Objective The objective of this study was to assess the efficacy of a newly developed warm-up programme (‘11+ Kids’) regarding its potential to reduce injuries in children’s football. Methods Children’s football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited. Clubs were randomised to an intervention group and a control group, and followed for one season. The intervention group replaced their usual warm-up by ‘11+ Kids’, while the control group warmed up as usual. The primary outcome was the overall risk of football-related injuries. Secondary outcomes were the risks of severe and lower extremity injuries. We calculated hazard ratios using extended Cox models, and performed a compliance analysis. Results In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years. During the study period, 374 (intervention group = 139; control group = 235) injuries occurred. The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32–0.86). Severe (74% reduction, hazard ratio 0.26; 95% confidence interval 0.10–0.64) and lower extremity injuries (55% reduction, hazard ratio 0.45; 95% confidence interval 0.24–0.84) were also reduced. Injury incidence decreased with increasing compliance. Conclusion ‘11+ Kids’ is efficacious in reducing injuries in children’s football. We observed considerable effects for overall, severe and lower extremity injuries. The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit. Trial Registration ClinicalTrials.gov identifier: NCT02222025.

Gait analysis serves as an important tool for clinicians and other health professionals to assess gait patterns related to functional limitations due to neurological or orthopedic conditions. The purpose of this study was to assess the validity of a body-worn inertial sensor system (RehaGait®) for measuring spatiotemporal gait characteristics compared to a stationary treadmill (Zebris) and the reliability of both systems at different walking speeds and slopes. Gait analysis was performed during treadmill walking at different speeds (habitual walking speed (normal speed); 15 % above normal walking speed; 15 % below normal walking speed) and slopes (0 % slope; 15 % slope) in 22 healthy participants twice 1 week apart. Walking speed, stride length, cadence and stride time were computed from the inertial sensor system and the stationary treadmill and compared using repeated measures analysis of variance. Effect sizes of differences between systems were assessed using Cohen’s d, and limits of agreement and systematic bias were computed. The RehaGait® system slightly overestimated stride length (+2.7 %) and stride time (+0.8 %) and underestimate cadence (−1.5 %) with small effect sizes for all speeds and slopes (Cohen’s d ≤ 0.44) except slow speed at 15 % slope (Cohen’s d > 0.80). Walking speed obtained with the RehaGait® system closely matched the speed set on the treadmill tachometer. Intraclass correlation coefficients (ICC) were excellent for speed, cadence and stride time and for stride length at normal and fast speed at 0 % slope (ICC: .91–1.00). Good ICC values were found for stride length at slow speed at 0 % slope and all speeds at 15 % slope (ICC: .73–.90). Both devices had excellent reliability for most gait characteristics (ICC: .91–1.00) except good reliability for the RehaGait® for stride length at normal and fast speed at 0 % slope and at slow speed at 15 % slope (ICC: .80–.87). Larger limits of agreement for walking at 15 % slope suggests that uphill walking may influence the reliability of the RehaGait® system. The RehaGait® is a valid and reliable tool for measuring spatiotemporal gait characteristics during level and inclined treadmill walking.

Background: Exercise training is a beneficial treatment strategy for depression. Previous meta-analytical reviews mainly examined the effect of aerobic exercise on depressive symptoms neglecting comparisons with neuromuscular training and meta-regression considering relevant exercise training prescriptors such as exercise duration, intensity, number of exercise sessions (volume) and frequency. Methods: A structured literature search was conducted in biomedical and psychological databases and study selection was conducted following the PICOS approach. (Randomized) controlled trials that compared supervised neuromuscular or endurance exercise interventions with an inactive control group (CON) in clinically depressed in- or out-patients over 18 years were included. Eligibility and study quality were evaluated by two independent researchers. Standardized mean differences (SMD) for the reduction of depressive symptoms, measured with different evaluation scales (e.g., BDI, HAM-D, PHQ-9, HRSD, MADRS, GDS) were calculated with the adjusted Hedges'g equation as main outcome for the comparison of endurance and neuromuscular exercise interventions vs. CON. Statistical analyses were conducted using a random effects inverse-variance model. Multivariate meta-regression analysis was performed in order to examine the modulating effects of exercise training prescriptors. Results: Twenty seven trials with 1,452 clinically depressed adults were included. 20 out of 27 included trials reached a PEDro score of at least 6, representing high-quality. Irrespective of the exercise mode and study quality, large effects in favor of exercise compared to the control condition were found. Compared to CON, sensitivity analyses revealed a moderate to large effect in favor of endurance exercise [SMD: −0.79 (90% CI: −1.10, −0.48); p < 0.00001, I² = 84%] and a large effect size in favor of neuromuscular exercise [SMD: −1.14 (90 CI: −1.50, −0.78); p < 0.00001, I² = 80%]. These effects decreased to moderate for endurance and remained large for neuromuscular trials when considering studies of high quality, indicating a significant difference (p = 0.04). Multivariate meta- regression revealed that exercise duration in endurance trials and exercise intensity in neuromuscular trials had a significantly moderating effect. Conclusions: Strong neuromuscular exercise interventions can be slightly more effective than endurance exercise interventions. Interestingly, exercise duration and exercise intensity moderated the effect size meaningfully. This result might be used on exercise in depression to increase efficacy.

Objective To evaluate a potential reduction in injury related healthcare costs when using the ‘11+ Kids’ injury prevention programme compared with a usual warmup in children’s football. Methods This cost effectiveness analysis was based on data collected in a cluster randomised controlled trial over one season from football teams (under-9 to under-13 age groups) in Switzerland. The intervention group (INT) replaced their usual warmup with ‘11+ Kids’, while the control group (CON) warmed up as usual. Injuries, healthcare resource use and football exposure (in hours) were collected prospectively. We calculated the mean injury related costs in Swiss Francs (CHF) per 1000 hours of football. We calculated the cost effectiveness (the direct net healthcare costs divided by the net health effects of the ‘11+ Kids’ intervention) based on the actual data in our study (trial based) and for a countrywide implementation scenario (model based). Results Costs per 1000 hours of exposure were CHF228.34 (95% CI 137.45, 335.77) in the INT group and CHF469.00 (95% CI 273.30, 691.11) in the CON group. The cost difference per 1000 hours of exposure was CHF−240.66 (95%CI −406.89, −74.32). A countrywide implementation would reduce healthcare costs in Switzerland by CHF1.48 million per year. 1002 players with a mean age of 10.9 (SD 1.2) years participated. During 76 373 hours of football, 99 injuries occurred. Conclusion The ‘11+ Kids’ programme reduced the healthcare costs by 51% and was dominant (ie, the INT group had lower costs and a lower injury risk) compared with a usual warmup. This provides a compelling case for widespread implementation.

Aims: To investigate how physical activity (PA) volume, intensity, duration, and fragmentation are associated with the risk of all-cause and cardiovascular disease mortality. To produce centile curves for PA volume and intensity representative of US adults. Methods and results: This study is based on the observational 2011–2014 National Health and Nutrition Examination Survey (NHANES). Adults (age, ≥20) with valid accelerometer, covariate, and mortality data were included. Average acceleration (AvAcc), intensity gradient (IG), and total PA served as proxies for volume, intensity, and duration of PA, respectively. Weighted Cox proportional hazard models estimated associations between outcome and PA metrics. In 7518 participants (52.0% women, weighted median age of 49), there were curvilinear inverse dose–response relationships of all-cause mortality risk (81-month follow-up) with both AvAcc [−14.4% (95% CI, −8.3 to −20.1%) risk reduction from 25th to 50th percentile] and IG [−37.1% (95% CI, −30.0 to −43.4%) risk reduction from 25th to 50th percentile], but for cardiovascular disease (CVD) mortality risk (n = 7016, 82-month follow-up) only with IG [−41.0% (95% CI, −26.7 to −52.4%) risk reduction from the 25th to 50th percentile]. These relationships plateau at AvAcc: ∼35–45 mg and IG: −2.7 to −2.5. Associations of PA with all-cause and cardiovascular disease mortality are primarily driven by intensity and secondary by volume. Centile curves for volume and intensity were generated. Conclusion: Intensity is a main driver of reduced mortality risk suggesting that the intensity of PA rather than the quantity matters for longevity. The centile curves offer guidance for achieving desirable PA levels for longevity.