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The Relationships Between Rugby Union, and Health and Well-Being

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Review Br J Sports Med: first published as 10.1136/bjsports-2020-102085 on 28 October 2020. Downloaded from The relationships between rugby union, and health and well- being: a scoping review Steffan A Griffin ,1,2 Nirmala Kanthi Panagodage Perera ,3,4 Andrew Murray ,1,5 Catherine Hartley ,6 Samantha G Fawkner,7 Simon P T Kemp ,2,8 Keith A Stokes ,2,9 Paul Kelly 10 1Centre for Sport and Exercise, ABSTRACT Indeed, there are widely published health benefits The University of Edinburgh, Objective To scope the relationships between rugby associated with participating in various individual Edinburgh, UK 7 8 2 and team sports, including improved aerobic Medical Services, Rugby union, and health and well- being. Football Union, London, UK Design Scoping review. fitness, cardiovascular function, metabolic fitness 3Centre for Sport, Exercise and Data sources Published and unpublished reports of and in some cases reduced mortality.9 Sport is also Osteoarthritis Research Versus any age, identified by searching electronic databases, considered an ‘underused yet important’ contrib- Arthritis, Botnar Research platforms and reference lists. utor to physical activity (PA) and health10 in the Centre, University of Oxford, Oxford, UK Methods A three- step search strategy identified World Health Organisation’s (WHO) 2019 Global 4Sports Medicine, Australian relevant published primary, secondary studies and grey Action Plan for Physical Activity. Institute of Sport, Bruce, literature, which were screened using a priori inclusion Despite global participation in rugby union, there Australian Capital Territory, criteria. Data were extracted using a standardised tool, has not been an overarching review of the evidence Australia 5 on the specific relationships between rugby union, Scottish Rugby Union, to form (1) a numerical analysis and (2) a thematic Edinburgh, UK summary. and health and well-being. A systematic review of 6Bodleian Health Care Libraries, Results and discussion 6658 records were identified, the potential health benefits of different sporting Oxford, UK and 198 studies met the inclusion criteria. All forms disciplines7 found 69 studies in total, but only 1 7The Institute for Sport, Physical of rugby union can provide health- enhancing physical focused on rugby union. Scientific efforts to date Education and Health Sciences, The University of Edinburgh, activity (PA). ’Non-contact’ and wheelchair rugby in have focused mainly on the relationship between Edinburgh, UK particular provide a wide range of physical and mental rugby union participation and injury. However, 8Faculty of Epidemiology and health and well- being benefits. The evidence is either given that health (as per WHO definition) is not Public Health, London School mixed or unclear in relation to ’contact’ rugby union and ‘merely the absence of disease or infirmity’,11 of Hygiene & Tropical Medicine, there is a need to consider the potential impact London, UK its effects on a range of physical health domains. Injury 9Department for Health, and concussion incidence rates are high for contact of rugby union participation on health and well- University of Bath, Bath, UK rugby union relative to other sports. being. Existing as well as potential future partici- 10Physical Activity for Health Conclusions A wide range of stakeholders as well pants and various other stakeholders (eg, parents, Research Centre, The University as existing and potential participants can use this medical professionals, schools, clubs and unions) of Edinburgh, Edinburgh, UK information to make a more informed decision about need to know the likely benefits as well as the risks participating in and promoting rugby union as a health- to make an informed choice about rugby union Correspondence to 12 http://bjsm.bmj.com/ Dr Steffan A Griffin, Centre enhancing activity. Industry and policy- makers can use participation. for Sport and Exercise, The this review to inform policies and strategies that look Therefore, and in line with this approach being University of Edinburgh, to increase participation rates and use rugby union used in different sports,13 the aim of this scoping Edinburgh EH8 9YL, UK; as a vehicle to contribute positively to population review is to inform participation, policy, advocacy steffangriffin@ gmail. com health. Further research understanding rugby union’s and research strategy by: Accepted 17 September 2020 contribution to PA as well as to muscle- strengthening (1) Identifying the relationships between rugby Published Online First and balance is indicated, as well as research examining union and various health and well-being outcomes. 28 October 2020 more health and well- being outcomes across more (2) Identifying evidence gaps and key research on October 2, 2021 by guest. Protected copyright. diverse cohorts. priorities for rugby union and health and well-being. METHODS A scoping review was considered the most appro- INTRODUCTION priate methodological approach to address this aim, Rugby union is a team-based sport, played in over especially given the iterative nature of researching 120 countries by over 8 million people.1 Multiple what is a novel topic. Scoping reviews are a type of forms of the game exist, with different rules as to review that seek to identify the nature and extent the number of players on each side (traditionally of research evidence for a given topic, in compar- © Author(s) (or their 15 or 7), and the degree of contact involved (full ison to, for example, systematic reviews that seek employer(s)) 2021. No commercial re-use . See rights contact/non- contact e.g. ‘tag’‘touch’). There are to provide an exhaustive appraisal and synthesis 14 and permissions. Published also adapted forms of rugby union for athletes with of research evidence. Scoping reviews are, there- by BMJ. disabilities, such as wheelchair rugby. fore, characterised as broad in nature, and are often As with many team and individual sports, any focused on mapping key concepts that underpin To cite: Griffin SA, Panagodage Perera NK, form of rugby union can involve moderate- to- research areas, and detailing the range of evidence 2 15–17 Murray A, et al. vigorous physical activity (MVPA), which along- available for a certain topic. Br J Sports Med side being ‘non- sedentary’ confers a wide range of This scoping review is based on Arksey and 2021;55:319–326. physical, mental and social well- being benefits.3–6 O’Malley’s five- stage scoping review process, and Griffin SA, et al. Br J Sports Med 2021;55:319–326. doi:10.1136/bjsports-2020-102085 1 of 11 Review Br J Sports Med: first published as 10.1136/bjsports-2020-102085 on 28 October 2020. Downloaded from regard to contact forms of rugby league and rugby union, there Table 1 Inclusion and exclusion criteria are inherently different rules, patterns of play and demands Inclusion criteria Exclusion criteria between both sports that limit comparability. ► Research articles not limited by age of study, by ► Anthropometric/biomechanical In regard to injuries, given the volume of research, and focus geographical location, language or setting. studies or studies relating to in this area, a decision was made to limit injury studies to system- ► Research articles that consider all abilities, performance, recovery or injury atic reviews (as per the published protocol).19 This has allowed age groups and gender of participants, as well prevention. as specific population groups (with a specific ► Opinion pieces/opinions, us to report review- level evidence on this topic, using previous health condition). magazine and newspaper syntheses conducted by other author teams, as has been done ► Research articles that consider all forms of articles. before in different subject areas.21 One potential approach rugby union (eg, 7- a- side/10- a- side, 15- a- side/ ► Research articles that do disability/touch/tag/beach/veterans/rugbyX). not scientifically investigate considered was to exclude studies in which the outcome variables ► Sources of information including primary measures of health, or directly are injuries or other acute health problems (as per previously research studies, reviews, systematic reviews, relate to function, or fitness (or published systematic reviews).7 However, we decided that this scoping reviews, meta- analyses, guidelines, as do not include data). well as grey literature to include unpublished ► Cadaver studies. approach might overlook a key concern that the author group’s and ongoing trials, annual reports, dissertations ► Health and safety/occupational professional experience tells us is critical to stakeholders, and and conference proceedings. issues not related to playing or would limit the applicability of this scoping review. ► Outcome variables that must be health related watching rugby union. in terms of: physical activity (eg, metabolic ► ‘Contact’ rugby league studies. equivalent of task value), physiological demand, ► Research articles in which the Search strategy mortality, morbidity or disease risk factors (eg, outcome variables were injuries The three- step search strategy (an initial limited search, followed effect on blood pressure); cardiorespiratory, or other acute health issues that neurological, metabolic or musculoskeletal are not systematic reviews or by the identification of key words and index terms, and then function/fitness; or social/psychological and meta- analyses. further searching of references and citations) using eight research more holistic measures of ‘well- being’. databases is summarised in online supplementary
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