{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T02:13:41Z","timestamp":1778552021669,"version":"3.51.4"},"reference-count":56,"publisher":"National Athletic Trainers' Association","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Understanding the relationship between training load and injury in runners may provide information on how to reduce the risk of running injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the association between training load and injury risk in recreational runners with the use of global positioning system data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study is part of a randomized controlled trial on running injury prevention among recreational runners. Runners who provided informed consent received 3 follow-up questionnaires and were requested to share global positioning system data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients or Other Participants<\/jats:title>\n                    <jats:p>Adult runners who registered for running events (distances, 10\u201342.195 km) in the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s)<\/jats:title>\n                    <jats:p>Global positioning system\u2013based training load was calculated as the acute\u2009:\u2009chronic workload ratio (ACWR) based on distance, duration, or speed of each training session. Cox regression models were performed to evaluate the association (hazard ratio [HR]) between the ACWR and running-related injury (RRI) onset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Global positioning system data from 461 participants (72.9% men; mean \u00b1 SD age = 43.8 \u00b1 12.4 years; 42.3% reported a new RRI during follow-up) were used for analyses with a total of 20\u2009425 training sessions. A positive association between the ACWR and RRI onset was found for distance (HR = 1.32; 95% CI = 1.00, 1.74) and duration (HR = 1.39; 95% CI = 1.07, 1.79). In the analyses adjusted for confounding variables, only the ACWR based on duration (HR = 1.33; 95% CI = 1.02, 1.74) remained positively associated with RRI onset. No significant association was found between the ACWR and RRI onset when excluding runners with an RRI at baseline (15.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified an association between the ACWR and RRI onset in runners based on distance and duration respectively. The clinical relevance of the identified associations is questionable given the small HRs and inconsistency in outcomes, which makes the role of general training load advice in the prevention of RRIs uncertain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4085\/1062-6050-0030.25","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:51:59Z","timestamp":1770771119000},"page":"341-347","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Global Positioning System\u2013Based Training Load and Injury Risk in Recreational Runners: A Large Prospective Study"],"prefix":"10.4085","volume":"61","author":[{"given":"Kyra L. A.","family":"Cloosterman","sequence":"first","affiliation":[{"name":"Department of General Practice, Erasmus MC University Medical Center Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert-Jan","family":"de Vos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sten","family":"Willemsen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"van Oeveren","sequence":"additional","affiliation":[{"name":"Move-Metrics, Ede, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edwin","family":"Visser","sequence":"additional","affiliation":[{"name":"FS Fysiotherapie, Capelle a\/d IJssel, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sita M. A.","family":"Bierma-Zeinstra","sequence":"additional","affiliation":[{"name":"Department of General Practice, Erasmus MC University Medical Center Rotterdam, The Netherlands"},{"name":"Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marienke","family":"van Middelkoop","sequence":"additional","affiliation":[{"name":"Department of General Practice, Erasmus MC University Medical Center Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2557","reference":[{"key":"i1938-162X-61-5-341-b01","series-title":"Prev Med","first-page":"14","article-title":"Global participation in sport and leisure-time physical activities: a systematic review and meta-analysis","volume":"95","author":"Hulteen","year":"2017","unstructured":"Hulteen RM,\nSmith JJ,\nMorgan PJ, et al. Global participation in sport and leisure-time physical activities: a systematic review and meta-analysis. Prev Med. 2017;95:14\u201325. doi:10.1016\/j.ypmed.2016.11.027"},{"key":"i1938-162X-61-5-341-b02","article-title":"Sportblessures in Nederland. Cijfers 2020. VeiligheidNL","author":"van Beijsterveldt","year":"2021","unstructured":"van Beijsterveldt A,\nStam C,\nValkenburg H. Sportblessures in Nederland. Cijfers 2020. VeiligheidNL. 2021. Accessed June 6, 2024. https:\/\/www.veiligheid.nl\/sites\/default\/files\/2022-04\/Cijferrapportage%20sportblessures%202020%20%281%29.pdf"},{"issue":"2","key":"i1938-162X-61-5-341-b03","series-title":"Sports Med","first-page":"367","article-title":"Health and economic burden of running-related injuries in Dutch trailrunners: a prospective cohort study","volume":"47","author":"Hespanhol Junior","year":"2017","unstructured":"Hespanhol Junior LC,\nvan Mechelen W,\nVerhagen E. Health and economic burden of running-related injuries in Dutch trailrunners: a prospective cohort study. Sports Med. 2017;47(2):367\u2013377. doi:10.1007\/s40279-016-0551-8"},{"issue":"10","key":"i1938-162X-61-5-341-b04","series-title":"Scand J Med Sci Sports","first-page":"2002","article-title":"The socio-economic impact of running-related injuries: a large prospective cohort study","volume":"31","author":"Sleeswijk Visser","year":"2021","unstructured":"Sleeswijk Visser TSO,\nvan Middelkoop M,\nFokkema T,\nde Vos RJ. The socio-economic impact of running-related injuries: a large prospective cohort study. 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BMC Sports Sci Med Rehabil. 2022;14(1):78. doi:10.1186\/s13102-022-00472-8"},{"key":"i1938-162X-61-5-341-b18","series-title":"Phys Ther Sport","first-page":"130","article-title":"Using wearable technology data to explain recreational running injury: a prospective longitudinal feasibility study","volume":"65","author":"Neal","year":"2024","unstructured":"Neal BS,\nBramah C,\nMcCarthy-Ryan MF, et al. Using wearable technology data to explain recreational running injury: a prospective longitudinal feasibility study. Phys Ther Sport. 2024;65:130\u2013136. doi:10.1016\/j.ptsp.2023.12.010"},{"issue":"9","key":"i1938-162X-61-5-341-b19","series-title":"Sports Med","first-page":"1613","article-title":"Is the acute: chronic workload ratio (ACWR) associated with risk of time-loss injury in professional team sports? A systematic review of methodology, variables and injury risk in practical situations","volume":"50","author":"Andrade","year":"2020","unstructured":"Andrade R,\nWik EH,\nRebelo-Marques A, et al. Is the acute: chronic workload ratio (ACWR) associated with risk of time-loss injury in professional team sports? A systematic review of methodology, variables and injury risk in practical situations. Sports Med. 2020;50(9):1613\u20131635. doi:10.1007\/s40279-020-01308-6"},{"issue":"12","key":"i1938-162X-61-5-341-b20","series-title":"Br J Sports Med","first-page":"676","article-title":"Educational online prevention programme (the SPRINT study) has no effect on the number of running-related injuries in recreational runners: a randomised-controlled trial","volume":"56","author":"Cloosterman","year":"2022","unstructured":"Cloosterman KLA,\nFokkema T,\nde Vos RJ, et al. 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Accessed June 6, 2024. https:\/\/www.veiligheid.nl\/sites\/default\/files\/2022-04\/Cijferrapportage%20sportblessures%202020%20%281%29.pdf"},{"issue":"2","key":"i1938-162X-61-5-341-b03","series-title":"Sports Med","first-page":"367","article-title":"Health and economic burden of running-related injuries in Dutch trailrunners: a prospective cohort study","volume":"47","author":"Hespanhol Junior","year":"2017","unstructured":"Hespanhol Junior LC,\nvan Mechelen W,\nVerhagen E. Health and economic burden of running-related injuries in Dutch trailrunners: a prospective cohort study. 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Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective. Phys Med Rehabil Clin N Am. 2005;16(3):651\u2013667, vi. doi:10.1016\/j.pmr.2005.02.002"},{"issue":"17","key":"i1938-162X-61-5-341-b08","series-title":"Br J Sports Med","first-page":"1030","article-title":"How much is too much? Part 1: International Olympic Committee consensus statement on load in sport and risk of injury","volume":"50","author":"Soligard","year":"2016","unstructured":"Soligard T,\nSchwellnus M,\nAlonso JM, et al. How much is too much? Part 1: International Olympic Committee consensus statement on load in sport and risk of injury. 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