This review proposes a macronutrient‑based framework for reducing CVD risk and improving cardiovascular disease outcomes.

Background: Gender-responsive approaches that have used football have been shown to be effective in both engaging men and improving health in specific male populations. This paper reports on the health impact of participation in an ongoing recreational football initiative (Football Cooperative, [FC]) for all men up to 12M. Findings from this paper will inform the implementation strategy to scale up the FC initiative. Methods: Adopting a quasi-experimental, longitudinal design, without control, participants were recruited through purposeful sampling. Self-report, anthropometric, and fitness data were collected at baseline and at 3, 6, and 12 months. Results: Findings show a significant improvement in aerobic fitness at all time points, a positive trend in WC reduction that was significant at 12M (2.5±4.6 cm) and an achievement in the 5% weight-reduction threshold for 17% of those tested at 12M. cardiovascular disease (CVD) risk (≥5 factors) reduced from baseline (52%) to 12M (26%). Loneliness reduced at 6M with a corresponding improvement in sleep quality. However, trends toward improved psychological and health behaviour metrics are evident; the low sample size coupled with high baseline metrics, which may be influenced by gender conditioning, were a challenge to detecting change over time. Conclusion: Participation in the FC initiative reduced CVD risk and improved health metrics ; men should be supported to participate beyond 6M for increased benefit. Future research should use alternative methods to assess psychological and health behaviour metrics and aerobic fitness and should ensure a control group comparison. These findings will inform the implementation of the FC initiative at scale.