Effect of adherence to exercise-based injury prevention programmes on the risk of sports injuries : a systematic review and meta-analysis of randomised controlled trials

Viiala, Janne (author), Čech, Pavol (author), Bakalár, Peter (author), Paravlić, Armin (author), Ružbarský, Pavel (author), Sučka, Jaroslav (author), Toivo, Kerrtu (author), Parkkari, Jari (author), Leppänen, Mari (author)

Background Adherence may affect the effectiveness of injury prevention programmes (IPPs), yet no previous meta-analyses have examined the pooled impact of adherence to exercise-based IPPs across multiple injury types. The objective of the systematic review and meta-analysis was to investigate the effect of exercise-based IPP adherence on the risk of sports injuries. Methods Six databases (PubMed, EMBASE, SPORTDiscus, PEDro, Cochrane Central Register of Controlled Trials and Web of Science) were searched from inception to the end of May 2023. Randomised, quasi-randomised controlled trials and cluster-randomised controlled trials investigating exercise-based sports injury prevention interventions and providing data on adherence were included in the systematic review. Studies included in the meta-analysis were divided into top (≥84%), middle (74%–83%) and bottom (<74%) adherence tertiles according to the percentage of completed intervention sessions with equal distribution in each tertile. Of 2647 identified reports, 52 studies were included in the systematic review and 35 of these were included in the meta-analysis. Results The top-adherence group had a 47% lower injury rate than the control group (rate ratio (RR)=0.53, 95% CI 0.42 to 0.67, p<0.001). In the middle and bottom-adherence groups, injury rates were RR=0.50 (95% CI 0.39 to 0.64, p<0.001) and RR=0.87 (95% CI 0.75 to 1.02, p=0.08), respectively. Meta-regression analysis confirmed the results of the primary meta-analysis showing that adherence level significantly moderates the sports injury rate (β=−0.013, p<0.001). Conclusions Higher adherence to IPPs resulted in reduced injury rates. When the adherence level was lower, the rate of injuries was not significantly reduced.

• Language: English
• Keywords: sport, injury prevention, exercise
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: FŠ - Faculty of Sport
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: Str. 31-40
• Numbering: Vol. 32, iss. 1
• PID: 20.500.12556/RUL-185605
• UDC: 796.01
• ISSN on article: 1475-5785
• DOI: 10.1136/ip-2025-045632
• COBISS.SI-ID: 250948355
• Publication date in RUL: 12.08.2026

Record is a part of a journal

• Title: Injury prevention
• Shortened title: Inj. prev.
• Publisher: BMJ Group
• ISSN: 1475-5785
• COBISS.SI-ID: 3746836

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

• Language: Slovenian
• Keywords: šport, športne poškodbe, preprečevanje poškodb, vadba

Projects

• Funder: Erasmus+ programme of the European Union
• Project number: 622594-EPP-1-2020-1-SK-SPO-SCP
• Name: Physical activity-related injury prevention in adolescents

• Funder: Björkqvist Foundation and Urheiluopistosäätiö
• Funding programme: Personal grant