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Do exercise-based prevention programmes reduce non-contact musculoskeletal injuries in football (soccer)? A systematic review and meta-analysis with 13 355 athletes and more than 1 million exposure hours
  1. Italo Ribeiro Lemes1,
  2. Rafael Zambelli Pinto1,2,
  3. Vitor N Lage2,
  4. Bárbara A B Roch2,
  5. Evert Verhagen3,
  6. Caroline Bolling3,
  7. Cecilia Ferreira Aquino4,5,
  8. Sérgio T Fonseca1,2,
  9. Thales R Souza1,2
  1. 1Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
  2. 2Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
  3. 3Amsterdam Collaboration on Health and Safety in Sports & Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Department of Physical Therapy, Universidade José do Rosário Vellano, Divinópolis, MG, Brazil
  5. 5Department of Physical Therapy, Universidade do Estado de Minas Gerais (UEMG), Divinópolis, MG, Brazil
  1. Correspondence to Thales R Souza, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 31270-901, MG, Brazil; thalesrs{at}


Objective The aim of this systematic review was to investigate the effect of exercise-based programmes in the prevention of non-contact musculoskeletal injuries among football players in comparison to a control group.

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources MEDLINE, EMBASE, CENTRAL, CINAHL, PEDro and SPORTDiscus databases were searched from the earliest record to January 2021.

Eligibility criteria Studies were eligible if they (1) included football players aged 13 years or older, (2) used exercise-based programmes as intervention, (3) presented the number of non-contact musculoskeletal injuries (ie, defined as any acute sudden onset musculoskeletal injury that occurred without physical contact) and exposure hours for each group, and (4) had a control group (eg, usual training, minimal intervention, education). All types of exercise-based prevention programmes were eligible for inclusion. Risk of bias for each included study and overall quality of evidence for the meta-analysis were assessed.

Results Ten original randomised controlled trials with 13 355 football players and 1 062 711 hours of exposure were selected. Pooled injury risk ratio showed very low-quality evidence that exercise-based prevention programmes reduced the risk of non-contact musculoskeletal injuries by 23% (0.77 (95% CI 0.61 to 0.97)) compared with a control group.

Conclusion Exercise-based prevention programmes may reduce the risk of non-contact musculoskeletal injuries by 23% among football players. Future high-quality trials are still needed to clarify the role of exercise-based programmes in preventing non-contact musculoskeletal injuries among football players.

PROSPERO registration number CRD42020173017.

  • soccer
  • exercise
  • sporting injuries
  • football
  • injury prevention

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  • Twitter @itolemes, @Rafael_Z_Pinto, @Evertverhagen, @cs_bolling

  • Contributors IRL, RZP, VNL, BABR and TRS conceived and designed the study. IRL and VNL conducted the search. IRL, VNL and BABR performed the screening, study selection and data extraction. IRL, RZP, STF and TRS analysed and interpreted the data. IRL, RZP and TRS drafted the manuscript with input from STF, EV, CB and CFA. All authors have read and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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