Physical activity-related injuries among university students: a multicentre cross-sectional study in China

The associated factors for physical activity-related injuries among first-year university students in southern China from a biopsychosocial perspective

Background

Understanding the diverse factors influencing physical activity-related injuries is crucial for developing effective interventions that enable individuals to participate in physical activity (PA) while minimizing injury risk. Currently, research evidence on the multiple factors associated with PA-related injuries is inadequate. This study aimed to examine the associations between PA-related injuries and various biological, psychological, and social factors among first-year university students in China.

Methods

We recruited first-year university students from Shantou University in Guangdong Province, China, to participate in our study. Data collection employed a structured self-administered questionnaire, gathering information on PA-related injuries, as well as relevant biological, psychological, and social factors. Binary logistic regression, using a stepwise modeling approach, was employed for the data analysis.

Results

Among 1,051 first-year university students, 28.16% reported having experienced PA-related injuries in the past year. Most of the injuries reported were minor, with the knee or lower leg being the most frequently injured part of the body. Improper posture, environmental conditions, and excessive physical load were the leading causes of PA-related injuries. Multiple logistic regression analysis revealed that female students (OR = 0.67, 95% CI: 0.47-0.94, p = 0.022) had reduced odds of PA-related injuries. Conversely, high neuroticism (OR = 1.61, 95% CI: 1.07-2.41, p = 0.022), being a member of a sports team (OR = 2.09, 95% CI: 1.34-3.27, p < 0.001), PA on the wet ground (OR = 1.73, 95% CI: 1.18-2.54, p = 0.005) increased the odds of PA-related injuries.

Conclusion

Our findings underscore the intricate interplay of various factors contributing to PA-related injuries. Identifying high-risk individuals based on physiological and psychological characteristics, coupled with targeted interventions addressing modifiable risk factors, is crucial for effective prevention.

Sleep characteristics and adolescent physical activity-related injuries in sports clubs, leisure time and schools

OBJECTIVE

Sleep has been identified as an important factor in relation to physical activity-related injury (PARI) in adolescents. The study aimed to explore associations between sleep duration, sleep problems and PARI among Slovak adolescents in three different settings: sports clubs, leisure time and schools.

METHODS

We analysed data from the cross-sectional Health Behaviour in School-aged Children study conducted in 2022 on a representative sample of 10 163 Slovak adolescents aged from 10.5 to 18.3 (mean age 13.4 (SD=1.5); 50.9% boys). Data were collected through self-administered online questionnaires completed by respondents in schools during the classes. Multiple logistic regression models were used to assess associations between sleep duration during schooldays and weekends, sleep problems and PARI in sports clubs, leisure time and schools.

RESULTS

Adolescents with normal sleep duration during schooldays and those who reported no problems with falling asleep, waking up at night and day sleepiness had a higher chance of not being injured during PA in sports clubs, leisure time and schools compared with adolescents with short sleep duration and sleep problems. Sufficient sleep duration during the weekend increased the probability of not having PARI in leisure time and schools, with the strongest association between long sleep duration and PARI in leisure time.

CONCLUSION

Good sleep quality and sufficient sleep duration were found to play a protective role in relation to PARI in adolescents. The findings suggest implementing sleep interventions in PARI prevention programmes, which must be considered a key component of adolescent PA promotion.

Sports-Related Musculoskeletal Injuries in Medical Students

Background

Little attention is paid to the problem of sports-related injuries in amateur or nonathletes or recreational student athletes. We investigated the prevalence of sports-related musculoskeletal (MSK) injuries in medical students and attempted to identify the risk factors for these injuries.

Methods

We conducted a cross-sectional questionnaire-based observational study on medical students of a tertiary care teaching hospital in central India. A total of 500 medical students were approached; the questionnaire consisted of details, such as age, gender, height, weight, predominant sport played or the sport during which they sustained an injury, estimated time spent playing every week, if they had undergone any formal training for the sport, any preexisting MSK condition, details of the injury and the treatment taken, if any, after joining medical school, and duration from getting injured to return to studies and sports. The odds ratio (OR) and logistic regression were calculated for multiple parameters. Statistical significance was set at P ≤ 0.05.

Results

Seventy-four of the 402 students who responded reported sustaining a sports-related injury; 33 and 41 students reported injury while playing contact and noncontact sports, respectively. Of these, 58 students reported that they had received formal training in sports. Football, volleyball, cricket, and kabaddi were the sports during which most injuries occurred. The injury rate was 3.7 per 1000 playing or practice hours.

Conclusions

Almost one-fifth of the students reported sustaining a sports-related MSK injury after joining medical school. The risk factors identified for these injuries were male gender, participation in team sports, participation in noncontact sports, and lack of adequate preparation or practice.

Discrepancy of eye injuries in mechanism, clinical features, and vision prognosis by different causative sports

Objective

To investigate the epidemiological and clinical characteristics of sports-related eye injuries in China, as well as how they differ depending on the sport or other specific factor that caused them.

Methods

Consecutive medical records from 2015 to 2019 of sports-related eye injuries from a standardized database in nine tertiary referral hospitals in China were retrospectively reviewed and analyzed.

Results

A total of 377 eyes in 376 inpatients (mean age, 22.5 ± 7.3 years; men:women 15.4:1) were included. Soccer (46.8%), basketball (27.1%), and badminton (16.8%) were the top three sports that caused injury. Ball strikes (74.7%), physical collision (13.8%), and racket/equipment beating (9.0%) were the common specific causes of injury. Blunt force injuries (95.8%) and close globe injuries (95.1%) accounted for the majority of injuries. Open globe injuries occurred more in basketball (8.3%) than in other sports, mainly due to physical collision (12.8%) and racket/equipment beating (11.8%). Basketball (13.4%) or physical collision (21.3%) caused Zone I injuries more frequently than other sports. Soccer (60.5%) and basketball (54.6%) caused more injuries to the posterior segment of the eyeball than other sports, mainly due to ball strikes (96.6%). Badminton (69.8%) and racket beating (61.8%) caused more Zone II globe injuries than other sports. In badminton, the percentage of hyphema (85.7%), the most typical symptom of eye damage, and ultimate visual acuity (VA) ≥20/40 (88.9%) was the greatest. A final low vision score of (≤4/200) was observed in 10.6% of all participants, including three participants who had an eye removed due to rupturing. The final VA was positively correlated with the presenting VA (r = 0.421).

Conclusion

Sports can lead to high proportions of ocular contusion injury and low vision. VA prognosis is closely related to initial VA following ocular sports trauma, which is directly determined by the causative sports and/or the specific causes. Effective eye protection is imperative to avoid or reduce visual impairments of sports participants.

Reference values of gait parameters in healthy Chinese university students: A cross-sectional observational study

BACKGROUND

Gait is influenced by race, age, and diseases type. Reference values for gait are closely related to numerous health outcomes. To gain a comprehensive understanding of gait patterns, particularly in relation to race-related pathologies and disorders, it is crucial to establish reference values for gait in daily life considering sex and age. Therefore, our objective was to present sex and age-based reference values for gait in daily life, providing a valuable foundation for further research and clinical applications.

AIM

To establish reference values for lower extremity joint kinematics and kinetics during gait in asymptomatic adult women and men.

METHODS

Spatiotemporal, kinematics and kinetics parameters were measured in 171 healthy adults (70 males and 101 females) using the computer-aided soft tissue foot model. Full curve statistical parametric mapping was performed using independent and paired-samples t-tests.

RESULTS

Compared with females, males required more time (cycle time, double-limb support time, stance time, swing time, and stride time), and the differences were statistically significant. In addition, the step and stride lengths of males were longer. Compared to males, female cadence was faster, and statures-per-second and stride-per-minute were higher. There were no statistical differences in speed and stride width between the two groups. After adjusting for height, it was observed that women walked significantly faster than men, and they also had a higher cadence. However, in terms of step length, stride length, and stride width, both genders exhibited similarities.

CONCLUSION

We established reference values for gait speed and spatiotemporal gait parameters in Chinese university students. This contributes to a valuable database for gait assessment and evaluation of preventive or rehabilitative programs.

Higher Sedentary Behaviors and Lower Levels of Specific Knowledge Are Risk Factors for Physical Activity-Related Injuries in Saudi Adolescents

Encouraging physical activity (PA) for adolescents is necessary to achieve and maintain optimal health, but it may increase the risk of PA-related injuries. This study sought to assess the frequency, location, type, and severity of PA-related injuries in Saudi students aged 13 to 18 years and to identify associated risk factors. A total of 402 students, including 206 boys aged 15.87 ± 1.69 years and 196 girls aged 15.83 ± 1.70 years, were randomly assigned to participate in this study. For each participant, height, weight, body mass index, and fat percentage were measured. Responses to a specially designed four-part self-administered questionnaire were also collected. Results revealed that better specific knowledge was associated with a lower likelihood of sustaining injuries (β = -0.136; p = 0.001) but increased sedentary behaviors were associated with a greater likelihood of sustaining a PA-related injury (β = 0.358; p = 0.023). Gender, knowledge, and sedentary behaviors were the factors overall associated with a greater likelihood of suffering 1, 2, and 3 or more PA-related injuries. However, gender, fat-free mass, knowledge, and sedentary behaviors were associated overall with a greater likelihood of bruises, strains, fractures, sprains, concussions, and at least two types of PA-related injuries. Collectively, we should pay attention to the PA-related injury problem among middle and high school students, particularly when promoting a physically active lifestyle.

Cross-sectional study of gender differences in physical activity-related injuries amongst Chinese college students majoring in rehabilitation

The main objective of the paper was to explore the potential risk factors for physical activity-related injuries (PARI) amongst college students majoring in rehabilitation and to analyse gender differences. A random whole group sampling method was used to recruit freshmen to seniors aged 15-25 years from over 90 universities in China that offer rehabilitation. The total number of people included was 6,032, of which 1,989 were male and 4,043 were female. The underlying risk factors for PARI of different genders were assessed using a structured self-management questionnaire including sociodemographic characteristics, physical activity levels, risk-taking and protective behaviors, and PARI. Totally 6,032 questionnaires were obtained for final analysis, with 792 total number of injured persons (415 males, 377 females), the sum of the cumulative frequency of injuries to injured persons is 1,607 (881 males, 726 females) and a PARI risk of 0.27 (males: 0.44, females: 0.18; p < 0.001; sum of the cumulative frequency of injuries/total number of people surveyed/year). For male and female students, participation in sports teams, having a high level of PA as well as with antisocial behavior were risk factors for developing PARI. Regarding female students, regional differences was associated with elevated odds to suffer from PARI. The prevalence rates of PARI vary between male and female students. The research subjects were university students in rehabilitation. Compared to general college students, rehabilitation students have a certain knowledge base related to injuries, which defines the specificity and research value of this subjects. This study provides guidance for reducing PARI in students in rehabilitation and may provide a basis for developing future injury prevention mechanisms for university students in general.

[Measurement and evaluation of the quadriceps muscle mass in young men based on magnetic resonance imaging]

OBJECTIVE

To investigate the correlation between the quadriceps cross-sectional area (CSA) and quadriceps muscle volume (QMV) at different horizontal levels from the upper edge of the patella, and to determine the best observation position.

METHODS

Thigh magnetic resonance imaging (MRI) images of 22 Chinese young men [age: (29±6) years] with anterior cruciate ligament (ACL) rupture were examined. The CSA was measured at 18, 15, and 12 cm above the upper edge of the pate-lla (denoted by CSA-18, CSA-15 and CSA-12 respectively), and the QMV and CSA were determined by semiautomatic segmentation. A curve model was established to estimate QMV. Bland-Altman analysis was performed to determine the confidence limits of the volumes.

RESULTS

On the unaffected side, the mean QMV was (1 944.45±323.77) cm³. The quadriceps CSA at the upper edge of the patella at 18, 15, and 12 cm was (80.80±12.16) cm², (77.53±12.03) cm², and (72.68±10.51) cm², respectively. The coefficients of determination (R²), ascertained using curve estimation models, for the 3 positions were 0.819, 0.755, and 0.684 (P < 0.001), and the standard deviations of the volume estimated value (SEE) were 7.4%, 8.7%, and 9.8%. The fitting equations of the three horizontal positions were all good, but the fitting degree of CSA-18 was the highest. The Bland-Altman scatter plot showed that the arithmetic means of the QMV at 18, 15 and 12 cm from the upper edge of the patella 0.8 cm³, -1.1 cm³, and 0.9 cm³ and 95% limits of agreement (LoA) were (-268.8, 270.5), (-315.2, 313.1), and (-355.7, 357.5), respectively. The estimated QMV was in good agreement with the measured value. The difference between the estimated CSA-18 and measured values was the smallest. The results on the affected side were consistent.

CONCLUSION

The correlation between QMV and CSA in the young men with the upper edge of patella as baseline was reliable and consistent. Among them, CSA-18 had the highest correlation with the QMV. However, different observation sites could be selected for different injuries of the quadriceps.

Association of COMT Polymorphisms with Multiple Physical Activity-Related Injuries among University Students in China

The catechol-O-methyltransferase (COMT) is a candidate gene to provide promising evidence of psychiatric disorders, but there is a knowledge gap between the genetic factor and multiple physical activity-related injuries (PARIs). The aim of this study was to explore the contribution of COMT to the risk of PARIs among university students in the Chinese Han population. We can further search for the intrinsic risk factors for the occurrence of multiple physical activity injuries and provide a scientific basis for early screening and precise intervention for the high-risk group of college students with multiple PARIs. A 1:1 matched case-control study of 61 PARIs cases and 61 healthy controls were carried out. DNA samples of the participants were isolated from saliva and genotyped on eight SNPs of the COMT gene (rs9265, rs4680, rs6269, rs4818, rs4633, rs165655, rs165656, and rs165722) using the MALDI-TOF MS method. We found that rs6269 and rs4818 were significantly associated with PARIs, and rs6269-GG and rs4818-GG contributed to the reduced risk of PARIs. Further haplotype analysis showed a four-marker C-G-C-G haplotype (rs165722-rs6269-rs4633-rs4818) acted with a protective role in the development of PARIs (p = 0.037; OR: 0.474, 95% CI: 0.269 to 0.834). However, the interactions between club membership and rs6269 or rs4818 would significantly increase the risk of PARIs (both p < 0.001, OR: 5.121 and 4.977, respectively). This is the first study to find the contribution of COMT to PARIs occurrence, suggesting that the COMT polymorphisms and the gene-environment interactions may alter the risk of PARIs.

When Do Individuals Get More Injured? Relationship between Physical Activity Intensity, Duration, Participation Mode, and Injury

The present study examines the association between physical activity (PA) participation modes (i.e., family, friends, club members, and alone), PA volumes (i.e., intensity and duration), gender, and injury. A total of 9000 Koreans aged 10-89 years participated in the Korean Survey of Citizens' Sports Participation project. However, participants who did not respond to a question regarding PA participation modes (n = 2429) and those under 18 years old (n = 489) were excluded from this study. Analysis of variance (ANOVA) was used to compare the groups' characteristics and the association between PA participation modes and injury was demonstrated by conducting multinomial logistic regression analysis. The risk of injury was significantly higher in the friend and club member groups than in the alone group. In addition, PA intensity and gender were critical risk factors of injury, while PA duration showed no significant results. The results indicated a strong association between PA participation modes, PA intensity, gender, and injury, and an interesting finding is that more injuries derived from a higher intensity of PA, not from a longer duration of PA. Therefore, this present study directly documented that considerable attention should be placed on the factors that affect injuries, such as gender and PA intensity, to prevent unpredictable injury and encourage potential participants to exercise with diverse participation modes and appropriate intensity.

Epidemiology of Sports-Related Eye Injuries Among Athletes in Tianjin, China

Purpose: To investigate the incidence, characteristics, and risk factors of sports-related eye injuries among athletes in Tianjin, China.

Methods: A cross-sectional study was carried out from March 2018 to October 2018. In this study, the athletes from Tianjin University of Sports, Tianjin Vocational College of Sports, and Tianjin provincial sports teams were selected for general investigation. In total, 1,673 athletes were invited and 1,413 participated in the study (response rate of 84.5%).

Results: In total, 1,413 athletes were enrolled; 151 had suffered from sports-related eye injuries, with an incidence of 10.7% (95% CI: 9.1–12.0%). Handball (38.5%) was the sport with the highest incidence of eye injuries, followed by water polo (36.4%) and diving (26.7%). Overall, 42.4% of the athletes were injured by ball and 22.5% of injuries came from teammates. The eye injuries usually occurred during training (64.2%) and competitions (14.6%). Adnexa wound (51.7%) was the most common type of injury. About 11.9% of the athletes with eye injuries had the impaired vision; 66.7% failed to see doctors on time. The athletes <18 years of age had a higher risk of eye injuries (odds ratio [OR] =1.60, 95% CI: 1.06–2.40). The athletes with lower family income (<1,000 RMB) were at risk population for sports-related eye injuries (OR = 3.91, 95% CI: 2.24–6.82). Training >4 h a day increased the risk of eye injuries (OR = 2.21, 95% CI: 1.42–3.43).

Conclusion: The incidence of sports-related eye injuries among athletes was 10.7% in Tianjin, China. Handball, water polo, and diving were the most common activities of injury. Age, family income, and training time were the risk factors for sports-related eye injuries.

Physical activity-related injuries of college students in southern China: A 1-year prospective study

This prospective study was to describe the incidence and characteristics of physical activity-related injuries (PARI) among college students in southern China. Online questionnaires and telephone interviews were combined to investigate the physical activity (PA) participation and PARI occurrences every two weeks. Totally, 84 college students (men: 49; women: 35) with a mean age of 19.4 years completed the entire 1-year follow-up. Overall, 14250.3 PA exposure hours were collected and 36 PARI episodes were reported by 26 students, with an injury incidence density of 2.53 injuries per 1000 PA exposure hours and an injury risk of 0.43 injuries/student/year. July to September accounted for a highest proportion of injuries and half of the injuries happened in the evening. The majority of injuries occurred outdoors, happened in non-contact activities, were acute and involved the lower limbs, with sprains and strains being the primary injury types. Of all injuries, 80.6% resulted in PA withdrawal immediately and 58.3% led to absence from the next planned PA. No significant difference was found between men and women. This study reveals the problem of PARI among college students, which provides the direction for the prevention of PARI in this population.

Associations between sport participation and knee symptoms: a cross-sectional study involving 3053 undergraduate students

Background

While a number of studies have investigated knee symptoms among elite athletes, few have directly compared the association between engagement in different sports and knee symptoms among young adults in the general population. The current study aimed to investigate the relation between sports participation hours, type/ number of sports engaged, self-rated competitiveness and knee symptoms among undergraduates.

Methods

Undergraduates were invited to participate in a self-administered online survey through invitation emails. Respondents were instructed to provide demographic information (e.g., age, gender, sports participation hours, types of engaged sports, self-rated competitiveness in sports and anxiety level etc.) and to report knee symptoms (current, the last 7 days, the last 12 months, and lifetime). Multiple logistic regressions were conducted to investigate the association between sports participation and current knee symptoms.

Results

Of 17,552 invitees, 3744 responded to the survey. Valid data from 3053 respondents was used for analysis. Forty-four percent of the respondents engaged in sports regularly (≥once per week). Running, cross-training and swimming were the most frequently participated sports among the respondents. The current prevalence rate of knee symptoms was 6.4%. Hours spent participating in combat sports, soccer, yoga, and basketball participation hours were significantly associated with current knee symptoms. Respondents who rated themselves as “competitive” demonstrated a higher risk of having current knee symptoms than “recreational” players. Number of engaged sports was not associated with current knee symptoms among undergraduates.

Conclusions

Certain sports types were associated with current knee symptoms. Compared to self-rated “recreational” players, self-rated “competitive” players were more likely to have current knee symptoms. Students should take preventive measures to minimize their risk of developing knee symptoms, especially when participating in combat sports, soccer, yoga, and basketball, or engaging in sports at a highly competitive level.

Characteristics and associated factors of physical activity-related injuries among university students in southern China

This cross-sectional study aimed to describe the characteristics of physical activity-related injury (PARI) and to explore its associated factors among university students in Chaoshan district. Selected from the baseline survey in March and April, 434 students graded 1-3 from two universities were interviewed face-to-face in April and May 2017. Socio-demographics, physical activity (PA) participation, risk-taking behaviors, and PARI occurrences in the past 12 months were collected. Group Lasso logistic regression was applied to identify the risk factors of PARI. Totally, 317 PARI episodes were reported by 184 subjects with an overall injury risk of 0.73 injuries/student/year (males: 1.00, females: 0.63) and an injury incidence density of 0.81 injuries per 1000 PA exposure hours (males: 1.13, females: 0.69). Most injuries involved the lower extremities and were sprains and strains. Males, sports team members, and those with high-risk rebellious and anti-social behaviors were more likely to sustain PARI compared to their counterparts. Those who participated in vigorous-intensity PA with longer duration (particularly ≥ 150 min/week) were at a higher risk for PARI. This study indicates that PARI is a health concern among university students and great efforts should be taken to prevent them from PARI when promoting a physically active lifestyle.

Epidemiology of physical activity-related injuries in Chinese university students

Knowledge gaps of the physical activity-related injury (PARI) problem among general undergraduates exist. We conducted a study in four universities, where 1421 students graded 1-3 were interviewed face-to-face during April and May after their completion of the baseline survey in March and April 2017, aiming to describe the incidence and characteristics of PARI. PARI experience and physical activity (PA) participation in the past 12 months were collected. Injury incidence density (IID) and risk, and injury characteristics were evaluated for the overall sample and by gender. Pearson chi-square or Fisher's exact tests and independent-sample t tests were used to test between-group differences. We found that 486 PARIs were reported totally by 289 participants, with an overall IID of 0.57 per 1000 hours of exposure (males: 1.07, females: 0.45) and an injury risk of 0.34 injuries/student/y (males: 0.52; females: 0.28). Higher IIDs were found in roller skating, football, and basketball. The majority of injuries occurred outdoors and involved the lower extremities, with sprain and strain being the primary injury types. Moreover, most injuries were new, acute, and happened in non-contact situations. Of all injuries, 52.1% required medical attention and 64.6% resulted in inactivity of one or more days. Some significant differences were observed between males and females. Our study indicates that PARI is a public health concern among Chinese university students, which can provide direction for targeted prophylactic interventions to underpin the sex-specific injury mechanism to reduce PARI.

Gender-Specific Risk Factors of Physical Activity-Related Injuries among Middle School Students in Southern China

This cross-sectional study was carried out to explore the potential risk factors of physical activity-related injuries (PARI) among middle-school students of different genders. Selected by the random cluster sampling method, students aged from 12 to 16 years old in grades 7-8 from six middle schools in Shantou, southern China, were recruited for this investigation in November 2017. Information about socio-demographics, physical activity (PA) exposure time, individual exercise behaviors, risk-taking behaviors, and PARI experiences in the past 12 months was collected. A multivariate logistic regression model was used to explore the risk factors of PARI. A total of 1270 students completed valid questionnaires, with an overall injury incidence of 33.6% (boys: 42.0%; girls: 25.0%), an injury risk of 0.68 injuries/student/year, and an injury rate of 1.43 injuries per 1000 PA exposure hours. For boys, living in a school dormitory, participating in sports teams, exercising on a wet floor, rebellious behavior, and having longer PA exposure time were the risk factors of PARI. For girls, those who were sports team members, whose parents were divorced or separated, and those with longer PA exposure time were more vulnerable to suffer from PARI. In conclusion, PARI was a health problem among middle school students in southern China. Boys and girls differed in PARI occurrence and were affected by different risk factors, which provides a basis for targeted gender-specific intervention programs to reduce the occurrence of PARI among middle-school students.