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The Association Between the Acute:Chronic Workload Ratio and Running-Related Injuries in Dutch Runners: A Prospective Cohort Study

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Abstract

Objective

To investigate the association between the acute:chronic workload ratio (ACWR) and running-related injuries (RRI).

Methods

This is a secondary analysis using a database composed of data from three studies conducted with the same RRI surveillance system. Longitudinal data comprising running exposure (workload) and RRI were collected biweekly during the respective cohorts’ follow-up (18–65 weeks). ACWR was calculated as the most recent (i.e., acute) external workload (last 2 weeks) divided by the average external (i.e., chronic) workload of the last 4, 6, 8, 10 and 12 weeks. Three methods were used to calculate the ACWR: uncoupled, coupled and exponentially weighted moving averages (EWMA). Bayesian logistic mixed models were used to analyse the data.

Results

The sample was composed of 435 runners. Runners whose ACWR was under 0.70 had about 10% predicted probability of sustaining RRI (9.6%; 95% credible interval [CrI] 7.5–12.4), while those whose ACWR was higher than 1.38 had about 1% predicted probability of sustaining RRI (1.3%; 95% CrI 0.7–1.7). The association between the ACWR and RRI was significant, varying from a small to a moderate association (1–10%). The higher the ACWR, the lower the RRI risk.

Conclusions

The ACWR showed an inversely proportional association with RRI risk that can be represented by a smooth L-shaped, second-order, polynomial decay curve. The ACWR using hours or kilometres yielded similar results. The coupled and uncoupled methods revealed similar associations with RRIs. The uncoupled method presented the best discrimination for ACWR strata. The EWMA method yielded sparse and non-significant results.

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Acknowledgements

Gustavo Nakaoka was granted with a Master’s scholarship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001. Luiz Hespanhol was granted with a Young Investigator Grant from the Sao Paulo Research Foundation (FAPESP), Grant 2016/09220-1.

Author information

Authors and Affiliations

  1. Masters and Doctoral Programs in Physical Therapy , Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno 448, Tatuapé, São Paulo, SP, 03071-100, Brazil

    Gustavo Nakaoka & Luiz Hespanhol

  2. Master Program in Health and Education , University of Ribeirão Preto, São Paulo, Brazil

    Saulo Delfino Barboza

  3. Department of Public and Occupational Health (DPOH), Amsterdam Public Health Research Institute (APH), Amsterdam Universities Medical Centers, Location VU University Medical Center Amsterdam (VUmc), Amsterdam, The Netherlands

    Saulo Delfino Barboza, Evert Verhagen, Willem van Mechelen & Luiz Hespanhol

  4. Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences, Amsterdam Universities Medical Centers, Location VU University Medical Center Amsterdam (VUmc), Amsterdam, The Netherlands

    Saulo Delfino Barboza, Evert Verhagen, Willem van Mechelen & Luiz Hespanhol

  5. Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Evert Verhagen & Willem van Mechelen

  6. Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia

    Willem van Mechelen

  7. School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland

    Willem van Mechelen

  8. Center of Human Movement Sciences, University Medical Center Groningen, Groningen, the Netherlands

    Willem van Mechelen

Authors
  1. Gustavo Nakaoka
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  2. Saulo Delfino Barboza
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  3. Evert Verhagen
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  4. Willem van Mechelen
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  5. Luiz Hespanhol
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Corresponding author

Correspondence to Gustavo Nakaoka.

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Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001. This study was financed in part by the Sao Paulo Research Foundation (FAPESP), process code 2016/09220-1.

Competing interests

GN, SDB, EV and LH declare that they have no conflict of interest of any nature. WvM declares for the avoidance of doubt that he is director of VU University Medical Center Amsterdam spin-out company Evalua Nederland B.V. (http://www.evalua.nl), and non-executive board member of Arbo Unie B.V. (http://www.arbounie.nl). Both companies operate on the Dutch Occupational Health Care market.

Ethics approval

All studies were approved by the medical ethics committee of the VU University Medical Center Amsterdam.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Transparency

The authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported. No important aspects of the study have been omitted. Any discrepancies from the study as planned have been explained.

Availability of data and material

Data are available upon reasonable request to GN (corresponding author). De-identified participant data might be available after the consent of all authors and the privacy policy office of the VU University Medical Center Amsterdam.

Contributors

LH and SDB were involved in the conceptualisation of the study. LH, EV and WvM were involved in designing and conducting the study. LH was responsible for cleaning the data and for the data analysis. All authors were involved in interpreting the data. GN drafted the first version of the manuscript. All authors revised the manuscript for intellectual content, and all approved the final version of the article. All authors had full access to the data (including statistical reports and tables) and can take responsibility for the integrity of the data and the accuracy of the data analysis.

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Nakaoka, G., Barboza, S.D., Verhagen, E. et al. The Association Between the Acute:Chronic Workload Ratio and Running-Related Injuries in Dutch Runners: A Prospective Cohort Study. Sports Med 51, 2437–2447 (2021). https://doi.org/10.1007/s40279-021-01483-0

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