Do exercise-based prevention programs reduce injury in endurance runners? A systematic review and meta-analysis

Background: Endurance running is a popular sport and recreational activity yet is associated with a high prevalence of injury. Running related injuries (RRIs) are a leading cause of drop-out and represent a substantial financial burden to runners and healthcare services. There is clear evidence for the use of exercise-based injury prevention programs in games-based and youth sport settings, yet the research investigating the use of exercise to reduce injury risk in endurance runners has not been adequately reviewed recently. 

Objectives: The aim of this review and meta-analysis was to systematically summarize the current research that has investigated the effect of exercise-based prevention programs and their state of supervision on the risk of RRIs in endurance runners. 

Methods: Three databases were searched for relevant studies. Selection and review were completed by two independent reviewers using the following inclusion criteria: (1) study population used endurance running training for health, occupational, or performance outcome(s); (2) participants performed running as their main form of exercise (> 50% of their total training time); (3) study was a randomized controlled trial; (4) a non-running-based exercise intervention was used; (5) a running-only or placebo exercise control group was included; (6) injury rate or incidence was reported; (7) injuries were recorded prospectively alongside the exercise training. Two meta-analyses were conducted using random-effects models, one based on log risk ratio and one based on log incidence rate ratio. The Cochrane Risk of Bias Assessment Tool 2 was used to evaluate the quality of studies and the Grading of Recommendations Assessment, Development and Evaluations approach was employed to grade the certainty of evidence. 

Results: A total of nine articles containing 1904 participants were included in analysis. Overall pooled results showed no significant differences between intervention and control groups in injury risk (z = − 1.60; p = 0.110) and injury rate (z = − 0.98; p = 0.329), while a post hoc analysis evaluating supervised interventions only showed that injury risk was significantly lower in the intervention group compared to the control group (z = − 3.75, p < 0.001). Risk of bias assessment revealed that seven studies included in the analysis were of low quality. 

Conclusions: Exercise-based interventions do not appear to reduce the risk and rate of running-related injuries. Supervision may be essential for exercise-based intervention programs to reduce risk of RRIs, possibly due to increased compliance. Studies with more robust designs that include supervised exercise interventions should be prioritized in the future. 

Trial Registry: Clinical Trial Registration: PROSPERO CRD42021211274.