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Sports and exercise medicine
Research
Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada
  1. Tracy A Blake1,9,2,
  2. Patricia K Doyle-Baker1,3,
  3. Brian L Brooks4,5,6,7,
  4. Luz Palacios-Derflingher1,
  5. Carolyn A Emery1,6,7,8
  1. 1 Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Alberta, Canada
  2. 2 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
  3. 3 Faculty of Environmental Design, University of Calgary, Calgary, Alberta, Canada
  4. 4 Neurosciences Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
  5. 5 Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
  6. 6 Cumming School of Medicine, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
  7. 7 Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  8. 8 Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  9. 9 Allied Health Department, University Health Network-Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Tracy A Blake; tracyablakeptphd{at}gmail.com

Abstract

Objective To examine the association between meeting physical activity (PA) volume recommendations and concussion rates in male ice hockey players aged 11–17 years.

Design Pooled prospective injury surveillance cohort data from the 2011–2012, 2013–2014 and 2014–2015 youth ice hockey seasons.

Participants Male Alberta-based Pee Wee (aged 11–12 years), Bantam (aged 13–14 years) and Midget (aged 15–17 years) ice hockey players participating in any of the three cohorts were eligible (n=1726). A total of 1208 players were included after the exclusion criteria were applied (ie, players with new/unhealed injuries within 6 weeks of study entry, missing 6-week PA history questionnaires, missing game and/or practice participation exposure hours, players who sustained concussions when no participation exposure hours were collected).

Outcome measures Dependent variable: medically diagnosed concussion. Independent variable: whether or not players’ self-reported history of PA (ie, hours of physical education and extracurricular sport participation) met the Canadian Society of Exercise Physiology and Public Health Agency of Canada recommendation of one hour daily during the 6 weeks prior to study entry (ie, 42 hours or more).

Results The PA volume recommendations were met by 65.05% of players who subsequently sustained concussions, and 75.34% of players who did not sustain concussions. The concussion incidence rate ratios (IRR) reflect higher concussion rates in players who did not meet the PA volume recommendations vs. players who met the PA volume recommendations among Pee Wee players (IRR 2.94 95% CI 1.30 to 6.64), Bantam players (IRR 2.18, 95% CI 1.21 to 3.93) and non-elite players aged 11–14 years (IRR 2.45, 95% CI 1.33 to 4.51).

Conclusion and relevance The concussion rate of players who did not meet the Canadian PA volume recommendations was more than twice the concussion rate of players who met recommendations among male Pee Wee players, Bantam players and non-elite level players. Further exploration of the impact of public health PA recommendations in a sport injury prevention context is warranted.

  • sports medicine
  • public health
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022735

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    Footnotes

    • Contributors TAB conceived of the study question, compiled, processed and analysed the data, and wrote the original version of the manuscript as part of her doctoral thesis. The original cohorts used to extract the population for this investigation were funded by grants on which CAE was a principal investigator, and PKD-B and BLB were coinvestigators. CAE (doctoral supervisor), as well as PKD-B and BLB (doctoral committee members) reviewed, and provided expertise to the study proposal and protocol development. LP-D was consulted in the development of the data processing and imputation protocol, and provided expertise with respect to the data analyses. All authors reviewed and approved of the final manuscript.

    • Funding This study is part of the PhD work of TAB, which was partially funded by Talisman Energy Fund in Support of Healthy Living and Injury Prevention through the Alberta Children Hospital Research Institute. BLB receives salary funding from the Canadian Institutes for Health Research (CIHR) Embedded Clinician Researcher Salary Award. CAE holds the Chair in Pediatric Rehabilitation through the Alberta Children’s Hospital Foundation. The Safe to Play study was funded by the Hotchkiss Brain Institute, and the Institute for Neurosciences, Mental Health, and Addiction Institute of the Canadian Institutes for Health Research (grant ID: TM2- 127049). The Alberta cohort of the Alberta Program in Youth Sport and Recreational Injury Prevention Program Hockey Research Study was funded by Alberta Innovates-Health Solutions (grant ID: 201201160/3685). Additional monetary support was provided by the McCarthy Tetrault Award, the Max Bell Foundation and the Alberta Children’s Hospital Research Institute (Alberta Children’s Hospital Foundation). The Sport Injury Prevention Research Centre at the University of Calgary is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee.

    • Competing interests Brooks reports and receives royalties for the sales of the Pediatric Forensic Neuropsychology textbook (2012, Oxford University Press) and three pediatric neuropsychological tests (Child and Adolescent Memory Profile (ChAMP, Sherman and Brooks, 2015, PAR), Memory Validity Profile (MVP, Sherman and Brooks, 2015, PAR) and Multidimensional Everyday Memory Ratings for Youth (MEMRY, Sherman and Brooks, 2017, PAR)). He has previously received in-kind support (free test credits) from the publisher of the computerised cognitive test (CNS Vital Signs, Chapel Hill, North Carolina). He acknowledges salary funding from the Canadian Institutes for Health Research (CIHR) Embedded Clinician Researcher Salary Award to study outcomes from concussion. TAB, PKD-B, LP-D and CAE have no competing interests to disclose.

    • Patient consent Obtained.

    • Ethics approval Ethics approval was obtained from the University of Calgary Conjoint Health Research Ethics Board for each study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We do not have a data sharing agreement. The results of this study will be publicly available.