Why does it work? Proposed biomedical effect mechanisms of exercise-based injury prevention programmes in football (soccer) and handball: a scoping review of 104 studies

Objective To describe the proposed biomedical effect mechanisms in research on exercise-based injury prevention programmes in football (soccer) and handball. Design Scoping review of randomised controlled trials (RCT), cohort studies and case studies. Data sources MEDLINE via PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to 2024. Eligibility criteria Studies were included if they described exercise-based injury prevention programmes in football (soccer) or handball and provided a biomedical rationale or proposition of effect mechanisms. Peer-reviewed studies of all ages and both sexes at elite, subelite or amateur level were eligible. Results We included 104 studies (78 RCTs, 25 cohort studies, 1 case study) with sample sizes ranging from 10 to 4556 participants. Most studies (83%) were published after 2010, and interventions were reported to have an effect in 82% of the studies. Four main themes emerged describing the proposed effect mechanisms: neuromuscular control (47%), strength (39%), range of motion (11%) and physical fitness (3%). Definitions of key terms related to the intervention were provided in only 19% of studies, measurements of specific biomedical effect mechanisms were conducted in just 59% of studies. Conclusion Neuromuscular control and strength were the predominant proposed effect mechanisms for injury prevention programmes in football and handball. To better establish effect mechanisms of exercise-based interventions, future research should consistently define key terms related to the interventions and strive to identify and test causal mechanisms to optimise injury prevention programmes. All data relevant to the study are included in the article or uploaded as supplementary information.