SYSTEMATIC REVIEW Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis Roland Ro ¨ssler • Lars Donath • Evert Verhagen • Astrid Junge • Thomas Schweizer • Oliver Faude Published online: 17 August 2014 Ó Springer International Publishing Switzerland 2014 Abstract Background The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of partic- ular importance in youth. Objective The aim of this systematic review was to quantify the effectiveness of exercise-based injury pre- vention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables. Data Sources An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EM- BASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth). Study Selection Randomized controlled trials and con- trolled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age. Data Extraction Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model. Results Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7–17.8]), were included. The overall RR was 0.54 (95 % CI 0.45–0.67) [p \ 0.001]. Girls profited more from injury prevention than boys (p = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95 % CI 0.37–0.63]) and those aiming at all injuries (RR 0.62 [95 % CI 0.48–0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial (p = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better (p = 0.002) injury preventive effect (RR 0.45 [95 % CI 0.35–0.57], Z = 6.35, p \ 0.001) than studies without such exercises (RR 0.74 [95 % CI 0.61–0.90], Z = 3.03, p = 0.002). Conclusions The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can Electronic supplementary material The online version of this article (doi:10.1007/s40279-014-0234-2) contains supplementary material, which is available to authorized users. R. Ro ¨ssler (&) Á L. Donath Á T. Schweizer Á O. Faude Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, CH-4052 Basel, Switzerland e-mail: roland.roessler@unibas.ch E. Verhagen Department of Public and Occupational Health, EMGO? Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands E. Verhagen Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia A. Junge FIFA-Medical Assessment and Research Centre (F-MARC), Zurich, Switzerland A. Junge Medical School Hamburg (MSH), Hamburg, Germany 123 Sports Med (2014) 44:1733–1748 DOI 10.1007/s40279-014-0234-2