Physicians Implement Exercise = Medicine (PIE=M)


  • The Netherlands Organisation for Health Research and Development (ZonMw)


  • University Medical Center Groningen (UMCG)

  • Huis voor de Sport Groningen

  • Gemeente Groningen

  • Lifelines

  • Hanze Hogeschool Groningen

  • Genomics Coordination Center UMCG


  • Kenniscentrum Sport 


Although prescription of physical activity in clinical care has been advocated worldwide through the ‘exercise is medicine’ (E=M) paradigm. E=M currently has no position in general routine hospital care, which is hypothesized to be due to attitudinal and practical barriers to implementation. This study aims to create E=M implementation strategies to reduce practical barriers to enforcing E=M in hospital care.


Firstly, this project will perform a mixed methods study (questionnaire and interviews) to investigate the current implementation status of E=M in clinical care as well as its facilitators and barriers to implementation among clinicians and hospital managers. In the second phase of the project, strategies will be developed in order to facilitate the implementation of E=M in clinical care. One of the strategies is the development of an E=M tool that will facilitate prescription of individually tailored E=M advice based on the combination of individual patient characteristics and data from earlier research. In the final stage of the project, the feasibility of the developed E=M implementation strategies will be investigated with a process evaluation. A pilot-study will, therefore, integrate the E=M implementation strategies in routine care in at least four clinical departments in two Dutch university hospitals. 

Injury prevention in volleyball and field hockey - Implementation of two efficacious warm-up programmes


  • The Netherlands Organisation for Health Research and Development (ZonMw)


  • Nevobo

  • KNHB

  • UMC Groningen

  • University of Bath (Department for Health)

  • Livewall

  • Dotcomsport Nederland


In the Netherlands, volleyball is in the top 5 sports with the highest number of injuries and field hockey in the top 5 sports with the most severe (medically treated) injuries. Therefore, the Dutch Volleyball Federation (Nevobo) and the Royal Dutch Hockey Association (KNHB) have allied few years ago in order to work towards injury prevention in recreational volleyball and field hockey. As a consequence, ‘VolleyVeilig’ and ‘Warming-up Hockey’ were developed as exercise-based warm-up programmes to reduce or prevent injuries. Two recent studies showed that both ‘VolleyVeilig’ and ‘Warming-up Hockey’ were efficacious for reducing or preventing injuries in recreational volleyball and field hockey. The logical next step is to work towards the implementation of both programmes in the Netherlands.

Objectives of the project:

  1. Develop a structured and evidence-based implementation (delivery) plan tailored to volleyball and field hockey contexts to promote the structured implementation of ‘VolleyVeilig’ / ‘Warming-up Hockey’.

  2. Initiate and evaluate the implementation of ‘VolleyVeilig’ / ‘Warming-up Hockey’ in volleyball and field hockey.

The implementation of ‘VolleyVeilig’ / ‘Warming-up Hockey’ is initiated in volleyball and field hockey for the 2019-2020 season. A quasi-experimental study based on a one-group design with repeated measurements is conducted to evaluate the implementation of the programmes in volleyball and field hockey, using the RE-AIM Sport Setting Matrix framework. For the evaluation, two convenient samples of clubs (one sample in volleyball and one sample in field hockey) are included: 10 volleyball clubs (in total 100 trainers/coaches and 20 technical policy/decision makers) and 10 field hockey clubs (in total 100 trainers/coaches and 20 technical policy/decision makers).

NL-Judo 9+: Translation, effectiveness and implementation of an injury prevention program


  • The Netherlands Organisation for Health Research and Development (ZonMw)


  • Judobond Nederland

  • Sportmedisch adviescentrum Jessica Gal Sportartsen

  • VeiligheidNL


With a top-3 position on the priority list of sports with the highest incidence rate of injuries (4.3 per 1,000 hours) and top-5 position on both absolute number of injuries (180,000) and injuries presenting at the emergency department (4,400) in the Netherlands, combat sports should be a priority for injury prevention interventions.

For judo, the most practiced combat sports, a specific prevention program based on existing proven effective exercises has been developed by experts who are both strongly embedded in judo practice, and world leading experts in judo research: the Judo 9+. Although sport-specific neuromuscular training programs have been shown to effectively reduce injury rates in various sports, the effectiveness and implementation of the judo 9+ program has not been studied yet.

Main research objectives:

1. Translation of the Judo 9+ exercise programme to the Dutch recreational judo practice: the NL-Judo9+

2. Evaluation of the effectiveness of the NL-Judo9+ exercise programme on injury risk profiles and injury rates

3. Preparation for national implementation of the NL-Judo9+ in recreational judo (if proven effective).

Effectiveness of VolleyVeilig: the prevention of injury among youth volleyball players


  • The Netherlands Organisation for Health Research and Development (ZonMw)


  • Nevobo

  • VeiligheidNL

  • UMC Groningen

  • Dotcomsport


Volleyball is played by around 500,000 Dutch youth and adult residents. In the Netherlands, volleyball is in the top 5 sports with the highest number of injuries. Therefore, the Dutch Volleyball Federation (Nevobo) initiated the development of a warm-up programme called ‘VolleyVeilig’ for youth and adult volleyball players to prevent injuries.

The effectiveness of ‘VolleyVeilig’ has been recently assessed through a randomized prospective controlled trial among recreational adult volleyball players. The logical next step is to evaluate the effectiveness of the intervention for youth volleyball players.

Objective of the project is to evaluate the effectiveness of ‘VolleyVeilig’ over one-season (2019-2020) on injury rate, severity, and burden among recreational youth volleyball players using a prospective controlled design. Secondary aim is to evaluate the delivery and use of the programme within the context of the effectiveness study, in order to explain programme outcomes and gain insight in facilitators and barriers that influence the uptake of the programme by youth volleyball trainers/coaches (process evaluation). Results will be used to optimize the programme for post-trial implementation and nationwide release by Nevobo.

Skating on thick ice


  • KNSB (Koninklijke Nederlandsche Schaatsenrijders Bond)


Long track speed skating is the most famous and successful competitive winter sport for the Netherlands. Dutch speed skaters won 16 out of 42 speed skating medals at the 2018 Olympics in PyeongChang. About 22.000 athletes are regularly competing in speed skating in the Netherlands.   

Speed skating is a physically highly demanding sport with a unique movement patternplacing a high mechanical load on the muscular- skeletal system. A skater adopts an aero dynamical, crouched body posture, characterized by a small knee angles and a nearly horizontal trunk position. In this position, the skater generates a powerful sideward directed impulse of the lower extremity to create a high forward speed.  

While clinically experience indicates that acute and overuse injuries are common in this physically highly demanding sport, there is little sport specific scientific data on injury epidemiology and injury prevention. Consequently, measures to prevent injuries are mainly based on clinical experience and knowledge of experts in this sport.  

The aim of this research project is therefore (i) to develop an evidence based, sport specific injury prevention program for young talented speed skaters in the Netherlands. Here, a broad research focus will be applied by including external evidence as well as (clinical) experience of experts in the field of speed skating injuries.  (ii) to implement this program in real-life sporting context and (iii) to evaluate its effectiveness. To initiate this, first the existing gaps in sport specific injury prevention knowledge needs to be closed by conducting a comprehensive analysis of relevant acute and overuse injuries in speed skating. 

Insights from this project will contribute to protect the health of talented Dutch speed skaters and, therefore, promote long term and healthy participation in speed skating. 

The effects of sports injuries on the brain

When an athlete suffered an injury in the past, the main focus of both researchers and clinicians was mainly directed to the affected peripheral structures. However, the current view of the World Health Organization (WHO) shifted this focus towards a more holistic rehabilitation approach with the introduction of the biopsychosocial model. This paradigm shift in patient care became also very present in sports rehabilitation and led to the development of a general Return-To-Sport-Algorithm. Nevertheless, current scientific research within this complex vision has made significant steps forward and contributed to new insights within this domain, but is still in its initial phase. This line of research will explore and document the function of the brain after (sports) injuries and its interactions with fatigue.

Fatigue & the athlete's injury risk profile

Sports injury prevention is becoming increasingly important in organised sports. This domain has evolved rapidly in the last decades, leading to a better understanding of peripheral risk factors and injury mechanisms. This line of research focuses on the role of the brain in the context of primary sports injury prevention and the influence of fatigue on the injury risk profile of athletes.

Run-Work-Sleep-Repeat: 24/7 monitoring for healthy running


  • The Netherlands Organization for Scientific Research (NWO)


  • 2M Engineering

  • Golazo Sports

  • Inno Sports Lab

  • City of Eindhoven

  • Fontys University of Applied Sciences

  • School of Sport Studies


The prevailing lifestyle in the Western world (immobility, unhealthy eating, smoking and drinking habits) is an important factor in the etiology of many chronic diseases. Physical activity through sports participation helps to reduce this risk but introduces new risk factors associated with exercise related injuries. The aim of the program ‘Citius, Altius, Sanius’ is to stimulate people at all performance levels to engage in and sustain physical activity through sports and fitness, improve their performance and prevent injuries by providing informative and motivating information using advanced sensor and data science techniques. The information provided is tailored to the individual user, by taking into account his or her characteristics, and by using effective, personalized feedback methods. Innovative unobtrusive wearable sensors (in clothing, and advanced cameras) will be used to estimate the mechanical and physiological load. Data science techniques will relate the load to injury mechanisms and provide an individual training advice to stimulate the athlete and prevent injuries or return to sports and exercise quicker. Six applied projects are defined incorporating the activities that are associated with most injuries. Sports associations, sports medicine and physical therapy, but also many small-to-medium-sized companies are involved to commercialize this innovative approach for recreational and elite athletes, but also for rehabilitation patients.

Physical activity is the best medicine to prevent health problems across the lifespan: it is more efficient than cure or rehabilitation, both from a health and an economic perspective. The goal of the present program is to stimulate people to start and continue participating in sports by providing motivational and informational cues about their performance, using (big) data science and unobtrusive sensor technology. Simultaneously, personalized information, based on a combination of individual and cohort data, will be provided to recreational and elite athletes to reduce the risk of injury and overload. There is a clear trend towards individualized sports participation. Tailoring information to individual needs concerning physical activity is therefore crucial. Modern sensor technology and data science, as well as web solutions and apps like Strava, provide opportunities for obtaining this tailored information. The internet enables comparison with peers of the same age, gender, experience, training and performance objectives, etc., as well as the full history of previous performances in the cloud. Knowledge about performance improvement is a highly stimulating factor that contributes to lasting engagement and attaining higher performance levels.

The challenges in promoting healthy participation in physical exercise are twofold: (1), to provide engaging information about the athlete’s physical and performance improvement, and (2) to ensure that no injuries will occur. Although injuries prevail in many sports (see Section 4.1), little is known about their relationship with physical load.

Hence, there is a clear need to strengthen the information chain from sensor information, via data science and analysis, to informative feedback applications, which we will pursue in three fundamentally oriented projects. This not only requires innovative research regarding each of these components, but also regarding the effectiveness of the resulting information chains. For the latter purpose, we will perform research in six sports-related domains with a high prevalence of injuries. The general relationship between physical exercise and injury incidence in these domains will be investigated by acquiring large amounts of data using new sensor technology and will then be tuned to individual athletes using their individual data. The resulting individualized information will be fed back to the athlete to improve performance in a healthy manner. The feedback in question will be based on novel technological possibilities, including virtual and augmented realities, as well as novel psychological insights into mechanisms of behavioral changes.

Within each of the fundamental projects, innovative devices or mathematical approaches will be developed. Within the applied projects, these innovations will be combined, and applied to six different sport specific domains to motivate athletes and improve their performance, as well as to prevent injuries. This general approach adopted in the program as a whole is unprecedented, both in terms of its interdisciplinary and translational nature and in terms of its scale and scope.

Who Stays Fit?



  • NWO Comenius


  • Codarts Rotterdam

  • Amsterdam University of Applied Sciences


Sport injuries are one of the main causes of poor physical performance and physical discomfort in sport active populations. Physical Education Teacher Education (PETE) students are sport active population who are, as part of their education and besides their own sport participation, confronted with curricular sport participation of approximately eleven hours a week in six different sports. Due to this high amount and variety of additional sport participations PETE students have a relative high sport incidence. Therefore this population is very suitable for research on the etiology of sport injuries and provides need for the development and implementation of preventive interventions. The main goal of the ‘Who stays fit’ project is to increase insight in the incidence and etiology of sport injuries of PETE students. Within this project we research the incidence of sport injuries, risk factors of medial tibial stress syndrome, risk factors of ankle injuries, psychological risk factors of injuries, injury mechanisms, and the prevention of sport injuries.

Long term effects of marathon running on cardiac health


  • Indonesia Endowment Fund for Education


In the last two decades, there has been a dramatic increase in the number of athletes training for and participating in organized and recreational long-long-distance running, such as marathons. However, while the beneficial cardiovascular effects long-distance running are well documented, little is known about potential negative cardiac effects of long-term repetitive marathon running. Observational data have shown elevated cardiac markers among marathoner runners, leading to the hypothesis that myocardial injury due to prolonged hypoxemia might take place, potentially leading to myocardial fibrosis (MF), but with a highly variable incidence. There is an urgent need for awareness among runners of potential detrimental cardiac effects of long-distance running.


To assess the proportion of subjects who has myocardial fibrosis using late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRC) among long term (> 5 years) marathon runners, compared to sedentary age matched controls.


Does repetitive long term marathon running cause myocardial fibrosis?


Case control study in a defined specific endurance running population compared to a matched controls. Consecutive sampling is used for the exposed subjects who meet the inclusion criteria. Dose of training (kilometers), participation hours, and cardiac findings (LGE on MRI) will be taken for analysis.

Injury incidence and patterns in U10-U15 soccer players


PhD fellowship fundamental research of Research Foundation Flanders (FWO), Belgium


  • Vrije Universiteit Brussel (Belgium)

  • Ghent Univeristy (Belgium)


The development of youth soccer players in the academies of professional clubs involves specialized training from a very young age onwards. These development programs characterized by their high training loads and high training frequency, are developed to prepare talented young players for the increasing demands of contemporary professional match play. Football is a complex contact sport, characterized by intermittent, explosive actions, and is associated with a high risk of acute and overuse injuries in elite level youth players. Injury incidence and risk factors are well known in older adolescent and adult players, but these are thought to be different in (pre)pubertal players due to a different susceptibility of the immature muscular-skeletal system. Moreover, during puberty, players appear to be even more susceptible for injuries due to the changing body proportions and physical characteristics, as well as the temporary motor awkwardness associated with the adolescent growth spurt. 

To date, epidemiological research in (pre)pubertal elite level football players from 9 to 15 years of age is limited and often faces methodological shortcomings leading to inconclusive evidence. Also, the determinant role of growth, maturation, physical fitness and motor coordination in the risk for sustaining injuries is not fully understood. Therefore, the overall aim of this three-year large scale prospective cohort study in Belgian U10 to U15 elite level football players, is to provide a detailed overview of the injury incidence and patterns. Furthermore, the risk for sustaining injuries in relation to growth, maturation, physical fitness, and motor coordination will be investigated in detail using different, state-of-the art methods of analysis. 

CHOiCE: Choosing the Healthy Option in a Choice Environment


Internal funding from the Department of Public and Occupational Health, VU University Medical Center


Technological and economic advances in the past decades have nowadays resulted in people living a lifestyle that is characterized by high rates of sitting and low levels of physical activity,  which increases people’s risk for non-communicable diseases. A promising approach to change health behaviors is the use of ‘choice architecture’. The term refers to practice of influencing behaviors by organizing the context in which people make choices. 

The aim of the CHOiCE project is to investigate which choice architecture interventions effectively (1) foster active health choices (that engender commitment towards specific health goals); and (2) support maintenance of health behaviors (by promoting habit formation), with choices and behaviors being in line with individuals’ beliefs, needs, values and preferences. The project focusses on two different populations: (a) sedentary, physically inactive healthy individuals and (b) individuals at increased risk for cardiovascular disease. 

The project consists of three main stages, with each new stage building on the insights derived in the previous stage(s):

  1. A systematic literature review on choice architecture interventions that promote physical activity and discourage sedentary behavior;

  2. Qualitative studies on people’s beliefs, needs, values and preferences in the context of choices about health behavior;

  3. Quantitative, experimental proof-of-principle studies on the effects of different types of choice architecture.

 The ultimate aim of the project is to empower people to make healthy choices and to engage in health behaviors in the long term.  

Finding the right balance: determining safe and healthy physical activity load


  • Amsterdam Movement Sciences


Physical activity leads to many health benefits but also entails a risk of injury. Injuries often lead to reduced physical activity levels and can even cause dropout from exercise. A large amount of injuries (30-40%) require medical attention, producing substantial health care costs.

Injuries occur when the stress applied to a tissue (load) is greater than the stress the tissue can withstand (load capacity). Fatigue reduces the load capacity of tissue and thus increases the risk of injury. Therefore, appropriate recovery is required between activity sessions. 

Finding the right balance between activity load and recovery is a common goal for sports participants to minimise injury risk and optimise health and performance outcomes. However, there is currently little high-quality evidence on the association between activity load, recovery, and injury risk. Further, the analytical methods used in previous studies are known to produce biased estimates. 

The proposed project aims to establish injury risk profile charts visualizing the individual risk of sport participants based on a multifactorial profile. The outcomes will support sports and clinical practice in managing activity load and recovery to prevent injury. 

Our results will lead to activity-, sex-, age- and population-specific recommendations on how to be as active as possible (for recreational sports) or train as much as possible (for high-level athletes) without getting injured. Together with our clinical partners, we will translate the findings into risk profiles to enable clinical recommendations.

Injuries and their aetiology in Physical Education students


Worldwide many students participate in physical activity and sports related studies. During the course of these studies a high level of physical activity and exercise skills is demanded. In physical education teacher education (PE) studies, during the first three years on average more than 250 hours per year are spent on practical sports classes. In addition, most PE students participate in extracurricular sports as well. Therefore, these students are at high risk of sustaining a sports injury during the course of their studies. Recent studies covered injuries during the freshman year only. 

This research project covers the first two steps of the “sequence of prevention” in PE studies.

The first aim is to describe the prevalence of injuries during the first three years of PE studies and to compare injury risks between curriculum periods (years and semesters) and between sexes in PE students. Injuries in PE students over the period 2000-2014 are investigated for this purpose. 

The second aim of this project is to identify possible risk factors for injuries in PE students. In a three-year prospective cohort study, intrinsic and extrinsic risk factors for injuries in freshman PE students are investigated. In a qualitative study, the perspectives from PE students on risk factors for injuries during the first three years of their study are investigated from a socio-ecological perspective.

Complex system analysis of injury in elite football players


·      Universidade Federal de Minas Gerais

·      Arsenal Football Club


In football, the incidence of muscle injuries remains high, despite several studies on their aetiology and prevention (Ekstrand et al., 2011). Traditionally, the investigation of risk factors for sports injuries has concentrated on linear and unidirectional causality (Arnason et al., 2004, Gabbe et al., 2006 and Engebretsen et al., 2010). However, injury (and muscle injury included) arises from the complex interaction among a web of determinants. This approach can be useful in an attempt to understand the sports injury aetiology and it may allow mapping of the interactions among potential risk factors and allow the development an athlete's ‘risk profile’ (Bittencourt et al., 2016). 

Data analysis will be performed using alternative approaches; (1) Classification and Regression Trees (CART), which captures nonlinear relationships between predictors and produces results easily applied in clinical practice; and (2) Direct acyclic graphs (DAG) that allows systematic representations of causal relationships and validates the CART outcomes.

The aim of this research project is to identify a web of determinants to better understand how and why muscle injuries may occur in elite football players

“Who me?! I thought you’d never ask” –Listening and analyzing injury prevention behaviors in elite sports context 


Caroline Bolling is a PhD candidate supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq , Brazil- grant number 202242/2015-3


Sports injury prevention researchers have developed many strategies to prevent injuries in the past years. Despite the evolution in research, how to apply the models/ programs from research into practice remains a challenge. The interventions are usually developed from the researcher’s perspective and despite having the injury prevention as the main goal, they don’t take into consideration the elite sports context and its particularities. A better understanding of this context is needed to developed customized interventions and improve the use of injury prevention strategies in practice. Qualitative methods can provide a contextual perspective on the injury problem by exploring different perpectives and enabling a more comprehensive understanding of the injury prevention process in practice. 



This project aims to recognize and understand the reality of the elite sports context through a qualitative study. We aim to explore and understand the beliefs, attitudes and knowledge about injury prevention from the athletes’ and other stakeholders’ (i.e. coaches and medical staff) perspective.