The built environment and active transportation safety in children and youth: a study protocol.

BACKGROUND: Active transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury. METHODS: First, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist's route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries. DISCUSSION: This program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team's national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

Movement and Physiological Demands of Australasian National Rugby League Referees.

PURPOSE: To evaluate the movement and physiological demands of Australasian National Rugby League (NRL) referees, officiating with a 2-referee (ie, lead and pocket) system, and to compare the demands of the lead and pocket referees. METHODS: Global positioning system devices (10 Hz) were used to obtain 86 data sets (lead, n = 41; pocket, n = 45) on 19 NRL referees. Total distance, relative distance covered, and heart rate per half and across match play were examined within and between referees using t tests. Distance, time, and number of movement "efforts" were examined in 6 velocity classifications (ie, standing <0.5, walking 0.51-2.0, jogging 2.01-4.0, running 4.01-5.5, high-speed running 5.51-7.0, and sprinting >7.0 m/s) using analysis of variance. Cohen d effect sizes are reported. RESULTS: There were no significant differences between the lead and pocket referees for any movement or physiological variable. There was an overall significant (large, very large) effect for distance (% distance) and time (% time) (P < .001) between velocity classifications for both the lead and pocket referees. Both roles covered the largest distance and number of efforts at velocities of 0.51-2.0 m/s and 2.01-4.0 m/s, which were interspersed with efforts >5.51 m/s. CONCLUSIONS: Findings highlight the intermittent nature of rugby league refereeing but show that there were no differences in the movement and physiological demands of the 2 refereeing roles. Findings are valuable for those responsible for the preparation, training, and conditioning of NRL referees and to ensure that training prepares for and simulates match demands.

The Efficacy of Injury Prevention Programs in Adolescent Team Sports: A Meta-analysis.

BACKGROUND: Intensive sport participation in childhood and adolescence is an established cause of acute and overuse injury. Interventions and programs designed to prevent such injuries are important in reducing individual and societal costs associated with treatment and recovery. Likewise, they help to maintain the accrual of positive outcomes from participation, such as cardiovascular health and skill development. To date, several studies have individually tested the effectiveness of injury prevention programs (IPPs). PURPOSE: To determine the overall efficacy of structured multifaceted IPPs containing a combination of warm-up, neuromuscular strength, or proprioception training, targeting injury reduction rates according to risk exposure time in adolescent team sport contexts. STUDY DESIGN: Systematic review and meta-analysis. METHODS: With established inclusion criteria, studies were searched in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, SPORTDiscus, Web of Science, EMBASE, CINAHL, and AusSportMed. The keyword search terms (including derivations) included the following: adolescents, sports, athletic injuries, prevention/warm-up programs. Eligible studies were then pooled for meta-analysis with an invariance random-effects model, with injury rate ratio (IRR) as the primary outcome. Heterogeneity among studies and publication bias were tested, and subgroup analysis examined heterogeneity sources. RESULTS: Across 10 studies, including 9 randomized controlled trials, a pooled overall point estimate yielded an IRR of 0.60 (95% CI = 0.48-0.75; a 40% reduction) while accounting for hours of risk exposure. Publication bias assessment suggested an 8% reduction in the estimate (IRR = 0.68, 95% CI = 0.54-0.84), and the prediction interval intimated that any study estimate could still fall between 0.33 and 1.48. Subgroup analyses identified no significant moderators, although possible influences may have been masked because of data constraints. CONCLUSION: Compared with normative practices or control, IPPs significantly reduced IRRs in adolescent team sport contexts. The underlying explanations for IPP efficacy remain to be accurately identified, although they potentially relate to IPP content and improvements in muscular strength, proprioceptive balance, and flexibility. CLINICAL RELEVANCE: Clinical practitioners (eg, orthopaedics, physical therapists) and sports practitioners (eg, strength and conditioners, coaches) can respectively recommend and implement IPPs similar to those examined to help reduce injury rates in adolescent team sports contexts.