+24 h
Winners	20.05 ± 2.13 *	15.90 ± 1.18 *	11.92 ± 1.79 *	17.75 ± 2.00 *
Losers	15.91 ± 2.40 *	10.16 ± 3.52 *	7.14 ± 2.73 *	11.61 ± 1.79 *
Total	17.98 ± 3.06 *	13.03 ± 3.90 *	9.53 ± 3.33 *	14.68 ± 4.02 *
Cortisol (nmol·L )
Winners	580.63 ± 83.18 *	706.00 ± 64.65 *	949.98 ± 59.20 *	522.22 ± 73.69 *
Losers	387.29 ± 147.64 Υ	482.03 ± 180.55 *	802.21 ± 94.43 *	351.69 ± 109.86 Υ
Total	483.96 ± 153.10 *	594.02 ± 144.99 *	876.09 ± 107.84 *	436.96 ± 126.26 *
Testosterone/Cortisol
Winners	34.76 ± 2.38 Υ	22.56 ± 8.52 *	12.49 ± 1.10 *	34.13 ± 1.43 Υ
Losers	40.15 ± 4.88 *	22.85 ± 7.70 *	8.66 ± 2.42 *	10.57 ± 2.69 *
Total	37.45 ± 4.65 *	22.70 ± 5.31 *	10.57 ± 2.69 *	34.30 ± 4.73 *

Table provided with authorship by Souza et al. [ 104 ]: * p < 0.05 compared with other moments; Υ p < 0.05 compared with other moments with the exception of −24 h and +24 h; p < 0.05 between losers and winners.

When checking the variables C, LAC, and GLU, De Souza et al. [ 104 ] report a contradictory performance, with their values increasing significantly ( p < 0.0001) between moments −24 h and 0 h and from −24 h at −1 h and −1 h at 0 h pre-fight, C, LAC, and GLU, showing a significant reduction behaviour ( p < 0.0001) between the moments 0 h and +24 h pre-fight, C, LAC, and GLU, respectively). For the variable CK, significant reductions ( p < 0.0001) are shown for its serum values between moments −24 h and −1 h pre-fight, as well as a significant increase ( p < 0.0001) between moments −1 h and 0 h and 0 h and + 24 h pre-fight (see Table 3 ) [ 104 ].

Mean ± SD of glucose, lactate and creatine kinase values in MMA fighters at selected moments.

Glucose (mg/dl)
	(−24 h)	(−1 h)	0 h	+24 h
Winners	4.48 ± 0.35 *	5.43 ± 0.83 *	11.73 ± 2.30 *	4.03 ± 0.21 *
Losers	3.80 ± 0.44 Υ	4.20 ± 0.49 *	8.27 ± 1.33 *¶	3.62 ± 0.18 *
Total	4.14 ± 0.52 *	4.81 ± 0.92 *	10.00 ± 2.55 *	3.82 ± 0.28 *
Lactate (nmol·L )
Winners	1.32 ± 0.47 *	2.02 ± 0.61 Υ	2.37 ± 3.18 *	1.72 ± 0.68 Υ
Losers	1.44 ± 0.27 *	2.22 ± 0.42 *	3.88 ± 1.30 *	1.82 ± 0.47 *
Total	1.38 ± 0.38 *	2.12 ± 0.52 *	13.13 ± 2.51 *	1.77 ± 0.52 *
Creatine Kinase (U/L)
Winners	510.17 ± 288.12 Φ	418.31 ± 277.67 +	491.40 ± 278.08 +	1304.73 ± 904.13 *
Losers	553.13 ± 128.31 ?	449.46 ± 144.27 *	492.21 ± 155.19 +	1520.48 ± 609.66 *
Total	531.15 ± 218.19 *	433.89 ± 215.95 *	491.81 ± 219.17 +	1412.69 ± 758.63 *

Table provided with authorship by Souza et al. [ 104 ]: * p < 0.05 compared with other moments; Υ p < 0.05 compared with other moments with the exception of −1 h and +24 h; Φ p < 0.05 compared with other moments with the exception of −1 h and 0 h; + p < 0.05 compared with other moments with the exception of −24 h; ? p < 0.05 compared with other moments with the exception of 0 h; p < 0001 between losers and winners. ¶ p < 0.05 between Losers and Winner.

Increased muscle damage markers (e.g., creatine kinase (CK: U/L)) reports median and interquartile range (IQR) of athletes not employing rapid weight loss procedures NWL and athletes employing rapid weight loss procedures (RWL) during Pre-match and Post-match. NWL, CK pre-match with median 230 IQR (136–345.1), post-match with median 252 IQR (146.1–407.1) and RWL, CK pre-match with median 259 IQR (165.5–2130) and median 306 IQR (200–2077.5) [ 65 ]. Coswig et al. [ 102 ] report on a comparison of a sample of fighters during simulated sparring matches versus real combat, in which they suggest that there are no differences between groups in blood lactate values Official: Pre-competition = 4 (3.4–4.4) mmol/L, Post-competition = 16.9 (13.8–23.5) mmol/L; Simulated: Pre-competition = 3.8 (2.8–5.5) mmol/L, Post-competition = 16.8 (12.3–19.2) mmol/L; p < 0.001). From a practical point of view, these data suggest that sparring training, when performed at high intensity, produces the same effects as real combat, as it generates similar damage to biochemical markers of muscle damage. Conversely, data from Ghoul et al. [ 105 ] report CK values (U/L) in simulated competition after Trest (Trest): 432 ± 606, round 1 (Trd1), round 2 (Trd2) and round 3 (Trd3) 505 ± 668, then 30 min (Trecovery30min) 468 ± 566 and 24 h (Trecovery24h) 598 ± 451, post simulated competition. Wiechmann et al. [ 106 ] demonstrated that during official fights there is damage ( p < 0.001) in the musculoskeletal system due to the exchange of blows to the lower and upper limbs of the body. Likewise, eccentric actions during the act of deceleration during kicks are associated with muscle damage markers [ 106 ]. The enzyme creatine kinase (CK) and the concentration of myoglobin (Mb) showed peak values at 24 h (829 ± 753 U/L −1 ), and Mb reached its peak at 2 h (210 ± 122 µg/L −1 ) after fights [ 106 ]. According to the authors, it is suggested that only 20% of the CK peak cannot be explained by the number of hits obtained in the upper and lower body (LBH) and by the number of punches and vertical kicks performed (UKF), while only 13% of the Mb variation cannot be explained by TFD and LBH [ 106 ].

Regarding the lactate values, Amtmann et al. [ 103 ] reported, in a sample of six athletes, values during training periods ranging from 8.1 to 19.7 mmol·L −1 and values after combat ranging from 10.2 to 20.7 mmol·L −1 (values measured 2 min after training phase or after combat). Corroborating the data, Kirk et al. [ 107 ] reported a mean post-combat lactate of 9.25 ± 2.96 mmol·L −1 . Furthermore, the authors additionally reported values of media lactate (mmol·L), maximum and minimum values (mmol·L) at different times: (1) At rest (2.7 ± 1.46) max 4.90 min 1.20; (2) After warm up (5.43 ± 2.74) max 8.90 min 2.2; (3) End of Round 1 (6.6 ± 1.99) max 9.20 min 3.60; (4) End of Round 2 (8.67 ± 2.86])max 11.60 min 5.40; (5) End of Round 3 (9.25 ± 2.96) max 13.10 min 5; (6) 5 min post out (7 ± 2.09) max 10.60 min 5.20. Subsequently, Coswig et al. [ 65 ] and [ 102 ] report that there are no differences between the values between simulated fights versus real combat regardless of whether there is rapid weight loss (RWL) or not (non-RWL) among professional athletes. Lactate (mmol/L) (median (interquartile range); pre to post-fight), Official (pre and post-fight) = 4 (3.4–4.4) to 16.9 (13.8–23.5) mmol/L and simulated (pre and post-fight) fight)= 3.8 (2.8–5.5) to 16.8 (12.3–19.2) mmol/L (2015) and lactate (mmol /L) (median (interquartile range); pre to post-fight), NWL= 4.0 (3.3–4.3) to 16.9 (12.7–24.1) (mmol/L) and RWL= 2.2 (1.7–2.4) to 15.9 (12.1–20) (mmol/L) [ 65 ].

These physiological results appear to occur regardless of the outcome of the fight [ 104 ] and may persist 24 h after a bout [ 104 , 105 ]. However, muscle damage seems to be related to the total duration of the fight and the number of blows received, especially in the lower body [ 106 ]. Regarding the inflammatory responses, professional MMA fighters present markers immediately after the fight, with results in the literature finding mild levels of oxidative stress, possibly mediated by IL-6 and by the defensive responses of thiol-tripeptide glutathione (GSH)-dependent antioxidant agents in blood plasma [ 108 ].

Similar to the metabolic responses, MMA participation causes intense perceptual demands, with values of 19 AU in a 6–20 Borg scale, after both training and official matches [ 103 ]. In addition, before official matches, glycolytic availability was raised, which may be associated with an effect of psychological stress [ 102 ].

Several studies have focused on describing the training characteristics of MMA athletes. Amtmann et al. [ 9 ] found that regional athletes performed specific training 3–12 times per week, with almost all athletes supplementing their routine with strength training 1–7 days per week, and some of them self-reporting the use of anabolic-androgenic steroids. According to Fares et al. [ 109 ], the use of band ergogenic aid by MMA athletes in the UFC is common. According to Fares et al. [ 109 ], doping is present among UFC MMA athletes with an average age of 32 years, in which the weight category was the most prevalent with the highest rate of fighters and anti-doping rule violations (ADRVs): 19.3 per 1000 tests. Between late 2015 and late 2019, n = ~1070 UFC athletes were tested 2624 times reporting 102 ADRVs and, of these, n = 93 fighters (8.7%) belonged to all weight categories [ 109 ]. This yields a corresponding rate of 16.55 per 1000 tests and an ADRVs rate of 8.08 per 1000 tests [ 109 ]. Kirk et al. [ 107 ], in an innovative and promising study exploring external loading during sparring training through the use of a tri-axial accelerometer, found the average accumulated load of the fighters (PLdACC was of 224.32 ± 26.59 au) and average accumulated load per minute (PLdACC.min-1 was 14.91 ± 1.78 au). These values were reported as greater than other sports, such as netball and soccer. In addition, the researchers reported a post-session lactate mean of 9.25 ± 2.96 mmol·L −1 [ 107 ]. Furthermore, the same study reported a work/rest ratio (W:R) of 1:1.01. Figure 6 presents the main findings regarding physiological responses and training characteristics in MMA matches.

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Main findings regarding physiological responses and training characteristics in MMA athletes.

3.2.6. Psychobiological Parameters

For competitive success to occur in a fight, fighters must present high levels of physical conditioning such as strength, power, agility, and flexibility [ 21 , 110 , 111 ] and present good sport related mental health. Andrade et al. [ 19 ] identified the fundamental role of mental skills throughout a fight, as it is associated with winning athletes (low anxiety, increased confidence, greater ability to control emotions). Sport psychology in the MMA context is of paramount importance in helping to understand feelings and confrontations, whether in life or in moments during combat [ 19 ]. Professional athletes show positive changes in managing emotions and performance while also demonstrating higher scores in mental strength when compared to amateurs [ 19 ].

Many psychological characteristics of fighters have been investigated and taken into account during the training process [ 112 ]. For example, the assessment of mental resistance in amateurs, semi-professionals, and professionals male MMA athletes (27.1 ± 4.8 years) showed that professional athletes demonstrate a better profile of “confidence”, “cognition positive”, “determination”, and greater “mental toughness”, up to 10% higher than amateur and semi-professional athletes [ 112 ]. The Positive Cognition (PPI-A) test demonstrated that professional athletes have on average 9.8% higher Mental Toughness scores than semi-professional competitors and 9.3% higher than amateur athletes. For Confidence (SMTQ), professional athletes have on average 9.1% and 7.1% higher scores than amateurs and semi-professionals athletes, respectively [ 112 ]. Qualitative investigation found that the self-regulation of internal and external factors is one of the psychological keys during the training process [ 113 ]. Factors as motivation, ongoing evaluation, maintenance of routine, self-induction of pain, self-efficacy, and production of stress/fatigue were listed as present in the MMA athlete routine [ 113 ]. This evidence suggests that MMA athletes need to pay more attention during the initial phases (amateur and semi-professional) to the psychological characteristics necessary for this combat sport modality [ 19 , 112 ]. Moreover, coping strategies have been very useful in sport dynamics due to the necessity to deal with many challenges during an athletic routine.

The MMA fighter who wants to achieve competitive success will have to undergo high training loads and adapt to them physically, physiologically, and psychologically. Knowing the difficulty and stress in the athletic training process and being able to identify talent and resiliency before its maturation process could help coaches in the choice. Thus, Niewczas et al. [ 114 ] reported that there is an interaction between DRD2 rs1799732 dopamine polymorphism and athletic level in the face of knowledge of loss containment and cooperation. According to the authors, a proper understanding of these associations could suggest which athletes would be more suited to combat sports and to facing the imminent risks in the profession [ 114 ].

Aggressiveness is also an object of study in MMA athletes’ psycho-social behaviour. According to Little et al. [ 115 ], facial cues predicted winners and losers in MMA fights. Independent groups of participants judged fighter’s faces to identify who would win in a physical fight. Observers, unfamiliar with the outcome, were presented with image pairs and asked to choose which of the two males was more likely to win if they fought, while other observers chose between the faces based on masculinity, strength, perceived aggressiveness, and attractiveness [ 115 ]. The authors found that individuals performed at rates above chance in correctly selecting the winner as more likely to win the fight than the loser. Moreover, the winners were seen to be more masculine, more aggressive, and stronger than losers. However, the effect sizes for each of these relationships were generally small, which lead to being cautious in the practical applications based on these findings [ 115 ]. Otherwise, the presence of a beard, despite being socially judged as a symbol of aggressiveness, masculinity, facial protection, and sexual loftiness, was not related to the fight outcome, being used for intimidation more than face protection [ 116 ]. Moreover, the stance predominance (i.e., southpaw, orthodox) and past experience also do not influence fight outcome, but the wingspan did [ 116 ]. Lastly, another behavioural action that might appear to be more aggressive and useful during combat is grunting. Indeed, Sinnett and Kingstone [ 117 ] found that the grunting increases the force during a kick and could distract the opponent, leading to error and slow response time. Moreover, lower voice tones are associated with successful mating and the reproductive act [ 117 ]. As such, a group of researchers used voice samples of 475 MMA fighters in order to predict competitive success. After investigating the relationship between tone of voice and competitive success, the hypothesis was not confirmed, as only 3–8% of the variance can be explained using these variables [ 118 ]. Corroborating the data, Schild et al. [ 119 ], in their sample of 135 MMA fighters, reported no associations with tone of voice and competitive success.

Psychological characteristics for developing excellence in MMA athletes were reported by Ruiz-Barquín et al. [ 120 ]. Amateur, semi-professional, and professional MMA athletes answered a 14-item questionnaire related to the characteristics of the development of excellence. Their responses were analysed and compared to other sports. MMA fighters obtained high scores in several factors, such as: “support for long-term success”, “imagery use during practice and competition”, and “support from others to compete to my potential” [ 120 ]. However, the factor “coping with performance and developmental pressures” was worse than other sports [ 120 ]. It is possible to conclude that MMA fighters have a better perception of positive factors related to excellence but may need specific psychological training related to stress coping strategies [ 120 ].

It has been established that the consumption of ergogenic aids (including banned substances) are commonly used in MMA to improve performance [ 109 ]. This use likely stems from their training environment and the professionals who make up the technical committee “reference group” (GR), that is coaches, teammates/training partners, and doctors [ 121 ]. According to Petrou et al. [ 121 ], this permissible environment and positive perceptions related to doping with banned substances stems from the GR, which makes the athlete feel more confident in their indiscriminate use of performance enhancing substances. Thus, it is relevant that MMA teams to staff a psychologist on their team to adequately analyse injunctive social norms that are misinterpreted or misrepresented, as these are strongly associated with permissive relationships to doping.

Beyond psychological investigations, investigations of physiological/biological aspects influence on perceptual/cognitive/behavioural responses have been investigated in the MMA related literature. Cherepkova et al. [ 122 ] compared genetic characteristics (i.e., variable number tandem repeat polymorphism of the dopamine 4 receptor and dopamine transporter) among males with antisocial behaviours (i.e., criminal males), MMA athletes with no history of antisocial behaviour, and the general population. The researchers reported a higher frequency of the D allele among convicts and MMA fighters than among the general population [ 122 ]. The tendency of MMA fighters to present violent behaviours is common within the sport, and this behaviour is seen as an attitude related to violence [ 122 ].

Pavelka et al. [ 99 ] investigated whether neuromuscular fatigue can impair cognitive performance. The authors found that upper-body neuromuscular fatigue decreased reaction time by 1.5% and consistency of response by 15%, concluding that the accumulated fatigue affects cognitive performance [ 99 ]. Finally, the quality and quantity of sleep is also an interesting variable of analysis on MMA athletes’ performance. An observational study carried out for six weeks in competitive practice aimed to verify the relationship between sleep and physical performance. The study demonstrated a negative relationship with significant findings between sleep latency (i.e., time to fall asleep after going to bed) and aerobic capacity (i.e., VO 2max ), heart rate recovery, vertical jump, and missed practice sessions [ 123 ]. Moreover, sleep latency was also significantly negatively related to heart rate recovery and missed practice sessions [ 123 ]. MMA athletes who exhibited consistency in sleep demonstrated stronger relationships with performance tests during the fight prep period [ 123 ]. Sleep duration and latency are among the most used sleep quality parameters by individual sports athletes [ 124 ]. Despite the findings, only eight athletes were included in the study and only a very limited period of time was investigated. Figure 7 presents the main finding regarding the psychobiological parameters of MMA athletes.

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Main findings regarding psychobiological parameters in MMA Athletes.

3.2.7. Intervention Studies

The strength and conditioning training programs for the Specific Training group can improve the physical fitness, balance, endurance, and flexibility in professional MMA athletes [ 125 , 126 , 127 ]. Kostikiadis et al. [ 127 ] compared a 4-week intervention of strength training and specific conditioning for short-term, high-intensity, low-volume MMA composed of two sessions, with session (1) (Strength training + Power exercises) and (2) Power exercises + SIT speed exercises) in the performance of national level MMA athletes. The authors reported improvement in performance in aerobic capacity (estimated VO 2max ), average power during 2000 m rowing (−3.4 ± 2.9), power (in SJ (3.0 ± 1.3 cm; 6.1 ± 5.3 W), CMJ height (7.4 ± 4.4 cm; 3.59 ± 7 W), medicine ball throw velocity MBT (right arms: 10.8 ± 4.4 m*s −1 ; left arms: 5.7 ± 7.5 m*s −1 ), 10 m sprint (−3.7 ± 1.4 s) and 2 m take down speed (−22.0 ±4.9 s). Back squat (19.5 ± 10.4 kg), 1RM (bench press (16.1 ± 7.8 kg), deadlift (20.1 ± 10.7 kg), and increase in fat-free mass (−4.5 ± 2.04%; − 4.3 ± 2.3 kg; 3.9 ± 2.5 fat free mass kg) were found only in the specific training group (3.7 to 22.2%; p < 0.05; Hedge’s g = −0.42–4.1) [ 127 ]. These findings suggest that programs based on strength and conditioning training implementing high intensity and low volume organized according to the specifics of combat demands can generate positive effects on the athletes [ 127 ]. Corroborating these results, Tota et al. [ 126 ] found that 14 weeks of periodized strength and conditioning with general, specific, and pre-competitive mesocycles proved to be useful, as the training protocol was able to reduce body fat and improve anaerobic peak power (Wingate test for upper limbs) and aerobic capacity (Vo2 and determination of the second ventilatory threshold) in MMA athletes. Chernozub et al. [ 128 , 129 ] conducted two relevant intervention studies with MMA athletes focusing on strength training. The authors reported the importance of strength training models adapted to the predominance of the fighting style (striking or grappling) [ 129 ]. Striking athletes used targeted interventions in a high intensity regime, predominantly focused on alactic and lactic energy sources, while the grappling group focused their training on lower intensity regimes with the predominance of the glycolytic energy source [ 129 ]. The second study by Chernozub and colleagues focused on MMA athletes who primarily used grappling. A 3-month intervention was performed by two groups separated into: (A) low-intensity, high-volume loading and (B) high-intensity, low-volume loading [ 128 ]. Both groups increased their muscle circumferences, group A: 1.9% and group B: 5.5% after 3 months of training [ 128 ]. However, although physiological adaptations were different between groups, changes over time were small [ 128 ]. In view of the biochemical results of the modifications of the testosterone hormones and the lactate dehydrogenase enzyme in both groups, it validates the use of high intensity loads that favour the evolution of the adaptive capacities of the fighters’ body to perform MMA training [ 128 ]. Thus, the need for correction in load parameters (kg) during strength training based on adaptive changes in body composition throughout the training cycle is recommended [ 128 ].

Bodden et al. [ 130 ] performed an 8-week corrective exercise program aimed at improving functional movement screen (FMS) scores and potentially decreasing injury risk. The authors suggest that the FMS would be a good tool to identify movement disorders and that, after the 4-week intervention, they would improve FMS scores [ 130 ], consequently reducing asymmetries at week 4 and 8 compared to baseline values. The authors point out that due to the high ratio of FMS tests and exercises used in MMA training programs, their applicability would be easily understood by fighters [ 130 ]. Ignatjeva et al. [ 131 ] proposed a method to evaluate or improve the performance of fighters through motor tests. According to the authors, with the progressive use of external resistance using the Keizer Leg Press A421 equipment, it is possible to measure the differences in the reaction time of the lower limbs, whether posterior or anterior.

The use of caffeine was investigated with the aim of improving punch performance (number of punches, strength of each punch, maximum strength, average strength, and frequency or “number of punches per series”) and the perceptual variables. Interestingly, no difference was found when compared to placebo at 5 mg·kg −1 of caffeine consumption [ 132 ]. Lymphatic drainage methods (manual lymphatic drainage, body flow therapy, and deep swing lymphatic drainage) have been tested to improve post-exercise regeneration in forearm muscles [ 133 ]. Zebrowska et al. [ 133 ] found that, in MMA athletes, all types of lymphatic drainage recovery interventions (with the use of manual techniques or the use of electrical stimulation) improved the regeneration of the forearm muscles after exercise, as measured by Doppler ultrasound velocity “Ultrasonograf”, and decreased the tension (measured by a myotonometric probe) in each area on the AUC curve (quotient between the amount of tissue deformation and the force applied by the myotonometer times the tissue displacement value at which AUC growth leads to a reduction in surface tension of tissues). The authors demonstrated effects on post-exercise AUC across the investigated sample at all times of recovery (Rec), −20 min, 24 h, 48 h after interventions, and recommend its use [ 133 ].

Assessments that allow the identification of changes in movement patterns which may cause functional limitations and interfere with physical performance through screening tools (history of injuries, Time–motion, FMS, etc.) are common methods to reduce the likelihood of injury risk. Moreover, it has been suggested that monitoring fatigue and workload can improve performance and further reduce injury risk. Thus, Kirk et al. [ 134 ] reported variations resulting from training loads over an 8-week cycle among 14 athletes, 7 in a competitive cycle and 7 in a general phase. The authors found that training duration (weekly mean range = 3.9–5.3 h), sRPE (weekly mean range = 1287–1791 AU), strain (weekly mean range = 1143–1819 AU), monotony (weekly mean range = 0.63–0.83 AU), fatigue (weekly mean range = 16–20 AU), and soreness did not change within or between weeks [ 134 ]. The reported data showed no differences between most investigation variables between groups (competitors vs. non-competitors), the only exception being in the pre-competition week, with abrupt changes in total training time [ 134 ]. While the present study demonstrates a possible classification of training intensities, it is necessary to observe the data with caution, given the size of the sample and the level of experience of the fighters. Figure 8 presents the main finding regarding interventions applied in MMA athletes.

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Main findings regarding interventions applied in MMA Athletes.

4. Conclusions

This review exploring MMA, whether in amateur or professional athletes, was based on 20,784 athletes and focused on investigations that evaluated injuries (mainly effects of head injuries: short and long term), effects of weight loss (prevalence 88% to 95% of all participants), technical and tactical analysis (time–motion analysis using winners and losers), physical fitness (reporting the importance of high strength levels and aerobic fitness), physiological responses and characteristics training (blood lactate increases after training (1.97–2.70 nmol/L) and RPE rating from 15 to 19), and psychobiological parameters (“controlled aggression” and sleep disturbances).

Currently, the scientific literature consists of a body of studies on time–motion analysis that allowed an advance in the knowledge area of technical and tactical coaching. However, there is a lack of intervention studies found, which suggests the need for more controlled trials to improve the level of evidence and understanding of sport. Furthermore, according to the inclusion criteria, only manuscripts written in English were selected, and this can be considered a limitation of the present study.

The results of this, the first exploratory systematic review on the subject, highlight the broad, but often superficial, research found in the literature related to MMA. By conducting a methodical, comprehensive, transparent, and replicable survey of the literature, we identified a number of trends in the literature on the subject. Of note, there is a paucity of research on female MMA fighters in multiple areas of study (weight loss, weight regain, nutritional profile, psychological profile, physical profile) and intervention studies that demonstrate a more comprehensive profile of MMA athletes.

Currently, topics including time–motion, weight loss, and incidence and prevalence of injuries have been explored in many published studies and serve to provide a better understanding of sport. Moving forward, this manuscript serves to educate practitioners on current evidence and inform researchers about gaps in the literature.

Abbreviations

UFC	Ultimate Fighting Championship
1RM	one-repetition maximum
RSI	reactive strength index
AU	arbitrary units
SJ	squat jump
CMJ	countermovement jump
FMS	functional movement screen
AUC	area under the curve
RPE	rating perceived exertion
MMA	Mixed Martial Arts
KO	knockout
TKO	technical knockout
PRISMA	Preferred Reporting Items for Systematic Reviews and Meta-Analyses
PECO	participants, exposure, comparators and outcomes
mTBI	mild traumatic brain injury
RWL	rapid weight loss
BM	body mass
WG	weight regain

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/sports10060080/s1 , Table S1: Risk Bias; Table S2: Application Risk Bias, Table S3: Main findings regarding studies Table S4. Summary of the studies reporting Effect Size.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, J.C.A.B. and J.G.C.; writing—preparation of original draft, J.C.A.B., H.F., A.F.G., S.B.C.D.D., A.L.B.R., B.V.C.d.S., C.A.C.F. and J.G.C.; data curation, J.C.A.B., A.L.B.R., B.V.C.d.S., C.A.C.F., S.L. and J.G.C.; writing—proofreading and editing, S.L., T.P.S.-J., A.A., J.C.S., B.M.d.V. and J.G.C.; general supervision, J.G.C. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

IMAGES

(PDF) “Martial Arts and Combat Sports: Science, Research and Culture
(DOC) Research Paper Martial Law
(PDF) Martial Arts Research: Weak Evidence—Response
(PDF) National Academy Of Martial Arts
Martial Art School for Kids
Book Review: Research of Martial Arts

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The effects of martial arts participation on mental and psychosocial health outcomes: a randomised controlled trial of a secondary school-based mental health promotion program

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