Background Little is known about the association between physical fitness and the risk of injury or illness in ice hockey.

Objective The aim of this study was to examine the association between pre-season fitness level and injury or illness risk among elite ice hockey players during the subsequent season.

Design Prospective cohort study.

Setting The GET League (the premier professional league in Norway).

Participants Male ice hockey players (n=133).

Interventions (or Assessment of Risk Factors) The players reported all health problems, acute injuries, overuse injuries and illnesses, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems weekly during the 2017/2018 competitive season (31 weeks), and completed eight different exercises (40 m sprint, countermovement jump, 3000 m run, squat, bench press, chins, brutal bench, and box jump) at the annual one-day, pre-season testing combine.

Main Outcome Measurements Number and severity of acute injuries, overuse injuries and illnesses.

Results The number of any health problem did not differ between fitness rank groups, except for all substantial health problems. There was no association between low physical fitness and the number of health problems, comparing the least fit tercile of the players to the rest of the cohort. The least fit players reported a greater cumulative burden of health problems, after adjusting for time on ice per game, position on ice and age.

Conclusions We found no association between low physical fitness and the number of health problems, comparing the least fit tercile of the players to the rest of the cohort. The least fit players reported a greater cumulative burden of health problems, after adjusting for time on ice per game, position on ice and age. Future research focusing on physical performance as risk factors for injury could consider including more specific performance tests on ice.