Physical fitness and training factors associated with injury risk in aerobic gymnastics: a systematic review

Objectives Aerobic gymnastics involves repeated high-impact technical elements, yet discipline-specific evidence linking modifiable physical fitness and training exposures to injury risk remains fragmented. Thus, the aim of this systematic review was to synthesize evidence on physical fitness attributes and training-related factors associated with injury risk in aerobic gymnasts, and to appraise study designs, injury definitions, and measurement approaches. Methods A systematic search was conducted in PubMed, Scopus, and Web of Science Core Collection. It were eligible studies including aerobic gymnasts that reported quantitative associations between modifiable fitness and/or training exposures and injury outcomes. Risk of bias was executed with QUIPS. Results Twelve studies were deemed eligible. Injury/pain burden was substantial and typically involved the lower limbs and, in some samples, the lumbar region. Greater exposure (training volume/competition density) was consistently associated with injury occurrence in some studies, and lower-limb alignment/loading-distribution measures differed between injured and uninjured aerobic gymnasts, although screening models showed limited sensitivity. Psychosocial factors and limited prevention/healthcare uptake were also reported. Conclusion Current evidence suggests injury risk in aerobic gymnastics is multifactorial, with exposure and selected alignment/loading measures as recurrent correlates. Prospective, standardized surveillance and robust analytic approaches are needed. Systematic review registration https://osf.io/d6pmj .