A Comparison of Recreational Soccer and Individual High-Intensity Interval Training for Prediabetes: A Literature Review and Analysis of Metabolic Markers in Latino-American Males Open Access

Woods, Nolan (Fall 2025)

Permanent URL: https://etd.library.emory.edu/concern/etds/12579v10m?locale=en
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Abstract

Background: Hispanic adults residing in the US are unequally burdened by prediabetes and diabetes-related mortality. Consequently, there is a clear need for novel interventions for the prediabetic population. Historically, HIIT has improved pre-diabetic metabolic and physiologic measures as well as associated morbidity and mortality. What has yet to be evaluated, however, is whether incorporating a culturally congruent model (i.e., soccer), a HIIT-style sport embedded in Latin American culture, may be an effective intervention. 

Methodology: In investigating this question, an in-depth literature review was first performed on (1) the physiology of HIIT and its effectiveness as a public health intervention with global communities, (2) soccer as HIIT, and (3) objective physical activity monitoring in sport-related research. After review, an analysis comparing the effectiveness study evaluating a soccer-based NDPP adaptation in Latino men with prediabetes against published individual HIIT data matched for training frequency and intensity in Part 2. 

Results: Both interventions showed statistically significant drops in HbA1c at 12 week follow-up. The individual HIIT group had a mean reduction of 1.20% (95% CI: [-1.38, -1.01], p<0.001), while the recreational soccer group 0.15% (95% CI: [-0.30, -0.01], p=0.035). ANCOVA, adjusted for baseline HbA1c, age, and BMI, demonstrated 0.66% greater HbA1c reduction for the individual HIIT group compared to recreational soccer (95% CI: [0.29, 1.03], p=0.0006) with a clinically meaningful effect size (Cohen's d-test ; d=2.06). Bootstrap resampling (n=2,000 iterations) and IPTW sensitivity analyses addressed ANCOVA violations. The recreational soccer study achieved sprint distances (mean=1290.7m) and w:r (1.6) comparable to HIIT in literature. However, gold-standard HIIT metrics of MAS/vVO2max were not evaluated, yielding insufficient evidence to equate recreational soccer as HIIT.

Conclusion: Recreational soccer remains a practical lifestyle intervention improving health across global communities. The present study showed it is not a HIIT substitute, though it can help patients reach cardiometabolic health goals. Future studies should be prospective, randomized trials that use gold-standard metrics (i.e., MAS/vVO2max) and assess long-term morbidity and mortality outcomes.

Table of Contents

FRONT MATTER ………………………………………………………………………………..

Distribution Agreement ....................................................................................................................

Approval Sheet .......…......................................................................................................................

Abstract Cover Page ….....................................................................................................................

Abstract .............................................................................................................................................

Title Page ..........................................................................................................................................

Acknowledgements ...........................................................................................................................

Table of Contents ..............................................................................................................................

I. INTRODUCTION .................................................................................................................... 1

II. LITERATURE REVIEW ....................................................................................................... 2

 2.1. Chronic Disease in Latino Populations ............................................................................... 2

 2.2. HIIT in Public Health & Medicine ..................................................................................... 4

   2.2.1. Improved Skeletal Muscle Insulin Sensitivity & GLUT4 Glucose Uptake .………. 5

2.2.2. Metabolic Signaling & Mitochondrial Biogenesis………...………….......………... 6

2.2.3. Improved Endothelial Function…………………………………….………………. 6

2.2.4. Reduced Systemic Inflammation & Adipose Tissue Changes…………...…....….... 7

2.2.5. Microvascular & Capillary Adaptations ...…....……..…………..…………………. 8

2.2.6 Autonomic & Cardiorespiratory Adaptations …………...….………………………. 8

2.2.7. Hepatic Effects ……………………………………………………………………. 10 

2.2.8 Global Public Health Implications ………………………………………………… 10

 2.3. Soccer as HIIT & "Football is Medicine" .............................,........................................... 11

 2.4. Social Context in Exercise ................................................................................................ 13

 2.5. Physical Activity Intensity In Global Public Health ......................................................... 14

2.5.1. Accelerometry & Associated Metrics………..….…...……...……………………... 16

2.5.2. HIIT Benchmarks & Soccer……………...….……….……...……………………... 17

 2.6. Gaps in Evidence .............................................................................................................. 19

III. METHODS .......................................................................................................................... 20

  3.1. Participants ....................................................................................................................... 20

  3.2. Matching Criteria ............................................................................................................. 23

  3.3. Intervention: Recreational Soccer Paradigm ................................................................... 23

3.4. Intervention: Individual HIIT Paradigm .......................................................................... 23

  3.5. Measurements .................................................................................................................. 24

  3.6. Data Analysis ................................................................................................................... 24

3.6.1. Primary Analysis ………...………………………….……...……………………... 24

IV. RESULTS .............................................................................................................................. 26

 4.1. Study Population & Retention .......................................................................................... 26

 4.2. Baseline Characteristics .................................................................................................... 26

 4.3. ANCOVA Analysis .......................................................................................................... 27

 4.4. Model Diagnostics & Assumption Testing …................................................................... 28   

 4.5. Sensitivity Analyses .......................................................................................................... 28

V. DISCUSSION ......................................................................................................................... 30

 5.1. Overview of Main Findings ............................................................................................... 30

 5.2. Context & Potential Mechanistic Explanations ................................................................. 30

 5.3. Strengths ……………………............................................................................................ 31

 5.4. Limitations ……………..................................................................................................... 32

 5.5. Clinical Significance & Public Health Implications .......................................................... 33

VI. CONCLUSION .................................................................................................................... 34

VII. BIBLIOGRAPHY .............................................................................................................. 35

VII. TABLES ...................................................................................................................................

 Table 1. Baseline Demographics - Recreational Soccer Cohort .............................................. 21

 Table 2. Baseline Demographics - Individual HIIT Cohort ..................................................... 22

 Table 3. Recreational Soccer Raw GPS Data 3 Months .......................................................... 22

 Table 4. Primary Outcome Variables for Between-Group Comparison .................................. 25

 Table 5. Baseline Characteristics by Intervention Group ........................................................ 26

Table 6. Within-Group Changes in HbA1c from Baseline to 3 Months .................................. 26

IX. FIGURES .............................................................................................................................….

Figure 1. ANCOVA Coefficient Plot and Summary Table ...................................................... 27  

Figure 2. ANCOVA Residuals and Bootstrap Distribution ..................................................... 29

 Figure 3. HbA1c Changes ........................................................................................................ 29

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