R
äisänen
e
al.,
C
ogen
Medicine
(2016),
3:
1260786
h p://dx.doi.o g/10.1080/2331205X.2016.1260786
Page
1
o
11
Recei ed: 18 Augus 2016
Accep ed: 09 No embe 2016
Fi s Published: 17 No embe 2016
*Co esponding au ho : Anu M.
Räisänen, Tampe e Resea ch Cen e
o Spo s Medicine, UKK Ins i u e o
H eal h P o mo i on R esea c h, P.O. Box 3 0 ,
33501 Tampe e, Finland
E-
mail: [email p o ec ed]i
Re iewing edi o :
Albe Lee, The Chinese Uni e si y o
Hong Kong, Hong Kong
Addi ional in o ma ion is a ailable a
he end o he a icle
SPORTS & EXERCISE | RESEARCH ARTICLE
Adolescen physical ac i i y- ela ed inju ies in
spo s club, school spo s and o he leisu e ime
physical ac i i ies
Anu M. Räisänen1*, Ja i Pa kka i1, Lo a Ka hola2and A ja Rimpelä3,4
Abs ac :Backg ound: The objec i e was o s udy physical ac i i y (PA)- ela ed
inju ies in spo s club, school spo s, and o he leisu e ime PA, and he associa-
ions be ween inju ies and PA pa icipa ion equency and in ensi y.
Me hods
: A
na ionally ep esen a i e sample was ob ained and a s uc u ed ques ionnai e
was sen . A o al o 9,462 Finns (12–18 yea s) comple ed he su ey. P e alence o
PA- ela ed inju ies was ga he ed by sepa a e ques ions abou spo s club inju ies,
school spo s inju ies and o he leisu e ime PA inju ies.
Resul s
: Inju y p e alence
was highe in spo s club ac i i ies han in o he leisu e ime PA o school spo s o
boys (
p
< 0.001) and gi ls (
p
< 0.001). The p e alence o o he leisu e ime inju ies
was highe han he p e alence o inju ies in school spo s o boys (
p
< 0.001) and
gi ls (
p
< 0.001). Inju ies we e associa ed wi h highe equency (OR 10.4, 95% CI
6.7–16.3) and in ensi y (OR 4.1, 95% CI 2.9–5.8) o PA.
Conclusions
: Ou o he h ee
se ings, inju y p e alence was highes in spo s club ac i i ies. Highe PA pa icipa-
ion equency and in ensi y inc eased he isk o inju y. The e seems o be a need
o u he p e en a i e measu es o educe he isks o PA- ela ed inju ies, espe-
cially in he spo s club se ing.
Subjec s: Physical Educa ion; You h Spo ; Heal h P omo ion; Spo s Inju y; Quan i a i e
Me hods in Spo ; Child en and You h
Keywo ds: adolescen ; a hle ic inju ies; exe cise; inju ies; physical ac i i y
© 2016 The Au ho (s). This open access a icle is dis ibu ed unde a C ea i e Commons A ibu ion
(CC-BY) 4.0 license.
ABOUT
THE
AUTHORS
This s udy is pa o he Adolescen Heal h and
Li es yle Su ey (AHLS). The AHLS is a na ionwide
su ey sys em moni o ing he heal h and heal h-
ela ed li es yle o young people in Finland. The
su ey has been conduc ed e e y second yea
since 1977. P o esso A ja Rimpelä has been he
p incipal in es iga o o AHLS nea ly 30 yea s.
Physical ac i i y has been pa o he subjec s
since e y beginning while inju ies ela ed o
physical ac i i y is a new subjec , led by adjunc
p o esso Ja i Pa kka i. The p incipal au ho Anu
Räisänen p epa es he doc o al hesis on physical
ac i i y ela ed inju ies and hei p e en ion
among adolescen s.
PUBLIC
INTEREST
ST
ATEMENT
Pa icipa ion in physical ac i i y (PA) p o ides
posi i e e ec s on heal h and wellbeing. The
downside o PA is he isk o inju y. Adolescen s a e
ac i e in di e en se ing: in spo s clubs, schools,
and in uno ganised ac i i ies du ing leisu e ime. In
spo s clubs he p opo ion o adolescen s who ge
inju ed is highe han in o he se ings. Bu on he
o he hand, o he leisu e ime PA is mo e widely
p ac iced. This leads o a high numbe o inju ies
e en hough he p opo ion o inju ed adolescen s
is lowe han in spo s clubs.
Highe equency and highe in ensi y o PA is
associa ed wi h a highe isk o inju ies. The e is
an u gen need o in oduce p o en inju y
p e en ion measu es, such as neu omuscula
aining, sa e equipmen and en i onmen in
di e
en
PA
se ings.
R
äisänen
e
al.,
C
ogen
Medicine
(2016),
3:
1260786
h p://dx.doi.o g/10.1080/2331205X.2016.1260786
Page
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1.
In oduc ion
Physical ac i i y (PA) in adolescence is associa ed wi h a ious posi i e ou comes on heal h, wellbe-
ing, and socio-economic ac o s. Adolescen PA p o ides heal h bene i s such as imp o ed bone
heal h (Hallal, Vic o a, Aze edo, & Wells, 2006), lowe blood p essu e (Janssen & LeBlanc, 2010),
posi i e changes on he ma ke s o me abolic synd ome (Janssen & LeBlanc, 2010), and lowe odds
o o e weigh and obesi y (Janssen, Ka zma zyk, Boyce, King, & Picke , 2004). Adolescen PA also
p omo es sel -es eem (Biddle & Asa e, 2011; Hallal e al., 2006) and men al heal h (Biddle & Asa e,
2011). In addi ion o he posi i e heal h e ec s, PA pa icipa ion in adolescence p edic s highe edu-
ca ional le el, highe socio-economic s a us and highe ea nings in adul hood (Ka i e al., 2016;
Koi usil a, Nupponen, & Rimpelä, 2011). O he impo an bene i s o PA pa icipa ion a e elaxa ion
( an Mechelen e al., 1996), un, enjoymen , social suppo , social in e ac ion (Allende , Cowbu n, &
Fos e , 2006) i p o ides.
E en hough spo s and ec ea ional ac i i ies a e gene ally sa e and p omo e good heal h, i has
been ecognized ha PA- ela ed inju ies ha e a signi ican impac on public heal h (Finch, Wong
Shee, & Clappe on, 2014; Schwebel & B ezausek, 2014). The incidence o PA- ela ed inju ies is high-
e among adolescen s han adul s (Schmikli, Backx, Kemle , & an Mechelen, 2009), and in he pas
decades, inju y occu ence among young people has inc eased (Tii ikainen, Lounamaa, Paa ola,
Kumpula, & Pa kka i, 2008). Pa icipa ion in spo s and ec ea ional ac i i ies has been iden i ied as
a majo cause o adolescen inju ies (Picke e al., 2005). In Finland, adolescen spo s club pa ici-
pa ion is he s onges isk ac o o inju y hospi aliza ion h oughou adolescence and ea ly adul -
hood (Ma ila, Pa kka i, Koi usil a, Kannus, & Rimpelä, 2009). PA- ela ed inju ies also ha e long e m
consequences since hey can lead o sub-op imal heal h in la e li e (D awe & Fulle , 2001; Kujala,
Kap io, & Sa no, 1994).
Inju ies ha e been epo ed o be he leading cause why people s op pa icipa ing in PA (Na ional
Cen e o Disease Con ol & P e en ion, 2002). I has been es ima ed ha annually 8% o adoles-
cen s d op ou o ec ea ional spo ing ac i i ies because o inju ies o he ea o ge ing inju ed
(G imme , Jones, & Williams, 2000). Reducing he isk o inju y inc eases he likelihood o he con in-
ued heal h bene i (MacKay e al., 2004).
The i s s ep in he sequence o p e en ion o PA- ela ed inju ies is es ablishing he ex en o he
inju y p oblem ( an Mechelen, Hlobil, & Kempe , 1992). S udies on adolescen PA- ela ed inju ies
o en ocus on he indi iduals who pa icipa e in spo s in he eli e le el, while ela i ely li le is
known abou he inju ies ha occu in o he PA se ings. Some p io s udies ha e in es iga ed PA-
ela ed inju ies in di e en se ings among 6–12-yea -old child en (Bloeme s e al., 2012; Jespe sen
e al.,2015; Ve hagen, Colla d, Paw, & an Mechelen, 2009), bu we a e no awa e o p e ious s udies
on spo s club, school spo s and leisu e ime PA- ela ed inju ies on adolescen popula ions.
In spo s club he ac i i ies a e usually s uc u ed and o en he ocus is on imp o ing he pe o -
mance in a single spo . In his s udy school spo s co e bo h he manda o y and sel -selec ed
physical educa ion classes ( hese a e manda o y in Finland) and possible s uden spo ac i i ies
o ganised by he school, o example ball games o ganised du ing he ecess o a e school. O he
leisu e ime PA consis s o uno ganised physical ac i i ies, which in Finland can a y by he season,
since win e o e s e y di e en oppo uni ies o PA summe .
The main objec i e o his s udy was o compa e he inju y a es o 12–18-yea -olds in h ee se -
ings: spo s club, school spo s and leisu e ime physical ac i i ies. The second aim was o s udy he
associa ion be ween age and inju y p e alence in di e en se ings. Thi dly his s udy se ou o in-
es iga e he associa ion be ween PA- ela ed inju ies and PA-pa icipa ion equency and exe cise
in ensi y. Based on p e ious s udies on younge popula ions, we hypo hesized ha he e would be
mo e inju ies in spo s clubs han in o he PA se ings.
R
äisänen
e
al.,
C
ogen
Medicine
(2016),
3:
1260786
h p://dx.doi.o g/10.1080/2331205X.2016.1260786
Page
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2. Ma e ials and me hods
2.1. Da a collec ion
This s udy is pa o he Adolescen Heal h and Li es yle Su ey (AHLS). The AHLS is a na ionwide
su ey sys em moni o ing he heal h and heal h- ela ed li es yle o young people in Finland. The
su ey has been conduc ed e e y second yea since 1977. The su ey co e s se e al opics ela ed
o adolescen heal h. Some o he opics al e na e and he ques ions abou PA- ela ed inju ies we e
included in he su ey in 2009 and 2013. This s udy epo s he combined da a om hose wo yea s.
In each s udy yea , a na ionally ep esen a i e sample o 12, 14, 16, and 18-yea -old Finns bo n
on ce ain days in June, July, and Augus was ob ained om he Popula ion Regis e Cen e. The
da es o bi h used in he sampling we e selec ed o ensu e he sample included di e en subjec s
o each s udy yea . A 12 page s uc u ed ques ionnai e was mailed in Feb ua y o bo h s udy yea s.
Enclosed wi h he ques ionnai e he subjec s ecei ed pe sonal use names and passwo ds, and in-
o ma ion abou he op ion o comple ing he ques ionnai e online. Up o h ee ollow-up enqui ies
we e sen o non- esponden s. The ques ionnai e was sen o a o al o 19,318 subjec s: 9,920 sub-
jec s in 2009 and 9,398 subjec s in 2013.
2.2. S udy pa icipan s
In 2009 he numbe o esponden s was 5,516, ou o which 2,288 we e boys and 3,228 we e gi ls. In
2013, 4,158 esponded (1,687 boys and 2,471 gi ls). Fo he combined da a o 2009 and 2013, he e-
sponse a e was 50%. A o al o 212 subjec s we e excluded om he analysis due o inconsis encies
be ween hei inju y in o ma ion and hei PA pa icipa ion in o ma ion o in o ma ion abou hei s u-
den s a us. In hese cases he subjec epo ed no PA pa icipa ion o being a s uden bu epo ed an
inju y in ha se ing, o ice e sa. Ou o he 9,462 subjec s included in he s udy, 59% we e gi ls and
41% we e boys. The dis ibu ions o age g oups o boys and gi ls a e p esen ed in Table 1. Pa icipa ion
a es in spo s club ac i i ies, school spo s, and o he leisu e ime PA a e p esen ed in Table 2.
2.3.
Measu emen s
2.3.1.
PA- ela ed inju ies
The inju y p e alence e e s o he p opo ion o subjec s who had been inju ed in physical ac i i ies
du ing he pas wel e mon hs. The inju y p e alence’s in h ee se ings we e based on h ee ques-
ions: “Du ing he pas yea , ha e you su e ed an inju y while pa icipa ing in spo s club ac i i ies?”,
“Du ing he pas yea ha e you su e ed an inju y while pa icipa ing in a physical educa ion class o
ins uc ed s uden spo ?”, and “Du ing he pas yea ha e you su e ed an inju y while pa icipa ing
in o he leisu e ime physical ac i i ies (no in a spo s club)?” In 2009, h ee op ions we e p o ided:
“No”, “Once”, and “Twice o mo e”. In 2013, he e we e ou op ions: “No”, “Once”, “Twice”, and
“Th ee imes o mo e”. Due o he di e en answe op ions in 2009 and 2013, he inju y da a we e
combined o c ea e a dicho omous a iable consis ing o classes “No inju ed” and “Inju ed a leas
once”. In o ma ion abou s uden s a us was inqui ed wi h he ques ion “A he momen , a e you a
s uden ?” Th ee op ions we e p o ided: “No, I’m no a s uden ”, “Yes, I am a ull ime s uden ”, and
“Yes, I’m a s uden alongside going o wo k”. In he Finnish educa ion sys em, physical educa ion is
manda o y in comp ehensi e schools, gene al uppe seconda y schools, and oca ional schools.
Table 1. P opo ions o subjec s in age g oups by gende
Age (yea s)
Boy s (
n
= 3,881) Gi ls (
n
= 5,581)
%
95% CI
%
95% CI
12 16.5 15.3–17.7 12.4 9.9–14.9
14 30.7 29.2–32.2 29.8 28.6–31.0
16 30.2 28.8–31.6 29.2 28.0–30.4
18 22.6 21.3–23.9 28.6 27.4–29.8
No e: CI = con idence in e al.
Page
4
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R
äisänen
e
al.,
C
ogen
Medicine
(2016),
3:
1260786
h p://dx.doi.o g/10.1080/2331205X.2016.1260786
Table 2. P opo ions o subjec s pa icipa ing in spo s club ac i i ies, school spo s and o he
leisu e ime physical ac i i ies by gende
Physical ac i i y se ing
Boy s (
n
= 3,881) Gi ls (
n
= 5,581)
%
95% CI
%
95% CI
Spo s club ac i i ies 52.5 50.8–54.2 47.7 46.3–49.1
School spo s 97.2 96.7–97.7 97.4 97.0–97.8
Leisu e ime PA
95.6 94.9–96.3 97.1 96.6–97.6
No e: CI = con idence in e al.
Based on his, i was assumed ha all he subjec s, who epo ed being s uden s, pa icipa e in
school spo s (physical educa ion classes and s uden spo s).
The inju y p e alence in spo s club ac i i ies was calcula ed as a pe cen age o subjec s epo ing
a leas one spo s club inju y ou o subjec s epo ing pa icipa ion in spo s club ac i i ies. The in-
ju y p e alence in school spo s ac i i ies was calcula ed as a pe cen age o subjec s epo ing a
leas one school spo s inju y ou o subjec s epo ing being s uden s. The inju y p e alence in o he
leisu e ime PA was calcula ed as a pe cen age o subjec s epo ing a leas one leisu e ime PA
inju y ou o subjec s epo ing pa icipa ion in o he leisu e ime PA.
2.3.2.
PA pa icipa ion and exe cise in ensi y
PA pa icipa ion le els we e de i ed om wo ques ions: “How o en do you pa icipa e in spo s in
you leisu e ime h ough spo s club aining, compe i ions o games?” and “How o en do you pa -
icipa e in PA in o he ways in you leisu e ime?” Se en al e na i es we e p o ided: “no a all”, “less
o en han once a mon h”, “1–2 imes a mon h”, “app oxima ely once a week”, “2–3 imes a week”,
“4–5 imes a week”, and “app oxima ely e e y day”. Exe cise in ensi y was de e mined om he
ques ion “When I do spo s o PA, usually I expe ience: no swea ing o ge ing ou o b ea h/some
swea ing o ge ing ou o b ea h/mode a e swea ing o ge ing ou o b ea h/ex ensi e swea ing o
ge ing ou o b ea h/I do no exe cise in my leisu e ime”.
To de e mine whe he exe cise in ensi y was ela ed o inju ies, he inju ies in spo s club, school
spo s, and o he leisu e ime PA we e combined in o a new dicho omous a iable: “Su e ed a leas
one PA- ela ed inju y”. The inju y p e alence was calcula ed as he p opo ion o subjec s epo ing
a leas one inju y ou o all he subjec s.
2.4.
E hics
The s udy ollows he e hical p inciples o he Decla a ion o Helsinki. Subjec s we e in o med o he
aims, me hods, olun a y pa icipa ion, p i acy and con iden iali y o he collec ed in o ma ion. The
s udy p o ocol has been app o ed by he E hics Commi ee o Tampe e Region ( e e ence Lausun o
2/2010) and he E hics Commi ee o he Pi kanmaa Hospi al Dis ic ( e e ence ETLR06226). W i en
in o med consen was no equi ed.
2.5. S a is ical me hods
S a is ical analyses we e pe o med using he SPSS so wa e (IBM SPSS S a is ics Ve sion 23 o
Windows). Since some subjec s had been inju ed in mo e han one PA se ing, he g oups we e no
conside ed o be independen when compa ing he inju y p e alence be ween he spo s club ac i i-
ies, school spo ac i i ies, and o he leisu e ime PA. The e o e McNema ’s es o wo ela ed
samples was used o es he di e ences in inju y p e alence be ween PA se ings. Pea son’s χ2 es
was used o es di e ences in he inju y p e alence be ween age g oups. Odds a ios (ORs) we e
used o es o di e ences in he inju y p e alence by spo club pa icipa ion equency, o he lei-
su e ime PA pa icipa ion equency and exe cise in ensi y. ORs we e ob ained om mul i a ia e
logis ic eg ession analysis. Age and gende whe e en e ed in o each mul i a ia e model o adjus
o hei po en ial con ounding e ec . A p- alue o <0.05 was conside ed s a is ically signi ican .
Page
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R
äisänen
e
al.,
C
ogen
Medicine
(2016),
3:
1260786
h p://dx.doi.o g/10.1080/2331205X.2016.1260786
3.
Resul s
3.1.
Inju y p e alence in di e en se ings
Ou o he subjec s who epo ed pa icipa ing in PA in any o he h ee se ings, 32.0% (95% CI,
31.0–33.0) had su e ed a leas one PA- ela ed inju y in he pas 12 mon hs. The inju y p e alence
in spo s club ac i i ies was 27.5% (95% CI, 25.4–29.6) o boys and 23.8% (95% CI, 22.0–25.6) o
gi ls. In school spo s ac i i ies, he inju y p e alence was 9.8% (95% CI, 8.8–10.8) o boys and
10.0% (95% CI, 9.2–10.8) o gi ls. In o he leisu e ime PA, he inju y p e alence was 17.6% (95% CI,
16.3–18.9) o boys and 13.3% (95% CI, 12.3–14.3) o gi ls.
Acco ding o he McNema ’s es o wo ela ed samples, he inju y p e alence in spo s club ac-
i i ies was signi ican ly highe han he inju y p e alence in school spo s and in o he leisu e ime
PA o boys (
p
< 0.001) and gi ls (
p
< 0.001). The p e alence o o he leisu e ime PA inju ies was
highe han he p e alence o school spo inju ies o boys (
p
< 0.001) and gi ls (
p
< 0.001).
Pea son’s χ2 es was used o es o di e ences be ween age g oups. The inju y p e alence in
spo s club, school spo s and o he leisu e ime PA by age g oups a e shown in Figu e 1. The inju y
p e alence a ied signi ican ly be ween he age g oups in spo s club inju ies o boys (p< 0.05) and
gi ls (p< 0.05). The spo s club inju y p e alence was highes in he 16 and 18-yea -olds among boys
Figu e 1. Inju y p e alence (%)
in spo s club ac i i ies, school
spo s and o he leisu e ime
physical ac i i ies in he pas
12 mon hs by age g oup o
boys and gi ls p esen ed wi h
95% con idence in e al (CI).
No es: P opo ions we e
calcula ed om hose
epo ing pa icipa ion in spo s
club ac i i ies/being s uden s/
pa icipa ion in o he leisu e
ime PA. Pea son’s
χ
2
es was
used o es o di e ences
be ween age g oups.

Page
6
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R
äisänen
e
al.,
C
ogen
Medicine
(2016),
3:
1260786
h p://dx.doi.o g/10.1080/2331205X.2016.1260786
Table 3. Age and gende -adjus ed ORs and 95% CIs o spo s club inju ies by equency o
spo s club ac i i y
F equency o spo s club ac i i y
OR 95% CI
p- alue
Less han once a mon h 1
1–2 Times a mon h 1.8
1.0–3.1 0.041*
App oxima ely once/week
1.5
0.9–2.3
0.103
2–3 Times/week 3.1
2.0–4.6 <0.001*
4–5 Times/week 6.9 4.5–10.5
<0.001*
App oxima ely daily 10.4 6.7–16.3
<0.001*
No e: ORs we e de i ed om mul i a ia e logis ic eg ession analysis.
*S a is ical signi icance based on p< 0.05.
and in he 14-yea -olds among gi ls. In school spo s and o he leisu e ime PA, he inju y p e alence
was lowes in he olde age g oups among boys (
p
< 0.001) and gi ls (
p
< 0.001).
3.2. Associa ions be ween inju ies and PA pa icipa ion and in ensi y
Mul i a ia e logis ic eg ession analysis was used o es o he associa ions be ween inju ies and
PA pa icipa ion and in ensi y. Spo s club inju ies we e associa ed wi h he equency o spo s club
ac i i ies. The odds a io was highes o hose who pa icipa ed in spo s club ac i i ies app oxi-
ma ely e e y day (OR 10.4, 95% CI 6.7–16.3). Pa icipa ing in spo s club ac i i ies 2–3 imes pe
week o mo e o en signi ican ly inc eased he isk o spo s club inju y. The ORs o spo s club inju-
ies by pa icipa ion equency a e p esen ed in Table 3.
The isk o o he leisu e ime PA inju ies inc eased when pa icipa ion equency was once a week
o highe . The ORs o o he leisu e ime inju ies by pa icipa ion equency a e p esen ed in Table 4.
Table 4. Age and gende -adjus ed ORs and 95% CIs o o he leisu e ime inju ies by equency
o leisu e ime physical ac i i y (PA)
F equency o o he leisu e ime PA OR 95% CI
p- alue
Less han once a mon h 1
1–2 Times a mon h 1.3
0.8–2.2
0.232
App oxima ely once/week
1.7
1.1–2.6 0.013*
2–3 Times/week 2.1
1.4–3.1 0.001*
4–5 Times/week 2.6
1.7–3.9 <0.001*
App oxima ely daily 3.1
2.0–4.7 <0.001*
No e: ORs we e de i ed om mul i a ia e logis ic eg ession analysis.
*S a is ical signi icance based on p< 0.05.
Table 5. Age and gende -adjus ed ORs and 95% CIs o all physical ac i i y- ela ed inju ies by
in ensi y o physical ac i i y
In ensi y (swea ing/ge ing ou o b ea h) OR 95% CI
p- alue
None
1
Some 1.6
1.1–2.3 0.009*
Mode a e
2.2
1.6–3.2 <0.001*
Ex ensi e 4.1
2.9–5.8 <0.001*
No e: ORs we e de i ed om mul i a ia e logis ic eg ession analysis.
*S a is ical signi icance based on p< 0.05.
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ogen
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Exe cise in ensi y was associa ed wi h he isk o PA- ela ed inju y. Those epo ing mode a e o
ex ensi e swea ing/ge ing ou o b ea h when exe cising had 4.1 imes highe isk o inju y com-
pa ed o hose, who didn’ swea /ge ou o b ea h when exe cising. The ORs o all PA- ela ed inju-
ies by in ensi y le el a e p esen ed in Table 5.
4.
Discussion
To ou knowledge, his is he i s s udy o compa e he inju y p e alence in spo s club ac i i ies,
schools spo s and o he leisu e ime PA among adolescen s. The indings o his s udy demons a e
ha he inju y p e alence was signi ican ly highe in spo s club ac i i ies han in school spo s ac-
i i ies and o he leisu e ime PA. In addi ion, he p e alence o o he leisu e ime PA inju ies was
highe han he p e alence o school spo inju ies. One possible explana ion o hese di e ences
could be he in ensi y o PA, since ou esul s also show ha exe cise in ensi y was associa ed wi h
he isk o inju y. The spo s club PA is s uc u ed and he goal is o imp o e spo s pe o mance,
he e o e i is possibly mo e in ense han o he leisu e ime PA. In school spo s he goal is mainly
educa ional and he in ensi y is likely o be lowe han in he o he PA se ings.
P e ious s udies on inju ies in spo s clubs, school spo s and o he leisu e ime inju ies ha e been
done on school child en, aged 12 yea s and unde . Jespe sen e al. (2015) s udied musculoskele al
inju ies among 6–12-yea -old Danish school child en. They epo ed he highes a e o auma ic
inju ies in spo s (1.57 inju ies/1,000 PA uni s), ollowed by leisu e ime PA (0.57 inju ies/1,000 PA
uni s) and PE lessons (0.14 inju ies/1,000 PA uni s). In he iPlay s udy Ve hagen e al. (2009) s udied
inju ies among 10–12 yea s old Du ch child en. The inju y incidence densi y was highes in spo s
(0.66), ollowed by PE (0.50) and leisu e ime PA (0.39). The di e ences be ween se ings we e no
signi ican . Besides hese s udies ocusing on child en, di ec compa isons a e di icul o make due
o di e ences in inju y de ini ions and da a collec ion me hods. The common end in he esul s o
his s udy and he wo k o Jespe sen e al. (2015) and Ve hagen e al. (2009) is ha in all he h ee
s udies, he p e alence o inju ies is highes among spo s club ac i i ies. The e o e i can be sug-
ges ed ha p e en a i e measu es should be in oduces mo e ex ensi ely o spo s club ac i i ies,
especially o he spo s popula among adolescen s.
Among boys he p e alence o spo s club inju ies inc eased wi h age. I has been p e iously e-
po ed ha in adolescen spo s he in ensi y and aining load inc ease p og essi ely wi h age
(Malisoux, F isch, U hausen, Seil, & Theisen, 2013b). In ensi y being associa ed wi h he isk o inju y,
he inc ease in in ensi y could explain he inc ease in boys’ inju y p e alence. P e ious s udies sug-
ges ha he ela ion be ween inju ies and age is spo -speci ic. In a socce inju y s udy he 16- and
18-yea -old boys had lowe inju y incidence han he 14-yea -olds (Eme y, Meeuwisse, & Ha mann,
2005). In a hockey inju y s udy he inju y incidence inc eased signi ican ly wi h age (Eme y &
Meeuwisse, 2006). In he cu en s udy he p e alence o spo s club inju ies among gi ls was high-
es in he 14-yea -olds. This is in line wi h he esul s o Eme y e al. ( 2005) epo ing a highe inci-
dence o socce inju ies among he 14-yea -olds han he 16 and 18-yea -olds. Spo is one possible
ac o con ibu ing o he di e ences in inju y p e alence be ween age g oups in his s udy.
In his s udy, isk o PA- ela ed inju ies inc eased when he equency o PA inc eased. The inc ease o
isk was highes in spo s club inju ies, whe e hose pa icipa ing app oxima ely daily had 10.4 imes
highe isk o inju y han hose pa icipa ing less han once a mon h. This high inc ease in he isk is
somewha su p ising, since he e is e idence ha aining has a p o ec i e e ec agains inju y
(Gabbe , 2016). In spo s, bo h o e aining and unde - aining could be linked wi h a high incidence o
inju ies (Gabbe , 2016). Unde - aining is possibly associa ed wi h inju ies in o he PA se ings also. In
he iPlay-s udy, Bloeme s e al. ( 2012) s udied inju ies in leisu e ime PA, spo s and physical educa ion
classes in 10–12-yea -old child en. They demons a ed ha he leas ac i e child en had he highes
isk o inju y and iden i i he cu -o le el o be 5 h o PA pe week. The esul s o he cu en s udy do
no suppo he heo y ha low le els o pa icipa ion o unde - aining inc ease he isk o inju y. I is
impo an o bea in mind ha in his s udy he equency o spo s club ac i i ies and o he leisu e ime
PA we e analysed sepa a ely and his could yield di e en esul s han using weekly o al exposu e.
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ogen
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In his s udy in ensi y was de ined as he le el o swea ing/ge ing ou o b ea h du ing exe cise.
Swea ing and ge ing ou o b ea h a e ecommended o adolescen s since hey need bo h mode -
a e and igo ous exe cise (Wo ld Heal h O ganiza ion, 2010). Pa icipa ing in in ense exe cise should
no be limi ed by he ea o inju y. One possible app oach o lowe ing he isk o inju y in in ense
exe cise is de eloping be e mo emen skills. Neu omuscula aining p og ams aimed o imp o e
mo emen skills ha e p oduced lowe inju y a es in high in ensi y spo s among adolescen popula-
ions (Hägglund, A oshi, Wagne , & Waldén, 2013; Rössle e al., 2014; Soliga d e al., 2008;
Wedde kopp, Kal o , Lundgaa d, Rosendahl, & F obe g, 1999). School-based inju y p e en ion p o-
g am consis ing o neu omuscula aining has also been used success ully o educe he inju y isk
and a he same ime o imp o e heal h ac o s like adiposi y and i ness (Richmond, Kang,
Doyle-Bake , Ne el-Agui e, & Eme y, 2016). In o ganized se ings, such as spo s clubs, ano he
me hod o lowe he inju y incidence is implemen ing an inju y su eillance sys em. Implemen ing
a su eillance sys em can imp o e awa eness o he p oblem and u he mo i a e coaching s a o
implemen p e en a i e measu es (Malisoux, F isch, U hausen, Seil, & Theisen, 2013a).
In he Finnish educa ion sys em, physical educa ion classes a e manda o y in comp ehensi e
schools, gene al uppe seconda y schools, and oca ional schools. In his s udy, he inju y p e a-
lence was lowe in school spo s ac i i ies han in o he PA se ings. Howe e , i could be a gued ha
when pa icipa ion is manda o y and he goal is educa ional, he isk o inju y should be as low as
possible. This esul could indica e ha u he p e en a i e measu es should be implemen ed o
lowe he inju y isk in school spo s ac i i ies.
The coaches in he spo club ac i i ies and he eache s in school spo s possess an impo an ole
in inju y p e en ion. The coaches, suppo s a and eache s mus en o ce ules and he use o sa e y
equipmen , such as helme s and p o ec i e eye wea when applicable. They mus also assess he
en i onmen al ac o s, like wea he condi ions, and e alua e o he condi ions in which equipmen
a e used, such as he appa a us in gymnas ics. In addi ion o hese ac o s load needs o be consid-
e ed. In spo s club coaches should moni o he load indi idually and make adjus men s o aining
and compe i ion loads i necessa y (Soliga d e al., 2016). In school spo s he eache s should con-
side ha he s uden s mos ac i e in physical educa ion lessons a e usually ac i e also in spo s
clubs, o he leisu e ime PA (T i ono Rexen e al., 2014). Child en wi h low habi ual le els o PA a e a
an inc eased isk o inju y (Nau a, Ma in-Diene , Ma in, an Mechelen, & Ve hagen, 2015). Manda o y
physical educa ion classes can be he only o m o PA o hese child en. The eache has a esponsi-
bili y o keep he lessons sa e o all child en and insu e ha he load is manageable o e e yone.
The la ge, andomly d awn sample can be conside ed a s eng h o his s udy. The esponse a e
o his s udy was 50%. I has been epo ed ha in su ey s udies he non- esponden s ha e poo e
heal h beha iou , heal h and socio-economic backg ound (Pie ilä, Ran akallio, & Lää ä, 1995). The
aim o his s udy was o compa e inju y a es in di e en PA se ings in gi ls and boys o di e en age
g oups. Physically ac i e adolescen s we e expec ed o espond a a highe a e, and hus, he o al
esponse a e was no conside ed o ha e a majo impac on he epo ed compa isons.
This s udy has some limi a ions. Re ospec i e, sel - epo ed inju y his o y has he po en ial o ecall
bias. Howe e , Gabbe, Finch, Bennell, and Wajswelne ( 2003) epo ed ha pa icipan s we e able o
co ec ly indica e whe he hey had been inju ed o uninju ed in he pas 12 mon hs. To minimize he
impac o ecall bias on he esul s, we only asked o he inju y s a us and did no eques mo e de ails,
such as he numbe o inju ies, he inju ed body egion, he inju y ype, he se e i y o he diagnosis.
In he su ey he wo d “inju y” was no de ined. I was up o he subjec how hey pe cei ed he
wo d. Since he pu pose o his s udy was o compa e he inju y a es in di e en se ings, we belie e
he lack o de ailed inju y de ini ion was no necessa y, since he subjec p obably de ined inju ies
simila ly in he di e en se ings. I is possible ha some mino inju ies and o e use inju ies ha e no
been epo ed, and hus, he epo ed inju y a es migh sligh ly unde es ima e he si ua ion. This is
a possible limi a ion o he s udy.
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ogen
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Since physical educa ion is manda o y, we in e p e ed ha all subjec s epo ing o be s uden s
pa icipa ed in schools spo s. Since he s uden s’ in gene al uppe seconda y schools and oca ional
schools ha e some eedom o choose when hey pa icipa e in physical educa ion classes, i is pos-
sible ha all he 18-yea -old s uden s had no pa icipa ed in PE du ing he pas 12 mon hs. Hence
he a e o school spo inju ies migh be sligh ly unde es ima ed. This can be seen as a limi a ion o
he s udy.
Acco ding o he “sequence o p e en ion” he nex should be es ablishing ae iology and mecha-
nisms o inju ies ( an Mechelen e al., 1992). The e o e in he u u e i would be bene icial o s udy in
which spo s and physical ac i i ies he inju ies occu . This would p o ide u he in o ma ion o
hose wo king on implemen ing inju y p e en ion me hods. To e alua e he e ec i eness o imple-
men a ion measu es and p og ammes, we ecommend egula moni o ing o inju y p e alence
among adolescen popula ion.
5.
Conclusions
This s udy sugges s ha he a e o PA- ela ed inju ies is highe in spo s club ac i i ies han in o he
se ings o PA among adolescen s. Since inju y in adolescence can ha e implica ions o u u e pa -
icipa ion in PA and also o u u e heal h, i is impo an o in oduce p e en a i e measu es mo e
ex ensi ely, mos u gen ly o he spo s club se ing. Some cau ion should be used when in e p e ing
hese esul s since his s udy is based on sel - epo ed inju ies.
This s udy also sugges s ha inju y a es a e associa ed wi h PA pa icipa ion equency and in-
ensi y. I is ecommended o heal h bene i s ha adolescen s pa icipa e in PA daily. Howe e ou
esul s indica e ha pa icipa ing in PA as li le as 2–3 imes a week inc eases he isk o PA- ela ed
inju y. Since PA pa icipa ion gene a es se e al bene i s o heal h and wellbeing, adolescen PA
pa icipa ion should no be limi ed due o ea o inju y. Ins ead, he esul s o his esea ch suppo
he idea ha u he p e en a i e measu es a e needed o lowe he isk o inju y in di e en se -
ings. To e alua e he e ec o p e en a i e measu es, i is impo an o moni o adolescen PA-
ela ed inju y p e alence and inju y se ings in egula basis. In he u u e, i is impo an o ollow
PA- ela ed inju ies egula ly so ha a po en ial inc ease in inju ies can be e ealed and p e en i e
measu es can be s a ed.
Acknowledgemen s
We hank M Lasse Pe e o he School o Heal h Sciences,
Uni e si y o Tampe e, o compiling he da a, and we a e
g a e ul o he s a is ical ad ice o M Ka i Tokola om he
UKK Ins i u e o Heal h P omo ion Resea ch.
Funding
This s udy was inancially suppo ed by he Finnish
Minis y o Social A ai s and Heal h (law on heal h
p omo ion app op ia ion); The Finnish Minis y o
Educa ion and Cul u e; The Compe i i e S a e Resea ch
Funding o he Expe Responsibili y A ea o Tampe e
Uni e si y Hospi al [g an numbe 9P041]; The Founda ion
o Spo s Ins i u e.
Compe ing In e es s
The au ho s decla e no compe ing in e es s.
Au ho de ails
Anu M. Räisänen1
E-mail:anu. aisanen@u a. i
Ja i Pa kka i
1
E-mail: ja i.pa kka i@u a. i
ORCID ID: h p://o cid.o g/0000-0001-5211-9845
Lo a Ka hola
2
E-mail: ka hola.lo a.m@s uden .u a. i
A ja Rimpelä
3,4
E-
mail: a ja. impela@u a. i
1
Tampe e Resea ch Cen e o Spo s Medicine, UKK Ins i u e
o Heal h P omo ion Resea ch, P.O. Box 30, 33501 Tampe e,
Finland.
2School o Medicine, Uni e si y o Tampe e, Tampe e, Finland.
3
School o Heal h Sciences and PERLA–Tampe e Cen e
o Childhood, You h and Family Resea ch, Uni e si y o
Tampe e, Tampe e, Finland.
4
Depa men o Adolescen Psychia y, Tampe e Uni e si y
Hospi al, Tampe e, Finland.
Ci a ion in o ma ion
Ci e his a icle as: Adolescen physical ac i i y- ela ed
inju ies in spo s club, school spo s and o he leisu e ime
physical ac i i ies, Anu M. Räisänen, Ja i Pa kka i, Lo a
Ka hola & A ja Rimpelä,Cogen Medicine(2016), 3: 1260786.
Au ho s’ con ibu ions
A ja Rimpelä and Ja i Pa kka i ini ia ed he s udy. Anu M.
Räisänen, Ja i Pa kka i, Lo a Ka hola, and A ja Rimpelä
con ibu ed o he s udy concep ion and design. Anu M.
Räisänen ca ied ou he li e a u e sea ch. A ja Rimpelä
conduc ed he da a collec ion and pe o med he
p elimina y da a p epa a ions. Anu M. Räisänen and Lo a
Ka hola conduc ed he da a analyses, and all he au ho s
con ibu ed o he in e p e a ion o da a. Anu M. Räisänen,