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Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis

Abstract

Background

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.

Objective

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.

Data Sources

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).

Study Selection

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.

Data Extraction

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.

Results

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).

Conclusions

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.

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Acknowledgments

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.

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Correspondence to Roland Rössler.

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Rössler, R., Donath, L., Verhagen, E. et al. Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis. Sports Med 44, 1733–1748 (2014). https://doi.org/10.1007/s40279-014-0234-2

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Keywords

  • Anterior Cruciate Ligament
  • Rate Ratio
  • Anterior Cruciate Ligament Injury
  • Injury Prevention
  • Injury Incidence