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Valentin S, Linton L, Sculthorpe NF. Effect of supervision and athlete age and sex on exercise-based injury prevention programme effectiveness in sport: A meta-analysis of 44 studies. Res Sports Med 2024; 32:705-724. [PMID: 37283040 DOI: 10.1080/15438627.2023.2220059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
We aimed to evaluate the influence of supervision, athlete age and sex and programme duration and adherence on exercise-based injury prevention programme effectiveness in sport. Databases were searched for randomized controlled trials evaluating exercise-based injury prevention programme effectiveness compared to "train-as-normal". A random effects meta-analysis for overall effect and pooled effects by sex and supervision and meta-regression for age, intervention duration and adherence were performed. Programmes were effective overall (risk ratio (RR) 0.71) and equally beneficial for female-only (0.73) and male-only (0.65) cohorts. Supervised programmes were effective (0.67), unlike unsupervised programmes (1.04). No significant association was identified between programme effectiveness and age or intervention duration. The inverse association between injury rate and adherence was significant (β=-0.014, p = 0.004). Supervised programmes reduce injury by 33%, but there is no evidence for the effectiveness of non-supervised programmes. Females and males benefit equally, and age (to early middle age) does not affect programme effectiveness.
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Affiliation(s)
- Stephanie Valentin
- Sport and Physical Activity Research Institute, University of the West of Scotland, Blantyre, UK
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Linda Linton
- Edinburgh Sports Medicine Research Network & UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), Institute for Sport, PE and Health Sciences, FASIC Sport and Exercise Medicine Clinic, University of Edinburgh, Edinburgh, UK
| | - Nicholas F Sculthorpe
- Sport and Physical Activity Research Institute, University of the West of Scotland, Blantyre, UK
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Vicens-Bordas J, Sarand AP, Beato M, Buhmann R. Hamstring Injuries, From the Clinic to the Field: A Narrative Review Discussing Exercise Transfer. Int J Sports Physiol Perform 2024; 19:729-737. [PMID: 38917984 DOI: 10.1123/ijspp.2024-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/28/2024] [Accepted: 05/09/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE The optimal approach to hamstring training is heavily debated. Eccentric exercises reduce injury risk; however, it is argued that these exercises transfer poorly to improved hamstring function during sprinting. Some argue that other exercises, such as isometric exercises, result in better transfer to running gait and should be used when training to improve performance and reduce injury risk. Given the performance requirements of the hamstrings during the terminal swing phase, where they are exposed to high strain, exercises should aim to improve the torque production during this phase. This should improve the hamstrings' ability to resist overlengthening consequently, improving performance and limiting strain injury. Most hamstring training studies fail to assess running kinematics postintervention. Of the limited evidence available, only eccentric exercises demonstrate changes in swing-phase kinematics following training. Studies of other exercise modalities investigate effects on markers of performance and injury risk but do not investigate changes in running kinematics. CONCLUSIONS Despite being inconsistent with principles of transfer, current evidence suggests that eccentric exercises result in transfer to swing-phase kinematics. Other exercise modalities may be effective, but the effect of these exercises on running kinematics is unknown.
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Affiliation(s)
- Jordi Vicens-Bordas
- Sport Performance Analysis Research Group (SPARG) and Sport and Physical Activity Studies Center (CEEAF), University of Vic-Central University of Catalonia, Vic, Spain
| | - Ali Parvaneh Sarand
- Department of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
| | - Marco Beato
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Robert Buhmann
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
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Liddle N, Taylor JM, Chesterton P, Atkinson G. The Effects of Exercise-Based Injury Prevention Programmes on Injury Risk in Adult Recreational Athletes: A Systematic Review and Meta-Analysis. Sports Med 2024; 54:645-658. [PMID: 37889449 DOI: 10.1007/s40279-023-01950-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Injuries are common in adult recreational athletes. Exercise-based injury prevention programmes offer the potential to reduce the risk of injury and have been a popular research topic. Yet, syntheses and meta-analyses on the effects of exercise-based injury prevention programmes for adult recreational athletes are lacking. OBJECTIVES We aimed to synthesise and quantify the pooled intervention effects of exercise-based injury prevention programmes delivered to adults who participate in recreation sports. METHODS Studies were eligible for inclusion if they included adult recreational athletes (aged > 16 years), an exercise-based intervention and used a randomised controlled trial design. Exclusion criteria were studies without a control group, studies using a non-randomised design and studies including participants who were undertaking activity mandatory for their occupation. Eleven literature databases were searched from earliest record, up to 9 June, 2022. The Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias in all included studies. Reported risk statistics were synthesised in a random-effects meta-analysis to quantify pooled treatment effects and associated 95% confidence intervals and prediction intervals. RESULTS Sixteen studies met the criteria. Risk statistics were reported as risk ratios [RRs] (n = 12) or hazard ratios [HRs] (n = 4). Pooled estimates of RRs and HRs were 0.94 (95% confidence interval 0.80-1.09) and 0.65 (95% confidence interval 0.39-1.08), respectively. Prediction intervals were 0.80-1.09 and 0.16-2.70 for RR and HR, respectively. Heterogeneity was very low for RR studies, but high for HR studies (tau = 0.29, I2 = 81%). There was evidence of small study effects for RR studies, evidenced by funnel plot asymmetry and Egger's test for small study bias: - 0.99 (CI - 2.08 to 0.10, p = 0.07). CONCLUSIONS Pooled point estimates were suggestive of a reduced risk of injury in intervention groups. Nevertheless, these risk estimates were insufficiently precise, too heterogeneous and potentially compromised by small study effects to arrive at any robust conclusion. More large-scale studies are required to clarify whether exercise-based injury prevention programmes are effective in adult recreational athletes. CLINICAL TRIAL REGISTRATION The protocol for this review was prospectively registered in the PROSPERO database (CRD42021232697).
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Affiliation(s)
- Nathan Liddle
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BA, UK.
| | - Jonathan M Taylor
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Paul Chesterton
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Greg Atkinson
- School of Sport and Exercise Science, Liverpool John Moores University, Merseyside, UK
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Gladdines S, Eygendaal D, van Boekel L, Verhagen E, Beumer A. How to optimise the fidelity of exercises in an unsupervised golf injury prevention programme? A pilot study. BMJ Open Sport Exerc Med 2024; 10:e001681. [PMID: 38347860 PMCID: PMC10860048 DOI: 10.1136/bmjsem-2023-001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 02/15/2024] Open
Abstract
Background Golf is an individual sport that is usually done without the supervision of a trainer or coach. Therefore, an injury prevention programme in golf will primarily be performed without supervision and feedback. However, the effectiveness of any preventive exercise programme is determined by exercise fidelity. Objective To investigate the different instruction options of an injury prevention programme on exercise fidelity in individual golfers. Methods We randomly assigned golfers to one of three groups receiving different exercise instructions. One group received only instructional cards (A), one received only instructional videos (B) and a third group (C) received both instructional cards and videos. The golfers were allowed to familiarise themselves with the exercises based on the provided instruction option, after which we recorded their exercise execution on video. Two authors independently scored each exercise's fidelity from these recordings. Results In total, 18 golfers (12 women and 6 men, average age of 61.94 years) were equally divided across the 3 study groups completed 108 exercises. In group A 73.7% of exercises were executed as intended, in group B 88.6% and in group C 86.3%. Significantly more exercises were conducted correctly in groups B and C compared with group A (p<0.05). Conclusion Golfers who received instructions that included a video explanation had a higher exercise fidelity when compared to only written instructions.
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Affiliation(s)
- Saskia Gladdines
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leonieke van Boekel
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Breda, The Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centres – Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annechien Beumer
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
- Coronel Institute of Occupational Health, Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Weishorn J, Jaber A, Zietzschmann S, Spielmann J, Renkawitz T, Bangert Y. Injury Patterns and Incidence in an Elite Youth Football Academy-A Prospective Cohort Study of 138 Male Athletes. J Clin Med 2023; 12:6138. [PMID: 37834782 PMCID: PMC10573676 DOI: 10.3390/jcm12196138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND There is a lack of evidence regarding injury incidence in German elite youth football academies, and the risk of re-injury is unknown. Therefore, the objectives of this study were (1) to determine injury patterns and incidence in an elite youth football academy in Germany, (2) to monitor overuse-/trauma-related injuries over the course of the season, and (3) determine the risk of re-injury. METHODS A prospective cohort study was conducted in the 2012/2013 season among 138 male players from an elite youth football academy in Germany. Injuries were recorded according to the consensus statement on injury definitions and data collection in studies of football injuries. Injury incidence was reported as the number of injuries per 1000 h of exposure and the number of injuries per squad season. RESULTS A total of 109 injuries were reported, resulting in a cumulative time-loss of 2536 days. A squad of 25 players sustained 19.7 injuries per season, with an average of 23.3 days (15.7-30.9; 95% CI lower-upper) of absence per injury. Ligament sprains (28%), muscle strains (19%) and physeal injuries (12%) were the most common causes of time-loss. Physeal injuries were the most common severe type of injury (29%), with a mean time-loss of 29.7 days (18.2-41.2; 95% CI lower-upper). Re-injuries accounted for 3% of all injuries and resulted in significantly more time-loss than non-re-injuries (60 vs. 23 days; p = 0.01). CONCLUSION In the youth academies studied, a team of 25 players sustained an average of 19.7 injuries per season, resulting in a cumulative time-loss of 459 days. Physeal injuries are a major contributor to severe injuries and therefore require special attention.
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Affiliation(s)
- Johannes Weishorn
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.W.); (A.J.); (S.Z.); (T.R.)
| | - Ayham Jaber
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.W.); (A.J.); (S.Z.); (T.R.)
| | - Severin Zietzschmann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.W.); (A.J.); (S.Z.); (T.R.)
| | - Jan Spielmann
- TSG ResearchLab gGmbH, Horrenberger Straße 58, 74939 Zuzenhausen, Germany;
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.W.); (A.J.); (S.Z.); (T.R.)
| | - Yannic Bangert
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.W.); (A.J.); (S.Z.); (T.R.)
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Behm DG, Alizadeh S, Daneshjoo A, Konrad A. Potential Effects of Dynamic Stretching on Injury Incidence of Athletes: A Narrative Review of Risk Factors. Sports Med 2023; 53:1359-1373. [PMID: 37162736 PMCID: PMC10289929 DOI: 10.1007/s40279-023-01847-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 05/11/2023]
Abstract
The use of dynamic stretching as a replacement for static stretching in the warm-up is widespread based on the reports of static stretching-induced performance impairments. While acute and chronic static stretching has been reported to reduce musculotendinous injuries, especially with explosive and change of direction actions, the influence of dynamic stretching on injury incidence lacks a similar volume of literature for acute and chronic responses. It was the objective of this narrative review to examine the acute and training effects of dynamic stretching on injury incidence and possible moderating variables such as dynamic stretching effects on range of motion, strength, balance, proprioception, muscle morphology, and psycho-physiological responses. One study demonstrated no significant difference regarding injury incidence when comparing a dynamic stretching-only group versus a combined dynamic stretching plus static stretching group. The only other study examined functional dynamic stretching training with injured dancers and reported improved ankle joint stability. However, several studies have shown that dynamic activity with some dynamic stretching exercises within a warm-up consistently demonstrates positive effects on injury incidence. Regarding moderating variables, while there is evidence that an acute bout of dynamic stretching can enhance range of motion, the acute and training effects of dynamic stretching on strength, balance, proprioception, and musculotendinous stiffness/compliance are less clear. The acute effects of dynamic stretching on thixotropic effects and psycho-physiological responses could be beneficial for injury reduction. However, the overall conflicting studies and a lack of substantial literature compared with SS effects points to a need for more extensive studies in this area.
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Affiliation(s)
- David G. Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL A1C 5S7 Canada
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL A1C 5S7 Canada
| | - Abdolhamid Daneshjoo
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL A1C 5S7 Canada
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Andreas Konrad
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL A1C 5S7 Canada
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria
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Seyedi M, Zarei M, Daneshjoo A, Rajabi R, Shirzad E, Mozafaripour E, Mohammadpour S. Effects of FIFA 11 + warm-up program on kinematics and proprioception in adolescent soccer players: a parallel‑group randomized control trial. Sci Rep 2023; 13:5527. [PMID: 37016130 PMCID: PMC10073194 DOI: 10.1038/s41598-023-32774-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/02/2023] [Indexed: 04/06/2023] Open
Abstract
This study aimed to compare the effects of 8 weeks 11 + warm-up injury prevention program on kinematics and proprioception in adolescent male and female soccer players. Forty adolescent soccer players (20 males, 20 females) aged between 14-16 years old were randomly assigned into four groups. The experimental group performed the 11 + program for 8 weeks and the control group did their warm-up program. The kinematic variable in a cutting maneuver was measured using VICON motion analysis and ankle and knees' proprioception by joint position sense (JPS) was measured using a digital inclinometer. For kinematic variables only significant differences in knee valgus among females 11 + compared with female and male control groups were found (P < 0.05). Moreover, there were significant improvements in joint position sense variables in 11 + groups compared to control groups (P < 0.05). In conclusion, the 11 + program was proven to be a useful warm-up protocol in improving knee valgus and JPS among female and male adolescent soccer players. We suggest adding more training elements to the 11 + program that aimed to enhance the proper alignment of lower extremities which may consequently improve joint kinematics.
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Affiliation(s)
- Mohammadreza Seyedi
- Department of Sport Medicine, Sport Sciences Research Institute, Tehran, Iran.
| | - Mostafa Zarei
- Sport Rehabilitation and Health Department, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Abdolhamid Daneshjoo
- Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport Science, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Reza Rajabi
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Elham Shirzad
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Esmaeil Mozafaripour
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Shadan Mohammadpour
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
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Obërtinca R, Hoxha I, Meha R, Lama A, Bimbashi A, Kuqi D, Shabani B, Meyer T, der Fünten KA. Efficacy of Multi-Component Exercise-Based Injury Prevention Programs on Injury Risk Among Footballers of All Age Groups: A Systematic Review and Meta-analysis. Sports Med 2023; 53:837-848. [PMID: 36752977 PMCID: PMC10036279 DOI: 10.1007/s40279-022-01797-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Playing football is associated with a high risk of injury. Injury prevention is a priority as injuries not only negatively impact health but also potentially performance. Various multi-component exercise-based injury prevention programs for football players have been examined in studies. OBJECTIVE We aimed to investigate the efficacy of multi-component exercise-based injury prevention programs among footballers of all age groups in comparison to a control group. METHODS We conducted a systematic review and meta-analysis of randomized and cluster-randomized controlled trials. CINAHL, Cochrane, PubMed, Scopus, and Web of Science databases were searched from inception to June 2022. The following inclusion criteria were used for studies to determine their eligibility: they (1) include football (soccer) players; (2) investigate the preventive effect of multi-component exercise-based injury prevention programs in football; (3) contain original data from a randomized or cluster-randomized trial; and (4) investigate football injuries as the outcome. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. The outcome measures were the risk ratio (RR) between the intervention and the control group for the overall number of injuries and body region-specific, contact, and non-contact injuries sustained during the study period in training and match play. RESULTS Fifteen randomized and cluster-randomized controlled trials with 22,177 players, 5080 injuries, and 1,587,327 exposure hours fulfilled the inclusion criteria and reported the required outcome measures. The point estimate (RR) for the overall number of injuries was 0.71 (95% confidence interval [CI] 0.59-0.85; 95% prediction interval [PI] 0.38-1.32) with very low-quality evidence. The point estimate (RR) for lower limb injuries was 0.82 (95% CI 0.71-0.94; 95% PI 0.58-1.15) with moderate-quality evidence; for hip/groin injuries, the RR was 0.56 (95% CI 0.30-1.05; 95% PI 0.00-102.92) with low-quality evidence; for knee injuries, the RR was 0.69 (95% CI 0.52-0.90; 95% PI 0.31-1.50) with low-quality evidence; for ankle injuries, the RR was 0.73 (95% CI 0.55-0.96; 95% PI 0.36-1.46) with moderate-quality evidence; and for hamstring injuries, the RR was 0.83 (95% CI 0.50-1.37) with low-quality evidence. The point estimate (RR) for contact injuries was 0.70 (95% CI 0.56-0.88; 95% PI 0.40-1.24) with moderate-quality evidence, while for non-contact injuries, the RR was 0.78 (95% CI 0.55-1.10; 95% PI 0.25-2.47) with low-quality evidence. CONCLUSIONS This systematic review and meta-analysis indicated that the treatment effect associated with the use of multi-component exercise-based injury prevention programs in football is uncertain and inconclusive. In addition, the majority of the results are based on low-quality evidence. Therefore, future high-quality trials are needed to provide more reliable evidence. CLINICAL TRIAL REGISTRATION PROSPERO CRD42020221772.
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Affiliation(s)
- Rilind Obërtinca
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken Campus, Building B8 2, 66123, Saarbrücken, Germany.
- Department of Physiotherapy, University of Gjakova "Fehmi Agani", Gjakova, Kosovo.
| | - Ilir Hoxha
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Research Unit, Heimerer College, Pristina, Kosovo
- Evidence Synthesis Group, Pristina, Kosovo
| | - Rina Meha
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken Campus, Building B8 2, 66123, Saarbrücken, Germany
- Research Unit, Heimerer College, Pristina, Kosovo
| | - Arber Lama
- Research Unit, Heimerer College, Pristina, Kosovo
- Evidence Synthesis Group, Pristina, Kosovo
- University Clinical Center of Kosovo, Pristina, Kosovo
| | | | | | - Bujar Shabani
- Research Unit, Heimerer College, Pristina, Kosovo
- University Clinical Center of Kosovo, Pristina, Kosovo
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken Campus, Building B8 2, 66123, Saarbrücken, Germany
| | - Karen Aus der Fünten
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken Campus, Building B8 2, 66123, Saarbrücken, Germany
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Montoro-Bombú R, Sarmento H, Buzzichelli C, Moura NA, Gonzáles Badillo JJ, Santos A, Rama L. Methodological considerations for determining the volume and intensity of drop jump training. A systematic, critical and prepositive review. Front Physiol 2023; 14:1181781. [PMID: 37153219 PMCID: PMC10160442 DOI: 10.3389/fphys.2023.1181781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
This systematic review provides critical and propositional information on criteria for determining the volume and intensity of drop jumps during plyometric training programs. Eligibility criteria were defined according to PICOS: Participants: male or female athletes, trained or recreationally active (16-40 years). Intervention duration: more than 4 weeks. COMPARATORS passive or active control group during a plyometric training program. OUTCOMES information on improvement with Drop Jump or Depth Jump, with other jumps, acceleration, sprint, strength, and power output. DESIGN randomized controlled trials. We searched articles published in PubMed, SPORTDiscus, Web of Science, and Scopus. The search was conducted until 10 September 2022 for English-language articles only. The risk of bias was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for randomized controlled studies. We identified 31495 studies, of which only 22 were included. We found that six groups presented results with women, 15 presented results with men, and the remaining four presented mixed studies. Of the 686 people recruited, 329 participants aged 25.79 ± 4.76 years were involved in training. Methodological problems in training intensity, volume distribution, and individualization were noted, but methodological recommendations for their solution are also provided. It is concluded that the drop height should not be understood as the intensity determinant of plyometric training. Intensity is determined by ground reaction forces, power output, and jump height, among other factors. Furthermore, the athletes' experience level selection should be based on the formulas recommended within this research. These results could be helpful for those who intend to conduct new plyometric training programs and research.
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Affiliation(s)
- Raynier Montoro-Bombú
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
- *Correspondence: Raynier Montoro-Bombú,
| | - Hugo Sarmento
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Carlo Buzzichelli
- Faculty of Exercise and Sport Science, University of Milano, Milan, Italy
| | | | | | - Amândio Santos
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Luís Rama
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
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van de Hoef PA, Brink MS, Brauers JJ, van Smeden M, Gouttebarge V, Backx FJG. Adherence to an injury prevention program in male amateur football players is affected by players’ age, experience and perceptions. BMJ Open Sport Exerc Med 2022; 8:e001328. [PMID: 35990760 PMCID: PMC9351342 DOI: 10.1136/bmjsem-2022-001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Adherence to injury prevention programmes in football remains low, which is thought to drastically reduce the effects of injury prevention programmes. Reasons why (medical) staff and players implement injury prevention programmes, have been investigated, but player’s characteristics and perceptions about these programmes might influence their adherence. Therefore, this study investigated the relationships between player’s characteristics and adherence and between player’s perceptions and adherence following an implemented injury prevention programme. Methods Data from 98 of 221 football players from the intervention group of a cluster randomised controlled trial concerning hamstring injury prevention were analysed. Results Adherence was better among older and more experienced football players, and players considered the programme more useful, less intense, more functional and less time-consuming. Previous hamstring injuries, educational level, the programme’s difficulty and intention to continue the exercises were not significantly associated with adherence. Conclusion These player’s characteristics and perceptions should be considered when implementing injury prevention programmes.
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11
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Okobi OE, Evbayekha EO, Ilechie E, Iroro J, Nwafor JN, Gandu Z, Shittu HO. A Meta-Analysis of Randomized Controlled Trials on the Effectiveness of Exercise Intervention in Preventing Sports Injuries. Cureus 2022; 14:e26123. [PMID: 35875288 PMCID: PMC9298606 DOI: 10.7759/cureus.26123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Athletes risk injury every day during practice sessions and actual games, with the majority of the affected population being young males. The Centers for Disease Control and Prevention 2011-2014 report on sport and recreation-related injuries in the United States has consistently shown the average annual estimate of the millions of dollars spent on sport and recreation injuries. These injuries translate to a significant financial implication for the athlete, the team, the health system, and the public health. We composed a review protocol. We enumerated our inclusion and exclusion criteria, injury definition, and search strategy. We searched PubMed and SPORTDiscus. Then we used Forrest plots for the meta-analysis of the relevant selected studies. We used various keywords in our search strategy. These included “injury,” “sports,” “exercise,” “prevention,” “techniques,” and every possible combination of them. Search results showed 2516 hits with our keywords, and we included 20 of those results. Twenty trials, including 19712 individuals with 2855 injuries, were analyzed. Eccentric Training relative risk (RR) of 0.54 (95% CI 0.395 to 0.739 with X2 of p < 0.05) showed that the risk of the injury was decreased by 54% in the intervention group compared to the control group. In the neuromuscular training group, a RR of 0.682 (95% CI 0.621 to 0.749 with X2 of p < 0.001) showed that the risk of the injury was decreased by 68.2% in its intervention group subgroup compared to its control group. Also, the “11” International Federation of Association Football (FIFA) program had a RR of 0.771, indicating that there was a 77.1% decrease in injury by this set of exercises (95% CI 0.728 to 0.816 with X2 of p < 0.05), and this “11” FIFA program also had the most preventative effects. Warm-up had a RR of 0.843 (95% CI 0.749 to 0.949 with X2 of p < 0.05) and showed small prevention. Strength Training RR of 0.97 (95% CI 0.57 to 1.63 with X2 of p > 0.05) had no preventive effect. Our analysis showed that different exercises have preventive roles in sports injuries. The warm-up FIFA, neuromuscular training, and eccentric training reduced the risk of injury in the intervention group compared to the control group by a high percentage. At the same time, neuromuscular warm-up and FIFA 11 dynamic warm-up also decreased the relative risk of injury in the intervention group. These effects varied among exercise type, injury type, and sport.
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Ripley NJ, Cuthbert M, Ross S, Comfort P, McMahon JJ. The Effect of Exercise Compliance on Risk Reduction for Hamstring Strain Injury: A Systematic Review and Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11260. [PMID: 34769778 PMCID: PMC8583500 DOI: 10.3390/ijerph182111260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 01/21/2023]
Abstract
Eccentric strength training can reduce the risk of hamstring strain injury (HSI) occurrence; however, its implementation can be impacted by athlete compliance and prescription. The aim of this review was to investigate the effects of intervention compliance, consistency and modality, on the prevention of HSIs among athletes. A literature search was conducted. 868 studies were identified prior to the application of the exclusion criteria which resulted in 13 studies identified. Random effects models were used to produce log odds ratios and 95% confidence intervals. Very high (>75.1%), moderate-high (50.1-75%), low-moderate (25.1-50%) and very low (<25%) and <1-, 1.01-3.00-, >3.01-weeks/session were used as thresholds of compliance and consistency, respectively. Modality was also observed. A positive effect on HSI incidence -0.61 (-1.05 to -0.17), favoring the intervention treatments (Z = -2.70, p = 0.007). There were non-significant, large differences between compliance (p = 0.203, Z = -1.272) and consistency (p = 0.137, Z = -1.488), with increased compliance and consistency showing greater effectiveness. A significant difference between intervention modalities was observed (p < 0.001, Z = -4.136), with eccentric interventions being superiorly effective. Compliance of >50.1% and consistent application with <3 weeks/session having positive effects on HSI incidence. Training interventions that can achieve high levels of compliance, and can be consistently performed, should be the objective of future practice.
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Affiliation(s)
- Nicholas Joel Ripley
- Human Performance Laboratory, University of Salford, Salford M5 4BR, UK; (M.C.); (S.R.); (P.C.); (J.J.M.)
| | - Matthew Cuthbert
- Human Performance Laboratory, University of Salford, Salford M5 4BR, UK; (M.C.); (S.R.); (P.C.); (J.J.M.)
- The FA Group, St George’s Park, Burton-upon-Trent, Staffordshire DE13 9RN, UK
| | - Steven Ross
- Human Performance Laboratory, University of Salford, Salford M5 4BR, UK; (M.C.); (S.R.); (P.C.); (J.J.M.)
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39 4QP, UK
| | - Paul Comfort
- Human Performance Laboratory, University of Salford, Salford M5 4BR, UK; (M.C.); (S.R.); (P.C.); (J.J.M.)
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett, Leeds LS1 3HE, UK
| | - John James McMahon
- Human Performance Laboratory, University of Salford, Salford M5 4BR, UK; (M.C.); (S.R.); (P.C.); (J.J.M.)
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Rosado-Portillo A, Chamorro-Moriana G, Gonzalez-Medina G, Perez-Cabezas V. Acute Hamstring Injury Prevention Programs in Eleven-a-Side Football Players Based on Physical Exercises: Systematic Review. J Clin Med 2021; 10:2029. [PMID: 34065138 PMCID: PMC8125962 DOI: 10.3390/jcm10092029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 12/26/2022] Open
Abstract
(1) Objective: To analyze the exercise programs used to prevent of acute hamstring injuries in eleven-a-side football players, and their effectiveness. (2) Methods: A systematic review (PRISMA) was conducted (2008-2020), including RCTs, that exclusively used physical exercises as a prevention method. (3) Results: Ten studies were selected considering 14 interventions, including nine different programs: FIFA11+ (11+), Harmoknee, eccentric Nordic Hamstring Exercise (NHE) exclusively, with eccentric exercises, with stretching or with proprioceptive, New Warm-up Program (NWP), Bounding Exercise Program (BEP), the only one with no positive results, and proprioceptive exercises. Incidence of injuries and strength were the most considered variables, both with favorable evidences. Programs including NHE, which assessed injury incidence, were always effective. The 11+ program was effective in injury incidence and strength; NWP was effective in balance, stability, and strength. (4) Conclusions: The exercise programs discussed were effective to prevent acute hamstring injuries in football players except BEP and partially Harmoknee. Exercises mostly used to reduce the risk of hamstring injuries are those of eccentric force due to its functionality, especially NHE. Only concentric contractions and isometric contractions obtained significant favorable results. The most complete and promising programs were 11+ (in injury incidence and strength) and NWP (strength, balance, and stability). NWP was the best in strength.
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Affiliation(s)
| | - Gema Chamorro-Moriana
- Head of Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain
| | - Gloria Gonzalez-Medina
- Research Group “Physiotherapy and Health” CTS 986, Department of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain;
| | - Veronica Perez-Cabezas
- Research Group “Empowering Health by Physical Activity, Exercise and Nutrition” [CTS1038], Department of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain;
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van de Hoef PA, Brink MS, van der Horst N, van Smeden M, Backx FJG. The prognostic value of the hamstring outcome score to predict the risk of hamstring injuries. J Sci Med Sport 2021; 24:641-646. [PMID: 33478885 DOI: 10.1016/j.jsams.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 08/25/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Hamstring injuries are common among soccer players. The hamstring outcome score (HaOS) might be useful to identify amateur players at risk of hamstring injury. Therefore the aims of this study were: To determine the association between the HaOS and prior and new hamstring injuries in amateur soccer players, and to determine the prognostic value of the HaOS for identifying players with or without previous hamstring injuries at risk of future injury. DESIGN Cohort study. METHODS HaOS scores and information about previous injuries were collected at baseline and new injuries were prospectively registered during a cluster-randomized controlled trial involving 400 amateur soccer players. Analysis of variance and t-tests were used to determine the association between the HaOS and previous and new hamstring injury, respectively. Logistic regression analysis indicated the prognostic value of the HaOS for predicting new hamstring injuries. RESULTS Analysis of data of 356 players indicated that lower HaOS scores were associated with more previous hamstring injuries (F=17.4; p=0.000) and that players with lower HaOS scores sustained more new hamstring injuries (T=3.59, df=67.23, p=0.001). With a conventional HaOS score cut-off of 80%, logistic regression models yielded a probability of hamstring injuries of 11%, 18%, and 28% for players with 0,1, or 2 hamstring injuries in the previous season, respectively. CONCLUSIONS The HaOS is associated with previous and future hamstring injury and might be a useful tool to provide players with insight into their risk of sustaining a new hamstring injury risk when used in combination with previous injuries.
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Affiliation(s)
- P A van de Hoef
- Utrecht University, University Medical Center, Division Brain, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, The Netherlands.
| | - M S Brink
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - N van der Horst
- FIFA Medical Center, Royal Netherlands Football Association, Zeist, The Netherlands
| | - M van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - F J G Backx
- Utrecht University, University Medical Center, Division Brain, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, The Netherlands
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Ishøi L, Krommes K, Husted RS, Juhl CB, Thorborg K. Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport - grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med 2020; 54:528-537. [PMID: 31937579 PMCID: PMC7212929 DOI: 10.1136/bjsports-2019-101228] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 01/09/2023]
Abstract
This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.
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Affiliation(s)
- Lasse Ishøi
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
| | - Kasper Krommes
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
| | - Rasmus Skov Husted
- Department of Orthopedic Surgery and Physical Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Carsten B Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kristian Thorborg
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
- Department of Orthopedic Surgery and Physical Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
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Vatovec R, Kozinc Ž, Šarabon N. Exercise interventions to prevent hamstring injuries in athletes: A systematic review and meta-analysis. Eur J Sport Sci 2019; 20:992-1004. [PMID: 31680644 DOI: 10.1080/17461391.2019.1689300] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this meta-analysis was to assess the effectiveness of exercise-based interventions for prevention of hamstring injuries in sport. PubMed, Cochrane Central Register of Controlled Trials, Web of Science, ResearchGate, CINAHL, PEDro, ScienceDirect and Google Scholar databases were searched for randomized controlled trials and prospective cohort studies exploring the effects of exercise interventions on hamstring injury incidence. Subgroup analyses were performed to determine effects of several independent variables related to the interventions. Altogether, 17 studies were included. Exercise interventions decreased hamstring injury risk (RR = 0.49; 95%CI = 0.40-0.59; p < 0.001). There were similar effects found for interventions performed ≤2 times per week (RR = 0.35; 95%CI = 0.15-0.82) and the interventions performed >2 times per week (RR = 0.44; 95%CI = 0.31-0.61). Similarly, there were similar effects found for the interventions with progressive increase in load (RR = 0.53; 95%CI = 0.37-0.74) and the interventions with constant loads (RR = 0.46; 95%CI = 0.36-0.58). Other subgroup analyses (intervention supervision, sport type, inclusion of Nordic hamstring exercise and type of the trial) also showed no indications on specific characteristics of the interventions, that increase the preventive effects. Our findings showed that hamstring injury incidence can be decreased with exercise-based interventions, and that weekly frequency and load progression are not among the most important variables to consider in prevention programmes design.
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Affiliation(s)
- Rok Vatovec
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Andrej Marušič Institute, University of Primorska, Koper, Slovenia
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Laboratory for Motor Control and Motor Behaviour, S2P, Science to practice, Ltd., Ljubljana, Slovenia
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van de Hoef PA, Brink MS, Huisstede BMA, van Smeden M, de Vries N, Goedhart EA, Gouttebarge V, Backx FJG. Does a bounding exercise program prevent hamstring injuries in adult male soccer players? - A cluster-RCT. Scand J Med Sci Sports 2019; 29:515-523. [PMID: 30536639 PMCID: PMC6850185 DOI: 10.1111/sms.13353] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/26/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
Background Although the Nordic Hamstring Exercise (NHE) prevents hamstring injury in soccer players effectively, the annual incidence of these injuries still increases. This may be because of poor long‐term compliance with the program. Furthermore, the timing and amplitude of gluteal and core muscle activation seem to play an important role in hamstring injury prevention, the NHE program was not designed to improve activation of these muscles. Therefore, we propose plyometric training as an alternative to reduce hamstring injuries in soccer players. Purpose To determine the preventive effect of the Bounding Exercise Program (BEP) on hamstring injury incidence and severity in adult male amateur soccer players. Study design A cluster‐Randomized Controlled Trial. Methods Thirty‐two soccer teams competing in the first‐class amateur league were cluster‐randomized into the intervention or control group. Both groups were instructed to perform their regular training program, and the intervention group additionally performed BEP. Information about player characteristics was gathered at baseline and exposure, hamstring injuries and BEP compliance were weekly registered during one season (2016‐2017). Results The data of 400 players were analyzed. In total, 57 players sustained 65 hamstring injuries. The injury incidence was 1.12/1000 hours in the intervention group and 1.39/1000 hours in the control group. There were no statistically significant differences in hamstring injury incidence (OR = 0.89, 95% CI 0.46‐1.75) or severity between the groups (P > 0.48). Conclusion In this large cluster‐randomized controlled trial, no evidence was found for plyometric training in its current form to reduce hamstring injuries in amateur soccer players.
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Affiliation(s)
- Peter Alexander van de Hoef
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department Rehabilitation, Physical Therapy Science & Sports, Utrecht University, Utrecht, The Netherlands
| | - Michel S Brink
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department Rehabilitation, Physical Therapy Science & Sports, Utrecht University, Utrecht, The Netherlands.,University Medical Center Groningen, Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands
| | - Bionka M A Huisstede
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department Rehabilitation, Physical Therapy Science & Sports, Utrecht University, Utrecht, The Netherlands
| | - Maarten van Smeden
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels de Vries
- FIFA Medical Center, Royal Netherlands Football Association, Zeist, The Netherlands
| | - Edwin A Goedhart
- FIFA Medical Center, Royal Netherlands Football Association, Zeist, The Netherlands
| | - Vincent Gouttebarge
- Dutch Consumer Safety Institute, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.,World Players' Union (FIFPro), Hoofddorp, The Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.,Division of Exercise Science and Sports Medicine (ESSM), University of Cape Town, Cape Town, South Africa
| | - Frank J G Backx
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department Rehabilitation, Physical Therapy Science & Sports, Utrecht University, Utrecht, The Netherlands
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