Lower extremity physical function and quality of life in patients with stroke: a longitudinal cohort study.

PURPOSE: Lower extremity physical function (LEPF) is a key component for mobility and is impacted in stroke-related disability. A reduction in LEPF can have a significant impact on an individual's Quality of Life (QoL). The aim of this study is to characterise the relationship between LEPF and QoL. METHODS: The MOBITEC-Stroke Study is a longitudinal cohort-study including patients with their first occurrence of ischaemic stroke. Using a linear mixed-effects model, the relationship between LEPF (timed up-and-go performance (TUG); predictor) and QoL (Stroke Specific Quality of Life scale (SS-QoL); outcome) at 3 and 12 months post stroke was investigated and adjusted for sex, age, Instrumental Activities of Daily Living (IADL), fear of falling (Falls Efficacy Scale-International Version, FES-I), and stroke severity (National Institute of Stroke Severity scale, NIHSS), accounting for the repeated measurements. RESULTS: Data of 51 patients (65 % males, 35% females) were analysed. The mean age was 71.1 (SD 10.4) years, median NIHSS score was 2.0. SS-QoL was 201.5 (SD 20.5) at 3 months and 204.2 (SD 17.4) at 12 months; the mean change was 2.7 (95% CI -2.4 to 7.7), p= 0.293. A positive association was found between baseline TUG performance (estimate log score -13.923; 95% CI -27.495 to -0.351; p=0.048) and change in SS-QoL score in multivariate regression analysis. CONCLUSION: Higher LEPF (i.e better TUG performance) at baseline, was associated with an improvement in QoL from 3- to 12-months post stroke. These results highlight the critical role of physical function, particularly baseline LEPF, in influencing the QoL of stroke survivors.

Focus of Attention During ACL Injury Prevention Exercises Affects Improvements in Jump-Landing Kinematics in Soccer Players: A Randomized Controlled Trial.

ABSTRACT: Dalvandpour, N, Zareei, M, Abbasi, H, Abdoli, B, Mohammadian, MA, Rommers, N, and Rössler, R. Focus of attention during ACL injury prevention exercises affects improvements in jump-landing kinematics in soccer players: a randomized controlled trial. J Strength Cond Res 37(2): 337-342, 2023-Anterior cruciate ligament tears are severe and complex knee injuries that commonly occur in soccer. Prevent injuries enhance performance (PEP) is an exercise-based prevention program to effectively reduce anterior cruciate ligament injuries. It is, however, unclear how the delivery of the program contributes to its effectiveness. Therefore, we aimed to investigate the effect of the focus of attention that was emphasized during the delivery of the PEP program on jump-landing kinematics in male, elite-level, U21 soccer players. Forty-two players participated in this randomized controlled trial and were allocated to (a) the internal focus of attention (IF) group, receiving instructions focusing on the execution of the exercise (b), the external focus of attention (EF) group, receiving instructions focusing on the outcome of the exercise, or (c) the control group. Before and after the 8-week intervention, players performed a jump-landing task during which we measured hip and knee angles at the initial contact, peak knee flexion, and peak vertical ground reaction force using a 3-dimensional motion analyzer. A repeated-measures analysis of variance was used to compare groups over time. Significant time-by-group interaction effects with large effect sizes were found for hip flexion at all moments (p < 0.032; η2 > 0.15) and for the knee flexion angle at initial contact and maximum knee flexion (p < 0.001; η2 > 0.35), all in favor of the EF group. This shows that EF during PEP improves hip and knee joint kinematics in the sagittal plane more than IF. Therefore, EF during PEP instructions is preferred to increase the effectiveness of this injury prevention program.

Most amateur football teams do not implement essential components of neuromuscular training to prevent anterior cruciate ligament injuries and lateral ankle sprains.

PURPOSE: Neuromuscular training (NMT) is effective at reducing football injuries. The purpose of this study was to document the use of NMT to prevent anterior cruciate ligament injuries and lateral ankle sprains in adult amateur football and to identify barriers for using NMT. METHODS: A preseason and in-season online survey was completed by players and coaches of 164 football teams. The survey contained questions concerning injury history, type and frequency of NMT, and barriers when NMT was not used. RESULTS: A total of 2013 players (40% female) and 180 coaches (10% female) completed the preseason survey, whereas 1253 players and 140 coaches completed the in-season survey. Thirty-four percent (preseason) to 21% (in-season) of players used NMT, but only 8% (preseason) to 5% (in-season) performed adequate NMT (i.e. both balance and plyometric exercises, at least twice per week). In the subpopulation of players with an injury history, 12% (preseason) and 7% (in-season) performed adequate NMT. With respect to the coaches, only 5% (preseason) and 2% (in-season) implemented adequate NMT. Most important barriers for using NMT for both players and coaches were a lack of belief in its effectiveness, a lack of knowledge, the belief that stretching is sufficient, and not feeling the need for it. CONCLUSION: Most amateur football teams do not implement essential components of NMT. The results highlight the urgent need for developing strategies to enhance the adequate use of NMT in amateur football. LEVEL OF EVIDENCE: II.

Psychometric properties of the MOBITEC-GP mobile application for real-life mobility assessment in older adults.

Aim of this study was to test the reliability and validity of the life-space measures and walking speed delivered by the MOBITEC-GP app. Participants underwent several supervised walking speed assessments as well as a 1-week life-space assessment during two assessment sessions 9 days apart. Fifty-seven older adults (47.4% male, mean age= 75.3 (±5.9) years) were included in the study. The MOBITEC-GP app showed moderate to excellent test-retest reliability (ICCs between 0.584 and 0.920) and validity (ICCs between 0.468 and 0.950) of walking speed measurements of 50 meters and above and of most 1-week life-space parameters, including life-space area, time spent out-of-home, and action range. The MOBITEC-GP app for Android is a reliable and valid tool for the assessment of real-life walking speed (at distances of 50 metres and above) and life-space parameters of older adults. Future studies should look into technical issues more systematically in order to avoid invalid measurements.

Accuracy of maturity prediction equations in individual elite male football players.

BACKGROUND: Equations predicting age at peak height velocity (APHV) are often used to assess somatic maturity and to adjust training load accordingly. However, information on the intra-individual accuracy of APHV in youth athletes is not available. AIM: The purpose of this study is to assess the accuracy of predication equations for the estimation of APHV in individual youth male football players. SUBJECTS AND METHODS: Body dimensions were measured at least every three months in 17 elite youth male football players (11.9 ± 0.8 years at baseline) from the 2008-2009 through the 2011-2012 seasons. APHV was predicted at each observation with four suggested equations. Predicted APHV was compared to the player's observed APHV using one-sample-t-tests and equivalence-tests. Longitudinal stability was assessed by comparing the linear coefficient of the deviation to zero. RESULTS: Predicted APHV was equivalent to the observed APHV in none of the players. A difference with a large effect size (Cohen's d > 0.8) was noted in 87% of the predictions. Moreover, predictions were not stable over time in 71% of the cases. CONCLUSIONS: None of the evaluated prediction equations is accurate for estimating APHV in individual players nor are predictions stable over time, which limits their utility for adjusting training programmes.

Comparison of the '11+ Kids' injury prevention programme and a regular warmup in children's football (soccer): a cost effectiveness analysis.

OBJECTIVE: To evaluate a potential reduction in injury related healthcare costs when using the '11+ Kids' injury prevention programme compared with a usual warmup in children's football. METHODS: This cost effectiveness analysis was based on data collected in a cluster randomised controlled trial over one season from football teams (under-9 to under-13 age groups) in Switzerland. The intervention group (INT) replaced their usual warmup with '11+ Kids', while the control group (CON) warmed up as usual. Injuries, healthcare resource use and football exposure (in hours) were collected prospectively. We calculated the mean injury related costs in Swiss Francs (CHF) per 1000 hours of football. We calculated the cost effectiveness (the direct net healthcare costs divided by the net health effects of the '11+ Kids' intervention) based on the actual data in our study (trial based) and for a countrywide implementation scenario (model based). RESULTS: Costs per 1000 hours of exposure were CHF228.34 (95% CI 137.45, 335.77) in the INT group and CHF469.00 (95% CI 273.30, 691.11) in the CON group. The cost difference per 1000 hours of exposure was CHF-240.66 (95%CI -406.89, -74.32). A countrywide implementation would reduce healthcare costs in Switzerland by CHF1.48 million per year. 1002 players with a mean age of 10.9 (SD 1.2) years participated. During 76 373 hours of football, 99 injuries occurred. CONCLUSION: The '11+ Kids' programme reduced the healthcare costs by 51% and was dominant (ie, the INT group had lower costs and a lower injury risk) compared with a usual warmup. This provides a compelling case for widespread implementation.

Effects of the '11+ Kids' injury prevention programme on severe injuries in children's football: a secondary analysis of data from a multicentre cluster-randomised controlled trial.

BACKGROUND: To assess the effects of the injury prevention programme '11+ Kids' on reducing severe injuries in 7 to 13 year old football (soccer) players. METHODS: Football clubs (under-9, under-11 and under-13 age groups) from the Czech Republic, Germany, the Netherlands and Switzerland were cluster-randomised (clubs) into an intervention (INT) and a control group (CON). INT replaced their usual warm-up by '11+ Kids' two times a week. CON followed their regular training regime. Match and training exposure and injury characteristics were recorded and injury incidence rates (IRs) and 95% CIs calculated. For the present analysis, only severe injuries (absence from training/match ≥28 days) were considered. Hazard ratios (HR) were calculated using extended Cox models. RESULTS: The overall IR of severe injuries per 1000 football hours was 0.33 (95% CI 0.25 to 0.43) in CON and 0.15 (95% CI 0.10 to 0.23) in INT. There was a reduction of severe overall (HR 0.42, 95% CI 0.24 to 0.72), match (0.41, 0.17 to 0.95) and training injuries (0.42, 0.21 to 0.86) in INT. The injury types that were prevented the most were: other bone injuries 66%, fractures 49% and sprains and ligament injuries 37%. Severe injuries located at the knee (82%), hip/groin (81%), the foot/toe (80%) and the ankle (65%) were reduced tremendously. CONCLUSIONS: '11+ Kids' has a large preventive effect on severe injuries by investing only 15 to 20 min per training session. The present results should motivate coaches to implement effective injury prevention programmes such as the '11+ Kids' in children's football. TRIAL REGISTRATION NUMBER: NCT02222025.

Relative age effects in Swiss talent development - a nationwide analysis of all sports.

Relative age effects (RAE) generate consistent participation inequalities and selection biases in sports. The study aimed to investigate RAE across all sports of the national Swiss talent development programme (STDP). In this study, 18 859 youth athletes (female N = 5353; mean age: 14.8 ± 2.5 y and male N = 13 506; mean age: 14.4 ± 2.4 y) in 70 sports who participated in the 2014 competitive season were evaluated. The sample was subdivided by sex and the national level selection (NLS, N = 2464). Odds ratios (ORs) of relative age quarters (Q1-Q4) and 95% confidence intervals (CI) were calculated. In STDP, small RAE were evident for females (OR 1.35 (95%-CI 1.24, 1.47)) and males (OR 1.84 (95%-CI 1.74, 1.95)). RAE were similar in female NLS athletes (OR 1.30 (95%-CI 1.08, 1.57)) and larger in male NLS athletes (OR 2.40 (95%-CI 1.42, 1.97)) compared to athletes in the lower selection level. In STDP, RAE are evident for both sexes in several sports with popular sports showing higher RAE. RAE were larger in males than females. A higher selection level showed higher RAE only for males. In Switzerland, talent identification and development should be considered as a long-term process.

Long-term effects of the 11+ warm-up injury prevention programme on physical performance in adolescent male football players: a cluster-randomised controlled trial.

This study examined the long-term effects of the 11+ on physical performance in adolescent male football (soccer) players. Eighty-two 14- to 16-year-old male football players (11+ = 42 players, control = 40 players) participated. Teams were randomised to control (CON) and intervention (INT) groups. INT applied the 11+ injury prevention programme for 30 weeks at least twice a week as a warm-up. CON performed their standard warm-up. Motor performance tests were conducted 1 week prior and 1 week after the competition season. We used magnitude-based inferences and linear mixed-effects models to analyse performance test results. INT showed superior results compared to CON in the vertical jump height 7.5% (95%-CI 4.4%, 10.7%), the Bosco 15-s-jump test 7.2% (95%-CI 2.2%, 12.4%), and the Illinois agility test -2.6% (95%-CI -4.1%, -1.1%). Possibly beneficial effects in favour of INT were found in the 9.1 m sprint test -3.1% (95%-CI -6.1%, 0.1%). Possibly harmful effects (i.e. in favour of CON) were observed in the dribbling test 2.8% (95%-CI -0.8%, 6.4%). The 11+ warm-up programme can improve different performance measures in football players. Coaches might implement additional dribbling drills next to the 11+ to achieve improvements observed in dribbling ability when using a regular warm-up programme.

Spatiotemporal gait characteristics across the adult lifespan: Reference values from a healthy population - Analysis of the COmPLETE cohort study.

BACKGROUND: Gait changes with aging have been investigated, but few studies have examined a wide range of gait parameters across the adult lifespan. This study aimed to investigate gait differences across age groups stratified by sex. METHODS: This cross-sectional study included 629 healthy, normal-weight (i.e., BMI < 30 kg/m2) participants from Switzerland of the COmPLETE cohort study, aged 20 to over 90 years. Gait metrics were assessed using an inertial measurement unit (IMU)-based gait analysis system, including speed, cycle duration variability, asymmetry, stride length, cycle duration, cadence, double support, stance (time foot is on the ground during a gait cycle), swing (time foot is in the air during a gait cycle), loading (early part of the stance phase), foot-flat (mid-stance phase when foot is flat), and pushing (late stance phase leading to toe-off) phases. Percentile curves were calculated using generalized additive models for location, scale, and shape. RESULTS: Gait data from 545 participants (273 men and 272 women) were analyzed. Participants were equally distributed across the seven age decades, with an average of 40 men and 40 women representing every decade. Both men and women showed a reduction in gait speed and stride length, and an increase in cycle duration variability and asymmetry with aging. Gait speed and stride length declined across the age groups, with a significant difference found in participants aged 80 to 91 compared to younger age groups. SIGNIFICANCE: Age-related changes in gait parameters were seen in both men and women. These may be attributed to the typical decline in muscle strength, balance, coordination, and neuromuscular function. The results of this study contribute to the understanding of gait changes throughout the lifespan and can be used for comparison with other populations and as reference values for individual patients.

Reliability and validity of the German version of the University of Jyvaskyla Active Aging Scale (UJACAS-G).

BACKGROUND: The University of Jyvaskyla Active Aging Scale (UJACAS) assesses active aging through willingness, ability, opportunity, and frequency of involvement in activities. Recognizing the lack of a German version, the Finnish original was translated (UJACAS-G). This study aimed: (1) to evaluate the test-retest reliability of UJACAS-G; and (2) to explore correlations with health-related parameters (concurrent validity). METHODS: The study (test-retest design) targeted healthy older adults aged 65+. Reliability of UJACAS-G (total and subscores) was assessed using Bland-Altman analyses and Intraclass Correlation Coefficients (ICCs). Furthermore, correlations (Spearman's rho) between UJACAS-G scores and physical function (walking speed, handgrip strength, balance, 6-minute walk distance), physical activity (International Physical Activity Questionnaire), life-space mobility (Life-Space Assessment), and health-related quality of life (Short Form-36 Health Survey) were calculated. RESULTS: Bland-Altman analyses (N = 60; mean age 72.3, SD 5.9 years; 50% women) revealed mean differences close to zero and narrow limits of agreement for all scores (total score: mean difference -1.9; limits -31.7 to 27.9). The ability subscore showed clustering at its upper limit. ICC was 0.829 (95% CI 0.730 to 0.894) for the total score and ranged between 0.530 and 0.876 for subscores (all p-values < 0.001). The total score correlated with walking speed (rho = 0.345; p = 0.008), physical activity (rho = 0.279; p = 0.033) and mental health (rho = 0.329; p = 0.010). CONCLUSIONS: UJACAS-G is reliable for assessing active aging among German-speaking healthy older adults. A potential 'ceiling effect' regarding the ability subscore should be considered when applying UJACAS-G to well-functioning populations. Analyses of concurrent validity indicated only weak correlations with health-related parameters.

Association between lower extremity physical function and physical activity after ischemic stroke: Longitudinal findings from the MOBITEC-Stroke project.

Background: Stroke often results in physical impairments. Physical activity is crucial for rehabilitation, enhancing mobility, strength, and overall health. This study examines the association between Timed Up-and-Go (TUG) test performance and changes in physical activity to improve lower extremity physical function. Methods: The MOBITEC-Stroke Cohort Study ("Recovery of mobility function and life-space mobility after ischemic stroke") included patients with a first incidence of stroke. Data assessed 3 and 12 months after stroke were used for analysis. Linear regression model adjusted for age, sex, instrumental activities of daily living, Falls Efficacy Scale-International, modified Ranking Scale, and National Institutes of Health Stroke Scale-score was used to examine the relationship between lower extremity physical function (i.e., TUG) and change in physical activity (i.e., minutes of physical activity measured with a wrist-worn accelerometer over 1 week). Results: Longitudinal data of 49 patients (65% male, mean age 71.2 (SD: 10.4) years) were analyzed. Mean daily physical activity was 291.6 (SD: 96.2) min at 3 months and 298.9 (SD: 94.4) min at 12 months, with a change from 3 to 12 months of 7.3 min (95% CI: -9.4 to 24.0; p = 0.394) post-stroke. We observed significant relationships between the baseline TUG performance and the change in total physical activity over 9 months (p = 0.011) and between the change of TUG performance over time and the change in total physical activity (p = 0.022). Conclusion: Our findings indicate that better initial lower extremity physical function and higher improvements in function over time are associated with a greater increase in physical activity levels after stroke. This suggests that interventions aimed at maintaining and improving lower extremity physical function may positively affect physical activity levels.

Timed up-and-go performance is associated with objectively measured life space in patients 3 months after ischemic stroke: a cross-sectional observational study.

BACKGROUND: Stroke is a common cause of mobility limitation, including a reduction in life space. Life space is defined as the spatial extent in which a person moves within a specified period of time. We aimed to analyze patients' objective and self-reported life space and clinical stroke characteristics. METHODS: MOBITEC-Stroke is a prospective observational cohort study addressing poststroke mobility. This cross-sectional analysis refers to 3-month data. Life space was assessed by a portable tracking device (7 consecutive days) and by self-report (Life-Space Assessment; LSA). We analysed the timed up-and-go (TUG) test, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and the level of functional outcome (modified Rankin Scale; mRS) in relation to participants' objective (distance- and area-related life-space parameters) and self-reported (LSA) life space by multivariable linear regression analyses, adjusted for age, sex, and residential area. RESULTS: We included 41 patients, mean age 70.7 (SD11.0) years, 29.3% female, NIHSS score 1.76 (SD1.68). We found a positive relationship between TUG performance and maximum distance from home (p = 0.006), convex hull area (i.e. area enclosing all Global Navigation Satellite System [GNSS] fixes, represented as a polygon linking the outermost points; p = 0.009), perimeter of the convex hull area (i.e. total length of the boundary of the convex hull area; p = 0.008), as well as the standard ellipse area (i.e. the two-dimensional ellipse containing approximately 63% of GNSS points; p = 0.023), in multivariable regression analyses. CONCLUSION: The TUG, an easily applicable bedside test, seems to be a useful indicator for patients' life space 3 months poststroke and may be a clinically useful measure to document the motor rehabilitative process.

Self-reported life-space mobility in the first year after ischemic stroke: longitudinal findings from the MOBITEC-Stroke project.

BACKGROUND: Life-space mobility is defined as the size of the area in which a person moves about within a specified period of time. Our study aimed to characterize life-space mobility, identify factors associated with its course, and detect typical trajectories in the first year after ischemic stroke. METHODS: MOBITEC-Stroke (ISRCTN85999967; 13/08/2020) was a cohort study with assessments performed 3, 6, 9 and 12 months after stroke onset. We applied linear mixed effects models (LMMs) with life-space mobility (Life-Space Assessment; LSA) as outcome and time point, sex, age, pre-stroke mobility limitation, stroke severity (National Institutes of Health Stroke Scale; NIHSS), modified Rankin Scale, comorbidities, neighborhood characteristics, availability of a car, Falls Efficacy Scale-International (FES-I), and lower extremity physical function (log-transformed timed up-and-go; TUG) as independent variables. We elucidated typical trajectories of LSA by latent class growth analysis (LCGA) and performed univariate tests for differences between classes. RESULTS: In 59 participants (mean age 71.6, SD 10.0 years; 33.9% women), mean LSA at 3 months was 69.3 (SD 27.3). LMMs revealed evidence (p ≤ 0.05) that pre-stroke mobility limitation, NIHSS, comorbidities, and FES-I were independently associated with the course of LSA; there was no evidence for a significant effect of time point. LCGA revealed three classes: "low stable", "average stable", and "high increasing". Classes differed with regard to LSA starting value, pre-stroke mobility limitation, FES-I, and log-transformed TUG time. CONCLUSION: Routinely assessing LSA starting value, pre-stroke mobility limitation, and FES-I may help clinicians identify patients at increased risk of failure to improve LSA.

Motor performance is not related to injury risk in growing elite-level male youth football players. A causal inference approach to injury risk assessment.

OBJECTIVE: To identify the causal relation between growth velocity and injury in elite-level youth football players, and to assess the mediating effects of motor performance in this causal pathway. DESIGN: Prospective cohort study. METHODS: We measured the body height of 378 male elite-level football players of the U13 to U15 age categories three to four months before and at the start of the competitive season. At the start of the season, players also performed a motor performance test battery, including motor coordination (Körperkoordinationstest für Kinder), muscular performance (standing broad jump, counter movement jump), flexibility (sit and reach), and endurance measures (YoYo intermittent recovery test). Injuries were continuously registered by the academies' medical staff during the first two months of the season. Based on the causal directed acyclic graph (DAG) that identified our assumptions about causal relations between growth velocity (standardized to cm/y), injuries, and motor performance, the causal effect of growth velocity on injury was obtained by conditioning on maturity offset. We determined the natural indirect effects of growth velocity on injury mediated through motor performance. RESULTS: In total, 105 players sustained an injury. Odds ratios (OR) showed a 15% increase in injury risk per centimetre/year of growth velocity (1.15, 95%CI: 1.05-1.26). There was no causal effect of growth on injury through the motor performance mediated pathways (all ORs were close to 1.0 with narrow 95%CIs). CONCLUSIONS: Growth velocity is causally related to injury risk in elite-level youth football players, but motor performance does not mediate this relation.

Proprioception is not associated with lower extremity injuries in U21 high-level football players.

Football is a contact sport with a significant risk of injury. Although proprioception is well studied in rehabilitation, little is known about the association between proprioception and the occurrence of sport injuries. The purpose of this study was to look into the association between ankle and knee proprioception and lower extremity injuries in young football players. Seventy-three football players from the highest U-21 league in Iran volunteered to participate in this study. Before the start of the 2017-2018 competitive season, joint position sense was measured at 30°, 60° and 90° knee flexion and at 10° and 15° ankle dorsiflexion, and inversion using the Biodex Isokinetic pro 4 system. The teams' medical staff recorded football-related lower extremity injuries. We used mixed effects Cox regression models to calculate hazard ratios (HRs) with 95% CIs, acknowledging the clustered data structure. Twenty-two players (30.1%) suffered one or more lower extremity injuries during the season. None of the proprioception measures examined was significantly associated with the risk of lower extremity injuries. Based on these results of our sample, joint position sense does not seem to be associated with lower extremity injuries in young male football players.

The 11+ Kids warm-up programme to prevent injuries in young Iranian male high-level football (soccer) players: A cluster-randomised controlled trial.

OBJECTIVE: To assess the effectiveness of the 11+ Kids warm-up programme regarding injury reduction in male high-level children's football players. DESIGN: Cluster-randomised controlled trial. METHOD: Male youth football teams of Iran's high-level football schools were invited to participate. Inclusion criteria were: teams are competing in the highest league of their province; players are between 7 and 14 years old; regular training takes place at least twice per week. Teams were excluded if they used an injury prevention measure. Participating clubs were randomised to an intervention (INT, N = 20 teams) and a control group (CON, N = 22 teams), stratified by the number of teams and the age group. The groups were blinded against each other. The follow-up period was one season (9 months). INT replaced their warm-up by 11+ Kids. CON performed a standard warm-up programme. The primary outcome was the injury incidence density (injuries per 1000 h of football exposure), compared between groups by incidence rate ratios (RR). RESULTS: In total, 64,047 h of football exposure of 962 players (INT = 443 players, 31,934 h of football, CON = 519 players, 32,113 h of football) were recorded. During the study, 90 (INT = 30; CON = 60) injuries occurred. The overall injury incidence density in INT was reduced by 50% compared to CON (RR 0.50; 95%-CI 0.32, 0.78). No injuries occurred during the execution of the intervention exercises. CONCLUSIONS: The 11+ Kids reduces injuries in high-level children's football players, thus supporting player health and potentially performance and player development.

The Effect of the "11+ Kids" Program on the Isokinetic Strength of Young Football Players.

PURPOSE: The "11+ Kids" injury-prevention program has been shown to reduce injuries and related costs in youth football players less than 14 y of age. A major argument to convince coaches to use this exercise-based injury-prevention program is a potential performance enhancement of the players. Therefore, this study investigated the effects of the "11+ Kids" program on isokinetic strength. METHODS: Two teams were randomly assigned to the intervention and control groups. The intervention group replaced their warm-up by the "11+ Kids" and the control group warmed up as usual. Two days before and after the 10-wk intervention, isokinetic strength of the hip adductors and abductors, knee flexors and extensors, and ankle invertors and evertors was tested. RESULTS: Thirty-one players (mean age 11.5 [0.8] y) completed the study. The intervention group showed large improvements in all isokinetic strength measures (P < .001 for all measures; Cohen d = 0.8-1.4), whereas the control group only showed negligible to medium positive effects (P values ranging from .006 to .718; Cohen d = -0.1 to 0.7). The intervention was beneficial compared with the control group regarding isokinetic strength of the hip adductors (P < .001), knee flexors (P = .002), and ankle evertors (P < .001) and invertors (P = .005). CONCLUSIONS: Given the relatively short intervention period of 10 wk, the observed improvements relate to a practically meaningful effect of the intervention. The gain in strength may improve players' performance and may contribute to a reduction of injury risk in the long-term application.

Risk of acute and overuse injuries in youth elite soccer players: Body size and growth matter.

OBJECTIVES: This study investigated anthropometric measures and growth as risk factors for overuse and acute injuries in younger (U10-U12) and older (U13-U15) elite level soccer players. DESIGN: Prospective cohort study. METHODS: Height, weight, and sitting height were measured at the start and the end of the 2016-2017 competitive season and growth velocities were calculated. Throughout the season, injuries were registered continuously by the (para-)medical staff of the included clubs. We analyzed the injury risk using multilevel Poisson regression models, accounting for club and team clustering. RESULTS: Of the included 314 players (11.7±1.7 years of age), 160 players sustained 133 overuse and 163 acute injuries (i.e. 106 injuries in 69 players of the younger group, 190 in 91 players of the older group). In the younger group, risk of overuse injuries was associated with an increase in leg length over the season (incidence rate ratio (IRR) 1.620 [95% CI 1.230-2.117]) and risk of acute injuries with relatively younger age (IRR 1.003 [95% CI 1.000-1.006]). In the older group, a higher leg length was associated with an increased risk of overuse injuries (IRR 1.055 [95% CI 1.011-1.108]), and a higher weight and a lower growth rate with an increased risk of acute injuries (IRR 1.043 [95% CI 1.021-1.067] and 0.903 [95% CI 0.831-0.981], respectively). CONCLUSIONS: Injury risk factors differ by age group and type of injury. The age-specific anthropometric and growth-related risk factors should be monitored and these risk profiles should be considered to manage injury risk effectively.