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ObjectiveExercise-training programmes have reduced lower limb injuries in trials, but their population-level effectiveness has not been reported in implementation trials. This study aimed to demonstrate that routinely collected hospital data can be used to evaluate population-level programme effectiveness.MethodA controlled ecological design was used to evaluate the effect of FootyFirst, an exercise-training programme, on the number of hospital-treated lower limb injuries sustained by males aged 16–50 years while participating in community-level Australian Football. FootyFirst was implemented with ‘support’ (FootyFirst+S) or ‘without support’ (FootyFirst+NS) in different geographic regions of Victoria, Australia: 22 clubs in region 1: FootyFirst+S in 2012/2013; 25 clubs in region 2: FootyFirst+NS in 2012/2013; 31 clubs region 3: control in 2012, FootyFirst+S in 2013. Interrupted time-series analysis compared injury counts across regions and against trends in the rest of Victoria.ResultsAfter 1 year of FootyFirst+S, there was a non-statistically significant decline in the number of lower limb injuries in region 1 (2012) and region 3 (2013); this was not maintained after 2 years in region 1. Compared with before FootyFirst in 2006–2011, injury count changes at the end of 2013 were: region 1: 20.0% reduction (after 2 years support); region 2: 21.5% increase (after 2 years without support); region 3: 21.8% increase (after first year no programme, second year programme with support); rest of Victoria: 12.6% increase.ConclusionEcological analyses using routinely collected hospital data show promise as the basis of population-level programme evaluation. The implementation and sustainability of sports injury prevention programmes at the population-level remains challenging.

This study investigates the challenges of returning to sport after a COVID-19 shutdown of sport from the perspective of community sport clubs (CSCs). We explore the relationship between the challen...

Purpose: Violence against women is a global epidemic. Such violence occurs in sport, although previous research has focused on child/youth sexual abuse or elite sport. Despite sport being identified as having a role in preventing violence against women, little is known about how sport organizations respond to violence against adult women in community sport. Methods: Twenty-two individual participants from 12 sports organizations based in Victoria, Australia participated in this empirical and applied Concept Mapping study to explore the perceived challenges sports organizations face in responding to violence against women. Concept Mapping is a mixed-method participatory approach and we analyzed the results using a socio-ecological framework. Results: Sports administrators considered training-related challenges as the most important but most difficult to address. Challenges related to organizational capacity/social environment were perceived as easier but less important to address. Conclusions: Key initiatives can be developed to support sport organizations to respond to violence against women in sport, but they will need assistance to prioritize initiatives addressing the most important challenges given a perceived lack of capacity to do so.

International audience; Objectives: The potential of sports clubs to promote health beyond physical activity has been acknowledged by researchers and policy-makers. This study gathered stakeholder ideas on support sports clubs need to increase health promotion efforts and prioritize them based on importance and feasibility. Study design: The study design used in this study is a mixed-methods concept mapping approach. Methods: French sports and public health stakeholders (n ¼ 45) were invited to participate. Steps included are as follows: (1) formulating a focus prompt, (2) brainstorming statements in response to the focus prompt, (3) sorting statements into themed piles, and (4) rating statements based on indicators. Multidimensional scaling and hierarchical cluster analysis were used to produce visual cluster maps, and descriptive statistics generated Go-Zone graphs based on mean importance and feasible ratings. Results: Participants generated 62 statements from the focus prompt: 'What assistance would benefit sports clubs to become a health-promoting setting?'. Final sorting produced 9 clusters: Tools for health promotion, Communication tools, Stakeholder training courses, Diagnostic and Financing, Awareness and Mobilization, Advocacy, Policies and Methods, Sharing and Networking, as well as Communication and Dissemination. Participant ratings produced 34 statements within the Go-Zone graphs. Conclusion: Understanding stakeholders' needs to increase health promotion activities in sports clubs is crucial to planning and implementing sustainable health promotion policies and practice. Priority areas include increasing awareness of health promotion benefits, mobilizing actors, advocating for support, and educating sports club actors.

Objectives: To explore the challenges that Victorian sporting organisations experience when developing, delivering or scaling non‐traditional social sport products to engage insufficiently active people. Methods: Online Concept Mapping was used to gather qualitative data and analyse it quantitatively. Results: A total of 68 participants (27 organisations) brainstormed 158 challenges. The research team synthesised these to 71 unique challenges for participants to sort into groups and rate for importance (0–5) and ease of overcoming (0–5). A nine‐cluster solution – Deliverers; Capacity to drive the product; Facilities and partnerships; Product development; Sustainable business model; Marketing to insufficiently active; Attracting the insufficiently active; Clubs and volunteers; and Shifting traditional sport culture – was considered most appropriate. Participants rated the Deliverers challenges as the most important (mean=3.52), and the Marketing to insufficiently active challenges as the easiest to overcome (2.72). Conclusions: Key ingredients to successfully developing and delivering non‐traditional sport opportunities for insufficiently active populations are: recruiting appropriate product deliverers; building the capacity of delivery organisations and systems; and developing products relevant to the delivery context that align with the needs and characteristics of the target population. Implications for public health: A system‐wide response is required to address the challenges associated with sport organisations developing, scaling and delivering innovative social sport products for insufficiently active populations.

Interagency partnerships and collaborations underpin a settings-based approach to health promotion in all settings, including sport. This study used an online concept mapping approach to explore the challenges that Regional Sports Assemblies (RSAs) in Victoria, Australia experienced when working in partnerships to develop and deliver physical activity programs in a community sport context. Participants from nine RSAs brainstormed 46 unique partnership-related challenges that they then sorted into groups based on similarity of meaning and rated for importance and capacity to manage (6-point scale, 0 = least, 5 = most). A six cluster map (number of statements in cluster, mean cluster importance and capacity ratings)—Co-design for regional areas (4, 4.22, 2.51), Financial resources (3, 4.00, 2.32), Localised delivery challenges (4, 3.72, 2.33), Challenges implementing existing State Sporting Association (SSA) products (9, 3.58, 2.23), Working with clubs (8, 3.43, 2.99), and Partnership engagement (18, 3.23, 2.95)—was considered the most appropriate interpretation of the sorted data. The most important challenge was Lack of volunteer time (4.56). Partnerships to implement health promotion initiatives in sports settings involve multiple challenges, particularly for regional sport organisations working in partnership with community sport clubs with limited human and financial resources, to implement programs developed by national or state-based organisations.

Women in rural and regional communities experience social, cultural, and geographical constraints to sport, physical activity, and leisure participation. This study uses leisure constraints theory ...

Objectives Energy-dense, nutrient-poor food and drink (‘junk food’) brands sponsoring sport is a growing public health concern. This study explored sports administrators' perceptions of the barriers to rejecting junk food sponsorship. Study design This study used concept mapping. Methods The Concept Systems Global MAX™ web platform was used to collect and analyse data from 29 sports administrators across all levels of sport in Victoria, Australia. Results Brainstorming generated 33 barriers to rejecting junk food sponsorship. After the barriers were synthesised and edited, participants sorted and rated 32 barriers. Multidimensional scaling and hierarchical cluster analysis identified a four-cluster solution: community attitudes and values (seven barriers); junk food is the easy sell (retail; five barriers); financial viability (16 barriers); and organisational capability (policy and governance; four barriers). The financial viability barriers were rated the most important (mean = 3.65 of 5) and the hardest to overcome (1.42). The organisational capability (policy and governance) barriers were rated the least important (2.14) and the easiest to overcome (3.20). Conclusions Sports administrators clearly perceive that rejecting junk food sponsorship could place significant financial strain on their organisations. There appears to be considerable scope to build the capacity of sporting organisations to rejecting junk food sponsorship. Despite the literature indicating that most parents think junk food companies are not suitable sponsors, sports administrators perceive that there is a broad public acceptance of junk food sponsorship in sport. The fact that sports administrators perceive a link between junk food sponsorship and the lack of healthy options at club canteens and venue food outlets adds an additional, not previously identified, level of complexity to the junk food sponsorship in sport debate.

Background Researchers and policymakers have acknowledged sports clubs (SCs) as health promoting settings. Limited research links the health promoting sports club (HPSC) concept with evidence-driven strategies to offer SCs guidance to develop health promotion interventions. As implementation science insists on theoretically grounded interventions, this work's objective was to provide SCs an evidence-driven intervention framework for planning health promotions. Methods A 4-step process was undertaken: 1) investigate indicators for SCs to be considered health promoting, 2) adapt the theoretical HPSC concept to create a HPSC model, 3) reformulate published evidence-driven guidelines into implementable intervention components (ICs) and 4) merge the model with the ICs to provide an intervention planning framework for SCs. During 3 workshops, researchers defined the model elements and ICs. Workshop participants classified ICs into the HSPC model. Each IC could be classified multiple times within the model. Results Researchers drafted 5 HPSC indicators: 1) an approach embracing all SC actions, 2) involve all SC levels in actions and decisions, 3) involve external partners, 4) promoting health is continuous and iterative and 5) base actions on needs. To create the HPSC model, elements were defined: 3 SC levels (club, management, coaches) and 4 health determinants (organizational, social, environmental, economic) per level based on the indicators. Published guidelines from literature reviews aided in developing 14 strategies with 55 ICs. Workshop classification of ICs into the model included: club (n = 79), management (n = 67) and coaches (n = 48). Conclusions The theoretical HPSC model and intervention planning framework act as starting points to develop and implement interventions to increase HP efforts by stakeholders in several ways: 1) SCs can apply strategies based on goals, 2) SCs can target specific levels with corresponding ICs or 3) ICs can target specific health determinants. Key messages A Health Promoting Sports Club model defines 4 health determinants at 3 levels (coach, management operational) of sports clubs to plan, develop and implement targeted health promotion activities. This HPSC intervention planning framework has 14 strategies with 55 intervention components targeting multiple sports club levels giving stakeholders a path to become a health promoting sports club.

Background: Sports clubs (SCs) offer a unique position to increase physical activity levels and offer additional health promotion opportunities. Purpose: To gather French stakeholder ideas on support SCs need to increase health promotion efforts and prioritized them. Methods: This concept mapping study included 4-steps: 1) drafting a key issue focus prompt, 2) brainstorming ideas in response to the focus prompt, 3) sorting ideas into themed piles and 4) rating ideas (1-6) based on two indicators. French sports and health stakeholders (45) were invited to respond using web-based groupwisdom��� software. Based on multi-dimensional scaling and hierarchical cluster analysis, visual cluster maps of piles and Go-Zone graphs displaying ideas rated as important and feasible were produced. Results: Participants generated 62 ideas from the focus prompt: ���What assistance would benefit SCs to become a health-promoting setting?���. Final idea sorting formed 9 clusters: Tools for health promotion, Communication tools, Stakeholder training courses, Diagnostic and Financing, Awareness and Mobilization, Advocacy, Policies and Methods, Sharing and Networking and Communication and Dissemination. Ratings produced Go-Zones with 34 ideas above the mean for both indicators. Priority areas include increasing awareness of health promotion benefits, mobilizing actors, advocating for support and educating club actors. Conclusions: Generating and organizing stakeholder ideas gives insight into perceptions of what support is needed to develop and implement health promotion interventions in the sports club context which increases the possibility of acceptance and integration into policies. Funding: Study was funded by a grant from Sant�� publique France., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress

Objectives Sport injury is the leading cause of hospitalization in Canadian youth and represents a high burden to the health care system. This study aims to describe the facilitators and barriers to implementation of a sport injury prevention program in junior high school physical education (known as iSPRINT), previously shown to reduce the risk of sport-related injury in youth (age, 11-15 years). Methods Focus group data were mapped onto constructs from the Consolidated Framework for Implementation Research (CFIR). Four schools that implemented iSPRINT participated in this study. Forty-seven key stakeholders (teachers, students, principals) participated in 9 semistructured focus groups and 4 interviews. The CFIR was used to guide the focus group discussions, data coding, and analysis using a qualitative content analysis approach. Results Of the 22 applicable CFIR constructs, 16 were identified in the transcripts. The most significant facilitators to successful implementation efforts included evidence strength and quality, adaptability, implementation climate, culture, and having a high level of compatibility facilitated successful implementation efforts. Barriers to implementation included intervention complexity, planning, and readiness for implementation. Constructs that acted as both a facilitator and a barrier, depending on the context, were self-efficacy, execution, and individual identification with the organization. Conclusions Participants in this study reported positive attitudes about implementing iSPRINT, citing evidence strength, adaptability, and constructs related to the organizational setting that contributed to successful implementation. Potential improvements include modifying certain program components, decreasing the number of components, and reducing the equipment required.

Objective: Sports clubs provide an opportunity to tackle childhood obesity rates through targeted interventions. Our study aimed to investigate if coaches providing healthy snacks to participants before junior netball sessions at five clubs in Melbourne, Australia, increased consumption of healthy foods and influenced coach perceptions of participants’ attention/participation levels. Methods: Coaches provided healthy snacks to participants before each netball session for one school term. Children's food consumption was observed at one session before, during and after the intervention. Parents attending the observed session completed pre- and post-intervention questionnaires. Coaches rated participants’ attention/participation at the observed sessions before and during the intervention, and completed a questionnaire post-intervention. Results: Baseline: Ice cream and cake were the most frequently consumed snacks. During intervention: Fruit, cheese and crackers and vegetables were the most frequently consumed snacks. Coaches ratings of participants’ attention/participation increased significantly (baseline: 6.4 ± 0.17, intervention: 7.5 ± 0.36; p=0.02) where the same coach undertook ratings at both time points. Conclusions: Coaches providing healthy snacks before sessions at sports clubs increased consumption of nutrient-dense foods at the session, and may have positively affected participants’ attention/participation. Implications for public health: This study highlights how a simple intervention could improve the diet of Australian children.

Objective Implementation of effective population-level injury prevention interventions requires broad multiagency partnerships. Different stakeholders address this from varying perspectives, and potential conflicts in priorities need to be addressed for such partnerships to be effective. The researcher-led National Guidance for Australian football Partnerships and Safety (NoGAPS) project involved the engagement and participation of seven non-academic partners, including government health promotion and safety agencies; peak sports professional and advocacy bodies and health insurance organisations. Design The partnership9s ongoing development was assessed by each partner completing the Victorian Health Promotion Foundation Partnership Analysis Tool (VPAT) annually over 2011–2015. Changes in VPAT scores were compared through repeated measures analysis of variance. Results Overall, mean total VPAT scores increased significantly over the 5-year period (125.1–141.2; F 5,30 =4.61, p=0.003), showing a significant improvement in how the partnership was functioning over time. This was largely driven by significant increases in several VPAT domains: ‘determining the need for a partnership’ (F 5,30 =4.15, p=0.006), ‘making sure the partnership works’ (F 5,30 =2.59, p=0.046), ‘planning collaborative action’ (F 5,30 =5.13, p=0.002) and ‘minimising the barriers to the partnership’ (F 5,30 =6.66, p Conclusion This is the first study to assess the functioning of a multiagency partnership to address sport injury prevention implementation. For NoGAPS, the engagement of stakeholders from the outset facilitated the development of new and/or stronger links between non-academic partners. Partners shared the common goal of ensuring the real-world uptake of interventions and research evidence-informed recommendations. Effective multiagency partnerships have the potential to influence the implementation of policies and practices beyond the life of a research project.

The study aim was to evaluate the implementation of group- and home-based exercise falls prevention programs delivered through community health agencies to community-dwelling older people. Interviews with program staff were guided by the Diffusion of Innovations theory. Highly consistent themes emerged for the two types of programs. Both had high overall compatibility, high relative advantage, good observability and high inherent trialability—all factors known to strengthen implementation. The level of complexity and low financial compatibility emerged as the strongest potential inhibitors to program implementation in the context examined. The two main factors contributing to complexity were the need to challenge balance safely across a broad range of capability, and practical considerations associated with program delivery.A range of strategies to provide more technical support for exercise program leaders to tailor balance challenge for exercise program leaders may enhance implementation of falls prevention exercise programs.

This study evaluated the impact of a brief (20-min) nutrition education intervention embedded in an existing mandatory coach education course for coaches of junior (8–12 years old) Australian football teams. A total of 284 coaches (68% of 415 coaching course participants) completed a presession questionnaire, and 110 coaches (27% of coaching course participants) completed an identical postsession questionnaire. The responses to the pre- and postsession surveys were matched for 78 coaches. Coaches’ ratings of their own understanding of the nutritional needs of young athletes (6.81, 8.95;p p = .001), their confidence in their own nutrition knowledge (7.24, 8.64;p p 95%) provided a correct response to six of the 15 nutrition and hydration knowledge questions included in the presession questionnaire. Even with this high level of presession knowledge, there was a significant improvement in the coaches’ nutrition and hydration knowledge after the education session across five of the 15 items, compared with before the education session. The results of this study suggest that a simple, short nutrition education intervention, embedded in an existing coach education course, can positively influence the nutrition knowledge and self-efficacy of community-level, volunteer coaches of junior sports participants.

Objectives To obtain benefits from sports injury prevention programs, players are instructed to perform the exercises as prescribed. We developed an observational checklist to measure the quality of exercise performance by players participating in FootyFirst, a coach-led, exercise-based, lower-limb injury prevention program in community Australian Football (AF). Design Observational. Methods The essential performance criteria for each FootyFirst exercise were described in terms of the technique, volume and intensity required to perform each exercise. An observational checklist was developed to evaluate each criterion through direct visual observation of players at training. The checklist was trialled by two independent raters who observed the same 70 players completing the exercises at eight clubs. Agreement between observers was assessed by Kappa-statistics. Exercise fidelity was defined as the proportion of observed players who performed all aspects of their exercises correctly. Results The raters agreed on 61/70 observations (87%) (Kappa = 0.72, 95% CI: 0.55; 0.89). Of the observations with agreed ratings, 41 (67%) players were judged as performing the exercises as prescribed. Conclusions The observational checklist demonstrated high inter-rater reliability. Many players observed did not perform the exercises as prescribed, raising concern as to whether they would be receiving anticipated program benefits. Where quality of exercise performance is important, evaluation and reporting of program fidelity should include direct observations of participants.

Objectives The “Mayday Safety Procedure” (MSP) is included in the Australian Rugby Union (ARU) Medical and Safety Recommendations and the mandatory SmartRugby training for coaches. Previous research indicates that translating the Mayday Safety Procedure into practice among community rugby coaches is challenging. This study investigated whether Mayday Safety Procedure translation could be enhanced by systematically planning and implementing a range of theory-informed and context-specific diffusion strategies. Design A controlled before-and-after study. Methods Coaches of senior community rugby teams in five zones in New South Wales (Australia) were invited to complete a questionnaire about their Mayday Safety Procedure knowledge and practice at the end of the 2010 and 2011 rugby seasons. During 2011, coaches in the intervention zone were exposed to a range of strategies to promote Mayday Safety Procedure diffusion which were planned by following Step 5 of the Intervention Mapping protocol. Coaches in the other four zones were exposed to usual strategies to promote Mayday Safety Procedure diffusion. Results Using the RE-AIM evaluation framework, statistically significant improvements were found among intervention zone coaches in: knowledge of most Mayday Safety Procedure key criteria; the number of coaches recognising their zone policy requiring them to train players in the Mayday Safety Procedure; frequency of provision of Mayday Safety Procedure training to players; coach perceptions of the quality of Mayday Safety Procedure training for players; and in confidence that referees could implement the Mayday Safety Procedure during a game if required. Conclusions The findings suggest that the translation of injury prevention policy into community practice can be enhanced by developing and implementing a theory-informed, context-specific diffusion plan, undertaken in partnership with key stakeholders.

Background/aim Concussion guidelines exist for multiple community sports. Parents are key stakeholders in guideline implementation and in appropriate responses following concussive injury. The purpose of this qualitative investigation was to understand how parents of community-level Australian Football (AF) players experience and perceive concussion guidelines in order to inform the design and implementation of concussion guidelines in community sport. Methods A cross-sectional qualitative approach was adopted to allow for an open and detailed exploration of the views of parents of junior community AF players (ie, those aged

Musculoskeletal injuries during military and sport-related training are common, costly and potentially debilitating. Thus, there is a great need to develop and implement evidence-based injury prevention strategies to reduce the burden of musculoskeletal injury. The lack of attention to implementation issues is a major factor limiting the ability to successfully reduce musculoskeletal injury rates using evidence-based injury prevention programs. We propose 7 steps that can be used to facilitate successful design and implementation of evidence-based injury prevention programs within the logical constraints of a real-world setting by identifying implementation barriers and associated solutions. Incorporating these 7 steps along with other models for behavioral health interventions may improve the overall efficacy of military and sport-related injury prevention programs.

Sports injuries are a significant clinical and public health concern. There is a growing call to improve the translation of available evidence-based and expert-informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent, and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.

Despite recent interest in understanding the implementation context for sports injury prevention interventions, little research attention has been paid to the management structures and processes of community sporting organisations. This study developed expert consensus about the importance of Occupational Health and Safety (OHS) setting-related safety management system (SMS) principles and performance indicators in the context of Australian community sporting organizations, and the feasibility of these organisations meeting the requirements for the SMS performance indicators. Twenty-nine sports injury prevention, community sports administration and OHS SMS experts participated in a three-round online Delphi study by rating the importance of 64 SMS performance indicators categorised under the five principles of Commitment and Policy; Planning; Implementation; Measurement and Evaluation; and Review and Improvement. Overall, consensus agreement – define as rated ‘essential’ or ‘very important’ on a five-point scale by ⩾75% of the participants in Round 3 – was reached for 57 performance indicators. Ten (15%) performance indicators were rated as ‘very difficult’ or ‘relatively difficult’, and six (9%) were rated as ‘very easy’ or ‘relatively easy’ on a four-point scale, by ⩾75% of participants. This research suggests that the guiding principles and associated performance indicators that underpin OHS safety management systems in the workplace are very relevant and applicable to community sporting organisations in Australia. However, considerable work is required to build organisational capacity to be able to develop and implement meaningfully and useful SMSs to prevent sports injuries in the most common setting in which they occur.

Objectives Energy-dense, nutrient-poor food and drink (‘junk food’) brands sponsoring sport is a growing public health concern. This study explored sports administrators' perceptions of the barriers to rejecting junk food sponsorship. Study design This study used concept mapping. Methods The Concept Systems Global MAX™ web platform was used to collect and analyse data from 29 sports administrators across all levels of sport in Victoria, Australia. Results Brainstorming generated 33 barriers to rejecting junk food sponsorship. After the barriers were synthesised and edited, participants sorted and rated 32 barriers. Multidimensional scaling and hierarchical cluster analysis identified a four-cluster solution: community attitudes and values (seven barriers); junk food is the easy sell (retail; five barriers); financial viability (16 barriers); and organisational capability (policy and governance; four barriers). The financial viability barriers were rated the most important (mean = 3.65 of 5) and the hardest to overcome (1.42). The organisational capability (policy and governance) barriers were rated the least important (2.14) and the easiest to overcome (3.20). Conclusions Sports administrators clearly perceive that rejecting junk food sponsorship could place significant financial strain on their organisations. There appears to be considerable scope to build the capacity of sporting organisations to rejecting junk food sponsorship. Despite the literature indicating that most parents think junk food companies are not suitable sponsors, sports administrators perceive that there is a broad public acceptance of junk food sponsorship in sport. The fact that sports administrators perceive a link between junk food sponsorship and the lack of healthy options at club canteens and venue food outlets adds an additional, not previously identified, level of complexity to the junk food sponsorship in sport debate.

Background Increasing participation by women in Australian football (AF) has made understanding their specific injury prevention needs a priority. In other sports, men and women have different injury profiles. This study aims to provide the first overview of self-reported injuries in women9s AF. Methods Nationwide survey of women aged 17+ years who played in an AF competition was conducted following the 2014 playing season. The players9 self-reported worst injury from the 2014 season is presented according to injury type, body part injured, treatment sought and games/training missed. Results Three-quarters of 553 respondents (n=431, 78%) reported at least 1 injury. Over half (n=235, 55%) of injuries were to the lower limb. Ankle ligament tears/sprains (n=50, 12% of all injuries) and knee ligament tears/sprains (n=45, 10%) were most frequent lower limb injuries reported. Two-thirds (65%) of all lower limb injuries led to at least 1 missed game. Of 111 (26% of all injuries) upper limb injuries reported, over half (n=57, 62%) were to the hand/fingers/thumb, including fractures (n=28, 6% of all injuries), ligament tears/sprains (n=18, 4%) and dislocations (n=11, 3%). Half of the upper limb injuries (51%) resulted in players missing matches/training. Conclusions The most frequent self-reported worst injuries for women playing AF were joint damage to the ankle and knee. A prospective injury study is needed to confirm the causes and rate of these lower limb injuries to identify the most suitable prevention interventions.

Ensuring community clubs implement centrally developed sports policy is a challenge for most sports. One hundred and eighty four (70% male, 68% aged 40 to 59 years) community Australian football club representatives (first-aid providers, administrators, parents, coaches, etc.) from across the country provided their perceptions of an Australian Football League-developed sports trainer policy and associated workforce training structure (jointly referred to hereafter as ‘the policy’) via an online survey. This article presents a qualitative analysis of the open-ended questions within the survey using the analytical lens of symbolic interactionism. Respondents generally supported the intent of the policy and identified many potential benefits of the policy, if adopted. They also provided insight into the organization and operation of community sports clubs and stressed that the volunteer intensive nature of community sport needs to be accommodated in the policy to enhance the likelihood of community-level acceptance and implementation. Successful community club implementation of this type of centrally developed micro-level sport policy requires that policy-makers understand and address the implementation context-related perspectives raised in this study.

Multi-purpose recreation facilities (MPRFs) are a popular setting for physical activity and it is therefore important that they are safe for all patrons. However, the attitudes of MPRF users towards safety are a potential barrier to the success of injury prevention programmes implemented within MPRFs. This article reports a survey of the safety attitudes of over 700 users of four indoor MPRFs. Factor analysis of 12 five-point Likert scale statements showed that the attitudes clustered around three major dimensions - the importance of safety, the benefits of safety and the perceptions of injury risk. Together, these three dimensions accounted for 49% of the variability in the attitudes. More than 85% of respondents agreed/strongly agreed that: safety was an important aspect of physical activity participation; being injured affected enjoyment of physical activity; people should adopt appropriate safety measures for all physical activity; and individuals were responsible for their own safety. The MPRF users, particularly women and older people, were generally safety conscious, believed in adopting safety measures, and were willing to take responsibility for their own safety. Facility managers can be confident that if they provide evidence-based injury prevention interventions in these settings, then users will respond appropriately and adopt the promoted behaviours.

Objective For effective sports injury prevention, information is needed about the implementation context for interventions. This study describes coaches9 feedback on the implementation of an evidence-informed injury prevention programme in community junior netball using coaches9 perceptions and the RE–AIM framework. Methods A lower-limb injury prevention programme (Down to Earth; D2E), for teaching safe-landing techniques, was delivered to 31 coaches from 31 junior community netball teams in a 1-h workshop. Coaches then delivered a 6-week programme at team training sessions starting in the week before the competition season commenced. 65% of coaches completed a feedback survey 17 weeks after they had delivered the programme. Results Most (88%) coaches believed that D2E improved their players9 ability to perform correct landing techniques in games and that players had retained these improvements over the season. The majority (83%) indicated that an improvement in player athletic attributes was the greatest advantage of D2E, followed by a reduction in injury risk. Identified barriers to implementing D2E were running out of time and very young players finding the drills too difficult. Coaches reported that they needed more ideas for training drills that could be incorporated into their programmes and believed that their own coaching training did not adequately prepare them to implement an injury prevention programme. Conclusions Although coaches believed that D2E was effective in developing correct landing techniques, some modifications are needed to make it more suitable for younger players and coach education by accreditation courses could be improved to support the implementation of injury prevention programmes.

This research investigated the under-explored area of safety in multi-purpose recreation facilities (MPRFs). Facility managers and other managerial staff (key informants) from four MPRFs in Victoria, Australia participated in semi-structured interviews. Safety was considered important from Occupational Health and Safety (OHS external (e.g. weather, demographic change); and governance (e.g. insurance, industry standards). Comprehensive, relevant and accessible industry safety standards, which focus not only on OH&S but equally on health promotion principles and public health perspectives linked to injury prevention, are required. Training is needed to reflect these broader and equally important perspectives. Health/injury, fitness/recreation and insurance sector links should be improved to ensure a consistent, sustainable approach to safety.

There has been increasing recognition of the need for effectiveness research within the real-world intervention context of community sport. This is important because, even if interventions have been shown to be efficacious in controlled trials, if they are not also widely adopted and sustained, then it is unlikely that they will have a public health impact. There is very little information about how to best conduct such studies, but application of health promotion frameworks, such as the RE-AIM framework, to evaluate the public health impact of interventions could potentially help to understand the implementation context. Care needs to be taken when directly applying the RE-AIM framework, however, because the definitions for each of its dimensions will depend on the level/s the intervention is targeted at. This paper provides a novel extension to the RE-AIM framework (the RE-AIM Sports Setting Matrix (RE-AIM SSM)), which accounts for the fact that many sports injury interventions need to be targeted at multiple levels of sports delivery. Accordingly, the RE-AIM components also need to be measured across all tiers of possible influence on the rate of uptake and effectiveness. Specific examples are given for coachdelivered exercise training interventions. The RE-AIM SSM is specific to the community sports setting implementation context and could be used to guide the delivery of future sports safety, and other health promotion, interventions in this area.

Issue addressed: Little is known about the effectiveness of once-weekly strength training programs for older adults based in community settings. This pilot study evaluated such a program to assess changes in the functional fitness of participants. Methods: A pre-test/post-test within subjects study design was used with new participants in the 10-week Staying Active, Staying Strong (SASS) program (all aged 50+ years). The Seniors Fitness Test (SFT) and SF-36 were used to assess functional fitness and health-related quality of life respectively. Perception of physical ability was assessed using a study-specific questionnaire. Pre- and post-test SFT and SF-36 scores were compared using paired t-tests. Frequency of responses was used to describe participant perceptions. Results: 110 evaluation participants (mean age 68.2 years; 85% female), 49% of those who completed the pre-test, also completed the post-test. Evaluation participants significantly improved their strength (assessed using arm curls and sit-to-stand); endurance (two-minute step test); flexibility (sit and reach, back scratch); and agility/dynamic balance (eight-foot up and go). SF-36 physical-functioning domain scores also significantly improved. Most participants reported improved strength, fitness, mobility, general well-being and confidence in performing daily activities. Conclusion: Weekly, community-based strength training programs show promise in improving the functional capacity, including the strength, of older adults. More thorough evaluation is now required to confirm these findings.

Background and aim The impact of any injury prevention programme is a function of the programme and its implementation. However, real world implementation of injury prevention programmes is challenging. Lower limb injuries (LLIs) are common in community Australian football (community-AF) and it is likely that many could be prevented by implementing exercise-based warm-up programmes for players. This paper describes a systematic, evidence-informed approach used to develop the implementation plan for a LLI prevention programme in community-AF in Victoria, Australia. Methods An ecological approach, using Step 5 of the Intervention Mapping health promotion programme planning protocol, was taken. Results An implementation advisory group was established to ensure the implementation plan and associated strategies were relevant to the local context. Coaches were identified as the primary programme adopters and implementers within an ecological system including players, other coaches, first-aid providers, and club and league administrators. Social Cognitive Theory was used to identify likely determinants of programme reach, adoption and implementation among coaches (eg, knowledge, beliefs, skills and environment). Diffusion of Innovations theory, the Implementation Drivers framework and available research evidence were used to identify potential implementation strategies including the use of multiple communication channels, programme resources, coach education and mentoring. Conclusions A strategic evidence-informed approach to implementing interventions will help maximise their population impact. The approach to implementation planning described in this study relied on an effective researcher-practitioner partnership and active engagement of stakeholders. The identified implementation strategies were informed by theory, evidence and an in-depth understanding of the implementation context.

This paper seeks to review the current international health-promoting sports club (HPSC) research, drawing together findings based on case studies from various countries to illustrate the status of HPSCs. In addition, future challenges for HPSC research and implementation are considered. The review includes six case studies from five countries. In summary, there are two major research themes in this area, namely ‘research into HPSC activity’ and ‘research into HPSC networks’. The first theme investigates the extent to which sports clubs and/or national sports organisations invest in health promotion (HP) – both in policy and practice. The latter theme is driven by an intention to widen the scope of HPSCs to reach novel internal actors, like parents, siblings, etc., and/or external non-sporting bodies, like communities, schools, etc. The future challenges for HPSC research require a better understanding of the motives, barriers and capacities of sports clubs and coaches. Sports organisations, clubs and coaches generally support the intent of the HPSC concept, but even with the best evidence- or theory-based HP programmes/guidelines/standards, nothing will happen in practice if the nature and capacities of sports clubs are not better acknowledged. Therefore, a call for embracing implementation science is finally made to enhance implementation.

Objectives Far fewer injury surveillance systems exist within community sport than elite sport. As a result, most epidemiological data on sports injuries have limited relevance to community-level sporting populations. There is potential for data from community club-based injury surveillance systems to provide a better understanding of community sports injuries. This study aimed to describe the incidence and profile of community-level Australian football injuries reported using a club-based injury surveillance system. Design Prospective, epidemiological study. Methods Sports trainers from five community-level Australian football leagues recorded injury data during two football seasons using the club-based system. An online surveillance tool developed by Sports Medicine Australia (‘Sports Injury Tracker’) was used for data collection. The injury incidence, profile and match injury rate were reported. Results Injury data for 1205 players were recorded in season one and for 823 players in season two. There was significant variability in injury incidence across clubs. However, aggregated data were consistent across football seasons, with an average of 0.7 injuries per player per season and 38–39 match injuries per 1000 h match exposure. A large proportion of injuries occurred during matches, involved the lower limb and resulted from contact. Conclusions Data from the club-based system provided a profile of injuries consistent with previous studies in community-level Australian football. Moreover, injury incidence was consistent with other studies using similar personnel to record data. However, injury incidence was lower than that reported in studies using player self-report or healthcare professionals and may be an underestimate of true values.

Physical inactivity (PI), a leading modifiable cause of disease and injury, is endemic in industrialised nations. Although considerable research has been undertaken in this field, we lack a system to synthesise the research literature to inform policy and identify research needs. The aims of this study were to (1) develop a system to classify physical inactivity intervention studies, (2) examine the distribution of PI interventions published in the peer-reviewed health literature using the system, and (3) consider implications for future research. We developed the Physical Inactivity Matrix (PIM), with 12 intervention points, created by the intersection of two dimensions: the intervention target (individual, physical environment and social/cultural environment) and the activity focus (transport, work/school, leisure and consumer). A formal search of the health research literature identified 529 eligible studies and each was classified into one of the 12 cells of the PIM. Most studies were categorised as: individual-leisure (68%), individual-work/school (12%) or social/cultural environment-leisure (13%). Only 4% targeted the physical environment. The findings of this initial application of the PIM support the call for greater investment in policies, interventions and research that focus on the relationship between the environment and PI, and transportation in particular. There would be merit in establishing the inter-rater reliability of the PIM and applying it to a wider variety of studies, including those published in the transportation and urban planning literatures. The PIM could be a useful tool for monitoring trends in research directions and funding levels over time and across countries.

Issue addressed: This paper describes and compares the first aid policies and practices of community sports clubs in northern Sydney, Australia. Methods: A piloted and validated questionnaire was used to assess the first aid policies and practices of 163 community netball, rugby league, rugby union, and soccer clubs. Response rate was 85%. Scales were developed to compare the adoption of first aid policies (range 0-14) and practices (range 0-32) across sports. Descriptive and inferential statistics were calculated to compare scores across sports. Results: The mean policy scores (95% Cl) were: netball 6.4 (5.9-7.0); rugby league 7.0 (6.0-8.0); rugby union 6.2 (5.5-6.9); soccer 3.9 (3.34.5). The mean practice scores were: netball 24.4 (23.2-25.6); rugby league 26.2 (24.3-28.1); rugby union 23.0 (21.1-24.9); soccer 17.6 (16.3-18.9). Soccer clubs achieved significantly lower mean policy (p 50% of all clubs reported not having a policy were: the attendance of qualified first aid providers at training (88%), infectious disease control (77%), pre-participation screening (72%), and head injury management (51%). Conclusions: There is room for improvement in the first aid policies and practices of community sports clubs, particularly soccer clubs, in northern Sydney. The lack of policies on the management of head injuries, preparticipation screening and infectious disease control and the poor attendance of qualified first aid providers at training should be addressed. (author abstract)

Despite increased national effort directed at sports injury prevention in Australia since the mid 1990s, there is a lack of information available about the sports safety policies and practices of community sports clubs. The aim of this study was to develop a valid and reliable sports safety audit tool (SSAT) to identify these safety policies and practices. A literature review identified issues to be covered by the SSAT. Consultation with "experts" and piloting the SSAT with 19 community sports clubs in metropolitan Sydney established face and content validity. Test-retest reliability was assessed in six clubs. Inter-rater reliability was assessed using twenty-four independent representatives from eight clubs. Face and content validity studies identified issues to include in the SSAT and improvements to language and layout. Test-retest reliability was 91% (range 68-100%). Inter-rater reliability ranged from 40-65% when missing data and 'don't know' answers were included, and from 62-75% when only 'definitive' answers were included. Club presidents and secretaries provided more definitive information than other informants. A preliminary list of safety issues that clubs addressed well or poorly was identified. The SSAT is a useful tool for gathering baseline data, benchmarking and targeting sports safety interventions with community sports clubs. Club presidents and secretaries are the preferred contact point and a face-to-face interview is the best administration mode. A tool to identify safety policies and practices is now available for use by anyone supporting community sports clubs to improve safety.

Background Female participation in Australian football (AF) has increased substantially over the last 5 years. Measures for reducing injury, whether through coaching, training or rules, are currently based on anecdotal injury experiences and research from male participants. To ensure the safety of female participants, consideration of their specific injury profile is required. Objective To provide the first understanding of injury in women9s AF. Design Two approaches were used. [1] compilation of four data sources: hospital-admissions, emergency department presentations, insurance claims, club-based collection; [2] online self-report survey of the worst injury sustained in the previous season. Setting Australia-wide Patients (or Participants) Female AF participants. Interventions (or Assessment of Risk Factors) Not applicable. Main Outcome Measurements Injury frequencies, injury types. Results The survey provided information on 431 self-considered ‘worst’ injuries. Over half (55%) were lower limb injuries of which joint ligament tears/sprains (29%), muscle strains (18%) and fractures (13%) dominated. The knee (18%), hand/fingers (16%), and ankle (14%) were most common body parts injured. Concussion comprised 6% of all injuries. Upper limb injuries were featured in the hospital admissions (n=500 injuries in total) and emergency presentations (n=1879), 47% and 51% of all injuries, respectively. These were largely wrist/hand injuries (32% and 40%). Most (65%) insurance claim injuries (n=522) involved the lower limb, 27% for knee ligament damage. A high proportion of concussions (33%) were reported in the club collected data (n=49). Conclusions Three injuries of particular significance were identified (knee joint ligament injuries, concussion, and wrist/hand/finger fractures, dislocations and sprains), which differ from key injuries identified in men9s football where lower limb muscle strains are most prevalent, particularly hamstring/groin strains. A comprehensive prospective injury study in women9s Australian football is now needed to support a robust collection of injury data, with a focus on identifying the cause and injury rates.

Objective To achieve expert consensus on the content of an exercise training program (known as FootyFirst) to prevent lower-limb injuries. Design Three-round online Delphi consultation process. Setting Community Australian Football (AF). Participants Members of the Australian Football Leagues' Medical Officers (n = 94), physiotherapists (n = 50), and Sports Science (n = 19) Associations were invited to participate through e-mail. Five people with more general expertise in sports-related lower-limb injury prevention were also invited to participate. Main outcome measures The primary outcome measure was the level of agreement on the appropriateness of the proposed exercises and progressions for inclusion in FootyFirst. Consensus was reached when ≥75% of experts who responded to each item agreed and strongly agreed, or disagreed and strongly disagreed, that an exercise or its progressions were appropriate to include in FootyFirst. Results Fifty-five experts participated in at least 1 Delphi round. In round 1, consensus was achieved that the proposed warm-up (run through and dynamic stretches) and the exercises and progressions for hamstring strength and for balance, landing, and changing direction were appropriate to include in FootyFirst. There was also consensus in round 1 that progressions for hip/core strength should be included in FootyFirst. Consensus was reached in round 2 that the revised groin strength and hip strength exercises should be included in FootyFirst. Consensus was reached for the progression of the groin strength exercises in round 3. Conclusions The formal consensus development process has resulted in an evidence-informed, researcher-developed, exercise-based sports injury prevention program that is expert endorsed and specific to the context of AF. Clinical relevance Lower-limb injuries are common in running, kicking, and contact sports like AF. These injuries are often costly to treat, and many have high rates of recurrence, making them challenging to treat clinically. Reducing these injuries is a high priority for players, teams, and medical staff. Exercise programs provide a method for primary prevention of lower-limb injuries, but they have to be evidence based, have currency with sports practitioners/clinicians, and utility for the context in which they are to be used. However, the comprehensive methods and clinical engagement processes used to develop injury prevention exercise programs have not previously been described in detail. This study describes the results of engaging clinicians and sport scientists in the development of a lower-limb sports injury prevention program for community AF, enabling the development of a program that is both evidence informed and considerate of expert clinical opinion.

BACKGROUND/AIMS: Despite evidence of the effectiveness of home safety interventions for preventing falls, there is limited uptake of such interventions within community services. Therefore, as part of a broader translational project, we explored issues underlying the implementation of an evidence-based home safety fall prevention intervention. METHOD: We conducted in-depth interviews with eight occupational therapists and two programme coordinators engaged to deliver a home safety fall prevention intervention. Six community health centres within two metropolitan regions of Melbourne, Australia participated. The RE-AIM framework and Diffusion of Innovations theory underpinned the interviews which examine the enablers and barriers to implementing a home safety fall prevention intervention and integrating it into routine community preventive practice. Analysis involved thematic and content analysis. RESULTS: Investment in the home safety for fall prevention intervention was supported and valued by coordinators and therapists alike, and a number of themes emerged which influenced implementation of this intervention. These included issues of: compatibility with organisational processes, individual practitioner practices and skills, a prevention approach, and client expectations; relative advantage in terms of flexibility of the process, client engagement and regional capacity building; complexity of implementing the intervention; and observability related to the invisible nature of fall prevention outcomes. CONCLUSION: Implementation of this home safety fall prevention intervention was influenced by a range of interrelated organisational, practitioner and client related factors. The findings from this project provide insights into, and opportunities to increase the sustainable implementation of the home safety fall prevention intervention into practice. Language: en

Preventing sports injuries requires behaviour change. Observational learning, or role modelling, is one way to develop self-efficacy, a key behavioural determinant. This premise underpins the social cognitive theory (SCT),1 and is the reason why role models have such a strong influence on behaviour. Most human behaviour is learned by observing others.2 Therefore, understanding role modelling and how to use it effectively could be important for sports injury prevention. Self-efficacy refers to an individual's confidence in their ability to enact a particular behaviour. According to the SCT, people need sufficient self-efficacy before they adopt a particular behaviour. Individuals with high self-efficacy are more likely to engage in a given behaviour.3 In our study of what influences community-level Australian football (AF) and rugby league coaches’ and sports trainers’ intention to use concussion guidelines,4 self-efficacy was a significant predictor of intention. Social modelling is one source of self-efficacy.5 Observing others can improve self-efficacy by altering perceptions of competency. Four processes govern observational learning: (1) attention: seeing and understanding …

Methods: Seventy-eight clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a larger injury prevention project (National Guidance for Australian Football Partnerships and Safety (NoGAPS)). System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively via semi-structured interviews with targeted-users (mainly sports trainers). Results: Across the 78 clubs, there was 69% reach (informed about/trained in use of injury surveillance system), 44% adoption (set up an online account with intention of recording injuries), 23% implementation (used system to record injuries throughout season) and 9% maintenance (used system over two consecutive seasons). Reach and adoption were highest in those leagues receiving concurrent support for the delivery of the NoGAPS injuryprevention trainingprogram(FootyFirst). Interviewees identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), sociocontextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online surveillance system). Discussion: The injury surveillance system was implemented andmaintained by only a small proportion of clubs. Outcomeswere best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with club personnel and organisations at all levels can enhance use of injury surveillance systems in community sport. Interview findings suggest that increased implementation could also be achievedby educating club personnel on the importance of recording injuries, asking leagues to create clearer injury surveillance guidelines, increasing club staffing, better remunerating those who conduct surveillance and offering flexible surveillance systems in a range of accessible formats. By increasing the use of surveillance systems, datawill better reflect the target population and increase our understanding of the injury problem in community sport.

Sporting bodies have developed guidelines for managing community-level players with suspected concussion in response to international consensus statements on concussion in sport. The purpose of this study was to examine the factors that influence the intended use of concussion guidelines among community-level coaches and sports trainers from two popular football codes in Australia: Australian football and rugby league.Cross-sectional survey.The survey, based on an extended theory of planned behaviour model, was completed by 183 Australian football coaches, 121 Australian football sports trainers, 171 rugby league coaches, and 142 rugby league sports trainers.Personal norms and self-efficacy were significant predictors of intention to use concussion guidelines, although the relationship between self-efficacy and intention was stronger among Australian football coaches than rugby league coaches. Analysis of the salient beliefs that underpin self-efficacy found that coaches, irrespective of football code, felt less familiar (χ(2)=25.70, p0.001) and less experienced (χ(2)=31.56, p0.001) than sports trainers in using the concussion guidelines. At the same time, Australian football personnel, irrespective of their team role, felt that they had insufficient time (χ(2)=8.04, p0.01) and resources (χ(2)=12.31, p0.001) to implement the concussion guidelines relative to rugby league personnel.Programmes aimed at increasing the intended use of sport concussion guidelines should focus on enhancing self-efficacy and leveraging personal norms. Increasing coaches' familiarity and experience in using the concussion guidelines would also be warranted, as would finding ways to overcome the perceived time and resource constraints identified among Australian football personnel.

Objective: To identify Department of Health programs with high potential to integrate evidence-based interventions to prevent falls among older people. Methods: Broad consultation within the Department followed by structured decision making. This work was informed by an analysis of Victorian hospital separations data and a Cochrane Systematic Review to identify relevant target groups and interventions. Ranking of the integration potential of interventions for a broad range of Department program areas was achieved through a facilitated workshop. A short list of program areas was then developed and scored, using pre-defined criteria, for their match with the interventions. Results: The ranked order of interventions, from most to least suitable for integration, were: multifactorial risk assessment and intervention; multi-component group exercise; medication review; occupational therapy-based home safety; home-based exercise; and first eye cataract surgery. Four of six program areas had a strong match (a score of ≥75% of the maximum score) with one or more of three interventions. Two program areas (Primary Care Partnerships, and Home and Community Care) had strong matches with three interventions (group- and home-based exercise; occupational therapy-based home safety) and were selected as priority areas. The Hospital Admissions Risk Program had strong and good matches respectively with home-based exercise and medication review, and was also selected. Conclusions: Our systematic methods identified Department programs with strong potential for integration of proven falls prevention interventions. Implications: Matching departmental programs and evidence-based interventions for integration may lead to more efficient resource allocation for falls prevention in Victoria.

OBJECTIVE:: High-quality sport-specific information about the nature, type, cause, and frequency of injuries is needed to set injury prevention priorities. This article describes the type, nature, and mechanism of injuries in community Australian Football (community AF) players, as collected through field-based monitoring of injury in teams of players. DATA SOURCES:: Compilation of published prospectively collected injury data from 3 studies in junior community AF (1202 injuries in 1950+ players) and 3 studies in adult community AF (1765 injuries in 2265 players). This was supplemented with previously unpublished data from the most recent adult community AF injury cohort study conducted in 2007 to 2008. Injuries were ranked according to most common body regions, nature of injury, and mechanism. MAIN RESULTS:: In all players, lower limb injuries were the most frequent injury in community AF and were generally muscle strains, joint sprains, and superficial injuries. These injuries most commonly resulted from incidental contact with other players, or from "overexertion." Upper limb injuries were less common but included fractures, strains, and sprains that were generally caused by incidental contact between players and the result of players falling to the ground. CONCLUSIONS:: Lower limb injuries are common in community AF and could have an adverse impact on sustained participation in the game. Based on what is known about their mechanisms, it is likely that a high proportion of lower limb injuries could be prevented and they should therefore be a priority for injury prevention in community AF. Language: en