Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis
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The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of particular importance in youth.
The aim of this systematic review was to quantify the effectiveness of exercise-based injury prevention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables.
An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EMBASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth).
Randomized controlled trials and controlled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age.
Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model.
Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7–17.8]), were included. The overall RR was 0.54 (95 % CI 0.45–0.67) [p < 0.001]. Girls profited more from injury prevention than boys (p = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95 % CI 0.37–0.63]) and those aiming at all injuries (RR 0.62 [95 % CI 0.48–0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial (p = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better (p = 0.002) injury preventive effect (RR 0.45 [95 % CI 0.35–0.57], Z = 6.35, p < 0.001) than studies without such exercises (RR 0.74 [95 % CI 0.61–0.90], Z = 3.03, p = 0.002).
The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. In particular, multimodal programs including jumping/plyometric exercises can be recommended. However, there is a considerable lack of data for children (under 14 years of age) and for individual sports in general. Future research should include these groups and focus on the effect of specific exercises and compliance.
KeywordsAnterior Cruciate Ligament Rate Ratio Anterior Cruciate Ligament Injury Injury Prevention Injury Incidence
Oliver Faude and Roland Rössler designed the study protocol. Roland Rössler and Thomas Schweizer searched the databases and checked the obtained studies regarding inclusion and exclusion criteria. Oliver Faude, Astrid Junge, and Evert Verhagen contributed to the search. Oliver Faude and Roland Rössler assessed the eligibility of the studies for inclusion. Roland Rössler and Thomas Schweizer extracted the data. Roland Rössler and Lars Donath assessed the quality of eligible studies. Oliver Faude contributed to the study quality assessment. Roland Rössler conducted the analysis and wrote the draft of the paper. All authors contributed to writing, reviewing, and revising the manuscript, agreed on the final draft, and take responsibility for the integrity of the data and accuracy of the analysis. No sources of funding were utilized in conducting this study. Roland Rössler, Lars Donath, Evert Verhagen, Astrid Junge, Thomas Schweizer, and Oliver Faude have no potential conflicts of interest that are directly relevant to the content of this review.
- 2.Sibley BA, Jennifer LE. The relationship between physical activity and cognition in children: a meta-analysis. Pediatr Exerc Sci. 2003;15:243–56.Google Scholar
- 9.Kahl H, Dortschy R, Ellsasser G. Injuries among children and adolescents (1–17 years) and implementation of safety measures. Results of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50(5–6):718–27. doi: 10.1007/s00103-007-0233-7.PubMedCrossRefGoogle Scholar
- 39.Malliou P, Gioftsidou A, Pafis G, et al. Proprioceptive training (balance exercises) reduces lower extremity injuries in young soccer players. J Back Musculoskelet Rehabil. 2004;17(3):101–4.Google Scholar
- 42.Wedderkopp N, Kaltoft M, Lundgaard B, et al. Prevention of injuries in young female players in European team handball. A prospective intervention study. Scand J Med Sci Sports. 1999;1:41–7.Google Scholar
- 43.Deeks JJ, Higgins JPT, Altman DG. Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0, Cochrane Collaboration; 2011.Google Scholar
- 46.Deeks J, Higgins J. Statistical algorithms in Review Manager 5. The Cochrane Collaboration; 2010.Google Scholar
- 47.Collard DC, Verhagen EA, Chinapaw MJ, et al. Effectiveness of a school-based physical activity injury prevention program: a cluster randomized controlled trial. Arch Pediatr Adolesc Med. 2010;2:145–50.Google Scholar
- 62.Herman K, Barton C, Malliaras P, et al. The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Med. 2012;10:75. doi: 10.1186/1741-7015-10-75.PubMedCentralPubMedCrossRefGoogle Scholar
- 66.Lubans DR, Sylva K, Morgan PJ. Factors associated with physical activity in a sample of British secondary school students. Aust J Educ Dev Psychol. 2007;7:22.Google Scholar
- 76.Steffen K, Emery CA, Romiti M, et al. High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. Br J Sports Med. 2013;47(12):794–802. doi: 10.1136/bjsports-2012-091886.PubMedCrossRefGoogle Scholar