Physical activity (PA) is any kind of physical movement that is performed through skeletal muscle contraction that requires energy expenditure. Active PA may decrease the risk of chronic non-communicable diseases (1, 2). Increased physical activity may lead to increased wellbeing in young people (3). Besides, active engagement in PA has been reported to improve physical fitness, such as VO₂ max indicators (4).

The World Health Organization (WHO) global recommendation for healthy physical activity for adults is 150 min of moderate-intensity activity (or equivalent) per week. For adolescents, the recommendation is 60 min of moderate- to vigorous-intensity activity per day (5). According to the WHO, one in four adults and 81% of adolescents worldwide are physically inactive (not in line with the WHO global recommendations on physical activity for health) (6). Whereas in China, the problem of physical inactivity amongst adolescents is even more serious, with a physical inactivity rate of 84.3% (7). A global study shows that the inactivity rate among college students is about 41.4% (8). The level of physical activity among university students has declined in different countries (9). Physical inactivity is the fourth most important risk factor for the occurrence of chronic diseases worldwide and is associated with higher mortality rates for Chinese residents (10). Appropriate strategies are adopted to promote increased physical activity (11).

Currently, almost all countries and regions, including China, are involved in a global movement to promote physical activity (12). Prevention of physical activity related injuries (PARI) should also be on the agenda throughout the promotion of physical activity (13, 14).

Physical activity-related injuries generally refers to injury to the human body during PA. The PARI covered in this study is consistent with the concept cited by Mechelen in Sports Medicine, 1992, and adapted by Bloemers (14, 15).

In the short term, the fear of re-occurrence of previous physical activity-related injuries among college students ultimately leads to a decrease in physical activity participation (16, 17). PARI not only affect the academic performance of university students but are also detrimental to future social progress and development in the long run (18). In addition, PARI among university students have a more direct and indirect economic and social cost to families and society (19).

There are significant differences in PARI between male and female (20). Males report more PARI than females in all countries, but the extent of these gender differences varies considerably between countries (21).

Therefore, injury prevention should be targeted. According to the “prevention sequence” model, to develop appropriate prevention strategies, epidemiological surveys should first be carried out to determine the characteristics of the target population (15). Previous studies have disclosed some influential factors in PARI (22, 23).

This study focuses specifically on the group of university students majoring in rehabilitation, a group for which there is a great demand due to the limited number of rehabilitation students and the severely overrepresented population in need of rehabilitation. At the same time, given the specific curriculum structure, rehabilitation students have a certain knowledge base related to sports injuries compared to general college students, which makes this group uniquely valuable to study. The prevalence and characteristics of PARI in the group of university students majoring in rehabilitation are not well understood. Therefore, the aim of this study was to explore gender-related predictors of PARI among university students majoring in rehabilitation. This will also provide a basis for more in-depth development of injury prevention mechanisms for general university students in the future.

This cross-sectional survey revealed that ~13% of college students majored in rehabilitation in China had suffered at least one PARI in the past 12 months, which was lower compared with the 22.7% prevalence rate in the previous study (28). In a survey on sports injuries among university students in Wuhan, the incidence of injuries among university students was 15.59% (29). In a survey of medical students, their lack of knowledge about physical health care led to a higher incidence of PARI (30). In contrast, the incidence of PARI was relatively low among university students in rehabilitation. The discrepancies in the rate of PARI found in this study could be related to the different study sample populations. Students in rehabilitation have background knowledge and skills in PARI concepts and related preventive measures (31).

In our study, males were at significantly higher risk of injury compared to females (0.44 vs. 0.18). Consistent with previous studies, different potential risk factors associated with PARI were observed between genders (14, 32). Males tend to be more actively involved in PA than females (6), which may increase their incidence of PARI. In addition, males are more likely to participate in competitive team sports such as basketball and football, which mostly involve high speed contact, jumping, sprinting, and spinning that are associated with common injury mechanisms (33). Given the gender-difference issue, the potential risk factors for the occurrence of PARI were experimentally explored separately by gender separately in our study.

Results of the study showed that the prevalence of PARI was higher in urban-dwelling females than those living in rural area (X² = 13.092, p < 0.01). This may be explained by several factors between urban and rural residence, including economic level, awareness and habit of regular PA (34). The popularity of bike-sharing in cities has made urban students keen to get around by bicycle (35). Improvements in urban sports infrastructure, such as the creation of basketball courts and large squares, as well as public sports equipment, such as outdoor fitness equipment and sports facilities, have increased opportunities for students living in urban areas to participate in sports and leisure activities (36). To some extent, the above factors may be accounted for the different PARI rate between urban and rural dwelling students. Regarding the geographic and economic regional distribution, injury rates were much higher for both males and females in the eastern China, which may be due to differences in PA levels and awareness of injury prevention in each region (37).

Additionally, it is found that the rate of PARI was higher amongst members of sports teams than those non-sports team members, for both males and females (p < 0.05). This is partly because members of sports teams are usually required to attend regular training sessions and participate in different types of sports competitions, so the chances of PARI are higher (38).

For males, the higher the annual household income per capita, the greater the risk of PARI (Chi Square, same as above x² = 9.724, p < 0.05). Those with higher household income are likely to be of middle-class or above social status and may place more emphasis on exercise and physical fitness. Students in a low-income family are less likely to be aware of the need for physical activity and afford popular sports, such as judo, gymnastics, tennis and so on (39).

In the current study, 29.1, 32.4, and 38.5% of the college students in rehabilitation responded engaged in high-, medium- and low-level PA, respectively. A significant correlation/association was observed between PA levels and the incidence of PARI in both males and females. Higher PA levels were associated with an increased risk of experiencing PARI, which echoed previous findings (40). The occurrence of PARI, in the short run, could place a negative impact on the motivation of college students to persevere in active PA due to fear of injury reoccurrence or aggravation (16, 17). In the long term, PARI may also increase the risk of other damage or disorders related to PA (41). Therefore, prophylactic measures to prevent PARI need to be advocated whilst promoting active PA engagement.

According to the findings, males who never warm up before exercise were less likely to be injured than those who always warm up. Several studies suggest that warming up is not associated with PARI (42), and more alternatives to warming up before exercise are more conducive to reducing PARI risk (43).

Risk-taking behaviors have been identified as a major contributor to PARI (44), and the results of this study showed that students with antisocial behaviors were at a higher risk for PARI (p < 0.05). Risk-taking behavior may be related to cognitive ability, which could explain why risk-taking behavior increases the risk of PARI (37). Poor awareness of risks also increases the odds of developing PARI (45).

In summary, this cross-sectional study had a relatively large sample size. It was possible to conduct a nationwide survey of rehabilitated college students in a low-cost electronic format. However, there are several limitations in the study. First, the cross-sectional design limited the findings of the study and no causal relationships could be drawn. In addition, the study was a self-administered questionnaire and did not include objective measures. Considering these limitations, longitudinal studies should be conducted in the future to expand the total sample size and sample specialty. Where necessary, measurement tools that objectively record physical activity could be used to avoid these limitations.

Physical activity-related injuries is not an uncommon health issue amongst Chinese college students majored in rehabilitation. The prevalence rates of PARI vary between male and female students. Different risk factors were found associated with the occurrence of gender-specific PARI in the study. For male students, participation in sports teams, having a high level of PA as well as with antisocial behavior were risk factors for developing PARI. Regarding female students, sports team membership, a higher level of PA, with antisocial behavior, as well as regional differences, were associated with elevated odds to suffer from PARI. Our findings may play an important role in the development of physical activity-related prevention programmes for college students majoring in rehabilitation, with attention to differences between genders. In addition, they also play a more important role in promoting physical activity and physical activity-related injury prevention among college students in general majors. These results could increase young people's awareness of physical activity and physical activity-related injuries and better avoid sports injuries while promoting physical activity. Also, in the future prevention of physical activity-related injuries among general college students, different measures could be taken to address the gender differences in physical activity injuries.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by the study was approved by the Ethics Committee of the Sixth Hospital of Sun Yat-sen University (IEC Ref: E2020035). The patients/participants provided their written informed consent to participate in this study.

YY and WY: conception of ideas and experimental design. YY and YW: data collection, analysis, and manuscript writing. LX, YW, FB, WY, and YJ: writing—review and editing. WY: editing and supervision. All authors contributed to the article and approved the submitted version.

This study was supported by the grants from the Guangdong Hopson-Pearl River Education Development Foundation (Grant Number H20190116202012724).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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