ReviewSports medicine (Auckland, N.Z.)2020
Analyzing Activity and Injury: Lessons Learned from the Acute:Chronic Workload Ratio.
Review in Sports medicine (Auckland, N.Z.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
41 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- A Systematic Review of the Relationship between Workload and Injury Risk of Professional Male Soccer Players.International journal of environmental research and public health · 2022Pooled it
- Is Cumulative Load Associated with Injuries in Youth Team Sport? A Systematic Review.Sports medicine - open · 2022Pooled it
- 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 medicine (Auckland, N.Z.) · 2020Pooled it
- The Relationship Between Games Missed for Rest or Load Management and Injury in the National Basketball Association, 2014-15 Through 2022-23.Sports medicine (Auckland, N.Z.) · 2026Observational
- Optimizing Athletic Performance: A Systems Framework for Adaptive Training, Load Management, and Decision-Making.Journal of functional morphology and kinesiology · 2026Review
- Time-Varying Associations Between Physical Activity and Injury Risk Among Children.Paediatric and perinatal epidemiology · 2026Article
- Multi-sensor fusion outperforms single indicators for fatigue prediction in university soccer players: a machine learning approach.Frontiers in physiology · 2026Article
- Morphological and Compositional Features of Lumbar Multifidus in Athletes with Chronic Non-specific Low Back Pain: A Systematic Review and Meta-Analysis.International journal of sports physical therapy · 2026Article
- Identifying contributory risk factors for neck pain in fast jet aircrew: a prospective cohort study.International archives of occupational and environmental health · 2025Article
- Article
- Changes of abdominal wall tension across various resistance exercises during maximal and submaximal loads in healthy adults: a cross-sectional study.BMC sports science, medicine & rehabilitation · 2025Article
- Comparison of External and Internal Training Loads in Elite Junior Male Tennis Players During Offensive vs. Defensive Strategy Conditions: A Pilot Study.Sports (Basel, Switzerland) · 2025Article
- Hamstring injury risk in male professional football: do external training loads play a role?BMJ open sport & exercise medicine · 2025Article
- Target trial framework for determining the effect of changes in training load on injury risk using observational data: a methodological commentary.BMJ open sport & exercise medicine · 2024Review
- A new statistical approach to training load and injury risk: separating the acute from the chronic load.Biology of sport · 2024Article
- Relationship between the contact load and time-loss injuries in rugby union.Frontiers in sports and active living · 2024Article
- Internal workload in elite female football players during the whole in-season: starters vs non-starters.Biology of sport · 2023Article
- Externally validated machine learning algorithm accurately predicts medial tibial stress syndrome in military trainees: a multicohort study.BMJ open sport & exercise medicine · 2023Article
- Which of the Physiological vs. Critical Speed Is a Determinant of Modern Pentathlon 200 m Front Crawl Swimming Performance: The Influence of Protocol and Ergometer vs. Swimming Pool Conditions.Sports (Basel, Switzerland) · 2022Article
- Is the Relationship between Acute and Chronic Workload a Valid Predictive Injury Tool? A Bayesian Analysis.Journal of clinical medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Injuries occur when an athlete performs a greater amount of activity than what their body can withstand. To maximize the positive effects of training while avoiding injuries, athletes and coaches need to determine safe activity levels. The International Olympic Committee has recommended using the acute:chronic workload ratio (ACWR) to monitor injury risk and has provided thresholds to minimize risk when designing training programs. However, there are several limitations to the ACWR and how it has been analyzed which impact the validity of current recommendations and should discourage its use. This review aims to discuss previously published and novel challenges with the ACWR, and strategies to improve current analytical methods. In the first part of this review, we discuss challenges inherent to the ACWR. We explain why using a ratio to represent changes in activity may not always be appropriate. We also show that using exponentially weighted moving averages to calculate the ACWR results in an initial load problem, and discuss their inapplicability to sports where athletes taper their activity. In the second part, we discuss challenges with how the ACWR has been implemented. We cover problems with discretization, sparse data, bias in injured athletes, unmeasured and time-varying confounding, and application to subsequent injuries. In the third part, conditional on well-conceived study design, we discuss alternative causal-inference based analytical strategies that may avoid major flaws in studies on changes in activity and injury occurrence.
Indexed as
Identifiers
32125672What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.