Systematic development of an injury and illness prevention programme for athletes with a physical impairment: the TIPAS study.

Background/aim: The participation of individuals with physical impairment in sports has numerous benefits, yet there is also the risk of sustaining sport-related injuries or illnesses. Therefore, prevention programmes of these problems are needed to ensure that individuals can maintain a healthy, active lifestyle. Currently, very few prevention interventions are accessible for these athletes. Therefore, the article aims to describe the development process of the Tailored Injury Prevention in Adapted Sports intervention, an online tailored injury and illness prevention intervention for athletes with a physical impairment. Methods: The development was guided by the Knowledge Transfer Scheme (KTS). Results: In the first step, a cohort study and a qualitative study were conducted to define the problem statement. In the second step, a systematic review was performed in order to learn from theory. Steps 3 and 4 involved an iterative process involving collaboration with diverse expert groups. This included defining athletes' needs and creating a health problem blueprint, after which the intervention content was created. To ensure accuracy and completeness, a feedback loop was incorporated. In the final phase of this step, we refined the language used within the intervention together with athletes. Finally, an effect and process evaluation will take place in the last step of the KTS. Conclusions: Through a five-step approach of the KTS, we developed an online injury and illness prevention intervention for athletes with a physical impairment. This intervention provides direct, timely feedback based on their current health status. Furthermore, it takes the sport and the physical impairment of the athletes into account with regard to the given prevention advices.

Implementing Individually Tailored Prescription of Physical Activity in Routine Clinical Care: A Process Evaluation of the Physicians Implement Exercise = Medicine Project.

BACKGROUND: Although the prescription of physical activity in clinical care has been advocated worldwide, in the Netherlands, "Exercise is Medicine" (E = M) is not yet routinely implemented in clinical care. METHODS: A set of implementation strategies was pilot implemented to test its feasibility for use in routine care by clinicians in 2 departments of a university medical center. An extensive learning process evaluation was performed, using structured mixed methods methodology, in accordance with the Reach, Effect, Adoption, Implementation, and Maintenance framework. RESULTS: From 5 implementation strategies employed (education, E = M tool embedded in the electronic medical records, lifestyle coach situated within the department, overviews of referral options, and project support), the presence of adequate project support was a strong facilitator of the implementation of E = M. Also, the presence of the lifestyle coach within the department seemed essential for referral rate. Although clinicians appreciated the E = M tool, barriers hampered its use in practice. CONCLUSIONS: Specific implementation strategies, tailored to the setting, are effective in facilitating the implementation of E = M with specific regard to education for clinicians on E = M, deployment of a lifestyle coach within a department, and project coordination. Care providers do see a future for lifestyle coaches who are structurally embedded in the hospital, to whom they can easily refer.

Physical Activity Levels, Correlates, and All-Cause Mortality Risk in People Living With Different Health Conditions.

BACKGROUND: To better understand physical activity behavior and its health benefits in people living with health conditions, we studied people with and without 20 different self-reported health conditions with regard to (1) their physical activity levels, (2) factors correlated with these physical activity levels, and (3) the association between physical activity and all-cause mortality. METHODS: We used a subsample (n = 88,659) of the Lifelines cohort study from the Netherlands. For people living with and without 20 different self-reported health conditions, we studied the aforementioned factors in relation to physical activity. Physical activity was assessed with the Short Questionnaire to Assess Health-Enhancing Physical Activity Questionnaire, and mortality data were obtained from the Dutch death register. RESULTS: People with a reported health condition were less likely to meet physical activity guidelines than people without a reported health condition (odds ratios ranging from 0.55 to 0.89). Higher body mass index and sitting time, and lower self-rated health, physical functioning, and education levels were associated with lower odds of meeting physical activity guidelines across most health conditions. Finally, we found a protective association between physical activity and all-cause mortality in both people living with and without different health conditions. CONCLUSION: People living with different health conditions are generally less physically active compared with people living without a health condition. Both people living with and without self-reported health conditions share a number of key factors associated with physical activity levels. We also observed the expected protective association between physical activity and all-cause mortality.

A sports-related injury prevention program for Dutch youth volleyball players: Process evaluation alongside a quasi-randomized controlled trial.

OBJECTIVE: This process evaluation aimed to gain insight into the implementation of the VolleyVeilig Youth program by Dutch volleyball clubs within the context of an effectiveness trial. METHODS: We applied the UK Medical Research Council framework for process evaluations and assessed the context, implementation and mechanisms of impact. Trainers participating in the effectiveness trial were asked to complete a questionnaire at the end of the study. A subsample of the trainers based on the self-reported adherence score was invited to participate in an interview accordingly. We used a thematic analysis to present the data. RESULTS: Thirty-one trainers (100%) completed the questionnaire, and seven agreed to participate in an interview. Although adherence gradually decreased over the volleyball season, most trainers reported partially adhere with the program until the end of the study. The main themes included factors associated with the (1) VolleyVeilig Youth program, (2) trainer, (3) players, and (4) volleyball club. CONCLUSION: Although (partial) adherence to the VolleyVeilig Youth program was high in this study, implementation strategies must be developed to target the barriers reported by the trainers before the program can be successfully implemented nationwide in the Netherlands.

Occurrence of injuries and illnesses in athletes with a physical impairment; a forty-week prospective cohort study.

OBJECTIVES: Currently, the knowledge about the epidemiology of sport-related health problems of athletes with a physical impairment is limited. Therefore, this study aims to describe the prevalence, incidence and severity of sport-related health problems of athletes with a physical impairment in the Netherlands over a one sport season. DESIGN: Prospective cohort study. METHODS: Athletes (n = 99) with a physical impairment participated in this study. After completing a baseline questionnaire, athletes started a 40-week health monitoring period, during which they completed the Dutch translation of the OSTRC Questionnaire on Health Problems every week. Based on the reported information, injury and illness prevalence, incidence, weekly cumulative severity score, weekly time loss from sport and the total burden were calculated. RESULTS: A total of 368 health problems were reported by 95 athletes. These health problems consisted of 258 injuries and 110 illnesses. The average weekly prevalence of health problems was 48.0 %; for injuries 34.6 %, and illnesses 13.4 %. Differences were found when considering injury severity, with the highest severity scores for athletes with a limb deficiency. Furthermore, recreational athletes reported the highest injury severity scores, followed by athletes who competed nationally and athletes who competed internationally. CONCLUSIONS: Data from this study show a high average weekly prevalence of health problems, and differences amongst various impairment categories and sport levels when considering the severity of injuries. These results add to the knowledge regarding sport-related health problem epidemiology in this population, indicating that impairment category and sport level should be taken into account when developing injury prevention strategies.

Sports-Related Health Problems in Para-Sports: A Systematic Review With Quality Assessment.

CONTEXT: Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports. OBJECTIVE: To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention. DATA SOURCES: A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist. STUDY SELECTION: The search yielded 3006 articles, of which 64 met all inclusion criteria. STUDY DESIGN: Systematic review with quality assessment. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence. RESULTS: A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days). CONCLUSION: This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.

Effectiveness of a warm-up programme to reduce injuries in youth volleyball players: a quasi-experiment.

OBJECTIVES: To establish the effectiveness of the 'VolleyVeilig' programme on reducing injury rate, injury burden and injury severity in youth volleyball players. METHODS: We conducted a quasi-experimental prospective study over one season of youth volleyball. After randomisation by competition region, we instructed 31 control teams (236 children, average age 12.58±1.66) to use their usual warm-up routine. The 'VolleyVeilig' programme was provided to 35 intervention teams (282 children, average age 12.90±1.59). This programme had to be used during each warm-up before training sessions and matches. We sent a weekly survey to all coaches, collecting data on each player's volleyball exposure and injuries sustained. Multilevel analyses estimated differences in injury rates and burden between both groups, and we used non-parametric bootstrapping to compare the differences in injury numbers and injury severity. RESULTS: We found an overall reduction in injury rates of 30% for intervention teams (HR 0.72; 95% CI 0.39 to 1.33). Detailed analyses revealed differences for acute (HR 0.58; 95% CI 0.34 to 0.97) and upper extremity injuries (HR 0.41; 95% CI 0.20 to 0.83). Compared with control teams, the intervention teams had a relative injury burden of 0.39 (95% CI 0.30 to 0.52) and a relative injury severity of 0.49 (95% CI 0.03 to 0.95). Only 44% of teams fully adhered to the intervention. CONCLUSION: We established that the 'VolleyVeilig' programme was associated with reduced acute and upper extremity injury rates and lower injury burden and severity in youth volleyball players. While we advise implementation of the programme, programme updates to improve adherence are needed.

LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change-study protocol.

BACKGROUND: A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO. METHODS: Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up. DISCUSSION: This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle. TRIAL REGISTRATION: ISRCTN ISRCTN13046877 . Registered 21 April 2022.

Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals.

BACKGROUND: There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as 'Exercise is Medicine' (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care. METHODS: A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide. RESULTS: An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients' electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care. CONCLUSIONS: This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation.

Facilitators and barriers for the implementation of exercise are medicine in routine clinical care in Dutch university medical centres: a mixed methodology study on clinicians' perceptions.

OBJECTIVES: Despite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres. DESIGN: A mixed methodologies study, using both online questionnaires and semi-structured interviews. SETTING: Dutch university medical centres. PARTICIPANTS: Clinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres. RESULTS: Forty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints). CONCLUSIONS: Our study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians.

Implementing Individually Tailored Prescription of Physical Activity in Routine Clinical Care: Protocol of the Physicians Implement Exercise = Medicine (PIE=M) Development and Implementation Project.

BACKGROUND: The prescription of physical activity (PA) in clinical care has been advocated worldwide. This "exercise is medicine" (E=M) concept can be used to prevent, manage, and cure various lifestyle-related chronic diseases. Due to several challenges, E=M is not yet routinely implemented in clinical care. OBJECTIVE: This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care. METHODS: PIE=M consists of 3 interrelated work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators, and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from 2 diverse university medical centers (both located in a city, but one serving an urban population and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, a generic E=M tool will be developed that will provide tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative design process in which all stakeholders reflect on the design of the E=M tool. Third, we will pilot-implement the set of implementation strategies, including the E=M tool, to test its feasibility in routine care of clinicians in these 2 university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches, and patients using a mixed-methods design based on the RE-AIM framework. RESULTS: This project was approved and funded by the Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package have been collected and analyzed and are expected to be published in 2021. Results of the second work package are described. The manuscript is expected to be published in 2021. The third work package is currently being conducted in clinical practice in 4 departments of 2 university medical hospitals among clinicians, lifestyle coaches, hospital managers, and patients. Results are expected to be published in 2021. CONCLUSIONS: The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage chronic disease, improve recovery, and enable healthy ageing by developing E=M implementation strategies, including an E=M tool, in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients' health, while minimizing the burden on clinicians.

A Warm-Up Program to Reduce Injuries in Youth Field Hockey Players: A Quasi-Experiment.

CONTEXT: Field hockey is popular worldwide; however, it entails a risk of injury. Injuries hamper players' participation in the sport and impose a burden on public health. OBJECTIVE: To investigate the effectiveness of a structured exercise program among youth field hockey players on the injury rate, severity, and burden. DESIGN: Quasi-experimental study. SETTING: On field during 1 season of field hockey (October 2016 through June 2017). PATIENTS OR OTHER PARTICIPANTS: A convenience sample of 22 teams (291 players): 10 teams (135 players, mean age = 11.5 years [95% confidence interval (CI) = 11.2, 11.7 years]) in the intervention group and 12 teams (156 players, mean age = 12.9 years [95% CI = 12.6, 13.2 years]) in the control group. INTERVENTION(S): The Warming-up Hockey program, a sex- and age-specific, structured, evidence-informed warm-up program consisting of a preparation phase (ie, agility and cardiovascular warm-up exercises), movement skills (ie, stability and flexibility exercises), and sport-specific skills (ie, speed and strength exercises in field hockey situations). Participants in the control group performed their usual warm-up routines. MAIN OUTCOME MEASURE(S): Injury rate (ie, the number of injuries per 1000 player-hours of field hockey exposure), severity (ie, days of player time-loss), and burden on athletes' availability to play (ie, days of time loss due to injury per 1000 player-hours of field hockey exposure). RESULTS: The injury rate was lower in the intervention group (hazard ratio of 0.64 [95% CI = 0.38, 1.07]); however, this result was not statistically significant. The severity of injuries was similar in both groups (t statistic P = .73). The burden of injuries on players' field hockey participation was lower in the intervention group (difference of 8.42 [95% CI = 4.37, 12.47] days lost per 1000 player-hours of field hockey). CONCLUSIONS: Exposure to the Warming-up Hockey program was not significantly associated with a lower injury rate. No reduction was observed in the severity of injuries alone; however, the burden of injuries on players' field hockey participation was lower in the intervention group.

Correction to: Injuries in Field Hockey Players: A Systematic Review.

Page 1: The listing of the author names and affiliations, which previously read.

Injuries in Field Hockey Players: A Systematic Review.

BACKGROUND: To commence injury prevention efforts, it is necessary to understand the magnitude of the injury problem. No systematic reviews have yet investigated the extent of injuries in field hockey, despite the popularity of the sport worldwide. OBJECTIVE: Our objective was to describe the rate and severity of injuries in field hockey and investigate their characteristics. METHODS: We conducted electronic searches in PubMed, Embase, SPORTDiscus, and CINAHL. Prospective cohort studies were included if they were published in English in a peer-reviewed journal and observed all possible injuries sustained by field hockey players during the period of the study. RESULTS: The risk of bias score of the 22 studies included ranged from three to nine of a possible ten. In total, 12 studies (55%) reported injuries normalized by field hockey exposure. Injury rates ranged from 0.1 injuries (in school-aged players) to 90.9 injuries (in Africa Cup of Nations) per 1000 player-hours and from one injury (in high-school women) to 70 injuries (in under-21 age women) per 1000 player-sessions. Studies used different classifications for injury severity, but-within studies-injuries were included mostly in the less severe category. The lower limbs were most affected, and contusions/hematomas and abrasions were common types of injury. Contact injuries are common, but non-contact injuries are also a cause for concern. CONCLUSIONS: Considerable heterogeneity meant it was not possible to draw conclusive findings on the extent of the rate and severity of injuries. Establishing the extent of sports injury is considered the first step towards prevention, so there is a need for a consensus on injury surveillance in field hockey.

Acceptability and perceptions of end-users towards an online sports-health surveillance system.

AIM: To describe the acceptability and the perceptions of athletes and staff members (ie, end-users) towards an online sports-health surveillance system. METHODS: A pilot study with a mixed-methods approach was pursued. Descriptive analysis was conducted to present the adherence of judo (n=34), swimming (n=21) and volleyball (n=14) athletes to an online registration of their sport exposure and any health complaints between April 2014 and January 2015. End-users' perceptions towards the system were investigated qualitatively with semistructured interviews (n=21). Qualitative analysis was based on the constant comparative method using principles of the grounded theory. RESULTS: The response rates of judo, swimming and volleyball athletes were 50% (SD 23), 61% (SD 27) and 56% (SD 25), respectively. Most athletes found it simple to register their sport exposure and health complaints online; however, personal communication was still preferred for this purpose. The system facilitated the communication between medical and trainer staff, who were able to identify in the system reports health complaints from athletes that were not necessarily communicated face-to-face. Therefore, staff members reported that they were able to intervene earlier to prevent minor health complaints from becoming severe health problems. However, staff members expected higher adherence of athletes to the online follow-ups, and athletes expected to receive feedback on their inputs to the system. CONCLUSION: An online system can be used in sporting settings complementary to regular strategies for monitoring athletes' health. However, providing feedback on athletes' inputs is important to maintain their adherence to such an online system.

Injury risk during different physical activity behaviours in children: a systematic review with bias assessment.

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.

A systematic review on the effectiveness of school and community-based injury prevention programmes on risk behaviour and injury risk in 8-12 year old children.

OBJECTIVES: To review existing literature on the effectiveness of community-based and school-based physical activity related injury prevention programmes implemented to increase safety behaviour and decrease injury risk in 8-12 year old children, considering the methodological quality of the studies. DESIGN: A systematic review with quality assessment. METHODS: A systematic search was performed using the CINAHL, Cochrane, EMBASE, PubMed and Sportdiscus databases. Inclusion criteria included the following: children aged 8-12 years; school- or community-based injury prevention programmes; an outcome defined as number of injuries, injury incidence or safety behaviour; published in an English language journal. Methodological quality was assessed for all included studies. RESULTS: The search yielded 5377 records, of which 11 were included in the review; four studies were considered as being of high quality. The focus of studies that were included was on the use of safety devices (8), pedestrian safety (2) and physical activity-related injury prevention (1). For safety device use, short term effects of school- and community-based interventions are promising for 8-12 year olds. Results regarding sustainability of the effect are inconsistent. A mediating effect on the distribution of safety devices was observed. Both financial and non-financial barriers seemed to prevent participants from purchasing a safety device. CONCLUSIONS: The short term effects for school- and community-based interventions using safety devices for 8-12 year olds are promising. More high quality research is, however warranted, preferably shifting focus from safety behaviour change to actual physical activity injury reduction.

Prevention of fall-related injuries in 7-year-old to 12-year-old children: a cluster randomised controlled trial.

INTRODUCTION: To counteract the recently observed increase in forearm fractures in children worldwide, an educational programme to improve fall skills was developed. In this 8-week programme children learned basic martial arts falling techniques in their physical education classes. In this study, the effectiveness of this educational programme to improve fall skills was evaluated. METHODS: A cluster randomised controlled trial was conducted in 33 primary schools. The intervention group received the educational programme to improve falling skills during their physical education (PE) classes whereas the control group received their regular PE curriculum. At baseline (October 2009) and follow-up (May 2010), a questionnaire was completed by the children about their physical activity behaviours. Furthermore, fall-related injuries were registered continuously during an entire school-year. RESULTS: A total of 36 incident injuries was reported in the intervention group, equalling an injury incidence density (IID) of 0.14 fall-related injuries per 1000 h of physical activity (95% CI 0.09 to 0.18). In contrast, 96 injuries were reported by the control group corresponding to an IID of 0.26 (95% CI 0.21 to 0.32). However, because intracluster correlation was high (ICC=0.46), differences in injury incidence were not statistically significant. When activity level was taken into account, a trend was shown suggesting that the 'falling is a sport' programme was effective in decreasing falling-related injury risk, but only in the least active children. DISCUSSION AND CONCLUSION: Although results did not reach significance because of strong clustering effects, a trend was found suggesting that a school-based educational programme to improve falling skills may be more beneficial for the prevention of falling-related injuries in children with low levels of habitual physical activity.

Determinants of physical activity and sedentary behaviour in young people: a review and quality synthesis of prospective studies.

OBJECTIVE: The aim of this systematic review was to summarise and update the existing literature on determinants of physical activity and sedentary behaviour in young people, considering the methodological quality of the studies. METHODS: Prospective studies were identified from searches in PubMed and PsycINFO, from April 2004 through November 2010. The authors included studies investigating the association between determinants of overall physical (in)activity and/or sedentary behaviour in healthy children or adolescents. When a determinant was investigated for its association with physical (in)activity and sedentary behaviour assessed between ages of 4-12, or mean age ≤12, it was classified as 'child determinant'. When a determinant was investigated for its association with physical activity and sedentary behaviour assessed between ages of 13-18 or mean age >12, it was classified as 'adolescent determinant'. Included articles were scored on their methodological quality and a best-evidence synthesis was applied to summarise the results. RESULTS: The authors identified 30 papers, of which seven were of high methodological quality. Intention was found as a determinant of children's physical activity. Determinants of adolescents' physical activity were age (ie, older children were more active), ethnicity (ie, being of African--American descent determined being less physically active) and planning. The authors found insufficient evidence for determinants of sedentary behaviour. CONCLUSION: Studies on determinants of physical activity and sedentary behaviour were in general of poor methodological quality. To develop long-term effective interventions that increase physical activity and decrease time spent in sedentary behaviours in young people, we need more high quality prospective evidence on the determinants of these behaviours.