Original research| Volume 23, ISSUE 3, P252-257, March 2020

Download started.


General health complaints and sleep associated with new injury within an endurance sporting population: A prospective study

Published:November 01, 2019DOI:



      To examine the association between subjective health complaints, sleep quantity and new injury within an endurance sport population.


      Prospective cohort study.


      Ninety-five endurance sporting participants were recruited from running, triathlon, swimming, cycling and rowing disciplines. Over 52-week period participants submitted weekly data regarding subjective health complaints (SHCs) (cardiorespiratory, gastrointestinal and psychological/lifestyle), sleep quantity, training load and new injury episodes. Applying a 7- and 14-day lag period, a shared frailty model was used to explore new injury risk associations with total SHCs and sleep quantity.


      92.6% of 95 participants completed all 52 weeks of data submission and the remainder of the participants completed ≥30 weeks. Seven-day lag psychological/lifestyle SHCs were significantly associated with new injury risk (Hazard ratio (HR) = 1.32; CI 95% = 1.01–1.72, p < 0.04). In contrast, cardiorespiratory (HR = 1.15; CI 95% = 0.99–1.36, p = 0.07) and gastrointestinal (HR = 0.77; CI 95% = 0.56–1.05, p = 0.09) SHCs were not significantly associated with new injury risk. New injury risk had a significant increased association with 14-day lag <7 h/day sleep quantity (HR = 1.51; CI 95% = 2.02–1.13, p < 0.01) and a significant decreased association with >7 h/day sleep quantity (HR = 0.63, CI 95% = 0.45–0.87, p < 0.01. A secondary regression analysis demonstrated no significant association with total SHCs and training load factors (Relative Risk (RR) = 0.08, CI 95% = 0.04–0.21, p = 0.20).


      To minimise an increased risk of new injuries within an endurance sporting population, this study demonstrates that psychological/lifestyle subjective health complaints and sleep quantity should be considered. The study also highlights a lag period between low sleep quantity and its subsequent impact on new injury risk. No association was demonstrated between subjective health complaints, sleep quantity and training load factors.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Science and Medicine in Sport
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hulme A.
        • Nielsen R.O.
        • Timpka T.
        • et al.
        Risk and protective factors for middle- and long-distance running-related Injury.
        Sports Med. 2017; 47: 869-886
        • Johnston R.
        • Cahalan R.
        • O’Keeffe M.
        • et al.
        The associations between training load and baseline characteristics on musculoskeletal injury and pain in endurance sport populations: a systematic review.
        J Sci Med Sport. 2018; : 910-918
        • Van Tonder A.
        • Schwellnus M.
        • Swanevelder
        • et al.
        A prospective cohort study of 7031 distance runners shows that 1 in 13 report systemic symptoms of an acute illness in the 8-12 day period before a race, increasing their risk of not finishing the race 1.9 times for those runners who started the race: SAFER study IV.
        Br J Sports Med. 2016; 50: 939-945
        • von Rosen P.
        • Frohm A.
        • Kottorp A.
        • et al.
        Multiple factors explain injury risk in adolescent elite athletes: applying a biopsychosocial perspective.
        Scand J Med Sci Sports. 2017; 27: 2059-2069
        • Wiese-Bjornstal D.M.
        Psychology and socioculture affect injury risk, response, and recovery in high-intensity athletes: a consensus statement.
        Scand J Med Sci Sports. 2010; 20: 103-111
        • Thygesen E.
        • Lindstrom T.C.
        • Saevareid H.I.
        • et al.
        The subjective health complaints inventory: a useful instrument to identify various aspects of health and ability to cope in older people?.
        Scand J Public Health. 2009; 37: 690-696
        • Biggins M.
        • Cahalan R.
        • Comyns T.
        • et al.
        Poor sleep is related to lower general health, increased stress and increased confusion in elite Gaelic athletes.
        Phys Sportsmed. 2018; 46: 14-20
        • Schwellnus M.
        • Derman W.
        • Page T.
        • et al.
        Illness during the 2010 Super 14 Rugby Union tournament – a prospective study involving 22 676 player days.
        Br J Sports Med. 2012; 46: 499
        • Gouttebarge V.
        • Frings-Dresen M.H.
        • Sluiter J.K.
        Mental and psychosocial health among current and former professional footballers.
        Occupat Med. 2015; 65: 190-196
        • Main L.C.
        • Landers G.J.
        Overtraining or burnout: a training and psycho-behavioural case study.
        Int J Sports Sci Coach. 2012; 7: 23-31
        • Cahalan R.
        • Purtill H.
        • O’Sullivan P.
        • et al.
        A cross-sectional study of elite adult Irish dancers: biopsychosocial traits, pain, and injury.
        J Dance Med Sci. 2015; 19: 31-43
        • Killen N.M.
        • Gabbett T.J.
        • Jenkins D.G.
        Training loads and incidence of injury during the preseason in professional rugby league players.
        J Strength Cond Res. 2010; 24: 2079-2084
        • Samuels C.
        Sleep, recovery, and performance: the new frontier in high-performance athletics.
        Phys Rehabil Clin N Am. 2009; 20 (ix): 149-159
        • Lastella M.
        • Lovell G.P.
        • Sargent C.
        Athletes’ precompetitive sleep behaviour and its relationship with subsequent precompetitive mood and performance.
        Eur J Sport Sci. 2014; 14: S123-130
        • Milewski M.D.
        • Skaggs D.L.
        • Bishop G.A.
        • et al.
        Chronic lack of sleep is associated with increased sports injuries in adolescent athletes.
        J Pediatr Orthop. 2014; 34: 129-133
        • Dennis J.
        • Dawson B.
        • Heasman J.
        • et al.
        Sleep patterns and injury occurrence in elite Australian footballers.
        J Sci Med Sport. 2016; 19: 113-116
        • Reardon C.L.
        • Hainline B.
        • Aron C.M.
        • et al.
        Mental health in elite athletes: International Olympic committee consensus statement.
        Br J Sports Med. 2019; 53: 667-699
        • Johnston R.
        • Cahalan R.
        • Bonnett L.
        • et al.
        Training load and baseline characteristics associated with new injury/pain within an endurance sporting population: a prospective study.
        Int J Sport Physiol. 2019; 14: 590-597
        • Piggott B.
        • Newton M.J.
        • McGuigan M.R.
        The relationship between training load and incidence of injury and illness over a pre-season at an Australian football league club.
        J Austr Strength Cond Res. 2009; 17: 4-17
        • Soligard T.
        • Schwellnus M.
        • Alonso J.-M.
        • et al.
        How much is too much? (Part 1) International Olympic committee consensus statement on load in sport and risk of injury.
        Br J Sports Med. 2016; 50: 1030-1041
        • O’Sullivan K.
        • O’Sullivan P.B.
        • Gabbett T.J.
        Pain and fatigue in sport: are they so different?.
        Br J Sports Med. 2018; 52: 555
        • Bonnett L.J.
        • Powell G.A.
        • Tudur Smith C.
        • et al.
        Risk of a seizure recurrence after a breakthrough seizure and the implications for driving: further analysis of the standard versus new antiepileptic drugs (SANAD) randomised controlled trial.
        BMJ Open. 2017; 7
        • Main L.C.
        • Landers G.J.
        • Grove J.R.
        • et al.
        Training patterns and negative health outcomes in triathlon: longitudinal observations across a full competitive season.
        J Sports Med Phys Fitness. 2010; 50: 475-485
        • Williams J.M.
        • Andersen M.B.
        Psychosocial antecedents of sport injury: review and critique of the stress and injury model’.
        J Appl Sport Psychol. 1998; 10: 5-25
        • Johnson U.
        • Ivarsson A.
        Psychological predictors of sport injuries among junior soccer players.
        Scand J Med Sci Sports. 2011; 21: 129-136
        • Junge A.
        The influence of psychological factors on sports injuries. Review of the literature.
        Am J Sports Med. 2000; 28: S10-15
        • Morgan W.P.
        • Brown D.R.
        • Raglin J.S.
        • et al.
        Psychological monitoring of overtraining and staleness.
        Br J Sports Med. 1987; 21: 107-114
        • Saw A.E.
        • Main L.C.
        • Gastin P.B.
        Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review.
        Br J Sports Med. 2016; 50: 281-291
        • Madigan D.J.
        • Stoeber J.
        • Passfield L.
        Perfectionism and training distress in junior athletes: a longitudinal investigation.
        J Sports Sci. 2017; 35: 470-475
        • Linton S.J.
        • Shaw W.S.
        Impact of psychological factors in the experience of pain.
        Phys Ther. 2011; 91: 700-711
        • Jones C.M.
        • Griffiths P.C.
        • Towers C.
        • et al.
        Pre-season injury and illness associations with perceptual wellness, neuromuscular fatigue, sleep and training in elite rugby union.
        J Aust Strength Cond. 2018; 26: 6-16
        • Andersen M.B.
        • Williams J.M.
        Athletic injury, psychosocial factors and perceptual changes during stress.
        J Sports Sci. 1999; 17: 735-741