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

FUNDING

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

BACKGROUND

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. 

 

 RESEARCH QUESTIONS/OBJECTIVES

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. 


"Reduced Achilles Pain" study

TITLE

"Effectiveness of a 12-week self-myofascial release therapy on pain and tendon stiffness in active recreational runners with self-reported Achilles tendon complaints"

BACKGROUND

Pain and stiffness of the Achilles tendon are a common running-related injury (RRI). One of the standard exercises in treating the complaints are eccentric exercises (ECC). It requires muscle activation thus focusing on the calf muscles. Anatomically, the Achilles tendon not only fuses with the calf muscles but has a fibrous connection with the plantar foot, the aponeurosis plantaris. Targeting not only the calf muscles but also the aponeurosis, sely-myofascial release (SMR) represents a good option for multifocal treatment. SMR has become more popular the last years. It is thought to it stimulate collagen I production and reverse pathological neovascularization. Moreover, although evidence is scarce so far, SMR has been described to loosen fascial adhesions and cross-links, increase the gliding capacities of connective tissue layers, decrease muscle tension and to alter mechanical stiffness. SMR does not impede athletic performance. It has also been suggested that SMR might have, as all manual therapies, a potentially pain-relieving effect. These analgesic effects may be mediated by either peripheral, spinal or supra-spinal mechanisms. All of the above mentioned processes might help to restore physiological tendon function.

OBJECTIVES

The purpose of this study will be to evaluate the effectiveness of a multifocal SMR treatment (directed to plantar aponeurosis, Achilles tendon and calf muscles) on pain and stiffness compared to ECC in active recreational runners with self-reported Achilles tendon complaints. 

RESEARCH QUESTIONS

Is a 12-week multifocal SMR treatment more effective in treating Achilles tendon complaints than ECC in active recreational runners?

STUDY DESIGN

Single blinded, randomized pilot study using a 2 group design with a treatment period of 12 weeks.

"Disagevantage": The influence of chronological and biological age on sport participation in children - a public health issue?

FUNDING

  • “Early Postdoc Mobility fellowship” from the  Swiss National Science Foundation (SNSF)

PROJECT PARTNERS

  • PD Dr. Oliver Faude, University of Basel, Switzerland

BACKGROUND

Physical activity provides many positive effects on health risk factors, skeletal and psychological health, as well as on mental, cardiorespiratory and neuromuscular fitness. Physical inactivity is one of the leading causes of chronic diseases, contributing to disability and death worldwide. Active participation in organised youth sport is positively associated with higher levels of adult physical activity. Hence, youth sport also has important implications for long-term individual health as well as public health. Children like to compete against each other. Therefore, having fun during sport participation is often linked to having success. Unfortunately, not all children have the same chance to be successful in sport. As children are growing rapidly, small differences in age can cause large differences in biological development. In the sport setting children are grouped according to their birth date using cut-off-dates. In consequence, some children in a sport team might be one year younger than others and therefore they might be smaller, weaker, and less successful. In addition, some children are early- and some are late-maturing which also can lead to performance differences in the sport setting. Hence, both aspects could lead to large differences in motor performance. Therefore, a considerable amount of children might be disadvantaged just by being born at the “wrong time of the year” and/or being late-maturing. This can lead to disappointments, loss of motivation, and drop-out from sport. Data from high-level competitive sport show that the aforementioned effects lead to a clear underrepresentation of such disadvantaged children. However, data from recreational and low-level competition sport are completely missing. This is surprising as most children are participating in low-level and recreational sport. In consequence, this might relate to a relevant public-health issue.

RESEARCH QUESTIONS

  • Does the time of birth within a year (i.e. "relative age") and/or the maturity status influence motor performance, sport participation, and physical activity levels in school children?

Injuries in disability sports; definitions and methodologies

BACKGROUND

Fifteen percent of the world’s population live with disability, and many of these individuals choose to play sport. There are barriers to sport participation for athletes with disability and sports injury can greatly impact on daily life, which makes sports injury prevention additionally important.

OBJECTIVES

The purpose of this project is to review the definitions, methodologies and injury rates in disability sport, which should assist future identification of risk factors and development of injury prevention strategies. A specific focus lies on concussions in disability sports. A secondary aim is to highlight the most pressing issues for improvement of the quality of injury epidemiology research for disability sport.


BokSmart “Safe Six” Injury Prevention Programme

BokSmart “Safe Six” Injury Prevention Programme

Rugby union (hence ‘rugby’) is an international sport played in over 100 countries worldwide, at amateur and professional levels. Within South Africa, rugby is extremely popular with approximately 600,000 participants. The injury incidence and severity of rugby is reported to be one of the highest of all sports. This is largely explained by the high frequency of collisions between players, inherent to the sport. This high burden of injuries in rugby has required preventative measures to be implemented.

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European Fans in Training (EuroFIT); Social Innovation to improve physical activity and sedentary behaviour through elite European football clubs

FUNDING

European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602170.

PROJECT PARTNERS

  • University of Glasgow (UK)
  • Norwegian School of Sports Sciences (Norway)
  • Technical University of Lisbon (Portugal)
  • Radboud University, Nijmegen Medical Centre
  • KU Leuven
  • Pintail Ltd
  • PAL Technologies Limited
  • European Healthy Stadia Network CIC

PROJECT WEBSITE

www.eurofitfp7.eu

BACKGROUND

20 million fans attend top division football games each week and many more watch on TV. Our aim is to attract these men, specially targeting low-SES men who do not achieve current recommendations for physical activity, to lifestyle change through the personal connection and loyalty to the club they support using the European Fans in Training (EuroFIT) programme. EuroFIT is informed and inspired by the Scottish FFIT programme, which validated several of the key concepts that underpin this project.

This project integrates two technologies within the EuroFIT programme. The first is a novel device (SitFIT) that allows self-monitoring of objectively measured sedentary time and physical activity through real-time feedback. SitFIT will be a low-cost device with an integrated display. The second is a game-based mobile-phone app, MatchFIT, in which players form ‘teams’ to participate in an ‘alternative MatchFIT league’ which mirrors fixtures in real football leagues. These technologies will be integrated into the new lifestyle change programme, EuroFIT, to be delivered in football club grounds by club coaches. 

The project will generate research evidence on the use of social innovation for health. Social impact will include reductions in health risk, improvements in well-being and the decreased inequalities as more men, especially those in low SES groups, are attracted to lifestyle change. Research impact will utilise new understanding of the how health indicators respond to change in sedentary behaviour and physical activity and through new knowledge of long-term maintenance of lifestyle changes. Policy impact will result from the production of clear implementation strategies and involvement of policy makers and opinion leaders from the outset, supported by a targeted communication strategy.

OBJECTIVES

  • Use State of the Art Theory and Evidence: To apply state-of-the-art theory and evidence on motivating and maintaining behavioral change to develop a technology-supported, culturally- and gender-sensitized lifestyle programme for men, to be delivered in top European football clubs.
  • Deliver EuroFIT in 15 Clubs: To deliver the EuroFIT programme in 15 leading football clubs across Europe and evaluate it in a pragmatic randomized controlled trial.
  • Review and Evaluate: To review and evaluate the programme in terms of experience of: a) its benefits (or harms) to participants; b) its benefits to families and wider social networks; and c) how best to refine the programme to make it most attractive to women, families and other groups.
  • Replication and Implementation: To maximize the likely implementation of EuroFIT beyond the funded project by developing detailed, validated guidelines on replication and implementation.

METHODS

This is a two arm, stratified, individually randomized, pragmatic, controlled trial with an accompanying process evaluation across 4 European countries. The trial will be conducted at 15 football clubs in Portugal, Norway, the Netherlands and England (UK). In each country, 60-80 participants will be recruited.

Using a mixed-methods, interdisciplinary approach the project will measure outcomes objectively, assess short-term cost-effectiveness and estimate long-term cost-effectiveness. We will investigate mediators of changes in health behaviours, and whether changes in lifestyle are themselves mediators of changes in clinically-measured risk factors, so that we can better understand pathways to improved physical health. We shall assess potential moderators of any effects of EuroFIT, to identify subgroups of the population for whom the programme is more or less beneficial. EuroFIT’s potential to impact on and attract other groups, particularly women and families, will be explored via qualitative research methods.


Recent Posts

Evaluation of the implementation effectiveness of the 'Strengthen your Ankle' app to prevent recurrent ankle sprains

Evaluation of the implementation effectiveness of the 'Strengthen your Ankle' app to prevent recurrent ankle sprains

 

Ankle sprains continue to pose a significant burden to the individual athlete, as well as society as a whole. However, despite ankle sprains being the single most common athletic injury and despite an active approach by various Dutch organizations in implementing our epidemiological knowledge on cost-effectiveness, large-scale community uptake of preventive measures, and thus actual prevention of ankle sprains, is lagging well behind. In an attempt to bridge this implementation gap VeiligheidNL looked into the possible role of new (social) media and has developed an freely available interactive App (‘Versterk je enkel’; available for iOS and Android) that contains - next to general advice on bracing and taping - the cost-effective neuromuscular program. This provides the user with, amongst others, video’s and an interactive exercise schedule. It is general belief that such interactive, online and mobile methods of information transfer are the way forward in implementation efforts. However, this has not yet been formally established for the uptake of evidence injury preventive measures, and - although user reviews are positive - the ‘Versterk je enkel’ App has not been evaluated against the ‘regular’ approach to advocate the neuromuscular program on paper and DVD.

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HealthPACT: a framework for prevention of sports injuries on the field

HealthPACT: a framework for prevention of sports injuries on the field

Regular participation in physical activity and sports increases the individual’s exposure to injury. Over the past decades the knowledge about prevention and treatment of various sports and physical activity related injuries (SPRI’s) has exponentially grown. Fortunately, based on the current available evidence it is reasonable to state that we are able to significantly cut down the risk of SPRI’s in for most participants in a wide array of sports and physical activities. However, wide-scale implementation of (cost-)effective measures under real-life conditions proves to be an ongoing challenge. 

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Improving physical activity in adolescents in deprived urban neighbourhoods

Improving physical activity in adolescents in deprived urban neighbourhoods

In general, schools have been recognized as key settings in promoting PA. Next to the home, the school is the environment where adolescents spent most of their time. Within the school, physical education lessons represents the main context in which adolescents have the opportunity to be physically active. Next to such structured and frequent PA opportunities, schools can cater irregularly for sporting days and other extracurricular activities. For the promotion of PA in the secondary school setting, interventions targeted at structural environmental changes have an important advantage over other interventions. Most PA provided by the school is on an irregular and/or non-daily basis. By altering the physical environment of a school’s grounds the adolescent is continuously exposed to PA possibilities. These changes then, of course, need to provide a continuous, appealing, challenging and socially safe PA environment. If this can be achieved all adolescents have the opportunity to be physically active each single day.

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Life after the game: quantitative and qualitative analyses of long-term effects of injuries in Rugby Union players

Life after the game: quantitative and qualitative analyses of long-term effects of injuries in Rugby Union players

Recent evaluations of the BokSmart programme indicate the programme is achieving some of it’s goals – the most important of which is the prevention of catastrophic injuries, there are some areas where the programme is less successful. These shortfalls could be ascribed, in part, to the enormous socioeconomic diversity that still exists in South Africa. Furthermore, some injury risk factors, specific to South Africa, have been identified during the evaluation of the BokSmart programme, particularly in youth populations. The South African Rugby Union has requested for on-going assistance from the existing ESSM/VUmc relationship to further improve the programme and to help ameliorate injury risk factors specific to the players of South Africa. Therefore, this research project aims to develop intervention strategies to reduce identified barriers and injury risk factors to a minimum.

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Running for health: the net health effect of running

Running for health: the net health effect of running

The objectives of this project are: (1) to summarise the evidence about the health benefits of running on biomedical health-indicators; (2) to summarise the evidence about the prevalence and incidence of the main running injuries; (3) to investigate the prevalence, nature and economical burden of running injuries in two different populations (trail and novice runners); and (4) to use the Knowledge Transfer Scheme (KTS) as a way to develop a strategy to implement in practice the current knowledge on running injury prevention.

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Sports Injury Prevention in Practice

Sports Injury Prevention in Practice

In the Netherlands, interventions have been developed and implemented to increase the uptake and correct use of efficacious preventive measures by community-level (amateur) athletes, with the overall goal to prevent sports injuries. These interventions include both primary and secondary sports injury prevention with the focus on individual athletes, trainers/coaches, sport clubs, and referees, within various field-based sport settings. Process and effect evaluations of these interventions provide insight into what works in real-world sport settings. The overall aim of the project is to gain insight into the effectiveness of various intervention strategies to promote the large-scale implementation of effective preventive interventions in real-world sports settings and optimize future implementation efforts.

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Stand Up For Health; Understanding sedentary behaviors & working towards healthy solutions

PROJECT PARTNERS

  • The Netherlands Twin Register

FUNDING

This project is funded through the ReVanche Program of the Emgo+ Institute for Health and Care Research

BACKGROUND

Changing sedentary behavior patterns in modern societies is increasingly deemed to be a public health priority and understanding the determinants of sedentary behavior is of utmost importance to this end. Much research has focused on potential environmental determinants such as socioeconomic status or the built environment. However, even under identical circumstances, some individuals are more predisposed towards a sedentary lifestyle than others. These individual differences must be due to factors that reside within the person, more specifically due to their genetic material. Twin- and family studies lend themselves to investigate the contribution of genes and the environment to a trait. In addition, they allow for a test of the association between two traits while controlling for genetic and shared environmental factors.

OBJECTIVES

This project has three main objectives, namely (1) to determine the contribution of genetic and environmental factors to subjectively and objectively assessed sedentary behavior, (2) to identify genetic variants that are related to sedentary behavior, and (3) to assess the relationship between sedentary behavior and cardio-metabolic health.

DESIGN

The STAND UP FOR HEALTH project uses survey data, DNA data and data on biomarkers for cardio-metabolic health of the Netherlands Twin Register. In addition, accelerometer data are being collected in a large number of twins and their siblings as part of the project.

To address objective 1, genetic twin models will be fitted on survey data and accelerometer data. These models allow the decomposition of variance into variance that is (1) due to genes, (2) due to the part of the environment that two twins of a pair share, or (3) due to the part of the environment that they do not share. Objective 2 will be addressed by means of an association study between sedentary behavior and genetic DNA markers. Finally, the association between sedentary behavior and biomarkers in the blood will be examined while controlling for genetic background and shared environmental effects.


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The effect of schoolzones on children's physical activity

FUNDING

The project is funded by the Sport programme of the Netherlands Organisation for Health Research and Development (ZonMw).

PROJECT PARTNERS

  • TNO
  • the Amsterdam Public Health Service
  • Jantje Beton Foundation
  • the Netherlands Institute for Sport and Physical Activity (NISB)
  • Royal HaskoningDHV
  • the City Region of Amsterdam
  • The Hague University of Applied Sciences

BACKGROUND

When children are involved in physical activity from an early age, this has a positive effect on their health later in life. This, in turn, will reduce future healthcare costs. That is why there is a great need for effective measures that stimulate children to be physically active. The built environment, and especially the school environment, can play a major role in promoting youth’s physical activity levels. The school environment provides the opportunity to reach children with diverse backgrounds within a setting in which children spend a large proportion of their time. Research has shown that a safer environment with sufficient crossing points and play areas has a positive effect on the amount of sports and exercise that children engage in.

SCHOOLZONES

In recent years, local Dutch governments have started to promote the traffic safety in the vicinity of primary school buildings, designating these area as a so-called ‘schoolzone’. Schoolzones increase traffic safety in the primary school area through infrastructural changes. These changes may include measures such as sidewalk improvements, traffic calming, pedestrian or bicycle crossings, bicycle facilities and traffic signs. Besides these infrastructural changes, education of the parents and enforcement of new regulations are an important part of the schoolzone. If, in addition to increasing traffic safety, these school zones have a positive influence on the amount sports and physical activity in youth, this can be an added incentive for local authorities to invest in them. TNO and the VU University Medical Center (VUmc) are conducting research to establish whether school zones are also encouraging children to be physically active.

STUDY METHODS

The School Zones project runs for three years (2013-2016) andcompares  schools that acquire schoolzones with those that do not. In total, 10 primary schools in the Netherlands will take part in the study. Physical activity and location of 400 children in stage 6 and 7 (9-11 years old) will be monitored using accelerometers and GPS. In addition to this objective measurement of physical activity, changes in the school environment will be assessed using questionnaires and observations. The cost-effectiveness of various measures will also be studied. This will provide insight into the factors that determine the success or failure of school zones to stimulate physical activity.


Recent posts

The Health & Safety of the Elite Swimmer

The Health & Safety of the Elite Swimmer

While aquatic sports have relatively low incidence of acute injuries there are health risks for the elite aquatic athlete. This project focuses on the health and safety of the elite swimmer in addition to the role of the International Federation in safeguarding the health and well-being of its athletes. In this study, various aspects of elite aquatic athlete health will be investigated to identify the prevalence of acute injuries and illnesses.

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The trAPP-study: Treatment of acute ankle sprains in general practice

PROJECT PARTNERS

•  ErasmusMC

FUNDING

This project is funded by a grant of The Netherlands Organisation for Health Research and Development (ZonMw)(project number 80-83910-98-13003) and the Dutch Arthritis Foundation. 

BACKGROUND

Ankle sprains are one of the most frequent injuries of the musculoskeletal system, with yearly around 680.000 new sprains in the Netherlands. Of these, about 130.000 people will visit the general practitioner (GP) each year. In addition, patients have an increased risk of a recurrent ankle sprain and about a third report at least one re-sprain. No optimal treatment strategy has proven to be effective in general practice. However, promising results were achieved by a recent preventive trial conducted among athletes in the Netherlands. An unsupervised neuromuscular training program was effective in the prevention of re-sprains. When this intervention also appears to be effective in general practice and could reduce the number of re-sprains, direct treatment tools will be available for the GP for acute ankle sprains

OBJECTIVES

The aim of this project is to examine the (cost)-effectiveness of an unsupervised e-health supported neuromuscular training program in combination with usual care in general practice compared to usual care alone in patients with acute ankle sprains in general practice.

DESIGN

This study is a multi-center, open-label randomized controlled trial, with a one-year follow-up. Patients with an acute lateral ankle sprain, aged between 14 and 65 years and visiting the GP within three weeks of injury are eligible for inclusion. Patients will be randomized in two study groups. The intervention group will receive, in addition to usual care, a standardized eight-week neuromuscular training program guided by an App. The control group will receive usual care in general practice alone. The primary outcome of this study is the total number of ankle sprain recurrences reported during one year follow-up. Secondary outcomes are subjective recovery after one year follow-up, pain at rest and during activity, function, return to sport, cost-effectiveness and compliance of the intervention. Measurements will take place monthly for the study period of 12 months after baseline measurement


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