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Sport for all, injury prevention for all
  1. E A L M Verhagen,
  2. W van Mechelen
  1. Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Evert Verhagen, Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; e.verhagen{at}

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Maintaining a healthy physically active lifestyle is a major contemporary public health issue.1 However, regular participation in physical activity and sports increases the individual’s exposure to injury. This threatens ongoing, healthy physical activity behaviour. Moreover, there are substantial direct and indirect costs of sports and physical activity- related injuries, so these injuries are also a societal problem. Thus, safety is an essential corollary of our global effort to promote sports and physical activity. For this reason, prevention, reduction and control of injuries are important goals for clinicians and researchers, as well as for society as a whole.

In the early 1990s, van Mechelen et al2 proposed a model of prevention research and implementation. This model emphasised that a crucial part of injury prevention requires understanding of injury risks and injury aetiology. Shortly after, the injury causation model proposed by Meeuwisse3 described the interplay between different factors along the path to injury. Over the past decade, both models have been widely adopted and appropriately adapted in sports-injury prevention research. These models have contributed to a wide array of proven preventive measures for a variety of sports-related injuries. In addition, adaptations of the conceptual models have been put forward and new conceptual insights have been formulated and described. Examples of such insights refer to the implementation phase of interventions and to the fact that sports-injury prevention requires above all behavioural change.

However, neither knowledge nor scientific proof of efficacious interventions guarantees immediate behaviour change. Smoking was proven lethal long before people started giving up the habit. Therefore, debate has recently arisen about the true effectiveness of “successful” injury prevention research. Finch4 has emphasised that only those research outcomes adopted by sports and physically active persons, coaches and sporting bodies will actually prevent injuries. For this reason she introduced the Translating Research into Injury Prevention Practice approach,4 which aims to better understand the implementation context for injury prevention. The rationale for the Translating Research into Injury Prevention Practice approach is that in current sports-injury prevention research, there is an overly strong focus on the efficacy and effectiveness of preventive measures and that we tend to forget the process that is needed to translate proven effective measures to real-life situations.

Although recent ideas in sports medicine acknowledge the important role of behaviour in the prevention of injuries, these ideas remain unclear as to the role of behaviour in sports-injury prevention. For this reason, a better understanding of the determinants of preventive behaviour and behavioural change and the relationship with injury risk is needed to successfully translate current and future knowledge in sports medicine to reallife injury prevention for all. Perhaps we should therefore learn from health promotion randomised controlled trials (RCTs) conducted to change human behaviour related to detrimental lifestyles, such as physical inactivity.

In the past decade, health promotion researchers, also in our group, have successfully applied the intervention mapping (IM) protocol when designing behavioural change interventions aimed at increasing levels of physical activity in the population.5 Basically, the IM protocol consists of five steps: (1) the definition of programme objectives, based on a thorough analyses of the health problem; (2) the selection of adequate theories and methods to realise behavioural change; (3) the design of the intervention programme, as well as the selection, pretesting and production of the intervention materials; (4) the development of a plan for the implementation; and (5) evaluation. An important feature of the IM protocol is a continuous and consistent dialogue with all stakeholders involved to make sure that the proposed intervention is acceptable and feasible from a practical, implementation standpoint. It guarantees that intervention materials and activities are tailored to relevant characteristics of the target population, as well as to the abilities and opportunities of the programme implementers and intermediaries. We have tried to learn from the IM protocol and our experiences in physical (in)activity RCTs in designing two of our recent pragmatic sports-injury prevention interventions. One RCT concerned the primary prevention of sports injuries in school children aged 10–12 years.6 The other RCT concerned the secondary prevention of recurrent lateral ankle ligament sprain in adult sports persons.7 Both trials proved effective.

Of course evidence of effectiveness does not equal successful implementation, but it does prove that we are able to prevent injuries in less controlled, pragmatic real-life situations. Although small, this is an important step forward towards injury prevention for all.


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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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