Acute:chronic workload ratio and load management for team sports: a multilevel meta-analysis
Liangbi Ding, Anthony Weldon, Jiaqing Xu, Shane Malone, Jaime Sampaio, Zhiyong Zhang et al. · Frontiers in Public Health · 2026
Objective: The acute:chronic workload ratio (ACWR) has been widely used to monitor training load and injury risk in team-sport athletes. However, its practical utility remains debated because of methodological heterogeneity across load metrics, calculation
Methods: , time-window definitions, sport types, and injury definitions. This systematic review and multilevel meta-analysis aimed to quantify the association between ACWR and injury risk in team-sport athletes and to examine potential moderators.
Methods Four electronic databases were searched from inception through October 2024. Prospective cohort studies or trials were eligible if they included team-sport athletes, reported associations between ACWR and injury outcomes, and provided sufficient data for effect size extraction or conversion. Study characteristics, participant information, injury definition, load metric, ACWR calculation
Method: , time window, sport type, and effect estimates were extracted. Effect sizes were converted to Hedges’ g and pooled using a three-level random-effects model.
Results: 41 studies met the inclusion criteria, and 16 studies involving 797 athletes were included in the meta-analysis. Elevated ACWR showed a small-to-moderate association with higher injury risk (g = 0.35; 95% CI, 0.16–0.54), with substantial heterogeneity (I 2 = 95.8%). Stronger associations were observed for contact and non-contact injuries, whereas effects were not significant for time-loss injuries or other moderators.
Conclusion: Elevated ACWR may be associated with increased injury risk in specific contexts, but current evidence does not support its use as a stand-alone causal or predictive model. ACWR should be interpreted as a contextual monitoring indicator within individualized, multi-marker load-management systems. Systematic review registration The systematic review was registered in PROSPERO under the unique identifier CRD420245127618.