Publications by authors named "Willem van Mechelen"

442 Publications

Trail running injury risk factors: a living systematic review.

Br J Sports Med 2022 Jan 12. Epub 2022 Jan 12.

Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa.

Objective: To review and frequently update the available evidence on injury risk factors and epidemiology of injury in trail running.

Design: Living systematic review. Updated searches will be done every 6 months for a minimum period of 5 years.

Data Sources: Eight electronic databases were searched from inception to 18 March 2021.

Eligibility Criteria: Studies that investigated injury risk factors and/or reported the epidemiology of injury in trail running.

Results: Nineteen eligible studies were included, of which 10 studies investigated injury risk factors among 2 785 participants. Significant intrinsic factors associated with injury are: more running experience, level A runner and higher total propensity to sports accident questionnaire (PAD-22) score. Previous history of cramping and postrace biomarkers of muscle damage is associated with cramping. Younger age and low skin phototypes are associated with sunburn. Significant extrinsic factors associated with injury are neglecting warm-up, no specialised running plan, training on asphalt, double training sessions per day and physical labour occupations. A slower race finishing time is associated with cramping, while more than 3 hours of training per day, shade as the primary mode of sun protection and being single are associated with sunburn. An injury incidence range 0.7-61.2 injuries/1000 hours of running and prevalence range 1.3% to 90% were reported. The lower limb was the most reported region of injury, specifically involving blisters of the foot/toe.

Conclusion: Limited studies investigated injury risk factors in trail running. Our review found eight intrinsic and nine extrinsic injury risk factors. This review highlighted areas for future research that may aid in designing injury risk management strategies for safer trail running participation.PROSPERO registration numberCRD42021240832.
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http://dx.doi.org/10.1136/bjsports-2021-104858DOI Listing
January 2022

Contributions of changes in physical activity, sedentary time, diet and body weight to changes in cardiometabolic risk.

Int J Behav Nutr Phys Act 2021 Dec 20;18(1):166. Epub 2021 Dec 20.

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.

Background: Increased physical activity (PA), reduced time spent sedentary (SED), healthier diet and reduced body weight may all have a positive impact on cardiometabolic risk. The relative importance of change in each of these variables on cardiometabolic risk, however, is unclear. We therefore sought to investigate the relative contributions of changes in PA, SED, diet and body weight on cardiometabolic risk.

Methods: This is a secondary analysis of data collected from the EuroFIT randomised controlled trial, which was a 12-week group-based lifestyle intervention for overweight middle-aged men delivered by coaches in football club stadia aiming to improve PA, SED, diet, and body weight. PA and SED were assessed by accelerometry, diet using the Dietary Instrument for Nutrition Education (DINE). An overall cardiometabolic risk score was derived from combining z-scores for glucose, HbA1c, insulin, lipids and blood pressure. In total, 707 men (from the overall cohort of 1113) with complete data for these variables at baseline and 12-month follow-up were included in the multivariable linear regression analyses.

Results: In multivariable analyses, change in number of steps (explaining 5.1% of R) and dietary factors (less alcohol, fatty and sugary food, and more fruit and vegetables) (together explaining 4.5% of R), but not changes in standing time or SED, were significantly associated with change in body weight. Changes in number of steps (R = 1.7%), fatty food score (R = 2.4%), and sugary food score (R = 0.4%) were significantly associated with change in cardiometabolic risk score in univariable models. However, in multivariable models which included changes in weight as well as changes in steps and dietary variables, change in weight explained a substantially larger proportion of the change in cardiometabolic risk score, explaining 14.1% of R (out of an overall model R of 19.0%). When baseline (as well as change) values were also included in the model, 38.8% of R for change in cardiometabolic risk score was explained overall, with 14.1% of R still explained by change in weight.

Conclusion: Change in body weight, together with baseline cardiometabolic risk explained most of the change in cardiometabolic risk. Thus, the benefits of increasing physical activity and improving diet on cardiometabolic risk appear to act largely via an effect on changes in body weight.

Trial Registration: International Standard Randomised Controlled Trials, ISRCTN-81935608. Registered 06052015. https://www.isrctn.com/ISRCTN81935608?q=&filters=recruitmentCountry:Portugal&sort=&offset=7&totalResults=92&page=1&pageSize=10&searchType=basic-search.
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http://dx.doi.org/10.1186/s12966-021-01237-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8686269PMC
December 2021

Epidemiology, Clinical Characteristics, and Risk Factors for Running-Related Injuries among South African Trail Runners.

Int J Environ Res Public Health 2021 11 30;18(23). Epub 2021 Nov 30.

Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0028, South Africa.

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males = 120, females = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months ( = 0.0032) and having a chronic disease ( = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.
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http://dx.doi.org/10.3390/ijerph182312620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656810PMC
November 2021

Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants.

Scand J Work Environ Health 2021 Oct 17. Epub 2021 Oct 17.

Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre (VUmc), Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.

Objectives Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality. Methods A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality. Results We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87-1.15] and females (HR 0.95, 95% CI 0.82-1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88-1.49). Conclusions While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.
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http://dx.doi.org/10.5271/sjweh.3993DOI Listing
October 2021

Correction to: Epidemiology of Injury and Illness Among Trail Runners: A Systematic Review.

Sports Med 2022 Jan;52(1):191-192

Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

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http://dx.doi.org/10.1007/s40279-021-01546-2DOI Listing
January 2022

Willingness to Participate in Alcohol Prevention Interventions Targeting Risky Drinking Employees. The WIRUS Project.

Front Public Health 2021 25;9:692605. Epub 2021 Jun 25.

Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.

The extent to which eligible individuals in a target population are willing to participate in interventions is important when evaluating the efficacy of public health interventions. As part of a process evaluation of an ongoing randomized controlled trial, this study aimed to identify the proportion of risky drinkers who were willing to participate in an alcohol prevention intervention in an occupational health setting, and correlates for such willingness. Risky drinking employees from 22 companies in Norway were identified through an alcohol screening survey. Risky drinkers' ( = 779) willingness to complete a health examination and to be randomized into an alcohol prevention intervention (digital or face-to-face intervention, or control) was recorded by personnel from occupational health services. The proportion of employees who were willing to participate was assessed on 31 potential correlates (sociodemographic, alcohol-related, work-related, and lifestyle/daily activity). Adjusted (multiple logistic regression) analyses were utilized to explore associations between potential correlates and willingness to participate. Altogether, 38.1% of employees were willing to participate in prevention interventions. In the adjusted analysis, only 5 out of 31 potential correlates were significantly associated with willingness to participate. Managers were more than twice as willing to participate than workers (OR = 2.17, < 0.01). Willing employees had less workplace decision latitude (perceived control over workplace decisions and less possibility of utilizing personal skills in the job) (OR = 0.62, < 0.05), and were more overcommitted with exorbitant work ambition and need for approval (OR = 1.49, < 0.05). Willing employees had to some extent less alcohol-related impaired work performance (presenteeism, OR = 0.78, < 0.05), and they spent less time on care activities (OR = 0.84, < 0.05). Reaching four out of ten with risky drinking habits for prevention interventions strengthens the rationale for targeting this public health problem in occupational health care settings. In particular, this study suggests the importance of ensuring secure commitment among workers, who were less willing til participate than managers. Nevertheless, tailoring recruitment and implementation strategies based on easily identifiable correlates may be onerous.
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http://dx.doi.org/10.3389/fpubh.2021.692605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267363PMC
August 2021

Association between self-reported sleep duration and cardiometabolic risk in corporate executives.

Int Arch Occup Environ Health 2021 Nov 29;94(8):1809-1821. Epub 2021 Jun 29.

Health Through Physical Activity Lifestyle and Sport Research Centre and Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Purpose: This cross-sectional study aimed to compare the association between self-reported sleep duration and cardiometabolic risk among men and women corporate executives and investigate potential lifestyle, work- and stress-related mediators thereof.

Methods: Self-reported sleep duration and lifestyle, occupational, psychological and measured anthropometrical, blood pressure (BP) and blood marker variables were obtained from health risk assessment data of 3583 corporate executives. Sex-stratified regression analyses investigated the relationships between occupational and psychological variables with self-reported sleep duration, and sleep duration with individual cardiometabolic risk factors. Mediation analyses investigated the effects of work, psychological and lifestyle factors on the relationships between self-reported sleep duration and cardiometabolic risk factors, as well as a continuous cardiometabolic risk score calculated from the sum of sex-stratified z-standardized scores of negative fasting serum HDL, and positive plasma Glu, serum TG, body mass index (BMI), waist circumference, systolic and diastolic BP.

Results: Longer work hours and work commute time, depression, anxiety and stress were associated with shorter sleep duration in both men and women (all p < 0.05). Shorter sleep duration was associated with higher BMI, larger waist circumference and greater cardiometabolic risk scores in both men and women (all p < 0.05), higher diastolic BP in men (p < 0.05) and lower HDL cholesterol in women (p < 0.05). Physical activity, working hours and stress significantly mediated the relationships between self-reported sleep duration and BMI, waist circumference, diastolic BP and cardiometabolic risk score in men only.

Conclusion: In these corporate executives, shorter self-reported sleep duration is associated with poorer psychological, occupational and cardiometabolic risk outcomes in both men and women. Given that physical activity, working hours and stress mediate this association among the men, the case for sleep health interventions in workplace health programmes is warranted.
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http://dx.doi.org/10.1007/s00420-021-01739-2DOI Listing
November 2021

The Association Between the Acute:Chronic Workload Ratio and Running-Related Injuries in Dutch Runners: A Prospective Cohort Study.

Sports Med 2021 11 30;51(11):2437-2447. Epub 2021 May 30.

Masters and Doctoral Programs in Physical Therapy , Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno 448, Tatuapé, São Paulo, SP, 03071-100, Brazil.

Objective: To investigate the association between the acute:chronic workload ratio (ACWR) and running-related injuries (RRI).

Methods: This is a secondary analysis using a database composed of data from three studies conducted with the same RRI surveillance system. Longitudinal data comprising running exposure (workload) and RRI were collected biweekly during the respective cohorts' follow-up (18-65 weeks). ACWR was calculated as the most recent (i.e., acute) external workload (last 2 weeks) divided by the average external (i.e., chronic) workload of the last 4, 6, 8, 10 and 12 weeks. Three methods were used to calculate the ACWR: uncoupled, coupled and exponentially weighted moving averages (EWMA). Bayesian logistic mixed models were used to analyse the data.

Results: The sample was composed of 435 runners. Runners whose ACWR was under 0.70 had about 10% predicted probability of sustaining RRI (9.6%; 95% credible interval [CrI] 7.5-12.4), while those whose ACWR was higher than 1.38 had about 1% predicted probability of sustaining RRI (1.3%; 95% CrI 0.7-1.7). The association between the ACWR and RRI was significant, varying from a small to a moderate association (1-10%). The higher the ACWR, the lower the RRI risk.

Conclusions: The ACWR showed an inversely proportional association with RRI risk that can be represented by a smooth L-shaped, second-order, polynomial decay curve. The ACWR using hours or kilometres yielded similar results. The coupled and uncoupled methods revealed similar associations with RRIs. The uncoupled method presented the best discrimination for ACWR strata. The EWMA method yielded sparse and non-significant results.
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http://dx.doi.org/10.1007/s40279-021-01483-0DOI Listing
November 2021

Can we explain running-related injury preventive behavior? A path analysis.

Braz J Phys Ther 2021 Sep-Oct;25(5):601-609. Epub 2021 May 3.

Department of Public and Occupational Health (DPOH), Amsterdam Public Health Research Institute (APH), Amsterdam Universities Medical Centers, Location VU University Medical Center Amsterdam (VUmc), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences, Amsterdam Universities Medical Centers, location VU University Medical Center Amsterdam (VUmc), Amsterdam, The Netherlands; Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Background: Behavioral and social science theories/models have been gaining attention in sports injury prevention.

Objective: To investigate the potential of the Theory of Planned Behavior in explaining running-related injury preventive behavior.

Methods: Six-month prospective cohort study based on data gathered from a randomized controlled trial. From a total of 1512 invited trail runners, 232 were included in this study. Preventive behaviors and their determinants were assessed at baseline and two and six months after baseline. Five-point Likert scales were used to assess the determinants of preventive behavior. A Bayesian path analysis was conducted applying mixed models and mediation analysis.

Results: A 1-point increase in intention, attitude, subjective norm, and perceived behavioral control predicted an increase of 54% (95% Bayesian credible interval [BCI]: 38, 71) in the rate of performing running-related injury preventive behavior, explaining 49% (R 0.49; 95% BCI: 0.41, 0.56) of the variance around preventive behavior. Intention and perceived behavioral control predicted running-related injury preventive behavior directly, while 40% (95% BCI: 21, 61) and 44% (95% BCI: 20, 69) of the total effect of attitude was mediated by intention and perceived behavioral control, respectively. Attitude, subjective norm, and perceived behavioral control predicted intention.

Conclusions: The Theory of Planned Behavior may have the potential to explain half of the variance around running-related injury preventive behavior and intention. Therefore, such theory may be considered a relevant and useful tool in developing, investigating, and/or implementing programs aimed at preventing running-related injuries.
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http://dx.doi.org/10.1016/j.bjpt.2021.04.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8536861PMC
October 2021

The mediating role of lifestyle in the relationship between shift work, obesity and diabetes.

Int Arch Occup Environ Health 2021 08 11;94(6):1287-1295. Epub 2021 Mar 11.

Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.

Purpose: Shift work has been related to obesity and diabetes, but the potential mediating role of lifestyle is yet unknown. Our aim was to investigate this mediating role of physical activity, diet, smoking, and sleep quality in the relationships between shift work, and obesity and diabetes.

Methods: In this cross-sectional study, 3188 shift workers and 6395 non-shift workers participated between 2013 and 2018 in periodical occupational health checks. Weight and height were objectively measured to calculate obesity (BMI ≥ 30 kg/m). Diabetes status, physical activity, diet, smoking, and sleep quality were assessed using standardized questionnaires. Structural equation models adjusted for relevant confounders were used to analyze the mediating role of lifestyle in the relationships between shift work, and obesity and diabetes.

Results: Shift workers were more often obese (OR: 1.37, 95% CI 1.16-1.61) and reported more often to have diabetes (OR:1.35, 95% CI 1.003-1.11) than non-shift workers. Shift workers had lower physical activity levels, ate fruit and vegetables less often, smoked more often, and had poorer sleep quality (p < 0.05). Mediation analysis revealed that shift workers had a higher odds of obesity (OR: 1.07, 95% CI 1.01-1.15) and diabetes (OR: 1.13, 95% CI 1.02-1.27) mediated by poorer sleep quality. Lower physical activity levels (OR: 1.11, 95% CI 1.05-1.19) and lower intake of fruit and vegetables (OR: 1.04, 95% CI 1.01-1.15) were also mediators in the relationship between shift work and obesity, but not in the relationship between shift work and diabetes (p ≥ 0.05).

Conclusion: These results imply that interventions targeting diet, physical activity and in particular sleep problems specifically developed for shift workers could potentially reduce the adverse health effects of shift work.
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http://dx.doi.org/10.1007/s00420-021-01662-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292292PMC
August 2021

Associations Between Self-Reported Sleep Duration and Mortality in Employed Individuals: Systematic Review and Meta-Analysis.

Am J Health Promot 2021 07 11;35(6):853-865. Epub 2021 Feb 11.

Health Through Physical Activity Lifestyle and Sport Research Centre & Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, Department of Human Biology, 37716University of Cape Town, South Africa.

Objective: Sleeping less or more than the 7-8 h has been associated with mortality in the general population, which encompasses diversity in employment status, age and community settings. Since sleep patterns of employed individuals may differ to those of their unemployed counterparts, the nature of their sleep-mortality relationship may vary. We therefore investigated the association between self-reported sleep duration and all-cause mortality (ACM) or cardiovascular disease mortality (CVDM) in employed individuals.

Data Sources: Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, searches between January 1990 and May 2020 were conducted in PubMed, Web of Science and Scopus. Inclusion/exclusion criteria: Included were prospective cohort studies of 18-64-year-old disease-free employed persons with sleep duration measured at baseline, and cause of death recorded prospectively as the outcome. Gray literature, case-control or intervention design studies were excluded.

Data Extraction: Characteristics of the studies, participants, and study outcomes were extracted. The quality and risk of bias were assessed using the Newcastle-Ottawa Scale.

Data Synthesis: The pooled relative risks (RR) with 95% confidence intervals (CI) were obtained with a random-effects model and results presented as forest plots. Heterogeneity and sensitivity analysis were assessed.

Results: Shorter sleep duration (≤6 h) was associated with a higher risk for (ACM) (RR: 1.16, 95% CI: 1.11 -1.22) and CVDM (RR: 1.26, 95% CI: 1.12 -1.41) compared to 7-8 h of sleep, with no significant heterogeneity. The association between longer sleep (≥8 h) and ACM (RR: 1.18, 95% CI:1.12 -1.23, P < 0.001) needs to be interpreted cautiously owing to high heterogeneity (I = 86.0%, P < 0.001).

Conclusion: Interventions and education programs targeting sleep health in the workplace may be warranted, based on our findings that employed individuals who report shorter sleep appear to have a higher risk for ACM and CVDM.
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http://dx.doi.org/10.1177/0890117121992288DOI Listing
July 2021

Epidemiology of Injury and Illness Among Trail Runners: A Systematic Review.

Sports Med 2021 May 4;51(5):917-943. Epub 2021 Feb 4.

Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

Background: Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies.

Objective: The primary aim of this review was to describe the epidemiology of injury and illness among trail runners.

Methods: Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool.

Results: Sixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6-4285.0 injuries per 1000 h of running and 65.0-6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported.

Conclusion: Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.
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http://dx.doi.org/10.1007/s40279-020-01418-1DOI Listing
May 2021

Accessing healthcare as a person with a rugby-related spinal cord injury in South Africa: the injured player's perspective.

Physiother Theory Pract 2021 Jan 24:1-17. Epub 2021 Jan 24.

Institute of Sport and Exercise Medicine (ISEM), Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.

: Rugby carries a risk for serious injuries, including acute spinal cord injuries. The lifetime health consequences of these injuries may be far-reaching.: In this study, we aimed to describe barriers and facilitators to healthcare and rehabilitation, in individuals with rugby-related spinal cord injuries in South Africa.: This study adopted a pragmatic qualitative approach. Stratified purposive sampling was used to select interviews from players from a variety of socio-economic status and geographical areas for inclusion in this study. The final sample consisted of thirty-one (n = 31) participants. Thematic analysis was used to analyze the data.: Participants described long-term, accessible, affordable, quality healthcare and rehabilitation as important contributors to their quality of life. Even though public healthcare is accessible from a cost point of view, quality of care, availability of rehabilitation services and factors such as affordability and availability of adequate transport remain a barrier for lower socio-economic groups.: This population was unique, as the support from a dedicated organization enabled participants to overcome some barriers, highlighting the challenges of the healthcare system in maintaining the health of people with spinal cord injuries. Every effort should be made to create equitable access to healthcare and rehabilitation for persons with spinal cord injuries in South Africa.
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http://dx.doi.org/10.1080/09593985.2021.1872753DOI Listing
January 2021

How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies.

Br J Sports Med 2020 Dec;54(24):1474-1481

Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

Objective: Physical activity (PA) has substantial benefits across a range of health outcomes. There is uncertainty about the PA-specific health effects, and in particular, the occupational domain. In this umbrella review, we synthesised available evidence on the associations between occupational PA (OPA) and health-related outcomes (including cancer, all-cause mortality and cardiovascular disease). This work informed the development of WHO's guidelines on PA and sedentary behaviour (2020).

Design: Umbrella review of systematic reviews.

Data Source: We performed a literature search in PubMed, Web of Science, Embase, CINAHL and Sportdiscuss from database inception to 2 December 2019.

Eligibility Criteria For Selecting Studies: We included systematic reviews if they contained a quantitative assessment of OPA and its relationship with at least one health-related outcome.

Results: We summarised the evidence of 17 reviews covering 23 unique health-related outcomes. We graded most evidence as low or very low, or moderate quality. We found health benefits for those engaging in high versus low OPA for multiple cancer outcomes (including colon and prostate), ischaemic stroke, coronary heart disease and mental health (ie, mental well-being and life satisfaction). High OPA was associated with unfavourable health outcomes for all-cause mortality in men, mental ill health (ie, depression and anxiety), osteoarthritis, and sleep quality and duration.

Conclusions: We found favourable associations for most health-related outcomes with high OPA levels, but we also found some evidence for unfavourable associations due to high OPA levels. At this point, there is a need for better quality evidence to provide a unequivocal statement on the health effects of OPA.
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http://dx.doi.org/10.1136/bjsports-2020-102587DOI Listing
December 2020

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

JMIR Res Protoc 2020 Nov 2;9(11):e19397. Epub 2020 Nov 2.

Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

Background: The prescription of physical activity (PA) in clinical care has been advocated worldwide. This "exercise is medicine" (E=M) concept can be used to prevent, manage, and cure various lifestyle-related chronic diseases. Due to several challenges, E=M is not yet routinely implemented in clinical care.

Objective: This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care.

Methods: PIE=M consists of 3 interrelated work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators, and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from 2 diverse university medical centers (both located in a city, but one serving an urban population and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, a generic E=M tool will be developed that will provide tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative design process in which all stakeholders reflect on the design of the E=M tool. Third, we will pilot-implement the set of implementation strategies, including the E=M tool, to test its feasibility in routine care of clinicians in these 2 university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches, and patients using a mixed-methods design based on the RE-AIM framework.

Results: This project was approved and funded by the Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package have been collected and analyzed and are expected to be published in 2021. Results of the second work package are described. The manuscript is expected to be published in 2021. The third work package is currently being conducted in clinical practice in 4 departments of 2 university medical hospitals among clinicians, lifestyle coaches, hospital managers, and patients. Results are expected to be published in 2021.

Conclusions: The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage chronic disease, improve recovery, and enable healthy ageing by developing E=M implementation strategies, including an E=M tool, in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients' health, while minimizing the burden on clinicians.
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http://dx.doi.org/10.2196/19397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669441PMC
November 2020

BokSmart rugby safety education courses are associated with improvements in behavioural determinants in attending coaches and referees: presurvey-postsurvey study.

Inj Prev 2021 08 24;27(4):363-368. Epub 2020 Aug 24.

Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Background/aim: BokSmart is a nationwide injury prevention programme that aims to reduce players' injury risk mainly through education of coaches and referees in mandatory biennial education courses. These courses are held throughout each rugby season. The objective of this cross-sectional study was to assess whether these courses were associated with improvements in attendees' behavioural determinants.

Methods: Coaches and referees completed a questionnaire based on the theory of planned behaviour, immediately before and after their 2012 BokSmart courses. Twelve behavioural determinants were assessed on a five-point Likert scale and open-ended questions. A meaningful change was defined as an improvement of ≥1 unit score supported by null hypothesis testing. Odds of improving by ≥1 unit score (compared with not improving) were assessed in attendees using multivariate logistic regression.

Results: In total, 390 coaches and 74 referees completed both questionnaires. 'Before' scores were high for most outcomes, except for knowledge. Although there was a significant (p<0.001) improvement in all 'after' course scores, the only meaningful change (=1 unit) was in knowledge of scrum techniques/rules.

Conclusion: Although the only meaningful improvement in 2012 BokSmart course attendees was in one outcome, it should be noted that before-course scores were already high, reducing the questionnaire's ability to assess change because of a ceiling effect. Nonetheless, the knowledge acquisition of these courses was low and not related to previous course attendance or more years of rugby experience. These results justify the biennial nature of this safety course but also indicate that knowledge acquisition is generally low.
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http://dx.doi.org/10.1136/injuryprev-2020-043903DOI Listing
August 2021

Shift work, and burnout and distress among 7798 blue-collar workers.

Int Arch Occup Environ Health 2020 Nov 30;93(8):955-963. Epub 2020 Apr 30.

Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.

Objective: This study aimed to investigate the association between shift work, and burnout and distress, and differences by degree of satisfaction with shift schedule and its impact on private life.

Methods: Population 4275 non-shift factory workers and 3523 rotating 5-shift workers. Workers participated between 2009 and 2016 one to three times in the companies' periodical occupational health checks. Burnout was measured using the distance, exhaustion and competence subscales of the Dutch Maslach Burnout Inventory and distress by the subscale of the Four-Dimensional Symptom Questionnaire (scale: 0-100). Multiple-adjusted linear mixed models were used to assess between- and within-subject associations between shift work and outcomes, and differences by age, years of shift work, and satisfaction with and impact of shift schedule.

Results: Shift work was significantly associated with lower scores on burnout distance (B - 1.0, 95% - 1.8 to 0.3), and among those aged < 48 years with burnout exhaustion (range B - 1.3 to - 1.6). However, the effect sizes were small. Compared to non-shift workers, shift workers dissatisfied with their schedule and those experiencing a high impact on private life had significantly higher burnout (range B 1.7-6.3) and distress levels (range B 4.9-6.1). In contrast, satisfied shift workers and those experiencing a low impact of shift schedule had lower burnout (range B - 0.2 to - 2.2) and no difference in distress levels (P ≥ 0.05). No clear pattern by years of shift work was observed.

Conclusions: Shift work was associated with burnout and distress in those who were dissatisfied with or who had perceived high impact on the private life of their shift schedule.
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http://dx.doi.org/10.1007/s00420-020-01536-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519910PMC
November 2020

Towards a better understanding of the 'physical activity paradox': the need for a research agenda.

Br J Sports Med 2020 Sep 7;54(17):1055-1057. Epub 2020 Apr 7.

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, Netherlands.

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http://dx.doi.org/10.1136/bjsports-2019-101343DOI Listing
September 2020

Five-year cost-effectiveness analysis of the European Fans in Training (EuroFIT) physical activity intervention for men versus no intervention.

Int J Behav Nutr Phys Act 2020 03 4;17(1):30. Epub 2020 Mar 4.

Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.

Objectives: Increasing physical activity reduces the risk of chronic illness including Type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle interventions can increase physical activity but few successfully engage men. This study aims to investigate the 5 year cost-effectiveness of EuroFIT, a program to improve physical activity tailored specifically for male football (soccer) fans compared to a no intervention comparison group.

Methods: We developed a Markov cohort model in which the impact of improving physical activity on five chronic health conditions (colorectal cancer, Type 2 diabetes, coronary heart disease, stroke and depression) and mortality was modelled. We estimated costs from a societal perspective and expressed benefits as quality adjusted life years (QALYs). We obtained data from a 4-country (England, Netherlands, Portugal and Norway) pragmatic randomised controlled trial evaluating EuroFIT, epidemiological and cohort studies, and meta-analyses. We performed deterministic and probabilistic sensitivity analyses to assess the impact of uncertainty in the model's parameter values on the cost-effectiveness results. We used Monte Carlo simulations to estimate uncertainty and presented this using cost-effectiveness acceptability curves (CEACs). We tested the robustness of the base case analysis using five scenario analyses.

Results: Average costs over 5 years per person receiving EuroFIT were €14,663 and per person receiving no intervention €14,598. Mean QALYs over 5 years were 4.05 per person for EuroFIT and 4.04 for no intervention. Thus, the average incremental cost per person receiving EuroFIT was €65 compared to no intervention, while the average QALY gain was 0.01. This resulted in an ICER of €5206 per QALY gained. CEACs show that the probability of EuroFIT being cost-effective compared to no intervention is 0.53, 0.56 and 0.58 at thresholds of €10,000, €22,000 and €34,000 per QALY gained, respectively. When using a time horizon of 10 years, the results suggest that EuroFIT is more effective and less expensive compared to (i.e. dominant over) no intervention with a probability of cost-effectiveness of 0.63 at a threshold of €22,000 per QALY gained.

Conclusions: We conclude the EuroFIT intervention is not cost-effective compared to no intervention over a period of 5 years from a societal perspective, but is more effective and less expensive (i.e. dominant) after 10 years. We thus suggest that EuroFIT can potentially improve public health in a cost-effective manner in the long term.
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http://dx.doi.org/10.1186/s12966-020-00934-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055048PMC
March 2020

The moderating role of lifestyle, age, and years working in shifts in the relationship between shift work and being overweight.

Int Arch Occup Environ Health 2020 08 10;93(6):697-705. Epub 2020 Feb 10.

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.

Purpose: This study aimed to investigate the relationship between the moderating role of lifestyle, age, and years working in shifts and, shift work and being overweight.

Methods: Cross-sectional data were used of 2569 shift and 4848 non-shift production workers who participated between 2013 and 2018 in an occupational health check. Overweight (BMI ≥ 25 kg/m) was calculated using measured weight and height; lifestyle was assessed by questionnaires. Multiple-adjusted logistic regression with interaction terms between shift work and potential moderators assessed multiplicative interaction; the relative excess risk due to interaction assessed additive interaction (synergism).

Results: Shift work was significantly related to being overweight (OR 1.53, 95% CI 1.33 1.76). The strength of this association did not differ by level of sleep quality, fruit and vegetable intake, and physical activity (p ≥ 0.05). Additive and multiplicative interaction by smoking status was present (p < 0.01), with a stronger relationship between shift work and being overweight among non-smokers compared to smokers. Older age as well as more years of exposure to shift work were, independently from each other, related to a stronger relationship between shift work and being overweight (multiplicative interaction p < 0.05).

Conclusion: Shift work was to a similar extent related to being overweight among those with a healthy and unhealthy lifestyle. This does, however, not imply that shift workers can behave unhealthy without any harm. Based on the evident health benefits of a healthy lifestyle, it is still recommended to get sufficient quality of sleep and to meet the recommended level of daily physical activity and, fruit and vegetable intake.
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http://dx.doi.org/10.1007/s00420-020-01519-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320962PMC
August 2020

Physical activity in patients with cancer: self-report versus accelerometer assessments.

Support Care Cancer 2020 Aug 9;28(8):3701-3709. Epub 2019 Dec 9.

Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.

Purpose: The level of daily physical activity in patients with cancer is frequently assessed by questionnaires, such as the Physical Activity Scale for the Elderly (PASE). Objective assessments, with for example accelerometers, may be a good alternative. The aim of this study was to investigate the agreement between the PASE questionnaire and accelerometer-assessed physical activity in a large group of patients with different types of cancer.

Methods: Baseline accelerometer and PASE questionnaire data of 403 participants from the REACT (Resistance and Endurance Exercise After Chemotherapy, n = 227), the EXIST (Exercise Intervention After Stem-Cell Transplantation, n = 74), and NET-QUBIC (NEtherlands QUality of Life And Biomedical Cohort Studies In Cancer, n = 102) studies were available for the current analyses. Physical activity was assessed by the PASE questionnaire (total score) and accelerometers (total minutes per day > 100 counts). Linear mixed models regression analysis was used to assess the agreement between the PASE questionnaire and accelerometer-assessed physical activity.

Results: The mean (SD) PASE score was 95.9 (75.1) points and mean (SD) time in physical activity measured with the accelerometer was 256.6 (78.8) min per day. The agreement between the PASE score and the accelerometer data was significant, but poor (standardized regression coefficient (B) = 0.36, 95%CI = 0.27; 0.44, p < 0.01).

Conclusion: Agreement between the PASE questionnaire and accelerometer-assessed physical activity was poor. The poor agreement indicates that they measure different physical activity constructs and cannot be used interchangeably to assess the level of daily physical activity in patients with cancer.
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http://dx.doi.org/10.1007/s00520-019-05203-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316671PMC
August 2020

Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data.

Med Sci Sports Exerc 2020 02;52(2):303-314

Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS.

Purpose: Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue.

Methods: We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test.

Results: Exercise interventions had statistically significant beneficial effects on fatigue (β = -0.17; 95% confidence interval [CI], -0.22 to -0.12). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (βdifference = -0.18; 95% CI -0.28 to -0.08). Supervised interventions with a duration ≤12 wk showed larger effects on fatigue (β = -0.29; 95% CI, -0.39 to -0.20) than supervised interventions with a longer duration.

Conclusions: In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration.
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http://dx.doi.org/10.1249/MSS.0000000000002154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962544PMC
February 2020

Letting the cat out of the bag: athletes, coaches and physiotherapists share their perspectives on injury prevention in elite sports.

Br J Sports Med 2020 Jul 9;54(14):871-877. Epub 2019 Aug 9.

Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands.

Objectives: To explore how sports injury prevention takes place in elite sport practice and to describe the perspectives of athletes, coaches and physiotherapists regarding the most critical factors that help prevent injury in the elite sports context.

Methods: Qualitative study. Semistructured interviews with 19 international level athletes, coaches and physiotherapists, from different Olympic sports. Interviews were transcribed verbatim and analysed using comparative data analysis based on Grounded Theory.

Results: The participants perceived injury risk as an inherent part of elite sports, because athletes try to enhance performance by pushing their limits. Participants described injury prevention as a learning process that changed over time, based on their sports experience and the injuries that they had sustained along their career. Communication among the athletes, coaches and physiotherapists was described as a key component of the injury prevention process. Study participants emphasised the relevance of teamwork and shared responsibility. Performance was presented as the core of the athlete's daily practice, indicating that injury prevention can be a means to that end but is not a goal in itself for this community.

Conclusion: Participants perceive injury prevention as part of elite sports and thus embrace the need for injury prevention. Injury prevention strategies in elite sports were described as a learning process, following the dynamic nature of training for maximal performance. Performance is the participants' main goal.
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http://dx.doi.org/10.1136/bjsports-2019-100773DOI Listing
July 2020

Association between alcohol consumption and impaired work performance (presenteeism): a systematic review.

BMJ Open 2019 07 16;9(7):e029184. Epub 2019 Jul 16.

Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.

Objectives: The aim of this review was to explore the notion of alcohol-related presenteeism; that is, whether evidence in the research literature supports an association between employee alcohol consumption and impaired work performance.

Design: Systematic review of observational studies.

Data Sources: MEDLINE, Web of Science, PsycINFO, CINAHL, AMED, Embase and Swemed+ were searched through October 2018. Reference lists in included studies were hand searched for potential relevant studies.

Eligibility Criteria: We included observational studies, published 1990 or later as full-text empirical articles in peer-reviewed journals in English or a Scandinavian language, containing one or more statistical tests regarding a relationship between a measure of alcohol consumption and a measure of work performance.

Data Extraction And Synthesis: Two independent reviewers extracted data. Tested associations between alcohol consumption and work performance within the included studies were quality assessed and analysed with frequency tables, cross-tabulations and χ tests of independence.

Results: Twenty-six studies were included, containing 132 tested associations. The vast majority of associations (77%) indicated that higher levels of alcohol consumption were associated with higher levels of impaired work performance, and these positive associations were considerably more likely than negative associations to be statistically significant (OR=14.00, 0.37, p<0.001). Alcohol exposure measured by hangover episodes and composite instruments were over-represented among significant positive associations of moderate and high quality (15 of 17 associations). Overall, 61% of the associations were characterised by low quality.

Conclusions: Evidence does provide some support for the notion of alcohol-related presenteeism. However, due to low research quality and lack of longitudinal designs, evidence should be characterised as somewhat inconclusive. More robust and less heterogeneous research is warranted. This review, however, does provide support for targeting alcohol consumption within the frame of workplace interventions aimed at improving employee health and productivity.

Prospero Registration Number: CRD42017059620.
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http://dx.doi.org/10.1136/bmjopen-2019-029184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661906PMC
July 2019

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

J Athl Train 2019 Apr 17;54(4):374-383. Epub 2019 Apr 17.

Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands.

Context: Field hockey is popular worldwide; however, it entails a risk of injury. Injuries hamper players' participation in the sport and impose a burden on public health.

Objective: To investigate the effectiveness of a structured exercise program among youth field hockey players on the injury rate, severity, and burden.

Design: Quasi-experimental study.

Setting: On field during 1 season of field hockey (October 2016 through June 2017).

Patients Or Other Participants: A convenience sample of 22 teams (291 players): 10 teams (135 players, mean age = 11.5 years [95% confidence interval (CI) = 11.2, 11.7 years]) in the intervention group and 12 teams (156 players, mean age = 12.9 years [95% CI = 12.6, 13.2 years]) in the control group.

Intervention(s): The Warming-up Hockey program, a sex- and age-specific, structured, evidence-informed warm-up program consisting of a preparation phase (ie, agility and cardiovascular warm-up exercises), movement skills (ie, stability and flexibility exercises), and sport-specific skills (ie, speed and strength exercises in field hockey situations). Participants in the control group performed their usual warm-up routines.

Main Outcome Measure(s): Injury rate (ie, the number of injuries per 1000 player-hours of field hockey exposure), severity (ie, days of player time-loss), and burden on athletes' availability to play (ie, days of time loss due to injury per 1000 player-hours of field hockey exposure).

Results: The injury rate was lower in the intervention group (hazard ratio of 0.64 [95% CI = 0.38, 1.07]); however, this result was not statistically significant. The severity of injuries was similar in both groups ( statistic .73). The burden of injuries on players' field hockey participation was lower in the intervention group (difference of 8.42 [95% CI = 4.37, 12.47] days lost per 1000 player-hours of field hockey).

Conclusions: Exposure to the Warming-up Hockey program was not significantly associated with a lower injury rate. No reduction was observed in the severity of injuries alone; however, the burden of injuries on players' field hockey participation was lower in the intervention group.
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http://dx.doi.org/10.4085/1062-6050-79-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522090PMC
April 2019

From the safety net to the injury prevention web: applying systems thinking to unravel injury prevention challenges and opportunities in Cirque du Soleil.

BMJ Open Sport Exerc Med 2019 1;5(1):e000492. Epub 2019 Mar 1.

Amsterdam Collaboration for Health & Safety in Sports, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

Objective: We undertook this qualitative study within an international circus company-Cirque du Soleil-to explore the narrative of artists and the artistic team in regards to injuries and their prevention and to describe the prevention of injuries from a systems thinking lens.

Methods: Focus groups (FG) with artists and semistructured individual interviews with the artistic team were conducted in six selected shows. The structure of the interviews and FGs concerned the themes: 'injury', 'injury-related factors' and 'injury prevention'. Data were analysed through comparative data analysis based on Grounded Theory. Concept mapping and systems thinking approaches were used to design a map of participants' views on how to prevent injuries.

Results: Injury was mainly described based on performance limitation. The factors mostly mentioned to be related to injury occurrence were physical load factors. Many of these factors were said to be connected and to influence each other. Injury prevention was mapped as a multilevel system, composed by artist-related factors (eg, technique and life style) and extrinsic factors (eg, touring conditions and equipment) that integrate different strategies and stakeholders.

Conclusion: Our study reinforces the importance of multilevel injury prevention approaches with shared responsibility and open communication among stakeholders.
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http://dx.doi.org/10.1136/bmjsem-2018-000492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407541PMC
March 2019

When This Happens, You Want the Best Care: Players' Experiences of Barriers and Facilitators of the Immediate Management of Rugby-Related Acute Spinal Cord Injury.

Qual Health Res 2019 11 13;29(13):1862-1876. Epub 2019 Mar 13.

Stellenbosch University, Stellenbosch, South Africa.

Most contact sports, including rugby union, carry a risk of injury. Although acute spinal cord injuries (ASCIs) in rugby are rare, the consequences of such injuries are far-reaching. Optimal management of these injuries is challenging, and a detailed understanding of the different barriers and facilitators to optimal care is needed. In this study, we aimed to describe the perception of players, regarding factors related to the optimal immediate management of a catastrophic injury in a developing country with socioeconomic and health care inequities. The most frequently reported barriers were transportation delays after injury and admission to appropriate medical facilities. Other barriers included inadequate equipment, the quality of first aid care, and barriers within the acute hospital setting. Barriers were more prevalent in rural and lower socioeconomic areas. These findings are relevant for all rugby stakeholders and may help shape education, awareness, and future policy around the immediate management of ASCIs.
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http://dx.doi.org/10.1177/1049732319834930DOI Listing
November 2019

The effect of a programme to improve men's sedentary time and physical activity: The European Fans in Training (EuroFIT) randomised controlled trial.

PLoS Med 2019 02 5;16(2):e1002736. Epub 2019 Feb 5.

Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.

Background: Reducing sitting time as well as increasing physical activity in inactive people is beneficial for their health. This paper investigates the effectiveness of the European Fans in Training (EuroFIT) programme to improve physical activity and sedentary time in male football fans, delivered through the professional football setting.

Methods And Findings: A total of 1,113 men aged 30-65 with self-reported body mass index (BMI) ≥27 kg/m2 took part in a randomised controlled trial in 15 professional football clubs in England, the Netherlands, Norway, and Portugal. Recruitment was between September 19, 2015, and February 2, 2016. Participants consented to study procedures and provided usable activity monitor baseline data. They were randomised, stratified by club, to either the EuroFIT intervention or a 12-month waiting list comparison group. Follow-up measurement was post-programme and 12 months after baseline. EuroFIT is a 12-week, group-based programme delivered by coaches in football club stadia in 12 weekly 90-minute sessions. Weekly sessions aimed to improve physical activity, sedentary time, and diet and maintain changes long term. A pocket-worn device (SitFIT) allowed self-monitoring of sedentary time and daily steps, and a game-based app (MatchFIT) encouraged between-session social support. Primary outcome (objectively measured sedentary time and physical activity) measurements were obtained for 83% and 85% of intervention and comparison participants. Intention-to-treat analyses showed a baseline-adjusted mean difference in sedentary time at 12 months of -1.6 minutes/day (97.5% confidence interval [CI], -14.3-11.0; p = 0.77) and in step counts of 678 steps/day (97.5% CI, 309-1.048; p < 0.001) in favor of the intervention. There were significant improvements in diet, weight, well-being, self-esteem, vitality, and biomarkers of cardiometabolic health in favor of the intervention group, but not in quality of life. There was a 0.95 probability of EuroFIT being cost-effective compared with the comparison group if society is willing to pay £1.50 per extra step/day, a maximum probability of 0.61 if society is willing to pay £1,800 per minute less sedentary time/day, and 0.13 probability if society is willing to pay £30,000 per quality-adjusted life-year (QALY). It was not possible to blind participants to group allocation. Men attracted to the programme already had quite high levels of physical activity at baseline (8,372 steps/day), which may have limited room for improvement. Although participants came from across the socioeconomic spectrum, a majority were well educated and in paid work. There was an increase in recent injuries and in upper and lower joint pain scores post-programme. In addition, although the five-level EuroQoL questionnaire (EQ-5D-5L) is now the preferred measure for cost-effectiveness analyses across Europe, baseline scores were high (0.93), suggesting a ceiling effect for QALYs.

Conclusion: Participation in EuroFIT led to improvements in physical activity, diet, body weight, and biomarkers of cardiometabolic health, but not in sedentary time at 12 months. Within-trial analysis suggests it is not cost-effective in the short term for QALYs due to a ceiling effect in quality of life. Nevertheless, decision-makers may consider the incremental cost for increase in steps worth the investment.

Trial Registration: International Standard Randomised Controlled Trials, ISRCTN-81935608.
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http://dx.doi.org/10.1371/journal.pmed.1002736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363143PMC
February 2019

Do Physical Activity, Social Cohesion, and Loneliness Mediate the Association Between Time Spent Visiting Green Space and Mental Health?

Environ Behav 2019 Feb 14;51(2):144-166. Epub 2017 Nov 14.

Vrije Universiteit Amsterdam, The Netherlands.

This cross-sectional study investigated whether physical activity, social cohesion, and loneliness mediate the association between time spent visiting green spaces and perceived mental health and vitality. Questionnaire data were collected from 3,948 residents from 124 neighborhoods across four European cities. Multilevel linear regression analysis revealed positive, but weak, associations between time spent visiting green space and Medical Outcome Study Short Form (SF-36) mental health and vitality score, which suggest small mental health benefits. Single mediation analyses showed that different indicators of physical activity (total, during leisure time, and walking during leisure time), social cohesion, and loneliness were mediators. Multiple mediation analyses showed that physical activity during leisure time and loneliness may explain about 25% of the relationship. The unmediated part of the association suggests that other mediators may explain the association.
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http://dx.doi.org/10.1177/0013916517738563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311621PMC
February 2019
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