Barden C, Stokes KA, McKay CD. Implementation of the Activate injury prevention exercise programme in English schoolboy rugby union. 

The full paper can be found here.



Tell us more about yourself and the author team.

I [Craig Barden] am a final year PhD student at the University of Bath. My PhD is titled “Injury Epidemiology and Prevention in Schoolboy Rugby Union” and is funded by the Rugby Football Union. My PhD primarily revolves around assessing the effectiveness and implementation of the Activate injury prevention programme. Alongside this, I am collecting injury surveillance data from schools throughout England (Youth Rugby Injury Surveillance Project) to further understand the risks, types and mechanisms of injury in schoolboy rugby.

I have a degree in Sports Rehabilitation (a member of the British Association of Sports Rehabilitators). I am qualified as certified strength and conditioning specialist (member of the National Strength and Conditioning Association). Alongside completing my PhD, I have clinical positions as the ‘Head of Strength, Conditioning and Sports Therapy’ at SGS College and with the professional Bristol Flyers Basketball Club (yes, professional basketball exists in England!).

My PhD supervisors, Dr Carly McKay and Professor Keith Stokes co-authored the study. Carly’s expertise is in behaviour change, and intervention development, whilst Keith has extensive experience investigating injury risk and prevention across numerous sports. Both are directors at the Centre for Health and Injury and Illness Prevention in Sport (CHi2PS), the name for our research group at the University of Bath. The aim of CHi2PS is to deliver high-quality research through epidemiology, biomechanics, physiology, psychology and social science that has a real-world impact on the safety and welfare of athletes across all levels of the sport.  Our group’s research has evolved from a focus on rugby union to include various sports, including football, cricket, gymnastics, horse racing and Paralympic sports.


What is the story behind your study?

Activate is a rugby-specific injury prevention programme designed to be completed as a warm-up before training and matches. A randomised controlled trial found that completing Activate three times per week reduced match injury incidence by 72% and concussions by 59%. The programme was subsequently endorsed by national and international governing bodies worldwide. However, previous research suggests that just because an intervention works in a trial, it doesn’t guarantee that it will work in the real world. There are numerous reasons for this. We have to ask; Who is the programme aimed at? Are they aware of the programme? What do they perceive their injury risk to be?  What are their perceptions of the programme? Do they use the programme as intended? What barriers impede them from using the programme? Activate was only rolled out in 2017, and thus these questions have never been answered. Understanding Activate implementation will potentially help shape future dissemination and intervention strategies to maximise intervention uptake.


In your own words, what did you find?

We administered baseline and post-season surveys to English schoolboy rugby coaches (n=106) and players (n=571), investigating their perceptions of injury risk, prevention, and Activate. The survey questions were underpinned by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. RE-AIM is a tool used in various settings to plan and assess the implementation of health-related interventions.

Coaches and players ‘slightly agreed’ that rugby players are at high risk of injury. However, coaches held significantly stronger perceptions that rugby injuries could be prevented. At baseline, coaches had significantly greater Activateawareness than players (75% and 13%, respectively), with player awareness coming from their coaches. 76% of coaches reported using the programme at post-season, but players were largely unaware if they had used the programme. This suggests that coaches decide to adopt Activate with players unknowingly completing the programme, and thus targeting behaviour change in coaches may be more beneficial than players. Activate should take 20-minutes to complete and be completed thrice weekly. However, coaches reported that it took them around 10-15 minutes with a median adherence of twice per week. This suggests that the programme was not completed in full. Activate was only efficacious when completed three times per week, and sub-optimal exposure may hinder its preventative effect. Further work is needed to understand why coaches don’t use the programme as intended to address barriers that exist in their contexts.


What was the main challenge you faced in your study?

Post-season data collection was hampered slightly by COVID-19. Many coaches, who acted as gatekeeper to the players, were furloughed or tending to more important tasks, and thus we didn’t get as many post-season survey responses as hoped. However, the greatest challenge was completing the data analysis, with nearly 700 participants and around 200 data points for each individual. This was fairly arduous.


If there is one take-home message from your study, what would that be?

In the English schoolboy rugby union, coaches appear to be responsible for adopting and implementing Activate, with players largely unaware of the programme and completing it. As such, focusing strategies to improve coaches’ Activate awareness, knowledge of the programme and their self-efficacy to deliver it will help increase the uptake of the intervention and hopefully result in a notable decrease in injury risk.

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