© 2014 John Wiley & Sons A/S.

Scand J Med Sci Sports 2014: ••: ••–•• doi: 10.1111/sms.12180

Published by John Wiley & Sons Ltd

Is overweight a risk factor for sports injuries in children, adolescents, and young adults? E. Kemler1, I. Vriend1, W. D. Paulis2, W. Schoots1, M. van Middelkoop2, B. Koes2 VeiligheidNL, Amsterdam, The Netherlands, 2Erasmus MC, Rotterdam, The Netherlands Corresponding author: Ellen Kemler, VeiligheidNL, PO Box 75169, 1070 AD Amsterdam, The Netherlands. Tel: 0031 20 5114559; Fax: 0031 20 6692831; E-mail: [email protected]

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Accepted for publication 17 December 2013

Physical activity and sports participation are promoted to counteract the increased prevalence of overweight and obesity in children and young adults. Both high body mass index and physical activity level have been associated with an increased risk of sports injuries. The objective is to determine the relationship between sports injuries and overweight in sports participants (4–24 years), taking physical activity into account. Data were obtained from the 2006–2011 “Injuries and Physical Activity in the Netherlands” survey. Analyses were based on a representative sample of 3846 sports participants (4–24 years). Univariate and multiple logistic regression analyses were applied to investigate the association between

sports injury and weight status. Of all the sports participants, 14.7% were overweight. Compared with normalweight sports participants, the odds of sustaining a sports injury was 0.73 [confidence interval (CI): 0.53–1.00, P = 0.050] for overweight sports participants; the odds for underweight sports participants was 0.80 (CI: 0.56– 1.15, P = 0.226). There is some evidence that overweight sports participants (4–24 years) do not have an increased injury risk compared with normal-weight sports participants, even when the level of physical activity is taken into account. Additional research is recommended regarding overweight people who start to participate in a physically active lifestyle.

The prevalence of overweight and obesity in children and adolescents is increasing worldwide (Lobstein et al., 2004; Schönbeck et al., 2011; Brug et al., 2012; Finkelstein et al., 2012). Prevalence in the Netherlands is now higher than ever: in 2009, 12.8% of Dutch men and 14.8% of Dutch women aged 2–21 years were overweight; of these, 1.8% and 2.2%, respectively, were obese (Schönbeck et al., 2011). Overweight children have twice the risk of normal-weight children of becoming overweight adults (Singh et al., 2008), which is associated with an increased risk of diabetes mellitus type 2, cardiovascular disease, and certain malignancies (La Vecchia et al., 2011). Obesity also decreases mean life expectancy by almost 7 years (Peeters et al., 2003). To counteract overweight, a physically active lifestyle and regular sports participation are promoted (Tucker et al., 2006; Quinto Romani, 2011). However, literature shows a clear association in adults between rising body mass index (BMI) and sustaining injuries (Goulding et al., 2000; Finkelstein et al., 2007; Krul et al., 2009; McHugh, 2010). Recent evidence indicates that overweight and obese children and adolescents are at increased risk of injury in sports and physical activity as well (McHugh, 2010). In addition, obesity in childhood is associated with an increased risk of fractures and reported complaints of the musculoskeletal system (Goulding et al., 2000; Krul et al., 2009). These results

imply that overweight children are at an increased risk of injuries when participating in sports and other physical activities compared with normal-weight children. However, a recent study (Warsh et al., 2010) showed that the amount of physical activity, and not BMI status, was associated with a higher risk of injuries in overweight and obese youths (aged 11–15 years). Physical activity participation was consistently related to sustaining a sports injury across all BMI groups. An explication of the relationship between overweight (BMI), risk of sports injuries, and amount of physical activity would assist in making recommendations for physical activity participation for overweight children and adolescents. Sports injury rates among adolescents and young adults in the Netherlands are high, and are the highest among young adults aged 20–24 years, followed by adolescents aged 15–19 years. Recent Dutch registry data indicate that athletes aged 10–24 years are responsible for 39% of the 3.7 million sports injuries that are sustained each year (downloaded from http://www.veiligheid.nl/ cijfers/sportblessures on 29 January 2013). Moreover, the number of sports injuries treated at emergency departments (EDs) is highest among children aged 10–14 years, followed by adolescents aged 15–19 years and young adults aged 20–24 years (downloaded from http:// www.veiligheid.nl/cijfers/sportblessures on 29 January 2013). These data substantiate the need for increased

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Kemler et al. knowledge of risk factors related to the high sport injury rates in these age groups. To date, the reason for the increased risk of musculoskeletal disorders and injuries among overweight children and adolescents compared with their normal-weight peers is unclear (Wearing et al., 2006). In addition, current evidence of the association between overweight and the risk of injuries in children and adolescents is conflicting, and only a few studies have focused on the associations between overweight and musculoskeletal injuries, taking physical activity level into account. The aim of the present study was to examine the relation between weight status and the risk of sports injuries in Dutch sports participants aged 4–24 years, adjusting for physical activity. Material and methods

ing definition of a sports injury: “Physical damage of a musculoskeletal nature, sustained in the recall period (3 months) as a result of a sudden event during a sports activity or as a result of a gradual process related to sports activity.” As the first day of the recall period was always set at the beginning of a month, however, the average length of the recall period was 3.5 months (Schmikli et al., 2009).

Assessment of weight status BMI was used to determine the weight status of children, adolescents, and young adults within the sample of sports participants, based on self-reported individual weight and height. BMI was calculated as weight (kg)/height (m)2. For adults, a BMI < 18.5 indicates underweight, a BMI ≥18.5 and

Is overweight a risk factor for sports injuries in children, adolescents, and young adults?

Physical activity and sports participation are promoted to counteract the increased prevalence of overweight and obesity in children and young adults...
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