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The National Library of Medicine is the world’s largest biomedical library and a leader in research in computational health informatics. NLM plays a pivotal role in translating biomedical research into practice. NLM’s research and information services support scientific discovery, health care, and public health. NLM pioneers new ways to make biomedical data and information more accessible; builds tools for better data management and personal health; and helps create a more diverse and data-skilled workforce. NLM enables researchers, clinicians, and the public to use the vast wealth of biomedical data to improve health.

NLM’s cutting-edge research and training programs—with a focus on artificial intelligence (AI), machine learning, computational biology, and biomedical informatics and health data standards—help catalyze basic biomedical science, data-driven discovery, and health care delivery.

Every day, millions of scientists, health professionals, and members of the public from around the world use NLM’s online information resources to translate research results into new treatments, develop new products, inform clinical decision making, and improve public health. In addition, NLM leads research and research training in biomedical informatics, information science, and data science. Its vibrant intramural and extramural research programs conduct and support research and training in institutions across the United States.

NLM is part of the National Institutes of Health (NIH), U.S. Department of Health and Human Services, and located in Bethesda, Maryland. NLM started in 1836 as a small collection of medical books and journals in the office of the U.S. Army Surgeon General.

Leveraging its 187-history, NLM develops and applies innovative approaches to acquire, organize, curate, and deliver biomedical information across the United States and the world. NLM’s advanced biomedical information services are among the most visited websites in the Federal Government.

NLM carries out its mission of enabling biomedical research, supporting health care and public health, and promoting healthy behavior by:

• Acquiring, organizing, preserving, and providing free online access to scholarly biomedical literature from around the world.
• Providing access to biomedical and health information across the country in partnership with the over 8,100 members of the National Network of Libraries of Medicine  (NNLM).
• Serving as a leading global resource for building, curating, and providing sophisticated access to molecular biology and genomic, clinical trial, environmental health and other types of biomedical data, including those from high-profile, trans-NIH initiatives.
• Conducting research and development on biomedical communications systems, methods, technologies, and networks and information dissemination and utilization among health professionals, patients, and the public.
• Funding advanced biomedical informatics and data science research and serving as the primary supporter of pre- and post-doctoral research training in biomedical informatics and data science at 16 U.S. universities.

Important Events in NLM History

1836 —Library of the Office of the Surgeon General of the Army (the present National Library of Medicine) established.

1865 —John Shaw Billings, MD, appointed to supervise Surgeon General's Library, which he developed into a national resource of biomedical literature. He served as director until 1895.

1879 —First volume of Index Medicus, the first attempt to identify and code the medical literature, published.

1880 —First volume of Index-Catalogue, a multi-part printed bibliography, published.

1922 —Library of the Office of the Surgeon General (Army) renamed Army Medical Library.

1952 —Army Medical Library renamed Armed Forces Medical Library.

1956 —Act of Congress moved Armed Forces Medical Library to U.S. Public Health Service (PHS) and renamed it the National Library of Medicine.

1961 —New National Library of Medicine building, #38 (8600 Rockville Pike, Bethesda, Maryland, on the NIH campus), dedicated.

1964 —Medical Literature Analysis and Retrieval System ( MEDLARS ), a computer-based system for medical professionals to retrieve biomedical information, became operational at NLM.

1965 —Medical Library Assistance Act gave NLM responsibility of helping the nation's medical libraries through a grant program and created the Regional Medical Library Network (now the  National Network of Libraries of Medicine ).

1968 —NLM became a component of NIH. The  Lister Hill National Center for Biomedical Communications , NLM's research and development component, created by Congress.

1971 —MEDLINE ("MEDLARS Online") initiated to provide online access to a subset of references in the MEDLARS database.

1972 — TOXLINE , an online bibliographic service covering pharmacology and toxicology, became operational.

1980 —NLM's Lister Hill National Center for Biomedical Communications, building #38A, dedicated. Adjacent to the Library, it houses NLM's research and development components.

1986 —Grateful Med, user-friendly software for accessing MEDLARS, introduced to the health community.

1988 —The National Center for Biotechnology Information (NCBI) established at NLM by Congress as a national resource for molecular biology information.

1992 —NCBI assumed responsibility for GenBank and US participation in the International Nucleotide Sequence Consortium.

1993 — National Information Center on Health Services Research and Health Care Technology  established at NLM by Congress as a national resource for health services research and evidence-based practice guidelines.

1993 —NLM's website ( www.nlm.nih.gov ) appeared.

1994 —The  Visible Human Male , a large computer dataset of images based on a cadaver, was introduced. The  Visible Human Female  appeared one year later.

1997 —Access to NLM's  MEDLINE /PubMed database became free via the World Wide Web.

1998 — MedlinePlus  released, providing access to consumer health information.

2000 — ClinicalTrials.gov , an online resource to give the public easy access to information about research studies, launched.

2000 — PubMed Central (PMC), a free archive of biomedical and life sciences journal literature, launched.

2002 —NLM launched traveling historical exhibition program with release of Frankenstein: Penetrating the Secrets of Nature .

2003 —NLM released standard format for electronic archiving and publishing of journal articles—the journal article tagging suite or JATS, which later became a national standard.

2004 —The Secretary of HHS designated NLM as the HHS Coordinating Body for Clinical Terminology Standards.

2006 — NIH MedlinePlus magazine launched to provide Americans with reliable, current health information in a consumer-friendly format. The Spanish-English version,  Salud , followed two years later.

2006 —dbGaP, the database of genomes and phenomes, launched to provide access genome-wide association studies.

2006 —DailyMed made FDA-approved electronic structured product labels (drug package inserts) available to the public and system developers.

2008 —NIH public access policy, requiring deposit in PMC of peer-reviewed articles resulting from NIH-funded research became mandatory, as specified in 2008 appropriations law.

2008 —Deposit of summary results data in ClinicalTrials.gov became mandatory for selected clinical trials of FDA-regulated drugs and devices, as specified in the FDA Amendments Act of 2007.

2010— MedlinePlus Connect , a service linking patients or providers in electronic health record (EHR) systems to related MedlinePlus information on conditions or medications, released.

2010— Vocabulary standards supported or developed by NLM (LOINC, RxNorm, SNOMED CT) included in rule specifying U.S. certification criteria for electronic health record systems.

2015 —AccessGUDID made medical device information submitted to the FDA available to the public.

2015 —Other HHS agencies and other Federal Departments elected to require deposit of publications resulting from their funded research into PMC.

2016— Patricia Flatley Brennan, RN, PhD, became the first woman and first nurse appointed to head the Library.

2017 —HHS issued final rule for registration and reporting of summary results of clinical trials at ClinicalTrials.gov. NIH issued policy extending the requirements to all NIH-funded clinical trials.

2017 —NLM launched its Strategic Plan 2017-2027: A Platform for Biomedical Discovery and Data-Powered Health

2019 — NIH MedlinePlus magazine became available in both English and Spanish online. 

2019 —NLM’s Sequence Read Archive (SRA) public data moved to the cloud, completing the first phase of an ongoing effort to better position these data for large-scale computing. 

2020 —NLM launched an updated version of PubMed , providing an enhanced design and technology to improve the user experience.

NLM Legislative Chronology

August 3, 1956 —An amendment to Title III of the Public Health Service Act, the National Library of Medicine Act, placed the Armed Forces Medical Library under the PHS, and renamed it the National Library of Medicine (Public Law 84-941).

October 22, 1965 —The Medical Library Assistance Act of 1965 (Public Law 89-291) authorized NLM's extramural programs of grant assistance to help expand and improve the nation's medical library and health communications resources, technology, and professional staff for service to the health community.

August 3, 1968 —Public Law 90-456 authorized the designation of the Lister Hill National Center for Biomedical Communications.

November 4, 1988 —Health Omnibus Programs Extension Act (Public Law 100-607) authorized establishment of the National Center for Biotechnology Information at NLM.

June 10, 1993 —National Institutes of Health Revitalization Act (Public Law 103-43) authorized establishment of the National Information Center on Health Services Research and Health Care Technology at NLM.

November 21, 1997 —The Food and Drug Administration Modernization Act (Public Law 105-115) called for the creation of a centralized, consumer-friendly online listing of clinical trials, which became  ClinicalTrials.gov .

September 27, 2007 —The Food and Drug Administration Amendments Act (Public Law 111-85) extended the scope of clinical trials to be registered at ClinicalTrials.gov and expanded the data bank to include summary results of completed clinical trials.

Biographical Sketch of NLM Acting Director Stephen Sherry, PhD

Stephen Sherry, PhD, is the Acting Director of the National Library of Medicine (NLM) at the National Institutes of Health (NIH). NLM is a leader in biomedical informatics and computational health data science research and the world’s largest biomedical library.

Dr. Sherry brings a history of innovation and leadership to NLM. Prior to serving as Acting Director in October 2023, Dr. Sherry served as Director of NLM’s National Center for Biotechnology Information (NCBI) and NLM Associate Director for Scientific Data Resources. Under his leadership, NLM developed advanced computational solutions for life and health science information needs and facilitated open science and scholarship through a growing array of data, literature, and other information offerings and services made available by NLM.

Dr. Sherry’s vision to advance NLM’s mission includes enhancing health and research through robust, sustainable information resources and transformative information science, engineering, and technology development, all while leading in engineering excellence for resilience, reliability, and representation in the era of artificial intelligence. He is recognized for his inventiveness in leveraging research assets to support public health emergency response. Dr. Sherry has been central in key innovations at NLM including the ClinicalTrials.gov Modernization effort and development of the NIH Comparative Genomics Resource, ensuring public input and technical innovation in the process. Dr. Sherry positioned NCBI as a strong collaborative force across the NIH and in support of major NLM projects including the NIH Preprint Pilot for rapid access to NIH-funded research and the MEDLINE 2022 initiative, which resulted in 100% automated indexing of the biomedical literature available through NLM’s PubMed and PubMed Central (PMC).

Throughout his tenure at NLM, Dr. Sherry has participated in many NIH efforts to characterize human genetic diversity and has served on numerous working groups across NIH to address a range of data science issues including the development of the genomic data sharing policy, privacy analysis for risk-sensitive data sets and advances in scientific publications.

Dr. Sherry earned his PhD in Anthropology at Pennsylvania State University in 1996 and completed a postdoctoral fellowship at the Louisiana State University Medical Center prior to joining NLM in 1998.

NLM Directors

Major divisions.

NLM’s Extramural Programs Division offers grant support for research projects and research training in biomedical informatics and data science. Biomedical informatics and data science research develop methods and approaches to improve the capture, integration, management, analysis, visualization, retrieval, and use of biomedical and behavioral information and data relating to human health. The Extramural Programs Division provides research support for both basic and applied research in these and related areas.

To expand the biomedical workforce in the area of biomedical informatics and data science, NLM supports training in biomedical informatics at educational institutions throughout the U.S. These programs offer pre-doctoral and post-doctoral training for research careers in health care informatics, biomedical data science, translational informatics, clinical research informatics, public health informatics, and related areas. In addition, individual pre-doctoral fellowships in biomedical informatics or data science are offered, as are career transition awards.

Grants are also made to U.S. small businesses that seek to undertake informatics research and development leading to commercialization. Critical research areas include helping consumers visualize health data, data integration of large disparate data resources, artificial intelligence techniques for biomedical data resources, and the enhancement of biomedical data, including personal health data, to allow access to data for more than one user at the same time. NLM also participates in NIH initiatives for small businesses relating to the adoption of the Fast Healthcare Interoperability Resources (FHIR) standard for exchanging electronic health information, and seeking improved therapies and techniques to enhance pain measurement  and treatment in support of the NIH Helping to End Addiction Long-term (HEAL) Initiative .

The Extramural Programs Division has two unique programs to support developing information resources to help reduce health disparities and developing resources related to the history and philosophy of medicine and public health.

NLM is a leader in research training in biomedical informatics, computational biology, and data science. NLM supports 200 pre-doctoral and post-doctoral trainees per year in biomedical informatics and data science in 16 university-based programs across the country. These programs encourage applications from people traditionally underrepresented in biomedical informatics and research; eleven of the programs offer special short-term summer training to enhance recruitment. In FY 2019, NLM partnered with the National Science Foundation to engage data science research experts with biomedical researchers studying and developing advanced analytical methods applied to health.

All active grant programs of NLM, lists of recent awardees, and contact information for grant staff are provided at  https://www.nlm.nih.gov/ep/ .

Division of Library Operations (LO)

The Division of Library Operations acquires, organizes, preserves, and provides access to the NLM Collection, which represents the intellectual content and diversity of the world’s biomedical literature, data, and other research objects and information. These activities are guided by the NLM Collection and Preservation Policy approved by the NLM Board of Regents in 2019. LO also creates and disseminates controlled vocabularies including  MeSH ,  UMLS , and  RxNorm , and a library classification scheme. LO is home to the National Information Center on Health Services Research and Health Care Technology, which provides resources such as HSRProj , a database of health services research projects.

LO produces authoritative indexing and cataloging records and builds and distributes bibliographic, directory, and full-text databases including MEDLINE through PubMed and DailyMed.

NLM uses multiple channels to reach the public, including consumer-friendly websites, direct contact, and community networks. Trusted and authoritative consumer health information is available through MedlinePlus , MedlinePlus en español , and MedlinePlus Connect , a free service that links patient portals and electronic health records to consumer health information.

LO is also home to the  NIH Common Data Element Repository , part of an NIH-wide initiative to encourage health data standards in clinical research and patient registries. LO provides document delivery, primarily through the NLM system DOCLINE , and customer service that helps people effectively use NLM collections and resources.

The History of Medicine Division collects, preserves, makes available, and interprets the world’s richest collection of historical materials, spanning the 11 th to 21 st centuries in both physical and digital formats, including a historical exhibitions program and a blog called Circulating Now .

NLM’s Office of Engagement and Training (OET), home of the National Network of Libraries of Medicine (NNLM), engages more than 8,100 academic health science libraries, hospital and public libraries, and community organizations across the United States to improve access to health information. In partnership with NIH’s All of Us Research Program , NNLM engages communities that are underrepresented in biomedical research to provide information about precision medicine. NNLM also increases the data science capacity of research libraries and librarians to manage and analyze biomedical data. OET coordinates training, engagement, and capacity-building on NLM offerings for priority stakeholders and the public.

Intramural Research Program

NLM conducts pioneering research to advance knowledge in biomedical informatics, computational biology, and data science. The NLM Intramural Research Program brings together the Lister Hill National Center for Biomedical Communications and the National Center for Biotechnology Information's (NCBI) Computational Biology Branch.

NLM’s research portfolio includes artificial intelligence, computational biology, clinical decision support, and public health surveillance. NLM’s research produces novel analytical approaches and visualization tools that help scientists accelerate discovery from data and translate findings to clinical solutions. This research contributes to a deeper understanding of the effects of medications, procedures, and other factors that influence human health and the prevention and treatment of disease. NLM produces tools that make discoveries and health data more understandable to patients and helps people access, store, use, and understand their own health data. 

NLM supports research in medical language processing, high-speed access to biomedical information, analysis and use of high-quality biomedical imaging data, and large-scale analysis of clinical and administrative data to predict patient outcomes. Its work has validated findings from clinical research, helped locate and identify viruses that pose a threat to public health, and enhanced machine learning and image processing to screen for cervical cancer and assist in early treatment. NLM’s computational biology research creates new ways to represent and connect genomic and biological data with the biomedical literature and advance the understanding of evolutionary genomics. NLM produces analytic software tools for gaining insights about genetic mutational patterns and factors in disease, molecular binding, and protein structure and function.

NLM also hosts postdoctoral research fellows who apply informatics science to research, education, and clinical care. 

Lister Hill National Center for Biomedical Communications (LHNCBC)

Congress established the Lister Hill Center for Biomedical Communications in 1968 to improve communication about health education, research, and practice. Today, LHNCBC focuses on improving health through methodological advances in Health Data Science and Informatics. LHNCBC activities are centered on clinical data and aim to produce interoperable data, scalable methods, and translation of research discoveries into operations.

In addition to contributing to the NLM Intramural Research Program, LHNCBC staff translate research insights into products and services offered to the public (e.g., Open-i ® , an open access biomedical image search engine) and to the research community (e.g., the NLM Scrubber, a software package for de-identifying clinical text) or for use in NLM operations (e.g., the Medical Text Indexer, a tool that produces indexing recommendations for MEDLINE citations). LHNCBC has a long tradition of applying artificial intelligence techniques to clinical images for diagnostic or prognostic purposes. Examples include identification of malaria parasites in blood smears, classification of chest X-rays for tuberculosis, and detection and staging of cervical cancer from uterine cervix photographs and histology images. LHNCBC staff also lead the development, enhancement, and adoption of clinical vocabulary (e.g., SNOMED CT, LOINC and RxNorm) and information model standards, with focus on the HL7 FHIR standard (Fast Healthcare Interoperability Resources) for exchanging clinical information.

National Center for Biotechnology Information (NCBI)

Congress established the National Center for Biotechnology Information in 1988 as a division of NLM and as a national resource for molecular biology information. Since then, NCBI has been a leading source for public biomedical databases, software tools for analyzing molecular and genomic data, and research in computational biology

NCBI creates and maintains over 40 databases for the medical and scientific communities as well as the general public; these include literature, molecular, and genomic databases. NCBI’s core literature database is PubMed, which provides abstracts and citations for millions of articles from thousands of biomedical journals. PubMed records include links to full-text versions of the articles (when available) from NCBI’s PubMed Central (PMC) electronic archive and from journal websites, as well as links to related information from other NCBI sites, such as the genomic and molecular databases.

Some of NCBI’s core genomic and genetic resources include GenBank, an annotated collection of all publicly available DNA sequences; RefSeq, a curated collection of DNA, RNA, and protein sequences; the Sequence Read Archive (SRA), which houses high-throughput sequencing data; dbSNP, a database of short genetic variations (areas of the genome that have been found to vary among humans); dbGaP, a database that connects genotype and phenotype data from genome-wide association studies (GWAS) and other studies; ClinVar, a collection of reported relationships between genetic variations and observed health status; the Genetic Testing registry, a database of genetic tests; and the Pathogen Detection resource, which integrates sequence data for bacterial pathogens obtained from food, the environment, and human patients to facilitate active, real-time surveillance of pathogens and foodborne disease. NCBI also produces ClinicalTrials.gov, a database of privately and publicly funded clinical studies conducted around the world. Additional databases include information on chemical structures and their biological activities, protein sequences, protein structure, chromosomal aberrations in cancer, genes and gene expression, taxonomy, and more.

Office of Computer and Communications Systems (OCCS)

The Office of Computer and Communications Systems provides information technology services and technical advice to support the research and management programs offered through NLM. OCCS manages and operates the NLM network backbone, connections to the Internet and Internet2 networks, internal computer networks within NLM, NLM’s onsite and offsite data center facilities, platforms for enterprise compute and storage, platforms for end-user computation, and mobile user and remote access technologies.

OCCS develops and operates IT services and software applications that support the Library’s mission. OCCS develops applications both for internal and public use—with specific expertise in developing software applications that use standardized medical terminology.

OCCS provides customer support, training, and documentation for computer and network users. In addition, OCCS develops standards and guidance for managing and using information technology at NLM in accordance with industry best practices and applicable federal government mandates. OCCS provides oversight of all information security programs at NLM and ensures that NLM information systems comply with federal information security standards.

As the chief information officer of NLM, the director of OCCS approves acquisitions related to information technology, oversees the governance process for NLM investments in information technology and ensures NLM complies with relevant federal laws, directives and standards.

This page last reviewed on November 3, 2023

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Discovery resource for women’s health research now available.

Partnering with the National Library of Medicine (NLM), the Office of Research on Women's Health (ORWH) launched the first phase of a novel discovery resource for women’s health research (WHR), called DiscoverWHR.

DiscoverWHR is a centralized resource for women’s health research and information from NIH that supports NIH-wide efforts to close the gaps in women’s health across the life course.

This innovative resource simplifies the finding women’s health information by patients, caregivers, medical professionals, researchers, and the public.

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Learn more about DiscoverWHR , the NIH Discovery Portal for Women’s Health Research.

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Intramural research at NLM consists of the development and application of computational approaches to a broad range of problems in biomedicine, molecular biology, and health. READ RESEARCH HIGHLIGHTS | MEET OUR PRINCIPAL INVESTIGATORS | EXPLORE TRAINING OPPORTUNITIES

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The Library started as a shelf of books in the Surgeon General’s office in 1836 but has grown to a collection of millions of print and electronic resources.

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National Library of Medicine

The National Library of Medicine (NLM) is a leader in research in biomedical informatics and data science and the world’s largest biomedical library. NLM conducts and supports research in methods for recording, storing, retrieving, preserving, and communicating health information. It is part of the National Institutes of Health (NIH).

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The top list of research databases for medicine and healthcare

3. Cochrane Library

4. pubmed central (pmc), 5. uptodate, frequently asked questions about research databases for medicine and healthcare, related articles.

Web of Science and Scopus are interdisciplinary research databases and have a broad scope. For biomedical research, medicine, and healthcare there are a couple of outstanding academic databases that provide true value in your daily research.

Scholarly databases can help you find scientific articles, research papers , conference proceedings, reviews and much more. We have compiled a list of the top 5 research databases with a special focus on healthcare and medicine.

PubMed is the number one source for medical and healthcare research. It is hosted by the National Institutes of Health (NIH) and provides bibliographic information including abstracts and links to the full text publisher websites for more than 28 million articles.

• Coverage: around 35 million items
• Abstracts: ✔
• Related articles: ✔
• References: ✘
• Cited by: ✘
• Links to full text: ✔
• Export formats: XML, NBIB

Pro tip: Use a reference manager like Paperpile to keep track of all your sources. Paperpile integrates with PubMed and many popular databases. You can save references and PDFs directly to your library using the Paperpile buttons and later cite them in thousands of citation styles:

EMBASE (Excerpta Medica Database) is a proprietary research database that also includes PubMed. It can also be accessed by other database providers such as Ovid .

• Coverage: 38 million articles
• References: ✔
• Cited by: ✔
• Full text: ✔ (requires institutional subscription to EMBASE and individual publishers)
• Export formats: RIS

The Cochrane Library is best know for its systematic reviews. There are 53 review groups around the world that ensure that the published reviews are of high-quality and evidence based. Articles are updated over time to reflect new research.

• Coverage: several thousand high quality reviews
• Full text: ✔
• Export formats: RIS, BibTeX

PubMed Central is the free, open access branch of PubMed. It includes full-text versions for all indexed papers. You might also want to check out its sister site Europe PMC .

• Coverage: more than 8 million articles
• Export formats: APA, MLA, AMA, RIS, NBIB

Like the Cochrane Library, UpToDate provides detailed reviews for clinical topics. Reviews are constantly updated to provide an up-to-date view.

• Coverage: several thousand articles from over 420 peer-reviewed journals
• Related articles: ✘
• Full text: ✔ (requires institutional subscription)
• Export formats: ✘

PubMed is the number one source for medical and healthcare research. It is hosted at the National Institutes of Health (NIH) and provides bibliographic information including abstracts and links to the full text publisher websites for more than 35 million items.

EMBASE (Excerpta Medica Database) is a proprietary research database that also includes in its corpus PubMed. It can also be accessed by other database providers such as Ovid.

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Effects of Participating in Martial Arts in Children: A Systematic Review

Aleksandar stamenković, roberto roklicer, tatjana trivić, pavle malović, patrik drid.

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Correspondence: [email protected]

Received 2022 Jul 12; Accepted 2022 Aug 1; Collection date 2022 Aug.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/ ).

Background: The application of various martial arts programs can greatly contribute to improving the of physical fitness of preschool and school children. The purpose of this review paper was to determine the effects and influence that martial arts program intervention has on children’s physical fitness, which includes motor skills and the aerobic and anaerobic abilities of children. Method: We searched the following electronic scientific databases for articles published in English from January 2006 to April 2021 to gather data for this review paper: Google Scholar, Pub Med, and Web of Science. Results: After the search was completed, 162 studies were identified, of which 16 studies were selected and were systematically reviewed and analyzed. Eight studies included karate programs, four studies included judo programs, two studies contained aikido programs, and two studies contained taekwondo programs. The total number of participants was 1615 (experimental group = 914, control group = 701). Based on the main findings, karate, judo, taekwondo, and aikido programs showed positive effects on the physical fitness of the experimental group of children. According to the results, the effects of these programs showed statistically significant improvements between the initial and final measurements of most of the examined experimental groups. Conclusion: We concluded that martial arts programs were helpful for improving the physical fitness of preschool and school children, especially for parameters such as cardiorespiratory fitness, speed, agility, strength, flexibility, coordination, and balance.

Keywords: combat sports, physical fitness, motor skills, cardiorespiratory fitness

1. Introduction

Martial arts have been practiced for hundreds of years, and today, with modification, they are often used in the form of sports, self-defense, and recreation [ 1 ]. Applying well-organized martial arts programs to children can lead to an increase in physical fitness, although the test results are not unequivocal [ 2 ]. Many studies have explored the application of various martial arts programs in children in order to improve their motor skills and physical fitness [ 1 , 2 , 3 , 4 , 5 ]. Positive effects could sometimes be visible, especially in children who have been practicing martial arts since childhood. Regarding motor abilities, the development of explosive power, speed of movement, agility, strength, balance, and precision could be noticed [ 6 , 7 ], while on the other hand, in addition to specific physical fitness, aerobic and anaerobic endurance were developed [ 8 , 9 , 10 ]. In addition, the link between positive socio-psychological responses and involvement in martial arts has also been reported in children. Specifically, increased social skills and self-confidence, along with less aggressiveness, were evident among young martial artists [ 11 ]. Furthermore, martial arts can have a significant influence on mental health and on the formation of personal character in young people. Moreover, practicing martial arts helps young people to learn the elements of self-defense and improve their fitness level [ 12 ].

The progress of science and technology has led to a decrease in motor activity in favor of a sedentary lifestyle, which has negatively affected the physical development of children [ 7 ]. The percentage of children who meet the World Health Organization (WHO) criteria for the recommended level of physical activity [ 13 ] is very small and ranges from 2% to 14% and from 9% to 34% in European girls and boys, respectively [ 5 ]. Practicing martial arts greatly affects the improvement of the conative characteristics of a person, such as determination, consistency, and motivation [ 14 ], as a result of well-organized training, which can directly affect the improvement of physical fitness [ 15 ]. This correlates with the results of a study performed by Pinto-Escalona et al. [ 5 ]. Pinto-Escalona et al. conducted a one-year investigation in which the experimental group underwent karate intervention at school that led to improved cardiorespiratory fitness and balance in the children. This study was in line with the findings of Pavlova et al. [ 16 ] who conducted research with children aged between 5 and 6 years of age. The experimental group (EG) of children underwent a one-year karate program, compared to the classic program of preschool education that the control group (CG) underwent. The results showed that the EG had twice the overall growth rate of physical fitness compared to the CG, with the highest growth rate observed in children in the EG in the “Flamingo” pose (balance). In a study by Boguszewski and Socha [ 7 ], which included three groups of children from preschools (children that practiced karate, gymnasts, and inactive children), the best results in the upper extremity strength test were achieved by girls that practiced karate. In addition, based on the obtained results, Boguszewski et al. [ 17 ] reported significant improvements in deep squats, shoulder mobility, and torso stability (push-ups) in the experimental karate group. These two karate studies were correlated with the research of Kirpenko et al. [ 18 ], which showed that there was a significant improvement in the maximum aerobic capacity, strength, speed–power quality, endurance, and flexibility in the Kyokushin karate experimental group in which children between 10 and 12 years of age were examined. The existing literature reveals the positive impact of various martial arts and combat sports on children’s well-being. The available evidence demonstrates a positive impact on the physiological and physical development of children who practice judo and meet the recommended standards of health-related physical activity [ 19 ]. Moreover, Lee and Kim [ 20 ] used 16-week taekwondo training in their work and found that children in the the experimental group showed increases in maximum strength and balance. Wasik et al. [ 21 ] reported positive effects on body posture; the number of occurrences of body asymmetry was reduced in children and adolescents following a taekwondo training program. In research by Falk and Mor [ 6 ], the experimental group of children, which contained children between 6 and 7 years of age, that underwent the 12-week resistance training and martial arts program, showed significant ( p < 0.05) improvements compared with the control group in the sit-up and long jump tests.

Based on the authors’ findings, there are a small number of review studies that have investigated the effects and impacts of martial arts programs on children’s physical fitness [ 22 ]. Considering that the modern age has led to obesity and the deterioration of motor skills in children, this research could contribute to solving this global problem through the organization of martial arts programs, which could be performed as additional activities alongside regular physical education classes. Hence, this review aimed to determine the effects and influence that martial arts program intervention has on children’s physical fitness, which includes motor skills and the aerobic and anaerobic abilities of children.

2. Materials and Methods

2.1. inclusion criteria.

The following criteria were used to select the articles to be included in the review: (1) original scientific articles; (2) all studies that dealt with martial arts; (3) articles written in English; (4) articles where the participants in the sample were children of preschool and school age (between 4 and 18 years of age).

2.2. Exclusion Criteria

The following criteria were used to select the articles to be excluded from the research: (1) review studies; (2) studies in which the subjects were children younger than 4 years of age and older than 18 years of age; (3) articles with research in which the experimental groups of children were not subjected to martial arts training programs; (4) articles in which the results or investigated parameters were not adequately presented for further analysis.

2.3. Search Strategy and Study Selection

Electronic database searches were performed using Google Scholar, Pub Med, and Web of Science. The search terms covered the areas of the influence of martial arts training on physical fitness and martial arts programs for preschool and school children using a combination of the following keywords: “martial arts”, “physical fitness”, “children”, “motor skills”, “cardiorespiratory fitness”. The results of a search of articles written in English and published between January 2006 and April 2021 were analyzed. Articles from the database list that were clearly not relevant were removed before assessing all other titles and abstracts using our predetermined inclusion and exclusion criteria. Inter-reviewer disagreements were resolved by consensus opinion or arbitration by a third reviewer. Reference lists of the selected manuscripts were also examined for any other potentially eligible articles.

2.4. Assessment of Bias

Two independent reviewers assessed the risk of bias. The agreement between the two reviewers was evaluated using k full-text screening statistics and an assessment of relevance and the risk of bias. When there was disagreement over the risk of bias, the third reviewer checked the data and formed the final decision. The agreement rate for k among reviewers was k = 0.95. Inter-observational reliability and agreement were calculated using the interclass correlation coefficient and Cohen’s kappa test with values interpreted as follows: 0—no agreement; 0.01–0.20—slight agreement; 0.21–0.40—good agreement; 0.41–0.60—moderate agreement; 0.61–0.80—significant agreement; and 0.81–1.0—almost perfect agreement.

Selection and Inclusion of Studies

We collected 159 studies through a database search in Google Scholar, PubMed, and Web of Science. Three more studies were found from other sources; thus, the total number of collected studies was 162. Next, we excluded 63 duplicate studies (duplicate search or publication of the thesis in a journal). After reviewing the research titles and abstracts of the 99 remaining selected studies, an additional 26 studies were excluded that included children with diseases and children older than 18 years of age. Another 10 studies were excluded because they included martial arts that were not classified as budo martial arts. In addition, seven other studies were excluded because full texts were not available. Therefore, we selected 67 studies after excluding 32 studies. We reviewed the full text of the 67 selected studies and classified them according to the PICOS criteria. After that, 24 studies with no control groups, seven studies with unclear statistics, and 18 studies with uncertain training durations were excluded. Therefore, we finally included 16 studies (8 studies included only male participants, 1 study included only female participants, and 7 studies included both sexes) ( Table 1 ). The data selection method is presented within the following flow diagram ( Figure 1 ).

Results of the included studies.

Legend: M—male; F—female; E—experimental group; C—control group; wk—week; m—month; ND—not defined; PE—physical education; B—boys; G—girls; B/N—boys of normal weight; G/N—girls of normal weight; B/O—overweight boys; G/O—overweight girls; Ob—obese; NOb—non-obese; PH—physical; HW—healthy weight; OW—overweight; S—strength; MS—muscle strength; ES—explosive strength; ULES—upper limb explosive strength; LLES—lower limb explosive strength; RS—repetitive strength; COR—coordination; AGL—agility; FLEX—flexibility; SP—speed; BAL—balance; EN—endurance; MEN—muscular endurance; CREN—cardiorespiratory endurance; CREF—cardiorespiratory fitness; FMS—functional movement screen; CPET—cardiopulmonary exercise testing; TAOR—total angle of rotation; AOER—angle of external rotation; AOIR—angle of internal rotation; Lh—left hip; Rh—right hip; ↑—increased (↑*– significantly increased); ↓—decreased (↓*– significantly decreased); ↔—no significant difference; ↔*—significant difference; (E, C)—between groups E and C.

PRISMA flow diagram.

The study included 16 original research articles that tested the effects of martial arts programs in children aged between 4 and 13 years of age. The articles are presented in tabular form by year of publication from 2006 to 2021, respectively. There were no control groups in four articles [ 2 , 23 , 30 , 32 ]. The youngest participant was 4.5 years old [ 7 ], and the oldest participant was 13 years [ 33 ]. The total number of participants was 1615 (EG = 914, CG = 701). The sample sizes of the studies were analyzed and ranged from 10 [ 25 ] to 721 children [ 5 ]. In seven studies, both genders were included [ 2 , 4 , 5 , 7 , 25 , 30 , 31 ]. In eight studies, the participants were only male children [ 16 , 18 , 23 , 26 , 27 , 28 , 29 , 32 ], while one study included only girls [ 24 ]. The longest experimental treatment lasted two years [ 18 ] and the shortest only lasted a week [ 26 ]. Frequently, the duration of the sessions in all martial arts programs was 60 min [ 2 , 4 , 5 , 7 , 16 , 26 , 27 , 28 , 32 ]. Eight studies included experimental treatments of karate [ 2 , 4 , 5 , 7 , 16 , 18 , 26 , 29 ], four studies included judo treatments [ 23 , 24 , 25 , 32 ], in two articles taekwondo treatments were employed [ 26 , 27 ], and two studies included experimental aikido treatments [ 27 , 28 ].

4. Discussion

This study examined the effects of various martial arts programs on children’s physical fitness. Based on the main findings, karate, judo, taekwondo, and aikido programs showed positive effects on physical fitness components. According to the results, the effects of these programs showed significant differences between the initial and final measurements of most of the examined experimental programs, but also when compared to the control groups. Cardiorespiratory fitness, speed, agility, strength, flexibility, coordination, and balance were used to assess physical fitness, while other parameters, such as body composition, mental conative, and cognitive capacities, were excluded.

4.1. Cardiorespiratory Fitness

Cardiorespiratory fitness as a parameter of physical fitness was represented in only three studies [ 18 , 28 , 32 ]. After a 24-month karate program, Kyrpenko et al. [ 18 ] found a large statistically significant improvement ( p < 0.01) in the cardiorespiratory endurance parameter in the EG of karatekas, while in inactive children in the CG, this was not the case. The 1000 m test is a middle-distance running test that gives participants the opportunity to increase their cardiorespiratory fitness at the expense of muscle strength and to improve their running technique, unlike running for 20 m, 30 m, and 100 m, where the type of muscle fibers, despite the training, plays a major role. Since the treatment in the EG lasted 24 months, it was no wonder that there was a significant improvement in the final measurement, given that the subjects had enough time to increase their strength and improve their running technique. In addition, Brasil et al. [ 32 ] assessed the cardiorespiratory ability of obese and non-obese children after participating in a 12-week judo program. The authors concluded that there was a decrease in the VO2peak parameter in the obese children and statistically significant differences in HR at the VO2peak between non-obese and obese children. Given that obese children have an excess of inefficient adipose tissue that leads to accelerated fatigue, it was no wonder that HRs at the VO2peaks were higher in the obese children. Pop et al. [ 28 ] examined cardiorespiratory endurance, where the EG, in addition to regular classes of physical education, was subjected to an eight-month aikido program, while the control group attended only physical education classes. Testing was performed using the 20 m beep test, and, on that occasion, it was concluded that there were no statistically significant differences between the EG and the CG in the final measurements.

4.2. Speed and Agility

The shuttle run agility test has been the main tool to test this motor ability in many studies in which agility as a parameter of physical fitness was presented [ 7 , 18 , 23 , 24 , 29 , 31 ]. Specifically, using the nine-month judo program, Sekulic et al. [ 23 ] found statistically significant differences ( p < 0.05) in the final measurements of the 4 × 1.98 m shuttle run agility test in an experimental group of subjects composed of boys. This was in correlation with the findings of Krstulović et al. [ 24 ], who also found statistically significant differences using the same test as the judo program of the same duration in female participants. In addition, using a six-month karate program, Boguszevski and Socha [ 7 ] used the 4 × 5 shuttle run test to assess agility, concluding that progress had been made in the final measurements, but they remained statistically insignificant. This was not correlated with Ma and Qu [ 29 ], who used the same 4 × 5 shuttle run test to identify the effects of a two-month karate program. They found a statistically significant difference ( p < 0.01) in the final measurement of the EG that correlated with the results obtained by Top et al. [ 31 ] and Kyrpenko et al. [ 18 ], who tested the agility of the 4 × 9 shuttle run test using a two-year karate program and found a statistically significant improvement ( p < 0.01) in the EG compared to the CG.

Padulo et al. [ 26 ] used frontal/side jumps in a quadratic agility assessment test to compare the effects of a one-week high- and low-intensity karate program. They found a statistically significant improvement in the EG. They also found a statistically significant difference between the EG and the CG in favor of the EG on the final measurement. Speed was one of the monitored parameters of physical fitness in five articles [ 4 , 23 , 24 , 25 , 28 ]. Various running speed tests were used to measure speed as a parameter of physical fitness. Sekulic et al. [ 23 ] concluded that the change in speed in boys did not occur in the initial and final EG measurements. This correlated with the findings of Krstulović et al. [ 24 ], who applied almost the same program for 9 months in female participants; however, this was not correlated with the findings of Demiral [ 25 ], whose research showed statistically significant differences between the EG and the CG in the 20 m sprint test. Perhaps the reason was that Demiral’s study lasted 3 months longer than the previously mentioned studies [ 23 , 24 ], where the participants were subjected to experimental treatment for a longer period of time. A study conducted by Pop et al. [ 28 ] used 20 m sprint tests, while Alesi et al. [ 4 ] applied a transfer-running test to check the speed skill of participants and also found statistically significant differences between the EG and the CG in favor of the EG.

4.3. Strength

Strength, as a parameter of physical fitness, was assessed in 12 research articles [ 2 , 4 , 7 , 16 , 18 , 23 , 24 , 25 , 26 , 29 , 30 , 31 ]. In most of the studies, the explosive strength of the legs and arms was measured using standing long jumps and medical ball throws tests. Specifically, in all studies in which explosive power was tested by these test protocols, statistically significant improvements in the EGs were present [ 2 , 4 , 7 , 16 , 18 , 22 , 23 , 24 , 25 , 26 , 29 , 31 ] and also in some CGs [ 16 , 22 , 24 ]. Since the ULES parameter (upper limb explosive strength) was presented in five articles [ 7 , 16 , 25 , 26 , 29 ], and the fact that in each of these articles medical ball throws were used, it was the main test for estimating this parameter. In four of the five studies, the karate program was applied, while the judo program was implemented in only one study [ 25 ]. Considering that karate is a striking martial art and sport, which requires highly developed explosiveness and quickness that is constantly emphasized during the training, it is absolutely justified and logical that this parameter improved. Repetitive strength was presented in three studies [ 7 , 16 , 29 ]. Based on the results of their research, Boguszevski and Socha [ 7 ] found no statistically significant differences between the EG and the CG on the initial and final measurements of the sit-up test in their study in which a six-month karate program was applied. This correlated with the results obtained by Ma and Qu [ 30 ], who tested the repetitive strength of karatekas conducting the same test and concluded that there were no statistically significant improvements in their EG at the final measurements. Interestingly, the authors of both articles came to the same conclusions, even though the karate program proposed by Boguszevski and Socha [ 7 ] lasted 24 weeks and the program of Ma and Qu [ 29 ] lasted only 8 weeks. It is probable that the main reason for this is the fact that there were no exercises in the experimental karate programs that affected the repetitive strength of the abdominal muscles. Pavlova et al. [ 16 ] found that after a 12-month karate program, there was a statistically significant improvement ( p < 0.01) in the EG in repetitive leg strength. A significant improvement ( p < 0.01) was also registered in the CG, where the participants attended only physical education classes. Since the children were aged between 5 and 6 years old at the beginning of the treatment, it is likely that one of the reasons for the great improvement was maturation.

4.4. Flexibility

Flexibility was one of the parameters for assessing physical fitness in 10 articles [ 2 , 5 , 7 , 18 , 23 , 24 , 26 , 27 , 29 , 30 ]. The most common flexibility assessment test used in as many as five articles was the “sit and reach” test [ 2 , 23 , 24 , 29 , 30 ]. The results of this test showed statistically significant differences in flexibility between the EG and the CG in the final measurements in two articles by Krstulović et al. [ 24 ] and Sekulic et al. [ 23 ], in which 9-month judo programs were conducted. This was partially in line with the findings of Rutkowski et al. [ 2 ], who, by applying a 10-week karate program, found a statistically significant decrease in flexibility in normal-weight boys, while in normal-weight girls, there was a statistically significant difference. In addition, this did not correlate with the results of Pathare et al. [ 30 ] and Ma and Qu [ 29 ]; in these studies no statistically significant improvement in flexibility was observed. In addition, the author Mrockowski [ 27 ] used a nine-month aikido program, where the hip flexibility test “samurai walk” was used to examine flexibility, and the presence of statistically significant differences between the EG and the CG were evident. Boguszevski and Socha [ 7 ] used the “finger floor” test to assess flexibility and found that the participants in the EG group (girls) significantly improved their performances compared to the control group. This correlated with Padulo et al. [ 26 ], who obtained similar results, checking the flexibility of the joints after a one-week program of high-intensity karate (EG) and low-intensity karate (CG); however, this did not correlate with the findings of Kirpenko et al. [ 18 ] who concluded that 12 months of karate did not cause an improvement in flexibility.

4.5. Coordination

Coordination as a parameter of physical fitness was represented in four articles [ 23 , 24 , 25 , 31 ]. The results of the 10 m polygon test conducted by Krstulović et al. [ 24 ] and Sekulić et al. [ 23 ] did not show statistically significant differences in coordination between the EG and the CG in the final measurements of both studies. In his research, Demiral [ 25 ] applied the coordination test (balance skill) and rapidity test in the EG and the CG of judokas and found statistically significant improvements ( p < 0.01) in both sexes of the EG. In addition, statistically significant differences ( p < 0.01) in coordination were found in the EG of girls compared to the CG. However, these results were partially in line with the results of Top et al. [ 31 ], which indicated a statistically significant improvement ( p < 0.05) in the EG, but no statistically significant differences between the EG and the CG in the final measurements were observed.

4.6. Balance

Balance was tested in the majority of studies using the “flamingo” balance test [ 16 , 25 , 28 ]. In addition, other articles used the following tests: the Y balance test [ 5 ], the single-leg balance test with closed and open eyes [ 2 , 31 ], and a test that involved balancing on a force plate device [ 30 ]. Demiral [ 25 ] found a statistically significant improvement in balance in the EG of boys and girls following a 12-month judo program. These findings were not correlated with the results of Pop et al. [ 28 ], who found no significant differences between the EG and the CG after an eight-month aikido program in addition to regular physical education classes. In addition, according to Demiral’s findings, a partial correlation was found with the study of Pavlova et al. [ 16 ]; the EG achieved a statistically significant improvement in balance, which was the same as the CG, whose participants only attended regular physical education classes. Speaking of the Y balance test, Pinto-Escalona et al. [ 5 ] found a slight improvement in the EG group that was not statistically significant. In the research performed by Rutkowski et al. [ 2 ], in which all the subjects underwent experimental treatment, only boys of normal weight achieved a statistically significant improvement in balance. This was not consistent with the findings of Pathare et al. [ 30 ], who discovered that overweight children had greater improvements in balance than healthy-weight children.

4.7. Future Research

Important considerations were identified from this review to support the development of future research in this research field, such as the following:

One needs to be cautious when adopting an intervention program model that has already been performed and has relevant methodological limitations.

There is a lack of studies dealing with the impact of martial arts on children’s cardiorespiratory and motor-skill parameters. In future studies, the emphasis should be on non-budo martial arts such as capoeira, muay Thai, Brazilian jiu-jitsu, wrestling, and other combat sports [ 33 ].

The following studies might have investigate preschool children because, in most countries, children start practicing martial arts from an early age.

Various martial arts programs for school and preschool children need to be analyzed and a larger number of physical fitness parameters with an emphasis on body composition, as well as the heterochronism of their development, need to be monitored.

4.8. Strengths and Limitations

This is one of the first review papers that combined several different martial arts and analyzed their effect on children, including a comprehensive search of studies and the assessment of their methodological qualities. The main limitation of this study is the fact that, in addition to judo, taekwondo, and aikido, the majority of the research papers were based on karate. Therefore, the karate program was the most effective in terms of positive impact on physical fitness. Additionally, a significantly larger number of male children were included in the monitored studies. Given that there are large differences in motor skills and cardiorespiratory fitness between boys and girls, the gender should be defined separately.

5. Conclusions

This review confirmed that martial arts programs lead to improved physical fitness in preschool and school children. Based on the results of the analysis, it could be concluded that cardiorespiratory fitness, speed, agility, strength, flexibility, coordination, and balance were the most important parameters of physical fitness, which demonstrated considerable improvement in the final measurements of EG participants. The obtained information could be very useful in promoting and advertising the positive aspects of these budo martial arts, which can directly affect children’s and parents’ choices when it comes to choosing the sport that they will practice.

Author Contributions

Conceptualization, A.S. and M.M.; methodology, R.R. and T.T.; software, M.M.; validation, P.M. and P.D.; formal analysis, M.M.; investigation, A.S.; resources, P.D.; data curation, M.M.; writing—original draft preparation, A.S. and M.M.; writing—review and editing, R.R., T.T., P.M. and P.D.; visualization, A.S.; supervision, P.D.; project administration, A.S.; funding acquisition, P.D. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement.

Data are contained within the article.

Conflicts of Interest

The authors declare no conflict of interest.

Funding Statement

This work was supported by the Serbian Ministry of Education, Science, and Technological Development and the Provincial Secretariat for Higher Education and Scientific Research (142-451-2594).

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

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Tusi: a new ketamine concoction complicating the drug landscape

Affiliation.

• 1 Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
• PMID: 37162319
• PMCID: PMC10636235
• DOI: 10.1080/00952990.2023.2207716

A drug concoction called tusi has emerged in Latin America and in Europe and is now beginning to acquire popularity in the United States. "Tusi" is a phonetic translation of "2C," a series of psychedelic phenethylamines. The concoction is also sometimes referred to as "pink cocaine" as it typically comes in the form of pink powder. However, despite its name, the concoction rarely contains 2C series drugs. Multiple drug checking studies have found that the majority of tusi samples contain ketamine, often combined with 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine, cocaine, opioids, and/or new psychoactive substances. The tusi phenomenon complicates the drug landscape because it has the potential to confuse both people who use it and researchers alike. People using may think the drug is 2C/2C-B, and they may also be unaware that the concoction tends to consist of ketamine and a wide variety of other drugs. Unintentional exposure to its contents can lead to increased risk of adverse effects. The tusi phenomenon also has the potential to complicate drug research as unknown exposure to drugs like ketamine and MDMA will lead to underreporting of use. A combination of self-report and toxicological testing may be needed to inform the most accurate estimates of use. Both researchers and people at risk for use need to be informed about this new concoction. Drug researchers need to be cognizant about the way they query use, and people at risk for using need to be educated about the possible contents of tusi and associated dangers.

Keywords: Tusi; club drugs; ketamine; new psychoactive substances.

Publication types

• Research Support, N.I.H., Extramural
• Hallucinogens*
• Ketamine* / adverse effects
• Methamphetamine*
• N-Methyl-3,4-methylenedioxyamphetamine* / adverse effects
• Substance-Related Disorders* / epidemiology
• N-Methyl-3,4-methylenedioxyamphetamine
• Hallucinogens
• Methamphetamine

Grants and funding

• R01 DA044207/DA/NIDA NIH HHS/United States

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