What is the Current Evidence Base for Exercise-based MSI Prevention Strategies in the Military?

Research Paper Title

Exercise Programmes to Reduce the Risk of Musculoskeletal Injuries in Military Personnel: A Systematic Review and Meta-Analysis.


To evaluate the effect of exercise programmes on reduction of musculoskeletal injury (MSI) risk in military populations.

This was a systematic review and meta-analysis with a database search was conducted in PubMed/MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTdiscus, WHO International Clinical Trials Registry Platform Search Portal, Open Gray, National Technical Reports Library, and reference lists of included articles up to July 2019.

Randomised and cluster-randomised controlled trials evaluating exercise programmes as preventive interventions for MSIs in armed forces compared to other exercise programmes or to usual practice were eligible for inclusion.


Two authors independently assessed risk of bias and extracted data.

Data were adjusted for clustering if necessary and pooled using the random-effects model when appropriate.

The researchers included 15 trials in this review, with a total number of 14,370 participants.


None of the included trials appeared to be free of any risk of bias.

Meta-analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment could be performed for static stretching compared to no stretching (3,532 participants), showing low quality of evidence indicating no favourable effect of stretching.

Gait retraining, an anterior knee-pain targeted programme, and resistance exercises showed cautious favourable effects on reducing injury risk in military personnel.


The current evidence base for exercise-based MSI prevention strategies in the military is of low quality.

Areas worthy of further exploration include the effects of gait retraining, anterior knee-pain targeted programmes, agility training, and resistance training programmes, on medial tibial stress syndrome incidence, anterior knee pain incidence, attrition due to injuries and any type of MSI, respectively.


Dijksma, I., Arslan, I.G., van Etten-Jamaludin, F.S., Elbers, R.G., Lucas, C. & Stuiver, M.M. (2020) Exercise Programs to Reduce the Risk of Musculoskeletal Injuries in Military Personnel: A Systematic Review and Meta-Analysis. PM & R: The Journal of Injury, Function, and Rehabilitation. doi: 10.1002/pmrj.12360. Online ahead of print.


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