Efficacy of a Neuromuscular Warm-up Program in Reducing the Risk of School Sports Injury among Chinese Children: A Cluster Randomized Controlled Trial.

Background: Children who participate in sports have reduced cardiovascular risk, obesity, and type 2 diabetes. However, sports participation also comes with an inherent risk of sports-related injuries. Purpose: To examine the efficacy of a school-based neuromuscular warm-up program (NWP) in reducing the risk of school sports injury (SSI) in children and the impact of different levels of compliance on the effectiveness of the program. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 421 students from grades 4 to 6 at a single school (age range, 9-14 years) were randomized by grade to an intervention group and a control group. The intervention group participated in a 13-week simplified (8-minute) NWP designed to reduce SSI risk. The control group participated in a standard warm-up of the same length and duration. Exposure, compliance, and injury data were collected via a weekly form. The primary injury outcome was all SSIs. Secondary outcomes included injuries from physical education (PE) and non-PE class, upper and lower extremity injuries, other location injuries, and time-loss injuries. A Poisson regression model using an intent-to-treat analysis was performed to estimate the incidence rate ratio (IRR) for all injuries in the intervention group compared with the control group. To examine the influence of level of compliance, we divided the intervention group into low compliance (participation 1-2 times/wk) and high compliance (participation >2 times/wk) then compared the difference on injury rates (IRs) between these groups and the control group. Results: There were significant differences between the intervention and control groups regarding all SSIs (IRR, 0.47; 95% CI, 0.23-0.96; P = .038), PE class injuries (IRR, 0.37; 95% CI, 0.14-0.99; P = .048), and other location injuries (IRR, 0.20; 95% CI, 0.05-0.82; P = .025). The compliance analysis revealed that although the low-compliance group was able to reduce the risk of SSIs (IR, 4.43; 95% CI, 2.49-6.37) compared with the control group (IR, 7.60; 95% CI, 5.61-9.59), the high-compliance group produced a better effect in reducing the SSI risk (IR, 1.80; 95% CI, 0.04-3.56). Conclusion: The simplified NWP used in this study was efficacious in the reduction of SSIs in children. Registration: ChiCTR2100043875 (Chinese Clinical Trial Registry; http://www.chictr.org.cn).

Intention for Warm-Up among Children and Adolescents Scale: Development and Initial Validation.

The purpose of this study was to develop and validate the Intention for Warm-up among Children and Adolescents Scale (IWCAS). There were four phases and four sets of participants in the development of the IWCAS. In the first phase, the domains of intention were defined, and related components were developed, organized, and validated. In the second phase, 446 elementary and middle school students participated in a pilot study for the first version of the scale, which was revised based on the information obtained. In the third phase, 12 graduates in sports pedagogy served on an expert panel and organized the items into domain areas and developed a second version of the IWCAS. In the final phase, 1322 elementary and middle school students from three k-12 schools completed the revised version of the IWCAS, and exploratory and confirmatory factor analyses were conducted. Based on the results, the IWCAS was shortened by deleting some items in two domains; this resulted in 11 items of the final version with 3 domains: (1) attitude toward warm-up, (2) subjective norm, and (3) perceived behavioral control that, according to the indices, generate reliable and structurally valid scores. The composite internal consistency for the three domains ranged from 0.74 to 0.85. The researchers hypothesized the IWCAS is a valid and reliable scale, which can be used by P.E. teachers or coaches to evaluate the intention of primary and secondary school students to perform warm-ups.

Factors Associated with School Sports Injury among Elementary and Middle School Students in Shanghai, China.

School sports activity (SSA) is beneficial to gaining and maintaining optimal health among elementary and middle school students but might increase risks for school sports injury (SSI). This cross-sectional study aimed to investigate the incidence and identify risk factors of SSI among Chinese elementary and middle school students in Shanghai. Students in grades 4-5 (elementary) and 7-9 (middle) from three k-12 schools (aged from 9 to 16 years old) in Shanghai selected via the method of cluster random sampling were invited to participate in the study. Information on socio-demography, sleep duration, individual internal and external risk factors, and SSI experiences in the past 12 months was collected. A multivariate logistic regression model was performed to estimate the risk factors of SSI. A total of 1303 participants completed the questionnaires, with an overall SSI incidence rate of 29.5%. Along with boys, elementary school students, and sports team members, students scoring high on internal and external risk factors were at higher risk for SSA. In summary, SSI was prevalent among elementary and middle school students in Shanghai, China, and was associated with several modifiable risk factors. The findings provide insights regarding actions that could be taken to reduce the occurrence of SSI and maximize the benefits of SSA, including improvements in safety education, maintenance of facilities and equipment, and completion of warm-up exercises.

Effectiveness of Warm-Up Intervention Programs to Prevent Sports Injuries among Children and Adolescents: A Systematic Review and Meta-Analysis.

Sports participation by children and adolescents often results in injuries. Therefore, injury prevention warm-up programs are imperative for youth sports safety. The purpose of this paper was to assess the effectiveness of Warm-up Intervention Programs (WIP) on upper and lower limb sports injuries through a systematic review and meta-analysis. Searches for relevant studies were performed on PubMed, EMBASE, Web of Science, SPORTDiscus, and Cochrane databases. Studies selected met the following criteria: original data; analytic prospective design; investigated a WIP and included outcomes for injury sustained during sports participation. Two authors assessed the quality of evidence using Furlan's criteria. Comprehensive Meta-Analysis 3.3 software was used to process and analyze the outcome indicators of the literature. Across fifteen studies, the pooled point estimated injury rate ratio (IRR) was 0.64 (95% CI = 0.54−0.75; 36% reduction) while accounting for hours of risk exposure. Publication bias assessment suggested a 6% reduction in the estimate (IRR = 0.70, 95% CI = 0.60−0.82), and the prediction interval intimated that any study estimate could still fall between 0.34 and 1.19. Subgroup analyses identified one significant moderator that existed in the subgroup of compliance (p < 0.01) and might be the source of heterogeneity. Compared with the control group, WIPs significantly reduced the injury rate ratio of upper and lower limb sports injuries in children and adolescents.