Acute physiological, endocrine, biochemical and performance responses associated with amateur boxing: A systematic review with meta-analysis

Figures & data

Figure 1. Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) flow diagram of literature screening process.

Table 1. Physiological and perceptual alterations in competitive bouts, sparring, and boxing-specific simulations.

Reference	Participants	Activity	Time	HRave (b.min^−1)	% HRmax	HRpeak (b.min^−1)	% HRmax	V̇O2ave (ml.kg^−1 min^−1)	% V̇O2max	V̇O2peak (ml.kg^−1min^−1)	% V̇O2max	BLa (mmol.l^−1)	RPE (Borg 6–20)
Simulated Activity
Finlay et al. (2020)	14 M English elite amateur boxers age 22 ± 2	3 × 3 Punch bag simulation	Baseline Round 1 Round 2 Round 3 Post (5 mins)	– 144 ± 15 150 ± 17* 157 ± 16*# –	– 75 79 82 –	– 158 ± 20 165 ± 20* 170 ± 17*# 118 ± 14	– 83 86 89 –	– 33.2 ± 6.8 35.0 ± 7.9 35.1 ± 7.8 –	– 59 62 63 –	– 42.4 ± 6.0 43.8 ± 7.3 44.4 ± 5.6 –	– 76 78 79 –	1.2 ± 0.5 2.1 ± 0.8 2.7 ± 1.0* 3.3 ± 1.2*# 2.5 ± 0.9	– 11 ± 1 13 ± 1* 14 ± 2*# –
		3 × 3 Pads simulation	Baseline Round 1 Round 2 Round 3 Post (5 mins)	– 154 ± 10 163 ± 9 * 167 ± 9*# –	– 81 85 87 –	– 167 ± 12 175 ± 12* 178 ± 9*# 114 ± 10	– 87 92 93 –	– 37.7 ± 6.9 38.1 ± 6.7 38.2 ± 6.9 –	– 67 68 68 –	– 46.9 ± 8.1 47.3 ± 8.5 47.0 ± 8.4 –	– 84 84 84 –	1.1 ± 0.5 2.3 ± 0.7 3.1 ± 0.8* 4.0 ± 1.0*# 3.0 ± 0.9	– 11 ± 2 13 ± 2* 14 ± 2*# –
El-Ashker et al. (2018)	11 M Elite amateur boxers age 21.4 ± 2.1	3 × 3 Semi contact pads simulation	Round 1 Round 2 Round 3	– – –	– – –	176 ± 4 179 ± 1* 182 ± 5*#	90 91 92	– – –	– – –	55.3 ± 4.4 53.8 ± 6.5 50.4 ± 7.9	100 97 91	– – –	– – –
Finlay et al. (2018)	9 M English elite amateur boxers age 21 ± 4	3 × 3 Punch bag simulation	Baseline Round 1 Round 2 Round 3	– 150 ± 15 156 ± 16* 157 ± 18*	– 79 83 83	– 162 ± 12 166 ± 13* 169 ± 14*	– 86 88 89	– 32.3 ± 4.9 33.0 ± 5.8 32.7 ± 6.0	– 59 60 59	– 43.8 ± 7.3 43.3 ± 8.2 43.5 ± 8.5	– 80 79 79	1.1 ± 0.9 2.4 ± 1.3 3.3 ± 1.7* 4.3 ± 2.6*#	– 11 ± 1 13 ± 1* 14 ± 2*#
Davis et al. (2014)	10 M Novice boxers 23.7 ± 4.1	3 × 2 Pads	Round 1 Round 2 Round 3	– – –	– – –	166 ± 19 173 ± 12 174 ± 13*	87 90 91	– – –	– – –	42.6 47.5* 47.2*	– – –	6.7 ± 1.4 8.6 ± 1.5* 9.5 ± 1.8*#	– – –
Halperin et al. (2019)	15 M Australian elite amateur boxers age 21 ± 4	3 × 2 punch simulation (Differing performance feedback)	Round 1 Round 2 Round 3	– – –	– – –	– – –	– – –	– – –	– – –	– – –	– – –	– – –	14 ± 1 16 ± 1* 17 ± 1*#
Arseneau et al. (2011)	9 M Canadian regional level amateur boxers age 22 ± 3.5	3 × 2 Pads simulation	Average Round 1 Round 2 Round 3	– 152 ± 14 168 ± 12* 172 ± 12*	– 78 86 88	– – – –	– – – –	41.1 ± 5.1 – – –	∼66 – – –	– – – –	– – – –	– – – 4.0 ± 1.7	– – – 13.6 ± 2.1
Thomson and Lamb (2017)	28 M Non-elite amateur boxers age 22.4 ± 3.5	3 × 3 Pads simulation	Average Round 1 Round 2 Round 3	– 165 ± 11 172 ± 10* 175 ± 10*#	– – – –	– 178 ± 13 187 ± 8* 189 ± 11*	– – – –	– 42.1 43.7 40.7	∼ 69 – – –	– – – –	∼92 – – –	– – – 4.6 ± 1.3	(CR-10 scale) 5.8 ± 1.4 6.8 ± 1.1* 8.1 ± 1.1*#
Ghosh (2010)	6 M Indian elite amateur boxers age 21.4 ± 3	4 × 2 Punch bag simulation	Round 4	–	–	192 ± 6	–	–	–	–	–	13.6 ± 3.2	–
Lutoslawska et al. (1995)	9 M Polish elite amateur boxers age 24.6 ± 3.7	3 × 3 Punch simulation	Average Baseline Round 3	– – –	– – –	183 ± 8.9	– – –	– – –	– – –	– – –	– – –	– 0.9 ± 0.2 14.0 ± 1.4#	– – –
Sparring and simulated bouts
Khanna and Manna (2006)	21 M Indian elite amateur boxers age 17.7	3 × 2 Competitive sparring (all weight classes)	Round 1 Round 2 Round 3	171 ± 16 179 ± 13* 183 ± 15*	93 97 99	– – –	– – –	– – –	– – –	– – –	– – –	6.2 ± 3.4 6.3 ± 3.4 8.3 ± 4.5	– – –
Hukkanen and Hakkinen. (2017)	7 M Finish elite amateur boxers age 20.3 ± 2.7	3 × 3 Sparring (pre-comp phase) 3 × 3 sparring (Comp phase)	Baseline Round 2 Round 3 Baseline Round 1 Round 2 Round 3	– – – – 183 ± 6 ∼185 ± 11 191 ± 7	– – – – – – –	– – – – – – –	– – – – – – –	– – – – – – –	– – – – – – –	– – – – – – –	– – – – – – –	5.0 ± 1.0 14.0 ± 2.0 17.0 ± 2.0 3.0 ± 1.0 – 12.0 ± 3.0 13.0 ± 3.0	– – – – – – –
Obminski et al. (1993)	11 M Elite amateur boxers Age 22.1	3 × 3 Sparring	Baseline Round 1 Round 2 Round 3	– – – –	– – – –	– 181 ± 9 186 ± 10 187 ± 9	– – – –	– – – –	– – – –	– – – –	– – – –	1.6 ± 0.1 – – 14.4 ± 2.2*	– – – –
Nassib et al. (2017)	15 M Tunisian elite amateur boxers age 19.56 ± 3.6	3 × 3 Competitive sparring	Average Round 1 Round 3	173 ± 7 – –	93 – –	– – –	– – –	– – –	– – –	– – –	– – –	– 1.8 ± 0.9 8.9 ± 2.0#	– – –
Ghosh (2010)	6 M Indian elite amateur boxers age 21.4 ± 3	6 × 2 Competitive sparring	Average Round 6	– –	–	190 ± 7	–	–	–	–	–	– 14.5 ± 0.6	– –
Arseneau et al. (2011)	9 M Canadian regional level amateur boxers age 22 ± 3.5	3 × 2 Sparring LAB	Average Round 1 Round 2 Round 3	– 162 ± 10 168 ± 12* 172 ± 12*	– – – –	– – – –	– – – –	43.4 ± 5.9 – – –	70 – – –	– – – –	– – – –	– – – 6.1 ± 2.3	12.2 ± 1.3 – – –
		3 × 2 Sparring GYM	Round 1 Round 2 Round 3	174 ± 8 181 ± 8* 183 ± 8*	89 93 94	– – –	– – –	– – –	– – –	– – –	– – –	– – 9.4 ± 2.2	– – –
Nikolaidis et al. (2017)	15 M Greek novice Amateur boxers age 21.4 ± 6.3	3 × 3 Simulated boxing (sitting and standing rest)	Round 1 Round 2 Round 3	177 ± 12 184 ± 7* 187 ± 7*	– – –	– – –	– – –	– – –	– – –	– – –	– – –	– – –	12.9 ± 3.0 14.2 ± 2.5* 14.6 ± 2.7*
de Lira et al. (2013)	6 M 4 F Brazilian experienced boxers age 17.9 ± 1.8	3 × 2 Simulated bouts	Round 1 Round 2 Round 3	175 ± 11 183 ± 6* 186 ± 7*	91 95 96	190 ± 8 194 ± 6 199 ± 5*	98 101 103	44.2 ± 7.2 48 .0 ± 6.1* 49.6 ± 5.6*	85 92 95	50.8 ± 5.6 52.6 ± 5.2 54.6 ± 6.2*	99 102 105	– – –	– – –
Chatterjee et al. (2006)	20 F Elite Indian amateur boxers Age 19.7 ± 2.2	3 × 2 Sparring	Round 1 Round 2 Round 3	171 ± 11 181 ± 8 184 ± 7	– – –	183 ± 6 189 ± 6 193 ± 7	– – –	– – –	– – –	– – –	– – –	– – –	– – –
Competitive Bouts
Davis et al. (2013)	32 M British novice amateur boxers age 19.3 ± 1.4	3 × 2 Competitive bouts	Baseline Round 3 Post (5 mins) Post (7 mins)	– – – –	– – – –	– – – –	– – – –	– – – –	– – – –	– – – –	– – – –	1.3 ± 0.5 11.8 ± 1.6# 10.8 ± 2.2 9.9 ± 2.5	– – – –
Hanon et al. (2015)	33 M Elite amateur boxers age 21.5 ± 2.1	3 × 3 Competitive bouts	Round 3	–	–	–	–	–	–	–	–	13.6 ± 2.4	–
Obminski et al. (2009)	15 U Elite amateur boxers age 20–25	3 × 3 Competitive bouts	Post (3 mins)	–	–	–	–	–	–	–	–	12.6 ± 4.7	–

Data are mean ± SD, % where applicable, or ∼ for estimates. M = male; F = female; HRave = average heart rate; HRmax = heart rate maximum; HRpeak = heart rate peak; V̇O₂ave = average oxygen consumption; V̇O₂max = maximal oxygen uptake; V̇O₂peak; maximum oxygen consumption; BLa = blood lactate; RPE = rating of perceived exertion; LAB = laboratory.

*Denotes significant (p < 0.005) difference compared to round 1.

#Denotes significant (p < 0.005) difference compared to previous round.

Table 2. Endocrine, biochemical and performance alterations in competitive bouts, sparring, and boxing-specific simulations.

Reference	Participants	Activity	Measures	Pre	Post-activity			ES
Endocrine response
Graham et al. (2011)	16 M Novice amateur boxers Full sparring n = 8 Age 19.1 ± 3.2 Body sparring n = 8 age 17.6 ± 5.3	Boxing (Full sparring) Boxing (Body sparring)	Serum cortisol (nmol.1^−1)	373 ± 202 416 ± 140	5 mins post 756 ± 93* 417 ± 135	– –	– –	2.30 0.01
Kilic et al. (2019)	20 M Elite amateur boxers age 25.9 ± 3.3	3 × 3 Competitive bout	Plasma cortisol (ug/dl)	∼9 ± 7	10 mins post ∼28 ± 13*	–	–	1.86
Obminski et al. (1993)	11 M Elite amateur boxers age 22.1	3 × 3 Competitive bout 3 × 3 min Sparring	Salivary cortisol (nmol.1^−1)	84.4 ± 17.3 28.6 ± 14	3 mins post 73.5 ± 11.6 40.7 ± 29.2	15 mins post 93.5 ± 19 51.2 ± 17.1	30 mins post 103.9 ± 17.9* 52.5 ± 9.6*	1.02 1.80
Obminski et al. (2009)	15 U Elite amateur boxers age (range 20–25)	3 × 3 Competitive bout	Serum cortisol (nmol^−1) Testosterone (nmol^−1)	– –	3 mins post 600 ± 104 11.6 ± 4.7	– –	– –	– –
Biochemical response
Graham et al. (2011)	16 M Novice amateur boxers Full sparring n = 8 age 19.1 ± 3.2 Body sparring n = 8 age 17.6 ± 5.3	Boxing (full sparring) Boxing (body sparring)	CK (u/L) CK (u/L)	207 ± 107 150 ± 43	5 mins post 244 ± 118* 195 ± 63*	– –	– –	0.33 0.79
Kilic et al. (2019)	20 M Turkish elite amateur boxers age 25.9 ± 3.3	3 × 3 Competitive bout	AST (u/L) ALT (u/L)	∼14 ± 4 ∼5 ± 4	10 mins post ∼35 ± 13* ∼14 ± 4*	– –	– –	2.14 2.21
Zuliani et al. (1985)	8 M Non-elite amateur boxers age (range 15–32)	3 × 3 Competitive bout 3 × 3 Shadow boxing	CK (u/L) Mb (ng/ml) LDH (u/L) CK(u/L) Mb (ng/ml) LDH (u/L)	119 ± 38 15 ± 3 136.75 114 ± 38 15 ± 3 127.06	15 mins post 139 ± 43 52 ± 27* 152.38 149 ± 61 28 ± 11* 135.03	5 hrs post 194 ± 82* 75 ± 36* 143.52 156 ± 61* 31 ± 13* 147.34	16 hrs post 183 ± 78* 27 ± 21 141.58 129 ± 53* 18 ± 9 134.94	1.11 2.22 – 0.78 1.60 –
Kaynar (2019)	14 U Novice amateur boxers age 17.9 ± 5.6	3 × 3 Body sparring	AST (u/L) ALT (u/LH) LDH (u/L) CK (u/L)	23.21 ± 4.12 14.93 ± 3.83 222.21 ± 36.00 242.14 ± 183.55	5 mins post 25.96 ± 4.69* 13.79 ± 4.82 287 ± 61.30* 332.14 ± 198.36*	– – – –	– – – –	0.62 0.26 1.29 0.46
Bianco et al. (2005)	15/18 M Italian elite amateur boxers age 24.9 ± 3.7	4 × 2 Competitive bout	CK (u/L) Mb (ng/ml)	208.7 ± 149.8 40.0 ± 11.9	– –	12 hrs post 300.1 ± 136.2* 53.9 ± 16.1*	–	0.65 0.96
Neuromuscular performance response
Nikolaidis et al. (2017)	15 M Greek novice amateur boxers age 21.4 ± 6.3	3 × 3 Simulated boxing (sitting and standing rest)	CMJ height (cm)	32.2 ± 4.6	5–10 mins post 34.2 ± 4.6*	–	–	0.42
Loturco et al. (2021)	8 M 6 F Brazilian elite amateur boxers Age 24.3 ± 4.3	3 × 3 Competitive bout	CMJ height (cm) HS power output (W.kg^−1) BP power output (W.kg^−1)	37.5 ± 7 7.70 ± 1.49 6.38 ± 1.06	1 hr post 39.4 ± 8.4 7.44 ± 1.61 6.43 ± 1.20	– – –	– – –	0.24 0.16 0.04
Task-specific performance response
				Pre	Round 1	Round 2	Round 3
Halperin et al. (2019)	15 M Australian elite amateur boxers age 21 ± 4	3 × 2 Punch simulation (Differing performance feedback)	Punch force (N) Various punch types	–	2081 ± 273	2119 ± 210	2141 ± 326	–
Hukkanen and Hakkinen (2017)	7 M Finnish elite amateur boxers age 20.3 ± 2.7	3 × 3 Competitive sparring (PC and C phase)	CP – Punch force (kg) Rear straight Jab Reaction time (ms) Rear straight Jab PCP – Punch force (kg) Rear straight Jab Reaction time (ms) Rear straight Jab	∼174 ± 36 ∼134 ± 37 354 ± 24 ∼303 ± 53 ∼192 ± 42 ∼148 ± 40 ∼347 ± 46 ∼293 ± 33	∼174 ± 33 ∼142 ± 31 ∼342 ± 42 ∼311 ± 45 ∼191 ± 41 ∼150 ± 39 332 ± 29 272 ± 62	∼169 ± 32 ∼138 ± 35 ∼344 ± 55 ∼290 ± 53 ∼194 ± 54 ∼148 ± 51 ∼346 ± 49 ∼312 ± 53	176 ± 52 149 ± 36 312 ± 36 323 ± 96 209 ± 61 156 ± 51 390 ± 57 324 ± 65	– – – – – – – –
Thomson and Lamb. (2017)	28 M Non-elite amateur boxers Age 22.4 ± 3.5	3 × 3 Pads simulation	Punch accelerations (g)	–	2697.3 ± 134.3	2768.1 ± 107.7#	2782 ± 100.1	–
Finlay et al. (2020)	14 M English elite amateur boxers Age 22 ± 2	3 × 3 Pads simulation 3 × 3 Punch bag simulation	PLTotal (a.u.) Cervical Lumbar Cervical Lumbar Overall	– – – – – –	39.48 ± 8.90 44.62 ± 7.59 44.04 ± 6.40 48.34 ± 9.91 44.12 ± 8.64	41.37 ± 8.32 46.48 ± 6.43 45.46 ± 6.03 51.82 ± 11.25 46.28 ± 8.84#	42.09 ± 8.13 47.33 ± 7.86 44.88 ± 6.17 51.23 ± 12.80 46.38 ± 9.42#	– – – – –
Finlay et al. (2018)	9 M English elite amateur boxers Age 21 ± 4	3 × 3 Punch bag simulation	PLTotal (a.u.) Cervical	– –	46.85 ± 6.88	48.69 ± 7.02	47.56 ± 6.13	–

Notes: Data are mean ± SD, or ∼ for estimates. M: male; F: female; ES: effect size (g) of pre-post (peak) alterations. CK: creatine kinase; Mb: myoglobin; AST: aspartate transaminase; ALT: alanine transaminase; LDH: lactate dehydrogenase; CMJ: counter-movement jump; HS: half squat; BP: bench press; PL_Total: PlayerLoad_TM total; PCP: pre-competition phase; CP: competition phase; ms: milliseconds; W.kg⁻¹: watts per kilogram per minute; kg: kilogram; g: g-force.

*Denotes significant (p < 0.005) pre-post difference in measure.

#Denotes significant (p < 0.005) difference compared to previous time-point.

Figure 2. Combined effect sizes of pre-post responses for each boxing-specific activity. Bla: blood lactate; CK: creatine kinase; AST: aspartate transaminase; ALT: alanine transaminase; SC: semi-contact; NM: neuromusuclar; CMJ: counter-movement jump. Time course range of post measures: BLa = immediately – 7 mins post; Myoglobin = 15 mins–16 hrs post; Cortisol = 3 mins–30 mins post; CK = 5 mins–16 hrs post; ALT/AST = 5 mins–10 mins; CMJ = 5 mins–1 hr.

Finlay, M. J., Greig, M., McCarthy, J., & Page, R. M. (2020). Physical response to pad- and bag-based boxing-specific training modalities. Journal of Strength and Conditioning Research, 34(4), 1052–1061.

 PubMed Web of Science ®Google Scholar

El-Ashker, S., Chaabene, H., Negra, Y., Prieske, O., & Granacher, U. (2018). Cardio-respiratory endurance responses following a simulated 3 × 3 minutes amateur boxing contest in elite level boxers. Sports, 6(4), 119.

 Google Scholar

Finlay, M., Greig, M., & Page, R. (2018). Quantifying the physical response to a contemporary amateur boxing simulation. Journal of Strength and Conditioning Research, 32(4), 1005–1012.

 PubMed Web of Science ®Google Scholar

Davis, P., Leithäuser, R. M., & Beneke, R. (2014). The energetics of semicontact 3×2-min amateur boxing. International Journal of Sports Physiology and Performance, 9(2), 233–239.

 PubMed Web of Science ®Google Scholar

Halperin, I., Chapman, D. W., Thompson, K. G., & Abbiss, C. (2019). False-performance feedback does not affect punching forces and pacing of elite boxers. Journal of Sports Sciences, 37(1), 59–66.

 PubMed Web of Science ®Google Scholar

Arseneau, E., Mekary, S., & Léger, L. A. (2011). V̇O2 requirements of boxing exercises. Journal of Strength and Conditioning Research, 25(2), 348–359.

 PubMed Web of Science ®Google Scholar

Thomson, E., & Lamb, K. (2017). Quantification of the physical and physiological load of a boxing-specific simulation protocol. International Journal of Performance Analysis in Sport, 17(1-2), 136–148.

 Web of Science ®Google Scholar

Ghosh, A. K. (2010). Heart rate: Oxygen consumption and blood lactate responses during specific training in amateur boxing. IJASS, 22, 1–12.

 Google Scholar

Lutoslawska, G., Eliasz, J., & Sitowski, D. (1995). Changes in concentrations of plasma substrates and metabolites in response to simulated boxing. Biology of Sport, 12(2), 77–84.

 Google Scholar

Khanna, G. L., & Manna, I. (2006). Study of physiological profile of Indian boxers. Journal of Sports Science and Medicine, 1(5), 90–98.

 Google Scholar

Hukkanen, E., & Häkkinen, K. (2017). Effects of sparring load on reaction speed and punch force during the precompetition and competition periods in boxing. Journal of Strength and Conditioning Research, 31(6), 1563–1568.

 PubMedGoogle Scholar

Obminski, Z., Stupnicki, R., Eliasz, J., Sitowski, D., & Klukowski, K. (1993). Changes in salivary cortisol in elite boxers following laboratory exercises and fights. Biology of Sport, 10(2), 83–88.

 Google Scholar

Nassib, S., Hammoudi-Nassib, S., Chtara, M., Mkaouer, B., Maaouia, G., Bezrati-Benayed, I., & Chamari, K. (2017). Energetics demands and physiological responses to boxing match and subsequent recovery. The Journal of Sports Medicine and Physical Fitness, 57(1-2), 8–17.

 PubMed Web of Science ®Google Scholar

Nikolaidis, T. P., Clemente, M. F., Busko, K., & Knechtle, B. (2017). Physiological responses to simulated boxing: The effect of sitting versus standing body position during breaks – a pilot study. Asian Journal of Sports Medicine, 8(3), e55434. doi:10.5812/asjsm.55434

 Google Scholar

de Lira, C. A. B., Peixinho-Pena, L. F., Vancini, R. L., de Freitas Guina Fachina, R. J., de Almeida, A. A., Andrade Mdos, S., … da Silva, A. C. (2013). Heart rate response during a simulated Olympic boxing match is predominantly above ventilatory threshold 2: A cross sectional study. Open Access Journal of Sports Medicine, 10(4), 175–182.

 Google Scholar

Chatterjee, P., Banerjee, A. K., Majumdar, P. (2006). Energy expenditure in women boxing. Kathmandu University Medical Journal (KUMJ), 4(3), 319–323.

 PubMedGoogle Scholar

Davis, P., Wittekind, A., & Beneke, R. (2013). Amateur boxing: Activity profile of winners and losers. International Journal of Sports Physiology and Performance, 8(1), 84–92.

 PubMed Web of Science ®Google Scholar

Hanon, C., Savarino, J., & Claire, T. (2015). Blood lactate and acid-base balance of world-class amateur boxers after three 3-minute rounds in international competition. Journal of Strength and Conditioning Research, 29(4), 942–946.

 PubMed Web of Science ®Google Scholar

Obminski, Z., Hubner-Wozniak, E., & Lakomiec, S. (2009). Hormonal and metabolic status in boxers after a 3-round match. Polish Journal of Sport Tourism, 16, 221–224.

 Google Scholar

Graham, M. R., Myers, T., Evans, P., Davies, B., Cooper, S. M., Bhattacharya, K., … Baker, J. S. (2011). Direct hits to the head during amateur boxing is associated with a rise in serum biomarkers for brain injury. International Journal of Immunopathology and Pharmacology, 24(1), 119–125.

 PubMed Web of Science ®Google Scholar

Kilic, Y., Cetin, H. N., Sumlu, E., Pektas, M. B., Koca, H. B., & Akar, F. (2019). Effects of boxing matches on metabolic, hormonal, and inflammatory parameters in male elite boxers. Medicina, 55(6), 288.

 PubMedGoogle Scholar

Zuliani, U., Bonetti, D., Franchini, G., Servant, G., Ugolotti, G., & Varacca, A. (1985). Effect of boxing on some metabolic indices of musuclar contraction. International Journal of Sports Medicine, 6, 234–236.

 PubMedGoogle Scholar

Kaynar, O. (2019). Effect of sparring training model on liver enzymes and muscle damage in boxers. Journal of Education and Training Studies, 7(3S), 114–117.

 Google Scholar

Bianco, M., Colella, F., Pannozzo, A., Oradej, A., Bucari, S., Palmieri, V., … Zeppilli, P. (2005). Boxing and “commotio cordis”: ECG and humoral study. International Journal of Sports Medicine, 26(2), 151–157.

 PubMedGoogle Scholar

Loturco, I., McGuigan, M. R., Freitas, T. T., Bishop, C., Alcaraz, P. E., Romano, F., … Franchini, E. (2021). Variations in the physical performance of Olympic boxers over a four-day national qualifying tournament. Sports, 9(5), 62. doi:10.3390/sports9050062

 Google Scholar