Time to add a new priority target for child injury prevention? The case for an excess burden associated with sport and exercise injury : Population-based study
Description:
Objective: To determine the population-level burden of sports injuries compared with that for road traffic injury for children aged <15 years in Victoria, Australia. Design: Retrospective observational study. Setting: Analysis of routinely collected data relating to non-fatal hospital-treated sports injury and road traffic injury cases for children aged <15 years in Victoria, Australia, over 2004-2010, inclusive. Participants: 75 413 non-fatal hospital-treated sports injury and road traffic injury cases in children aged <15 years. Data included: all Victorian public and private hospital hospitalisations, using the International Statistical Classification of Diseases and Health Related Problems, 10th Revision, Australian Modification (ICD-10-AM) activity codes to identify sports-related cases and ICD-10-AM cause and location codes to identify road traffic injuries; and injury presentations to 38 Victorian public hospital emergency departments, using a combination of activity, cause and location codes. Main outcome measures: Trends in injury frequency and rate were analysed by log-linear Poisson regression and the population-level injury burden was assessed in terms of years lived with disability (YLD), hospital bed-days and direct hospital costs. Results: Over the 7-year period, the annual frequency of non-fatal hospital-treated sports injury increased significantly by 29% (from N=7405 to N=9923; p<0.001) but the frequency of non-fatal hospital-treated road traffic injury decreased by 26% (from N=1841 to N=1334; p<0.001). Sports injury accounted for a larger population health burden than did road traffic injury on all measures: 3-fold the number of YLDs (7324.8 vs 2453.9); 1.9-fold the number of bed-days (26 233 vs 13 886) and 2.6-fold the direct hospital costs ($A5.9 millions vs $A2.2 millions). Conclusions: The significant 7-year increase in the frequency of hospital-treated sports injury and the substantially higher injury population-health burden (direct hospital costs, bed-day usage and YLD impacts) for sports injury compared with road traffic injury for children aged <15 years indicates an urgent need to prioritise sports injury prevention in this age group.
Description:
Objective: To determine the population-level burden of sports injuries compared with that for road traffic injury for children aged <15 years in Victoria, Australia. Design: Retrospective observational study. Setting: Analysis of routinely collected data relating to non-fatal hospital-treated sports injury and road traffic injury cases for children aged <15 years in Victoria, Australia, over 2004-2010, inclusive. Participants: 75 413 non-fatal hospital-treated sports injury and road traffic injury cases in children aged <15 years. Data included: all Victorian public and private hospital hospitalisations, using the International Statistical Classification of Diseases and Health Related Problems, 10th Revision, Australian Modification (ICD-10-AM) activity codes to identify sports-related cases and ICD-10-AM cause and location codes to identify road traffic injuries; and injury presentations to 38 Victorian public hospital emergency departments, using a combination of activity, cause and location codes. Main outcome measures: Trends in injury frequency and rate were analysed by log-linear Poisson regression and the population-level injury burden was assessed in terms of years lived with disability (YLD), hospital bed-days and direct hospital costs. Results: Over the 7-year period, the annual frequency of non-fatal hospital-treated sports injury increased significantly by 29% (from N=7405 to N=9923; p<0.001) but the frequency of non-fatal hospital-treated road traffic injury decreased by 26% (from N=1841 to N=1334; p<0.001). Sports injury accounted for a larger population health burden than did road traffic injury on all measures: 3-fold the number of YLDs (7324.8 vs 2453.9); 1.9-fold the number of bed-days (26 233 vs 13 886) and 2.6-fold the direct hospital costs ($A5.9 millions vs $A2.2 millions). Conclusions: The significant 7-year increase in the frequency of hospital-treated sports injury and the substantially higher injury population-health burden (direct hospital costs, bed-day usage and YLD impacts) for sports injury compared with road traffic injury for children aged <15 years indicates an urgent need to prioritise sports injury prevention in this age group.
Description:
AIM: Injuries are common in all professional football codes (including soccer, rugby league and union, American football, Gaelic Football and Australian football). The aim of the present study was to assess the potential effect that rule changes can have on injuries in professional football. METHODS: The Australian Football League (AFL) conducts an annual audit of injuries and makes regular rule changes on a semi-annual basis. An injury was defined as “any physical or medical condition that causes a player to miss a match in the regular season or finals” with ongoing records kept and publicly released over the decade 2004-2013. RESULTS: Over the ten years from 2004-2013, the AFL Commission made 26 rule changes, of which eight were considered to have potential impact on injury rates. The 2005 centre circle rule has significantly reduced rates of posterior cruciate ligament (PCL) injury in ruckmen. The rates of head and neck injuries dropped after initial rule changes, but rates of concussion and other head and neck injuries have increased since 2011, since a rule change that players could not re-enter the game after suffering concussion. Rates of hamstring and groin injuries have significantly fallen since the substitute rule was instituted in 2011, but rates of other lower limb injuries have risen over the same time period. CONCLUSION: Rule changes have, in some instances, had a beneficial effect on the rates of specific injuries over the last decade. However, the overall injury incidence in the AFL has not fallen, possibly because of a concurrent background increase in the speed of player movement across the decade. The AFL is in a fortunate position of being able to easily institute rule changes as it is the peak body of the sport which does not have to consider international competitions. The well established annual injury survey is able to monitor the effects of any rule changes on injury rates in a timely manner.
What do community football players think about different exercise-training programmes? Implications for the delivery of lower limb injury prevention programmes
Description:
Background: Players are the targeted end-users and beneficiaries of exercise-training programmes implemented during coach-led training sessions, and the success of programmes depends upon their active participation. Two variants of an exercise-training programme were incorporated into the regular training schedules of 40 community Australian Football teams, over two seasons. One variant replicated common training practices, while the second was an evidence-based programme to alter biomechanical and neuromuscular factors related to risk of knee injuries. This paper describes the structure of the implemented programmes and compares players’ end-of-season views about the programme variants. Methods: This study was nested within a larger group-clustered randomised controlled trial of the effectiveness of two exercise-training programmes (control and neuromuscular control (NMC)) for preventing knee injuries. A post-season self-report survey, derived from Health Belief Model constructs, included questions to obtain players’ views about the benefits and physical challenges of the programme in which they participated. Results: Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit. Suggestions from players about potential improvements to the training programme and its future implementation included reducing duration, increasing range of drills/exercises and promoting its injury prevention and other benefits to players. Conclusions: Players provide valuable feedback about the content and focus of implemented exercise-training programmes, that will directly inform the delivery of similar, or more successful, programmes in the future.
Description:
Background: Players are the targeted end-users and beneficiaries of exercise-training programmes implemented during coach-led training sessions, and the success of programmes depends upon their active participation. Two variants of an exercise-training programme were incorporated into the regular training schedules of 40 community Australian Football teams, over two seasons. One variant replicated common training practices, while the second was an evidence-based programme to alter biomechanical and neuromuscular factors related to risk of knee injuries. This paper describes the structure of the implemented programmes and compares players’ end-of-season views about the programme variants. Methods: This study was nested within a larger group-clustered randomised controlled trial of the effectiveness of two exercise-training programmes (control and neuromuscular control (NMC)) for preventing knee injuries. A post-season self-report survey, derived from Health Belief Model constructs, included questions to obtain players’ views about the benefits and physical challenges of the programme in which they participated. Results: Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit. Suggestions from players about potential improvements to the training programme and its future implementation included reducing duration, increasing range of drills/exercises and promoting its injury prevention and other benefits to players. Conclusions: Players provide valuable feedback about the content and focus of implemented exercise-training programmes, that will directly inform the delivery of similar, or more successful, programmes in the future.
Description:
Current sports injury reporting systems lack a common conceptual basis. We propose a conceptual foundation as a basis for the recording of health problems associated with participation in sports, based on the notion of impairment used by the World Health Organization. We provide definitions of sports impairment concepts to represent the perspectives of health services, the participants in sports and physical exercise themselves, and sports institutions. For each perspective, the duration of the causative event is used as the norm for separating concepts into those denoting impairment conditions sustained instantly and those developing gradually over time. Regarding sports impairment sustained in isolated events, 'sports injury' denotes the loss of bodily function or structure that is the object of observations in clinical examinations; 'sports trauma' is defined as an immediate sensation of pain, discomfort or loss of functioning that is the object of athlete self-evaluations; and 'sports incapacity' is the sidelining of an athlete because of a health evaluation made by a legitimate sports authority that is the object of time loss observations. Correspondingly, sports impairment caused by excessive bouts of physical exercise is denoted as 'sports disease' (overuse syndrome) when observed by health service professionals during clinical examinations, 'sports illness' when observed by the athlete in self-evaluations, and 'sports sickness' when recorded as time loss from sports participation by a sports body representative. We propose a concerted development effort in this area that takes advantage of concurrent ontology management resources and involves the international sporting community in building terminology systems that have broad relevance.
What would you like? Identifying the required characteristics of an industry-wide incident reporting and learning system for the led outdoor activity sector
Description:
The aim of this study was to identify the characteristics that led outdoor activity providers agree are necessary for the development of a new industry-wide incident reporting and learning system (UPLOADS). The study involved: 1) a literature review to identify a set of characteristics that are considered to be hallmarks of successful reporting and learning systems in other safety-critical domains; and (2) the presentation of these characteristics to 25 Australian led outdoor activity providers using a two round modified-Delphi technique to obtain consensus views on their relative importance in this domain. Thirteen out of 30 characteristics were endorsed as "essential" for developing an incident reporting and learning system for the led outdoor activity sector, and a further 13 were endorsed as "required". "Essential" characteristics primarily related to operational or practical characteristics of the system, while "required" characteristics primarily related to system infrastructure, data quality and the basis for developing of countermeasures to address identified injury risks. The findings indicate that although led outdoor activity providers are primarily concerned that the demands of reporting do not adversely impact on their day to day operations, they also recognise that data collection methods and countermeasure development need to be of high quality. The paper concludes by highlighting some potential strategies for implementing the characteristics considered "essential" and "required".
Description:
The aim of this study was to identify the characteristics that led outdoor activity providers agree are necessary for the development of a new industry-wide incident reporting and learning system (UPLOADS). The study involved: 1) a literature review to identify a set of characteristics that are considered to be hallmarks of successful reporting and learning systems in other safety-critical domains; and (2) the presentation of these characteristics to 25 Australian led outdoor activity providers using a two round modified-Delphi technique to obtain consensus views on their relative importance in this domain. Thirteen out of 30 characteristics were endorsed as "essential" for developing an incident reporting and learning system for the led outdoor activity sector, and a further 13 were endorsed as "required". "Essential" characteristics primarily related to operational or practical characteristics of the system, while "required" characteristics primarily related to system infrastructure, data quality and the basis for developing of countermeasures to address identified injury risks. The findings indicate that although led outdoor activity providers are primarily concerned that the demands of reporting do not adversely impact on their day to day operations, they also recognise that data collection methods and countermeasure development need to be of high quality. The paper concludes by highlighting some potential strategies for implementing the characteristics considered "essential" and "required".
Description:
Objectives: To obtain benefits from sports injury prevention programs, players are instructed to perform the exercises as prescribed. We developed an observational checklist to measure the quality of exercise performance by players participating in FootyFirst, a coach-led, exercise-based, lower-limb injury prevention program in community Australian Football (AF). Design: Observational. Methods: The essential performance criteria for each FootyFirst exercise were described in terms of the technique, volume and intensity required to perform each exercise. An observational checklist was developed to evaluate each criterion through direct visual observation of players at training. The checklist was trialled by two independent raters who observed the same 70 players completing the exercises at eight clubs. Agreement between observers was assessed by Kappa-statistics. Exercise fidelity was defined as the proportion of observed players who performed all aspects of their exercises correctly. Results: The raters agreed on 61/70 observations (87%) (Kappa = 0.72, 95% CI: 0.55; 0.89). Of the observations with agreed ratings, 41 (67%) players were judged as performing the exercises as prescribed. Conclusions: The observational checklist demonstrated high inter-rater reliability. Many players observed did not perform the exercises as prescribed, raising concern as to whether they would be receiving anticipated program benefits. Where quality of exercise performance is important, evaluation and reporting of program fidelity should include direct observations of participants.
Description:
Objectives: To obtain benefits from sports injury prevention programs, players are instructed to perform the exercises as prescribed. We developed an observational checklist to measure the quality of exercise performance by players participating in FootyFirst, a coach-led, exercise-based, lower-limb injury prevention program in community Australian Football (AF). Design: Observational. Methods: The essential performance criteria for each FootyFirst exercise were described in terms of the technique, volume and intensity required to perform each exercise. An observational checklist was developed to evaluate each criterion through direct visual observation of players at training. The checklist was trialled by two independent raters who observed the same 70 players completing the exercises at eight clubs. Agreement between observers was assessed by Kappa-statistics. Exercise fidelity was defined as the proportion of observed players who performed all aspects of their exercises correctly. Results: The raters agreed on 61/70 observations (87%) (Kappa = 0.72, 95% CI: 0.55; 0.89). Of the observations with agreed ratings, 41 (67%) players were judged as performing the exercises as prescribed. Conclusions: The observational checklist demonstrated high inter-rater reliability. Many players observed did not perform the exercises as prescribed, raising concern as to whether they would be receiving anticipated program benefits. Where quality of exercise performance is important, evaluation and reporting of program fidelity should include direct observations of participants.
Description:
Falls are a common occurrence amongst older adults yet participation in prevention strategies is often poor. Although older adults may perceive a strategy works in general, they may not participate because they feel it will not benefit them personally. We aimed to describe how frequently and why older adults identify falls prevention strategies as being ‘‘better for others than for me’’. A cross-sectional survey with n = 394 community-dwelling older adults in Victoria, Australia was undertaken. Participants were provided with detailed descriptions of four evidence-based falls prevention strategies and for each were asked whether they felt that the strategy would be effective in preventing falls for people like them, and then whether they felt that the strategy would be effective for preventing falls for them personally. Follow-up questions asked why they thought the strategy would be more effective for people like them than for them personally where this was the case. We found the ‘‘better for others than for me’’ perception was present for between 25% and 34% of the strategies investigated. Participants commonly said they felt this way because they did not think they were at risk of falls, and because they were doing other activities they thought would provide equivalent benefit. Strategies to promote participation in evidence-based falls prevention strategies may need to convince older adults that they are at risk of falls and that what activities they are already doing may not provide adequate protection against falls in order to have greater effect.
Description:
Injuries are a major contributor to healthcare costs and individuals' health and disability status. In response to the overall public health burden, injuries were one of the first medical conditions identified as an Australian National Health Priority Area. Our previous epidemiological research has shown that sports injuries, especially those sustained through formal and highly competitive sport, are often associated with considerable pain and dysfunction. They have significant ongoing impact on quality of life and need for medical treatment, including in the hospital setting.They are also a major barrier towards both the uptake and continuance of health-generating physical activity guidance.
Description:
This study aims to present a new approach towards the analysis of intervention time-series studies in the context of sports-related injury data. We used Victoria-wide hospital admission injury data associated with the sport of Australian football during the period 2006 to 2013. To estimate the state-wide effect of an implemented exercise training intervention that aimed to reduce the number of football-related injuries, time-series analysis was performed using a generalised least square (GLS) method. We show how the GLS method can be used to evaluate the impact of the intervention. Trend and seasonal patterns time series were also assessed using the 'Seasonal and Trend decomposition using Loess' nonparametric seasonal decomposition procedure. The model identified a decreasing trend in the seasonally adjusted number of injuries after the implementation of the intervention in the hospital admission data. The seasonal decomposition plots also indicate strong seasonal patterns in the injury time series.
Description:
This Round Table on The Epidemiology of Fitness, Sport and Physical Recreation makes for compelling reading. Australia has long been regarded as a sports-mad nation and one that has achieved major international sporting achievements because of its long-term investment in sports medicine and sports science research. Sports spectatorship is also a major pastime in Australia, underpinning the value of using sport to promote a range of health promotion messages (e.g. in relation to tobacco, alcohol, social tolerance and most recently violence prevention). People of all ages now enjoy participating in a wide range of activities from general physical activity to fitness training to cycling to team ball sports such as Australian football to combat sports. All of these feature in papers in this issue.
Description:
There have been limited epidemiological studies that delve into injuries sustained during fitness activities, and fewer that have explored injury prevention strategies and evaluated their success. Popular individual and team sports such as athletics, swimming, basketball and various codes of football have enjoyed extensive epidemiological attention for years, and due to the sports' popularity and public profile, will continue to be highly researched areas. Other epidemiological research has focused on sports injuries more generally, or on specific injury types such as concussion, anterior cruciate ligament injury and hamstring injury. According to the Australian Bureau of Statistics' Exercise Recreation and Sport Survey (ERASS), fitness/gym is the second most popular recreation or sport activity participated in by Australians aged 15+ years. Considering the number of people who participate in fitness activities, and the devastating impact that injuries can have on the individual, their family and friends, and society, it is necessary to devote some research to preventing these.
Description:
OBJECTIVE: To achieve expert consensus on the content of an exercise training program (known as FootyFirst) to prevent lower-limb injuries. DESIGN: Three-round online Delphi consultation process. SETTING: Community Australian Football (AF). PARTICIPANTS: Members of the Australian Football Leagues' Medical Officers (n = 94), physiotherapists (n = 50), and Sports Science (n = 19) Associations were invited to participate through e-mail. Five people with more general expertise in sports-related lower-limb injury prevention were also invited to participate. MAIN OUTCOME MEASURES: The primary outcome measure was the level of agreement on the appropriateness of the proposed exercises and progressions for inclusion in FootyFirst. Consensus was reached when ≥75% of experts who responded to each item agreed and strongly agreed, or disagreed and strongly disagreed, that an exercise or its progressions were appropriate to include in FootyFirst. RESULTS: Fifty-five experts participated in at least 1 Delphi round. In round 1, consensus was achieved that the proposed warm-up (run through and dynamic stretches) and the exercises and progressions for hamstring strength and for balance, landing, and changing direction were appropriate to include in FootyFirst. There was also consensus in round 1 that progressions for hip/core strength should be included in FootyFirst. Consensus was reached in round 2 that the revised groin strength and hip strength exercises should be included in FootyFirst. Consensus was reached for the progression of the groin strength exercises in round 3. CONCLUSIONS: The formal consensus development process has resulted in an evidence-informed, researcher-developed, exercise-based sports injury prevention program that is expert endorsed and specific to the context of AF. CLINICAL RELEVANCE: Lower-limb injuries are common in running, kicking, and contact sports like AF. These injuries are often costly to treat, and many have high rates of recurrence, making them challenging to treat clinically. Reducing these injuries is a high priority for players, teams, and medical staff. Exercise programs provide a method for primary prevention of lower-limb injuries, but they have to be evidence based, have currency with sports practitioners/clinicians, and utility for the context in which they are to be used. However, the comprehensive methods and clinical engagement processes used to develop injury prevention exercise programs have not previously been described in detail. This study describes the results of engaging clinicians and sport scientists in the development of a lower-limb sports injury prevention program for community AF, enabling the development of a program that is both evidence informed and considerate of expert clinical opinion.
Description:
BACKGROUND: Head injuries, particularly concussion, are a major cause of concern in many sports, particularly the football codes, driving a need to better understand injury mechanisms and potential methods of prevention. The aim of this study was to describe the mechanisms and follow up care of concussion injuries sustained in adult male community Australian football to identify target areas for prevention and management. METHODS: Secondary analysis of injury data collected in a cluster randomised controlled trial in community Australian football across two states of Australia in 2007 and 2008. There were 1564 players from 18 clubs. The main outcome measures were the number and rate of head/neck/face (HNF) injuries and concussion sustained in games. A specific description of the mechanisms of the concussion injuries is presented along with the immediate return-to-play status of concussion cases. RESULTS: 143 HNF injuries were sustained by 132 players. The game HNF injury incidence was 4.9 per 1000 game hours (n = 138; 95 % confidence interval 4.1; 5.7). Just under a quarter (n = 34) of all HNF injuries were recorded as concussion. All concussions occurred during games (none in training), with all but one related to body contact with other players. Overall, 68 % of the concussions were considered within game rules, while 32 % were either outside of the rules or unclear. Most (88 %) players left the field immediately following concussion but 47 % later returned to play in the same game. CONCLUSIONS: Prevention strategies for concussion need to be based on knowledge of the mechanisms of injury. Most concussions in community Australian football occurred through body contact with other players or during tackling. Management of players post-concussion was generally poor with over half of the cases continuing to play in the same game. Therefore, new primary prevention strategies that target body-contact/tackling skills and improved secondary prevention measures relating to compliance with return-to-play protocols would be valuable.
Description:
BACKGROUND: Head injuries, particularly concussion, are a major cause of concern in many sports, particularly the football codes, driving a need to better understand injury mechanisms and potential methods of prevention. The aim of this study was to describe the mechanisms and follow up care of concussion injuries sustained in adult male community Australian football to identify target areas for prevention and management. METHODS: Secondary analysis of injury data collected in a cluster randomised controlled trial in community Australian football across two states of Australia in 2007 and 2008. There were 1564 players from 18 clubs. The main outcome measures were the number and rate of head/neck/face (HNF) injuries and concussion sustained in games. A specific description of the mechanisms of the concussion injuries is presented along with the immediate return-to-play status of concussion cases. RESULTS: 143 HNF injuries were sustained by 132 players. The game HNF injury incidence was 4.9 per 1000 game hours (n = 138; 95 % confidence interval 4.1; 5.7). Just under a quarter (n = 34) of all HNF injuries were recorded as concussion. All concussions occurred during games (none in training), with all but one related to body contact with other players. Overall, 68 % of the concussions were considered within game rules, while 32 % were either outside of the rules or unclear. Most (88 %) players left the field immediately following concussion but 47 % later returned to play in the same game. CONCLUSIONS: Prevention strategies for concussion need to be based on knowledge of the mechanisms of injury. Most concussions in community Australian football occurred through body contact with other players or during tackling. Management of players post-concussion was generally poor with over half of the cases continuing to play in the same game. Therefore, new primary prevention strategies that target body-contact/tackling skills and improved secondary prevention measures relating to compliance with return-to-play protocols would be valuable.
Description:
Purpose: The purpose of this study was to provide an epidemiological profile of injuries sustained by participants in fitness activities in Victoria, Australia, based on hospital admissions and emergency department (ED) presentations and to identify the most common types, causes, and sites of these injuries. Method: Hospital-treated fitness activity-related injury cases were identified from International Classification of Disease activity codes (for admissions) and from text narratives of injury events (for ED presentations) from 2003 to 2010, inclusive. Cases were categorized as being associated with aerobics/group exercise (n = 252), resistance/weight training (n = 830) or "other equipment" (motorized and general gym equipment; n = 1,156). Participation information was taken from the Exercise, Recreation and Sport Survey. Results: Overall, 2,238 cases were identified and 11.6% of all patients with ED presentations were subsequently hospitalized. Those participants with aerobics cases were generally female (76.6%) and aged 25 to 34 years old (35.3%), with injuries to the lower limbs (59.1%) and due to falls (57.9%). Resistance-training injuries increased significantly during the 8-year period (by 215.7%; 95% CI [133.5, 326.9]) and generally occurred in male participants (78.0%), in people aged 15 to 24 years old (36.4%), and with injuries to the upper limbs (45.1%) caused by being hit, struck, or crushed by weights or fellow exercisers (71.4%). The "other equipment" cases were equally distributed by gender; they occurred most commonly in people aged 15 to 24 years old (27.8%), with injuries to the lower limbs (41.5%) and due to falls (57.6%). Across all categories, dislocations, sprains, and strains were the most common injury types. Conclusions: Fitness activity-related injury prevention strategies should be targeted at different subgroups according to the type of fitness activity being undertaken.
Description:
Purpose: The purpose of this study was to provide an epidemiological profile of injuries sustained by participants in fitness activities in Victoria, Australia, based on hospital admissions and emergency department (ED) presentations and to identify the most common types, causes, and sites of these injuries. Method: Hospital-treated fitness activity-related injury cases were identified from International Classification of Disease activity codes (for admissions) and from text narratives of injury events (for ED presentations) from 2003 to 2010, inclusive. Cases were categorized as being associated with aerobics/group exercise (n = 252), resistance/weight training (n = 830) or “other equipment†(motorized and general gym equipment; n = 1,156). Participation information was taken from the Exercise, Recreation and Sport Survey. Results: Overall, 2,238 cases were identified and 11.6% of all patients with ED presentations were subsequently hospitalized. Those participants with aerobics cases were generally female (76.6%) and aged 25 to 34 years old (35.3%), with injuries to the lower limbs (59.1%) and due to falls (57.9%). Resistance-training injuries increased significantly during the 8-year period (by 215.7%; 95% CI [133.5, 326.9]) and generally occurred in male participants (78.0%), in people aged 15 to 24 years old (36.4%), and with injuries to the upper limbs (45.1%) caused by being hit, struck, or crushed by weights or fellow exercisers (71.4%). The “other equipment†cases were equally distributed by gender; they occurred most commonly in people aged 15 to 24 years old (27.8%), with injuries to the lower limbs (41.5%) and due to falls (57.6%). Across all categories, dislocations, sprains, and strains were the most common injury types. Conclusions: Fitness activity-related injury prevention strategies should be targeted at different subgroups according to the type of fitness activity being undertaken.
From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury