Sports Medicine

, Volume 45, Issue 3, pp 327–336 | Cite as

Injury Risk During Different Physical Activity Behaviours in Children: A Systematic Review with Bias Assessment

  • Joske Nauta
  • Eva Martin-Diener
  • Brian W. Martin
  • Willem van Mechelen
  • Evert Verhagen
Review Article

Abstract

Introduction

The current focus on a physically active lifestyle in children puts children at increased physical activity-related injury risk.

Objective

To summarise, in a systematic review, the evidence for the injury risk of several physical activity behaviours in 6- to 12-year-old children.

Methods

An electronic search was performed in three databases (Embase, PubMed and SPORTDiscus). Inclusion criteria were: age 6–12 years; report on injuries related to overall physical activity, active commuting, unorganised leisure time physical activity, physical education and/or organised sports; incidence rates expressed as injuries per hours of physical activity; and published after January 1st 2000. Risk of bias was assessed for all studies included.

Results

Eight studies were included. The risk of bias assessment resulted in two studies with a score that was higher than 75 %; risk bias of those two studies was considered low. The medically treated, injury incidence rate was reported to be between 0.15 and 0.27 injuries per 1,000 h of physical activity. The absolute number of injuries related to unorganised leisure time physical activity was higher than the absolute number of injuries reported in organised sports. The respective injury incidence rate expressed per 1,000 h exposure was, however, generally lower during unorganised leisure time than during organised sports. Reported injury incidence rates related to active commuting were comparable to those for unorganised leisure time physical activity. Conflicting injury incidence rates were reported for physical education. Subgroup analysis suggested that girls and children with low habitual levels of physical activity are at increased injury risk. A limitation of the review is that no standard bias assessment was available for this specific context.

Conclusions

Children are at an inherent injury risk while participating in physical activities. Most injury prevention efforts have focussed on the sports setting, but our results suggest that many children sustain an injury during unorganised leisure time physical activities.

Notes

Acknowledgments

Eva Martin-Diener and Brian W. Martin received partial funding for their contribution to the article in a Project with the Swiss Council for Accident Prevention (bfu). No sources of funding were used by Joske Nauta, Willem van Mechelen and Evert Verhagen to assist in the preparation of this review. The authors have no potential conflicts of interest that are directly relevant to the content of this review.

References

  1. 1.
    Global health risks: mortality and burden of disease attributable to selected major risks. WHO Library cataloguing-in-Publication Data; 2009.Google Scholar
  2. 2.
    Global recommendations on physical activity for health. WHO Library Cataloguing-in-Publication Data; 2010.Google Scholar
  3. 3.
    Physical activity among children. OECD Publishing. Health at a Glance: Europe; 2012.Google Scholar
  4. 4.
    Kohl HW, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305.CrossRefPubMedGoogle Scholar
  5. 5.
    Bloemers F, Collard D, Chinapaw MC, et al. Physical inactivity is a risk factor for physical activity-related injuries in children. Br J Sports Med. 2012;46(9):669–74.CrossRefPubMedGoogle Scholar
  6. 6.
    Collard DC, Verhagen EALM, Chinapaw MJM, et al. Acute physical activity and sports injuries in children. Appl Physiol Nutr Metab. 2008;33(2):393–401.CrossRefPubMedGoogle Scholar
  7. 7.
    Verhagen E, Collard D, Chinapaw MC, et al. A prospective cohort study on physical activity and sports-related injuries in 10–12-year-old children. Br J Sports Med. 2009;43(13):1031–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Collard DCM, Verhagen EALM, Chinapaw MJM, et al. Effectiveness of a school-based physical activity injury prevention program: a cluster randomized controlled trial. Arch Pediatr Adolesc Med. 2010;164(2):145–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Collard DC, Verhagen EALM, van Mechelen W, et al. Economic burden of physical activity-related injuries in Dutch children aged 10–12. Br J Sports Med. 2011;45(13):1058–63.CrossRefPubMedGoogle Scholar
  10. 10.
    de Loës M. Medical treatment and costs of sports-related injuries in a total population. Int J Sports Med. 1990;11(1):66–72.CrossRefPubMedGoogle Scholar
  11. 11.
    Gropp K, Janssen I, Pickett W. Active transportation to school in Canadian youth: should injury be a concern? Inj Prev. 2013;19(1):64–7.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, aetiology and prevention of sports injuries: a review of concepts. Sports Med. 1992;14(2):82–99.CrossRefPubMedGoogle Scholar
  13. 13.
    Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med. 2008;27(1):19–50 (vii).CrossRefPubMedGoogle Scholar
  14. 14.
    Spinks AB, McClure RJ. Quantifying the risk of sports injury: a systematic review of activity-specific rates for children under 16 years of age. Br J Sports Med. 2007;41(9):548–57.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Hedström EM, Svensson O, Bergström U, et al. Epidemiology of fractures in children and adolescents. Acta Orthop. 2010;81(1):148–53.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Beenackers MA, Kamphuis CBM, Giskes K, et al. Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act. 2012;9:116.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Lopes AD, Hespanhol LC Jr, Yeung SS, et al. What are the main running-related musculoskeletal injuries. Sports Med. 2012;425(10):891–905.CrossRefGoogle Scholar
  18. 18.
    Sundblad G, Saartok T, Engstrom LM, et al. Injuries during physical activity in school children. Scand J Med Sci Sports. 2005;15(5):313–23.CrossRefPubMedGoogle Scholar
  19. 19.
    Spinks AB, McClure RJ, Bain C, et al. Quantifying the association between physical activity and injury in primary school-aged children. Pediatrics. 2006;118(1):e43.CrossRefPubMedGoogle Scholar
  20. 20.
    Spinks AB, Macpherson AK, Bain C, et al. Injury risk from popular childhood physical activities: results from an Australian primary school cohort. Inj Prev. 2006;12(6):390–4.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Schofield GM, Gianotti S, Badland HM, et al. The incidence of injuries traveling to and from school by travel mode. Prev Med. 2008;46(1):74–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Schmikli SL, Backx FGJ, Kemler HJ, et al. National survey on sports injuries in the Netherlands: target populations for sports injury prevention programs. Clin J Sports Med. 2009;19(2):101–6.CrossRefGoogle Scholar
  23. 23.
    Martin-Diener E, Wanner M, Kriemler S, et al. Associations of objectively assessed levels of physical activity, aerobic fitness and motor coordination with injury risk in 7–9 year old school children: a cross-sectional study. BMJ Open. 2013;3(8).Google Scholar
  24. 24.
    Jespersen E, Rexen CT, Franz C, et al. Musculoskeletal extremity injuries in a cohort of schoolchildren aged 6–12: a 2.5-year prospective study. Scand J Med Sci Sports. 2014. doi:10.1111/sms.12177.
  25. 25.
    Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sport. Br J Sports Med. 2009;43:966–72.CrossRefPubMedGoogle Scholar
  26. 26.
    Clarsen B, Mykleburst G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. Br J Sports Med. 2013;47:495–502.CrossRefPubMedGoogle Scholar
  27. 27.
    Clarsen B, Rønsen O, Myklebust G, et al. The Oslo Sports Trauma Research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes. Br J Sports Med. 2014;48:754–60.CrossRefPubMedGoogle Scholar
  28. 28.
    Parkkari J, Kannus P, Natri A, et al. Active living and injury risk. Int J Sports Med. 2004;25(209):216.Google Scholar
  29. 29.
    Powell KE, Heath GW, Kresnow M, et al. Injury rates from walking, gardening, weightlifting, outdoor bicycling, and aerobics. Med Sci Sports Exerc. 1998;30(8):1246–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Pate RR, Freedson PS, Sallis JF, et al. Compliance with physical activity guidelines: prevalence in a population of children and youth. Ann Epidemiol. 2002;12:303–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Troiano RP, Berrigan D, Dodd KW, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Emery CA. Risk factors for injury in child and adolescent sport: a systematic review of the literature. Clin J Sports Med. 2003;13:256–68.CrossRefGoogle Scholar
  33. 33.
    Jespersen E, Holst R, Rexen CT, et al. Overuse and traumatic extremity injuries in schoolchildren surveyed with weekly text messages over 2.5 years. Scand J Med Sci Sports. 2013;24(5):807–13.CrossRefPubMedGoogle Scholar
  34. 34.
    Ma D, Jones G. Television, computer, and video viewing; physical activity; and upper limb fracture risk in children: a population-based case control study. J Bone Miner Res. 2003;18(11):1970–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Jespersen E, Verhagen EALM, Holst R, et al. Total body fat percentage and body mass index and the association with lower extremity injuries in children: a 2.5-year longitudinal study. Br J Sports Med. 2014;48(20):1497–502.CrossRefPubMedGoogle Scholar
  36. 36.
    Kemler E, Vriend I, Paulis WD, et al. Is overweight a risk factor for sports injuries in children, adolescents, and young adults? Scand J Med Sci Sports. 2014 [Epub ahead of print].Google Scholar
  37. 37.
    Clark EM, Tobias JH, Murray L, et al. Children with low muscle strength are at an increased risk of fracture with exposure to exercise. J Musculoskelet Neuronal Interact. 2011;11(2):196–202.PubMedGoogle Scholar
  38. 38.
    Jones BH, Bovee MW, Harris JM, et al. Intrinsic risk factors for exercise-related injuries among male and female army trainees. Am J Sports Med. 1993;21(5):705–10.CrossRefPubMedGoogle Scholar
  39. 39.
    Tonoli C, Cumps E, Aerts I, et al. Incidentie, risicofactoren en preventie van loopgerelateerde letsels bij lange afstandslopers: een systematische review [Incidence, riskfactors and prevention of running related injuries in long distance runners: a systematic review]. Sport Geneeskunde. 2010;5:12–7.Google Scholar
  40. 40.
    Verhagen E, Bolling C, Finch CF. Caution this drug may cause serious harm! Why we must report adverse effects of physical activity promotion. Br J Sports Med. 2014. doi:10.1136/bjsports-2014-093604.
  41. 41.
    Machado-Rodrigues AM, Santana A, Gama A, et al. Active commuting and its associations with blood pressure and adiposity markers in children. Prev Med. 2014;20(69):132–4.CrossRefGoogle Scholar
  42. 42.
    Lubans DR, Boreham CA, Kelly P, et al. The relationship between active travel to school and health-related fitness in children and adolescents: a systematic review. Int J Behav Nutr Phys Act. 2011;8(1):5.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Joske Nauta
    • 1
  • Eva Martin-Diener
    • 2
  • Brian W. Martin
    • 2
  • Willem van Mechelen
    • 1
  • Evert Verhagen
    • 1
    • 3
  1. 1.Department of Public and Occupational Health and EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Physical Activity and Health Unit, Institute of Social and Preventive MedicineUniversity of ZurichZurichSwitzerland
  3. 3.Australian Centre for Research into Injury in Sport and its Prevention (ACRISP)Federation University Australia, SMB CampusBallaratAustralia

Personalised recommendations