BACKGROUND: Physical activity is important in both prevention and treatment of many common diseases, but sports injuries can pose serious problems. OBJECTIVE: To determine whether physical activity exercises can reduce sports injuries and perform stratified analyses of strength training, stretching, proprioception and combinations of these, and provide separate acute and overuse injury estimates. MATERIAL AND METHODS: PubMed, Embase, Web of Science and SPORTDiscus were searched and yielded 3,462 results. Two independent authors selected relevant randomised, controlled trials and quality assessments were conducted by all authors of this paper using the Cochrane collaboration domain-based quality assessment tool. Twelve studies that neglected to account for clustering effects were adjusted. Quantitative analyses were performed in STATA V.12 and sensitivity analysed by intention-to-treat. Heterogeneity (I2) and publication bias (Harbord's small-study effects) were formally tested. RESULTS: 25 trials, including 26,610 participants with 3,464 injuries, were analysed. The overall effect estimate on injury prevention was heterogeneous. Stratified exposure analyses proved no beneficial effect for stretching (RR 0.963 (0.846 to 1.095)), whereas studies with multiple exposures (RR 0.655 (0.520 to 0.826)), proprioception training (RR 0.550 (0.347 to 0.869)), and strength training (RR 0.315 (0.207 to 0.480)) showed a tendency towards increasing effect. Both acute injuries (RR 0.647 (0.502 to 0.836)) and overuse injuries (RR 0.527 (0.373 to 0.746)) could be reduced by physical activity programmes. Intention-to-treat sensitivity analyses consistently revealed even more robust effect estimates. CONCLUSIONS: Despite a few outlying studies, consistently favourable estimates were obtained for all injury prevention measures except for stretching. Strength training reduced sports injuries to less than 1/3 and overuse injuries could be almost halved.
Reproduced with permission from the BMJ Publishing Group.

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