The relationship of recreational runners' motivation and resilience levels to the incidence of injury: A mediation model.

Running participation has increased significantly in the last decade. Despite its association with different health-related aspects, athletes may experience adverse outcomes, including injuries. The aim of this study was twofold: to examine the relationship between runners' resilience levels, motivation and incidence of injury, on the one hand; and to analyse the mediation that intrinsic and extrinsic motivation has on the association between the number of injuries and psychological resilience levels among amateur athletes. The sample consisted of a total of 1725 runners (age: 40.40 ± 9.39 years), 1261 of whom were male (age: 43.16 ± 9.38), and 465 of whom were female (age: 40.34 ± 9.14). Athletes completed the Behavioural Regulation in Exercise Questionnaire (BREQ-3), the Resilience scale (CD-RISC 10), and an Injury retrospective survey. Three mediation models were constructed, and the results showed a significant indirect association of athletes' intrinsic motivation and resilience on the number of injuries (β = 0.022, CI = 0.007, 0.0) in mediation model 1, whereas extrinsic motivation was found to have no significant association on those variables (β = -0.062, CI = -0.137, 0.009) in mediation model 2. Model 3 showed significant differences with respect to resilience (p < 0.05) and intrinsic motivation (p < 0.05). Therefore, the mediation of intrinsic motivation on athletes' resilience levels and incidence of injury was demonstrated, i.e., it was found that intrinsic motivation was associated with a higher incidence of injury, while no such correlation was found for extrinsic motivation. This study shows that the amateur long distance runners with a high level of intrinsic motivation tend to suffer from a greater number of injuries, and at the same time psychological resilience was associated with a lower number of injuries.

Introduction

Participation in recreational running has increased in recent years in western countries [1,2]. An example of this is participation in the Behobia-San Sebastian half marathon race, where the total number of runners has almost tripled in the past ten years [3], reaching approximately 30,000 registrations in 2018. This increase in participation can be explained by the nature of recreational running or jogging, which provides a low-cost option with very few extra expenses. Given the limited free time available to most people in western countries, this sport can be easily adapted to tight schedules and different age ranges [4].

Physical Activity (PA) in general is associated with improvement in physical health [5] and with good mental health [6,7]. Recreational running or jogging, in particular, is also connected to participants’ health benefits [4,8-10]. However, overuse injury is more highly associated with running than with any other form of aerobic exercise [11,12] especially among novice runners, a field which has been little researched [1,13]. Working along similar lines, Van Gent et al. [14] took into account athletes’ experience and used a multifactorial approach to this area. They classified injury risk factors into: personal factors, running/training-related factors and health and lifestyle factors. Adopting a wider approach to injury in high-performance sport, McGregor [15] took into consideration a range of factors such as team environment, facilities, athletes-coach relationship, technical-tactical skills, and different psychological aspects such as confidence, resilience and motivation. Injuries usually cause periods away from the sports practice [16] and beyond physiological and physical attributes associated with athletes’ injuries, numerous studies have linked the incidence of sports injuries to some psychological attributes e.g. stress, resilience, etc [16-19].

The psychological aspect that has been analysed most has been the motivational characteristics of athletes, as several studies have been conducted on the basis of Self-Determination Theory (SDT) [20]. In this sense, motivational aspects also help to explain athletes’ participation in running practice [21]. Also, motivational aspects have been among the most analysed aspects within athletes’ personal factors, and have been associated with multiple variables, including motives for participation [21], resilience [22], and performance in endurance races [23], focusing mostly on intrinsic and extrinsic motivation [19]. The positive impact of motivation on runners’ health status has also been shown [21,24], and motivation has been analysed as part of the psychological factors that affect return-to-play decisions made by athletes after injuries [25,26]. However, the relationship of this variable to athletes’ physical injuries has not been specifically addressed yet and remains unclear.

Psychological resilience (Resilience is defined as the human ability to adapt in the face of tragedy, trauma, adversity, hardship, and ongoing significant life stressors), or the ability to overcome adversity, has been analysed in a variety of contexts [27]. Due to the importance that it has gained over the past decade, this construct has started to be studied in the sports context too [28-31]. Most definitions of resilience encompass two core concepts: adversity and positive adaptation. Psychological resilience was defined by Fletcher and Sarkar [29] as ‘the role of mental processes and behaviour in promoting personal assets and protecting an individual from the potential negative effect of stressors’ (p.16). Specifically referring to the sports context, Secades et al. [31] defined resilience as the capacity to face and positively adapt to highly stressful situations, which is influenced by personal and contextual aspects [32,33].

Resilience research in sports settings has focused mainly on competitive athletes of different sports [34] on seeking improved performance by individuals [22,28,30,35-38] and teams [39-41] and on how resilience is connected with contextual factors [42,43]. In recent studies, resilience has been associated with elite athletes’ injuries [16,33,44], and even though some research has linked this construct to athletes’ competitive level [45], very little has been explored in relation to amateur athletes [43] or connecting this psychological factor with non-professional athletes’ injuries.

Current trends agree that resilience is a multifactorial and highly complex concept [32,33], which has been lately associated with athletes’ injuries [16]. However, sports people’s injuries have not been associated with the internal and external motivations to date. In light of this, and due to the scarcity of research related to amateur athletes’ psychological characteristics and injuries, and taking into account that women’s participation is significantly lower at the Behobia-San Sebastian race, and the number of research is lower for women [3] differences between male and female athletes will be considered, and the following objectives were formulated for this study: (1) to examine the relationship between runners’ resilience levels, internal and external motivation and incidence of injury; and (2) to evaluate the mediation role of intrinsic and extrinsic motivation on the number of injuries and resilience levels of amateur runners. In line with these objectives, the first hypothesis was that the number of injuries would be negatively associated with the resilience level of athletes. Hence, those runners with greater psychological resilience would be related with a fewer number of injuries. The second hypothesis was that intrinsic motivation would have a greater incidence on athletes’ resilience than extrinsic motivation, and that it would be positively associated with the number of injuries suffered by athletes. Thus, it was hypothesised that resilience levels could be explained by greater intrinsic motivation, and this relationship would show a higher number of injuries in athletes.

Material and methods

Design and participants

This is a descriptive, quantitative, cross-sectional study. The sample was chosen randomly from among the participants of the 54th Behobia- San Sebastián half marathon. The athletes who ultimately did not take part in the race were excluded (Fig 1). The questionnaire was completed by 1725 runners (age: 40.40 ± 9.39 years), 73% of whom (n = 1260) were male (age: 43.16 ± 9.38 years) and 27% of whom (n = 465) were female (age: 40.34 ± 9.14 years), and all of them provided written informed consent to participation in the survey.

Fig 1

Flow chart of participants according to inclusion criteria.

Instruments

Regulation of behaviour in physical exercise

We used a modified version of the Behavioural Regulation in Exercise Questionnaire (BREQ-3; [46,47]), which includes 6 styles of behaviour regulation: amotivation, external, introjected, identified, integrated, and intrinsic. Each regulation style has 4 items, rated on a 5-point Likert-scale (1 = ‘not true for me’, 3 = ‘sometimes true for me’, 5 = ‘very true for me’). The BREQ-3 supplies mean scores for each regulation subcategory, where each subcategory reflects the continuum of self-determination (or autonomous behaviour).

Resilience

Resilience was evaluated using the short version of the CD-RISC, in particular, the Spanish adaptation by Notario-Pacheco et al. [48] It is made up of 10 items (those numbered 1, 4, 6, 7, 8, 11, 14, 16, 17 and 19) from the original scale developed by Connor and Davidson. [49] Questions are ordered from one to ten (e.g., ‘I can deal with any situation’) in a five-point Likert scale, where the lowest score indicates ‘never’ and the highest score means ‘almost always’. Consistent with past research [32,50], a sum score was calculated for the analysis. The CD-RISC has been shown to have good reliability (α = .88 and .89), test-retest reliability (.87), and convergent and divergent validity in the development of the scale [49,50]. Cronbach’s alphas for the various CD-RISC versions in the current study were .77 for the 5-factor CD-RISC, .89 for the unidimensional CD-RISC, and .87 for the CD-RISC-10.

Injuries questionnaire

To assess the incidence and type of injuries sustained by runners, a retrospective questionnaire [51] was used that was adapted from a previously validated survey [52]. Athletes were labelled as ‘injured’ or ‘non Injured’ at the time of the data collection, and a record was made of the number of injuries they had sustained over the preceding twelve months [52]. The tool was changed to make it suitable for this specific context, and included some sociodemographic questions (e.g., place of birth) and questions concerning athletes’ physical characteristics (e.g., weight, height) and expected performance, among other aspects. The initial question ‘Have you ever suffered from an injury while running training?’ was followed by a more detailed battery of questions to define the region and characteristics of the injury.

Procedure

Approval was obtained from the Ethics Committee of the University of Extremadura, Spain. The study was consistent with the Helsinki declaration of 1975. Participants were treated ethically under the American Psychological Association ethics code [53] regarding consent, anonymity and responses. Participants were contacted by email two weeks before the race, and provided with a detailed introduction to the study and with a link to enable them to access the survey. The questionnaire was created using Google Docs technology [54] and was tested prior to its release. At the end of 2017, Fortuna Sports club and Behobia-SS organisers were contacted and presented with the research project. A formal document specifying the research aims and the different variables and tools to collect the data was also provided to them. Several meetings were held in 2018 to adjust the different measurements of recreational runners’ characteristics. Data collection was carried out through Behobia-SS organisers, who emailed a link to the online survey to the 28,737 runners who took part in the race. The confidentiality and anonymity of the data was guaranteed to the participants, who were also informed that the data collection would be used for academic purposes and in order to improve the Behobia-SS event. The participating athletes were provided with an email address that they could contact for any queries they might have while completing the survey.

Statistical analysis

Firstly, descriptive statistics were shown, including means and standard deviations (SD). The differences between data by sex were calculated using the student’s t test and the chi-square test for continuous and nominal variables. The partial correlations controlled for by sex and age were calculated to analyse the relationships between resilience, intrinsic motivation and extrinsic motivation. The confidence interval obtained after the analysis of the covariance of the dependent variables showed p < 0.20.

The association of number of injuries with resilience and motivation indicators was tested using a linear regression model. Linear regression analyses were performed and adjusted for covariates by creating 3 models. Model 1 was further adjusted for age, sex and resilience; Model 2 was additionally adjusted for intrinsic motivation, and Model 3 was further adjusted for extrinsic motivation.

The PROCESS SPSS version 3.00 Macro was used for the mediation analysis between number of injuries and resilience. Two different models were established. For mediation model one, extrinsic motivation was specified as a mediating variable; resilience was used as an independent variable and the number of injuries was used as a dependent variable. For mediation model two, the dependent and independent variables were maintained, but the mediating variable was intrinsic motivation. The mediation hypothesis was tested using the bootstrap method, based on 10,000 bias-corrected 95% confidence intervals. The point estimate was considered significant when the confidence interval (CI) did not contain zero. The remaining statistical analyses were performed using SPSS version 3.0 for Windows, and the level of significance was set at p < 0.05.

Results

Table 1 shows the descriptive statistics of the study sample. In general, male participants presented lower levels of intrinsic motivation (p < 0.01) and a greater number of injuries than female participants (p < 0.001). However, no significant differences were found for age, resilience and intrinsic motivation (p > 0.05).

Table 1

Descriptive characteristics of the study sample and differences by sex.

	All participants		Males		Females		P
	M	SD	M	SD	M	SD
N	1725		1260		465
Age	42.40	9.39	43.16	9.38	40.34	9.14	0.871
Resilience	4.05	0.55	4.04	0.55	4.05	0.55	0.780
Intrinsic motivation	4.63	0.51	4.61	0.52	4.70	0.47	0.003
Extrinsic motivation	3.25	0.37	3.23	0.37	3.31	0.35	0.448
Injuries	1.21	0.86	1.26	0.86	1.06	0.84	0.000

Table 2 shows the associations between number of injuries and resilience and motivational indicators. In model 1, the number of injuries did not show a significant association with resilience levels after controlling for sex and age (β = -0.063; p = 0.089). However, in model 2 the number of injuries was positively associated with intrinsic motivation after controlling for sex, age and resilience (β = 0.123; p < 0.05). On the other hand, there was no significant association between the number of injuries and extrinsic motivation after additional adjustment for intrinsic motivation in model 3 (β = -0.102; p = 0.072).

Table 2

Associations of number of injuries with resilience, intrinsic motivation and extrinsic motivation.

	Number of injuries
	Model 1		Model 2		Model 3
	β	p	β	p	β	p
Age	0.013	0.000	0.013	0.000	0.013	0.000
Sex	-0.169	0.000	-0.180	0.000	-0.173	0.000
Resilience	-0.063	0.089	-0.085	0.023	-0.088	0.019
Intrinsic motivation			0.123	0.003	0.140	0.001
Extrinsic motivation					-0.102	0.072

p: significance level. β: Values are standardised; Model 1: Age + Sex + Resilience; Model 2: Age + Sex + Resilience + Intrinsic motivation; Model 3: Age + Sex + Resilience + Intrinsic motivation + Extrinsic motivation

The results of the simple mediation model 1 (Fig 2: Model 1) showed a significant indirect effect of resilience levels on the number of injuries (β = -0.062, 95% SD = 0.036, 95% CI [-0.137, 0.009]). There was a negative correlation between the number of injuries and resilience levels (β = -0.062, t = -1.695, p > 0.05), and between the number of injuries and extrinsic motivation (β = -0.058, t = -1.056, p > 0.05). However, there was a positive correlation between extrinsic motivation and resilience levels (β = 0.002, t = 0.125, p > 0.05). The results obtained in the simple mediation Model 2 (Fig 2: Model 2) showed a significant indirect effect of resilience on the number of injuries (β = 0.022, SD = 0.082, 95% CI [-0.007, 0.009]). There was a positive correlation between the number of injuries and resilience levels (β = -0.085, t = -2.277, p > 0.05). There were also positive correlations between the number of injuries and intrinsic motivation (β = 0.122, t = 3.014, p < 0.001), and between intrinsic motivation and resilience levels (β = 0.186, t = 8.566, p < 0.001).

Fig 2

Mediation model.

Discussion

The aim of this study was to analyse how psychological resilience and intrinsic and extrinsic motivation are associated with the number of injuries suffered by amateur runners. The mediating effect of intrinsic and extrinsic motivation on the variables indicated above was also analysed. The results showed a positive correlation between athletes’ intrinsic motivation and their number of injuries, such that the higher the athletes’ intrinsic motivation, the higher their number of injuries. At the same time, athletes’ resilience was negatively related to injuries, which resulted in high psychological resilience being significantly associated with fewer injuries suffered by runners. However, the effect of extrinsic motivation did not show a significant relationship to the number on injuries. Therefore, it was concluded that resilience level of amateur runners was associated with suffering fewer injuries, and that athletes who were more intrinsically motivated were more likely to have higher number of injuries.

The results obtained by mediational models 1 and 2 revealed that extrinsic motivation and intrinsic motivation have a positive effect on the relationship between resilience and the number of injuries. In both cases, a negative correlation was shown between athletes’ resilience and number of injuries, thus confirming the first hypothesis of this study. In this line, Zurita et. al [19] and Abenza et. al [17] showed the influence of stressors and resilience on athletes’ injuries, and emphasised the importance for athletes to control stress and their relationship with the capacity to overcome these adverse outcomes. According to our findings, the more resilient athletes were, the better they were able to manage stressful situations, which may provide an explanation on why these athletes suffered fewer injuries than athletes with a lower level of psychological resilience. These characteristics have been shown to vary depending on athletes’ competitive level [45]. For example, Jaenes et al. [37] and de la Vega, Rivera, and Ruiz [38] described high-performance endurance runners as having a hardy personality, and Sarkar and Fletcher [33] also analysed athletes’ resilience in connection with performance. Moreover, athletes’ resilience and injuries have been studied in different competitive levels [45] and especially in high-performance athletes [16,44]. However, these psychological characteristics have been examined in relation to overcoming injury processes, i.e. recovery after injury, but not as an attempt to explain the relationship between these psychological variables and the incidence of injury.

The results also showed that the intrinsic motivation variable acts as a mediator of the relationship between athletes’ resilience and their number of injuries to a greater extent than extrinsic motivation does, thus confirming the second hypothesis of this study. Model 2 revealed that there were statistically significant associations among the different variables: Intrinsic motivation with resilience levels (β = 0.186, t = 8.566, p < 0.001) and the number of injuries (β = 0.122, t = 3.014, p < 0.001). From these results it can be concluded that the more intrinsically motivated athletes are, the greater the number of injuries they may experience. This may be due to the fact that athletes who are more self-determined towards PA are more likely to strive for self-improvement, and at the same time tend to push their boundaries further, which could lead them to have more injuries. Previous research has shown how high-performance endurance athletes present a high level of intrinsic motivation [23], but the higher the athletes’ performance level, the higher their capacity of being resilient and facing stressful situations. High-performance athletes have been found to be more capable to face different setbacks in a more effective way [45].

The study has some limitations. Some variables such as the training load and training programmes followed by athletes that were not taken into account as potential elements influencing motivation and incidence of injury. Likewise, another limitation was that the information on injuries was self-reported. The cross-sectional study design was another limitation, as it does not allow establishing causal relationships between the study variables. Despite these limitations, very few studies have analysed the association between psychological variables and the incidence of injury to date, and as far as we are aware, no research has focused so far on analysing motivational and resilience variables in connection with the number of injuries suffered by athletes. In line with Sánchez et al. [45], it would be useful for future research to analyse motivational aspects in different performance levels and in different sports, with regard to the incidence of injury and the psychological resilience of sportspeople when overcoming adverse situations. This would show to what extent athletes’ number of injuries relates to their resilience levels. In addition, controlling for training frequency and duration, as well as nutrition, hydration, and some physiological and contextual aspects would help gain a better understanding of the relationship between personal psychological variables and the number of injuries sustained.

Conclusions

In conclusion, this study shows that amateur long-distance runners with a high level of intrinsic motivation tend to suffer a greater number of injuries. However, no relationship was identified between external motivation and athletes’ resilience and number of injuries. Psychological resilience was associated with a lower number of injuries by amateur runners.

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4 Nov 2019

PONE-D-19-21930

The relationship of recreational runners’ motivation and resilience levels to the incidence of injury: A mediation model

PLOS ONE

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Please provide the anonymized datasets underlying Tables 1 and 2, this should include the individual data points used for the analyses.

The cross-sectional design does not allow for causal relationships to be established, please ensure the language in the manuscript is revised to only refer to associations. Please also revise the conclusions section to ensure the claims are aligned to the data presented, for example, this fragment is unsupported as it implies a causal relationship while the design does not allow establishing a temporal sequence for the items measured ‘The ability to overcome adverse situations reduces injury rate’.

In light of the cross-sectional design, it is also unclear that the data can support conclusions about mediating effects, which is one of the objectives outlined, please either revise to remove such a claim or provide a stronger justification for how this can be addressed based on the design and data collected.

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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Reviewer #1: General

This paper concerns a cross-sectional study on the relationship between internal and external motivation, resilience and injury rates. It is an interesting and relevant study in a large group of runners that adds to the current literature. However, I have some concerns about the methods (injury definition, in- and exclusion criteria are missing) and privacy of the data (use of Google docs).

Additional comments

1. Is the manuscript technically sound, and do the data support the conclusions?

Partly, the data support the conclusions. However, in the conclusion a causal relationship is implied, while based on this cross-sectional study no causal relationships could be established. In addition, no injury definition is presented and it is therefore unclear how injury rate was calculated. Did you focus on acute or overuse injuries? Why ask for injuries during whole lifetime? This implies a long recall period.

2. Has the statistical analysis been performed appropriately and rigorously?

I am not sure, I am not familiar with process SPSS and mediation models. So, I would suggest to let an expert check these analyses and results.

3. Have the authors made all data underlying the findings in their manuscript fully available?

No, I couldn’t find links to the underlying datasets.

4. Is the manuscript presented in an intelligible fashion and written in standard English?

Yes

General comment: Throughout the manuscript ‘resilience’ is written in various ways, eg. ‘the capacity of sportspeople of overcoming adverse situations’ and. Please be consistent in your terminology.

Specific comments:

Abstract:

• The results of the first aim are not described.

• The statistical tests are not described, which makes it difficult to follow the results

• “(β = -0.062, CI= -0.137, 0.009)” Is the last number the p-value?

• In the discussion you describe the content of the discussion in the paper. However, I am curious about the actual content. What is described in this discussion, e.g. what are future research ideas / practical implications?

Introduction:

Line 67. The transition to the study of Van Gendt and studies on risk factors is a bit abrupt and needs more introduction.

Line 75. Which psychological attributes do you mean?

Line 80. This sentence is not complete. And why is motivational written with a capital (also line 82)?

Line 80-93. This paragraph contains a quite broad description of motivation in relation to running. Is that necessary? In my opinion it distracts the reader from your storyline. Potentially a change in the order of this paragraph or adding a few lines as introduction may help.

Line 124-131: The aims need some more introduction. Why study internal and external motivation in relation to injuries?

Line 127-131: In the abstract you describe another first aim. Which one is correct?

Line 132-139: I am a bit confused after reading the hypotheses, this may have to do with unclarity about the aims and unclarity about the dependent and independent variables? Please clarify.

Methods

Line 141-146. What were in- and exclusion criteria? A flow diagram may provide insight in the selection of runners for your analysis.

line 142. What do you mean with ‘ex post facto study’?

line 144-146. Years / years old. Please be consistent

Line 175-177. Information about how injury rate was calculated is missing. What was your injury definition? In addition, in the results no information about the duration or other characteristics of the injuries is presented.

Line 184-185. Google docs was used as survey tool: therefore I have some concerns about privacy of the participants, European regulations require stricter rules in regards to use of survey tools and the location where the data is saved, did you inform the runners about this?

Line 185-187. Please add some information about Fortuna club? How did you adjust the measurement tools? And why? To make them more appropriate for the target group?

Line 198-204. Why are you looking at differences between male and female runners in specific?

Line 219-221. What do you mean by ‘the remaining analyses’?

Results

Line 224-225. In table 1, the number of injuries is presented, however in the discussion you talk about injury rate. In my opinion, injury rate is a percentage and not a number. Adding an injury definition to the methods will provide clarity about your injury outcome.

Line 229-242. You describe ‘significant differences’, however I am not sure what differences you calculated. Also, I cannot find it in table 2.

Discussion

Line 280-283. This is a harsh statement. In my opinion, not presenting high levels of resilience does not automatically mean ‘less psychologically gifted’. Please rephrase.

Line 291, ‘to overcoming injury processes’ Do you mean recovery after injury/return to play?

Line 324-326 “In addition, controlling for training frequency and duration, as well as nutrition, hydration, and some physiological and contextual aspects would help to gain a better understanding of the relationship between personal psychological variables and the number of injuries sustained.”

How do you expect nutrition, hydration etc to influence the relation of motivation and injuries.

line 326-330. ”To conclude, an interesting line of research in the future would be to assess external motivation among amateur and professional athletes, in an attempt to see how external motivation differs according to the athletes’ level, their salary and the effect that television and social media have on them.” This comes a bit out of the blue for me. Please explain.

Conclusion

Line 336-339. Your conclusion that high resilience levels reduce injury rates implies a causal relationship. As you already described in the limitations section, causality cannot be established. Please rephrase.

Line 337. How could you improve resilience? Could you provide an example?

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10 Dec 2019

Cáceres, December, 10th 2019

Dear Daniel Boullosa,

The authors appreciate the time you devoted to reading our manuscript and helping us to craft an improved version of the investigation. We are pleased to clarify your concerns, which we believe have improved the quality and applicability of this work. Please, find below our responses to each of your observations. We have made a concerted attempt to systematically address the specific concerns raised for this revision and we have highlighted the alterations to this revision within the manuscript in red for your convenience.

Editor requests:

EDITOR: Please provide the anonymized datasets underlying Tables 1 and 2, this should include the individual data points used for the analyses.

AUTHORS: Thank you for your requirement. The authors are agreeing with contributions, so have decided to include the individual data points used for the analyses.

EDITOR: The cross-sectional design does not allow for causal relationships to be established, please ensure the language in the manuscript is revised to only refer to associations. Please also revise the conclusions section to ensure the claims are aligned to the data presented, for example, this fragment is unsupported as it implies a causal relationship while the design does not allow establishing a temporal sequence for the items measured ‘The ability to overcome adverse situations reduces injury rate’.

AUTHORS: We would like to thank reviewer for his comment in order to improve the quality of the manuscript. We have revised the language of the manuscript and we have removed causalities, using instead associations, in line with the cross-sectional design of the study. Lines:154-155, 313, 318-319, 365,366.

AUTHORS: We have revised the conclusion section as well, in order to ensure that the claims are aligned to the data presented: Line: 389-391: “Psychological resilience was associated with a lower number of injuries”.

EDITOR: In light of the cross-sectional design, it is also unclear that the data can support conclusions about mediating effects, which is one of the objectives outlined, please either revise to remove such a claim or provide a stronger justification for how this can be addressed based on the design and data collected.

AUTHORS: Thank you for your comment. The authors are agreeing with the contributions, so have decided to modify the description objectives by: evaluate the mediation role of intrinsic and extrinsic motivation on the number of injuries and resilience levels of amateur runners.

Reviewer(s)’ Comments to the AUTHORS:

EDITOR: General

This paper concerns a cross-sectional study on the relationship between internal and external motivation, resilience and injury rates. It is an interesting and relevant study in a large group of runners that adds to the current literature. However, I have some concerns about the methods (injury definition, in- and exclusion criteria are missing) and privacy of the data (use of Google docs).

AUTHORS: Thank you for your comment. We added the definition of Injury (Lines:78-79) as follows “Injuries usually cause periods away from the sports practice”.

AUTHORS: Thank you for your comment. We added the exclusion criteria in design and participants of the study: Lines: 160-161 “using as exclusion criteria the athletes who did not finally take part at the race” [15]

AUTHORS: Thank you for your comment. We added a more detailed information about privacy and informed consent used during data collection. Lines: 154-155. “all of them accepted the informed consent at the beginning of the survey”

Additional comments

Is the manuscript technically sound, and do the data support the conclusions?

EDITOR: Partly, the data support the conclusions. However, in the conclusion a causal relationship is implied, while based on this cross-sectional study no causal relationships could be established. In addition, no injury definition is presented and it is therefore unclear how injury rate was calculated. Did you focus on acute or overuse injuries? Why ask for injuries during whole lifetime? This implies a long recall period.

AUTHORS: Thanks a lot for your comments. We totally agree with reviewer. Thus, the causal relationship in the conclusion was removed and modified by associations, i.e.: “Psychological resilience was associated with a lower injury rate” (Lines: 389-391), and “which is associated at the same time with a lower number of injuries suffered by amateur runners” (lines: 392-393).

AUTHORS: Thank you for your comment. Injury definition was added in Lines 78-79. “Injuries usually cause periods away from the sports practice”, and injury rate was calculated asking athletes whether they were “injured” or “non injures”.

AUTHORS: Thanks a lot for your comments. Even though we did collect the data about the typology of injuries, we did not take this into account when analyzing the data in this research. It will be tested more specifically in future manuscripts, in fact we included in Lines: 377-377 “Another future research, following Quesada et. al [53] could be to analyse the factors associated with injury in recreational runners”

AUTHORS: Thank you for your comment. We did not ask about athletes’ injuries during the whole life, it would be definitely too long. We asked athletes about injuries during the last season, following different previous studies which support the idea to ask for injuries during the last twelve months Line 192: “gathering athletes’ number of injuries during the last twelve months” (Quesada, J. I. P., Kerr, Z. Y., Bertucci, W. M., & Carpes, F. P. (2019). A retrospective international study on factors associated with injury, discomfort and pain perception among cyclists. PloS one, 14(1), e0211197).

Have the authors made all data underlying the findings in their manuscript fully available?

EDITOR: No, I couldn’t find links to the underlying datasets.

AUTHORS: Thank you for your comment. We have included the data in the submission system in order to be consulted by reviewers and editor.

Is the manuscript presented in an intelligible fashion and written in standard English?

Yes

EDITOR: General comment: Throughout the manuscript ‘resilience’ is written in various ways, eg. ‘the capacity of sportspeople of overcoming adverse situations’ and. Please be consistent in your terminology.

AUTHORS: Thank you for your comment. We used resilience or psychological resilience replacing different definitions of it in other to be consistent: Lines: 149-370. Zurita-Ortega, F., Chacón-Cuberos, R., Cofre-Bolados, C., Knox, E., and Muros, J. J. (2018). Relationship of resilience, anxiety and injuries in footballers: Structural equations analysis. PLoS ONE, 13, e0207860.https://doi.org/10.1371/journal.pone.0207860

EDITOR: Specific comments:

1. Abstract

EDITOR: The results of the first aim are not described.

AUTHORS: Thank you for your comment. We added the results of the first aim. Lines: 39-41. “Model 3 showed that significant differences were found with respect to resilience (p < 0.05) and intrinsic motivation (p < 0.05).”

EDITOR: The statistical tests are not described, which makes it difficult to follow the results

AUTHORS: Thank you for your comment. We added the statistical test that we used in the Statistical analysis (page 9, line 225): "The association of number of injuries with resilience and motivations indicators was tested by linear regression model. Linear regression analyses were hierarchically adjusted for covariates by creating 3 models. Model 1 further adjusted for by age, sex and resilience; Model 2 was additionally adjusted for intrinsic motivation, and Model 3 further adjusted for extrinsic motivation.

The PROCESS SPSS version 3.00 Macro (Hayes, 2017) was used for the mediation analysis between number of injuries and resilience. Two different models were established. For mediation model one, extrinsic motivation was specified as a mediating variable; resilience was used as an independent variable and the number of injuries was used as a dependent variable. "

EDITOR: “(β = -0.062, CI= -0.137, 0.009)” Is the last number the p-value?

AUTHORS: Thank you for your comment. Regarding the question indicated, that value is the one corresponding to the confidence interval, resulting from the mediation analysis. If this interval does not pass the value of 0, it is therefore considered that the indirect effect is significant.

EDITOR: In the discussion you describe the content of the discussion in the paper. However, I am curious about the actual content. What is described in this discussion, e.g. what are future research ideas / practical implications?

AUTHORS: Thank you for your comment. For instance, we find that intrinsic motivation is associated with a higher incidence of injury. Therefore, it would be important that very intrinsically motivated amateur athletes, having a good training plan, and being leaded by professionals, so that, the association between their intrinsic motivation and incidence of injury will be weaker, even when they push themselves hard.

2. Introduction

EDITOR: Line 67. The transition to the study of Van Gendt and studies on risk factors is a bit abrupt and needs more introduction.

AUTHORS: Thank you for your comment. We added a little introduction to Van Gendt. Line 72: “In this direction”

EDITOR: Line 75. Which psychological attributes do you mean?

AUTHORS: Thank you for your comment. We added couple of examples of psychological attributed that have been analyzed related to athletes’ injuries. Line 82: “e.g. stress, resilience”

EDITOR: Line 80. This sentence is not complete. And why is motivational written with a capital (also line 82)?

AUTHORS: Thank you for your comment. We completed the sentence Line: 87,88 “characteristics of athletes” and we change the capital letter of motivation in lines 87 and 91.

EDITOR: Line 80-93. This paragraph contains a quite broad description of motivation in relation to running. Is that necessary? In my opinion it distracts the reader from your storyline. Potentially a change in the order of this paragraph or adding a few lines as introduction may help.

AUTHORS: Thank you for your comment. We added a little introduction in other to improve reader’s comprehension. Lines 88-89. “with several studies based on Self-Determination Theory (SDT) (Deci and Ryan, 2000)”

EDITOR: Line 124-131: The aims need some more introduction. Why study internal and external motivation in relation to injuries?

AUTHORS: Thank you for your comment. We added some more introduction in other to improve reader understanding. Lines: 136-139. “However, sportsmen injuries have not been associated yet with athletes’ motivational characteristics, or athletes’ internal and external motivations.”

EDITOR: Line 127-131: In the abstract you describe another first aim. Which one is correct?

AUTHORS: Thank you for your comment. We adapted the first objective considering the objective stablished in the abstract. Lines: 141-143. “to examine the relationship between runners’ resilience levels, internal and external motivation and incidence of injury”

EDITOR: Line 132-139: I am a bit confused after reading the hypotheses, this may have to do with unclarity about the aims and unclarity about the dependent and independent variables? Please clarify.

AUTHORS: Thank you for your comment. We try to give you a clearer explanation in the following lines: The first hypothesis is that the number of injuries will be associated with the psychological resilience of athletes, i.e., the higher athlete’s resilience, the better athletes will deal with stressful situations, so, the association with the incidence of injury it will be lower. In the second hypothesis, our hypothesis connects athletes’ intrinsic and extrinsic motivation with the association with athletes’ injury rate, guessing that intrinsic motivation will be more associate with this incidence than extrinsic motivation. Lines. 147-155.

3. Methods

EDITOR: Line 141-146. What were in- and exclusion criteria? A flow diagram may provide insight in the selection of runners for your analysis.

AUTHORS: Thank you for your comment. Los autores están de acuerdo con las aportaciones de los revisores y han decidido incluir un diagrama de flujo con los criterios de selección de los participantes para la presente investigación.

EDITOR: line 142. What do you mean with ‘ex post facto study’?

AUTHORS: Thank you for your comment. Ex post facto study mean “retroactive” or after the fact, and as in our case the data collection was carried out two weeks before the race, we changed, and we decided adding “Cross sectional design”, which we consider more suitable for this research (Line: 158,159)

EDITOR: line 144-146. Years / years old. Please be consistent

AUTHORS: Thank you for your comment. In order to be consistent, we decided using “years” instead of “years old” (Lines: 163,164).

EDITOR: Line 175-177. Information about how injury rate was calculated is missing. What was your injury definition? In addition, in the results no information about the duration or other characteristics of the injuries is presented.

AUTHORS: Thank you for your comment. We added how injury rate was calculated “Injured “or “Non Injured” were labelled at the time of the data collection” Lines: 191,192.

AUTHORS: Thank you for your comment. We define what injury mean for us in Lines 80,81. “Injuries usually cause periods away from the sports practice”

AUTHORS: Thank you for your comment. Even though we collected the data about typology of injuries, we decided not including it in this research, because It was not connected with the main objectives of dis research.

EDITOR: Line 184-185. Google docs was used as survey tool: therefore, I have some concerns about privacy of the participants, European regulations require stricter rules in regards to use of survey tools and the location where the data is saved, did you inform the runners about this?

AUTHORS: Thank you for your comment. We added an extra information specifying that informed consent was asked at the beginning of the questionnaire. Lines: 164,165. “all of them accepted the informed consent at the beginning of the survey”

EDITOR: Line 185-187. Please add some information about Fortuna club? How did you adjust the measurement tools? And why? To make them more appropriate for the target group?

AUTHORS: Thank you for your comment. We added that Fortuna is an “Sports club” Line 206. Apart from that, we adapted the survey considering questions of interest for Fortuna Sports Club, since they are involved in a project to boost women participation in future editions. This way, we tried to adjust and make the tool more appropriate for the target group.

EDITOR: Line 198-204. Why are you looking at differences between male and female runners in specific?

AUTHORS: Thank you for your comment. We were looking at differences between male and female athletes since women’s participation is significantly lower at this race, and the number of research is lower for women [3].

[3] Mujika Alberdi, A., García Arrizabalaga, I., and Gibaja Martíns, J. J. (2018). Impact of the behobia-san sebastián race on promoting healthy lifestyles. [Incidencia de la carrera Behobia-San Sebastián en el fomento de estilo de vida saludable] Apunts.Educacion Fisica Y Deportes, (131), 34-48. doi:10.5672/apunts.2014-0983.es.(2018/1).131.03

EDITOR: Line 219-221. What do you mean by ‘the remaining analyses’?

AUTHORS: Thank you for your comment. With remaining statistical analyses (Line: 250), we mean the rest of the analyses that we carried out during this research: descriptive statistics, student’s t test, and the chi-square... Lines: 220,221

4. Results

EDITOR: Line 224-225. In table 1, the number of injuries is presented, however in the discussion you talk about injury rate. In my opinion, injury rate is a percentage and not a number. Adding an injury definition to the methods will provide clarity about your injury outcome.

AUTHORS: Thank you for your comment. We changed “injury rate” and we used instead “number of injuries” in the whole manuscript, in order to be coherent with the table 1 and to be consistent at the same time., Lines: 37, 311, 318, 314, 342, 372-387-388.

EDITOR: Line 229-242. You describe ‘significant differences’, however I am not sure what differences you calculated. Also, I cannot find it in table 2.

AUTHORS: Thank you for your comment. The authors agree with your contributions, so we have decided to modify the description (Please, see page 11, line 260-265): "Table 2 shows the associations between number of injuries and resilience and motivational indicators. In model 1, the number of injuries was not positively associated with resilience levels after controlling for sex, age (β = -0.063; p > 0.05). In Model 2 the positive association between number of injuries and intrinsic motivation remained significant (β = 0.123; p < 0.05). Finally, in Model 3 the number of injuries was relationship significant and positively with extrinsic motivation (β = 0.140; p < 0.05)."

5. Discussion

EDITOR: Line 280-283. This is a harsh statement. In my opinion, not presenting high levels of resilience does not automatically mean ‘less psychologically gifted’. Please rephrase.

AUTHORS: Thank you for your comment. We rephrased the sentence, and we wrote instead: “athletes with lower level of psychological resilience” Lines: 328,329.

EDITOR: Line 291, ‘to overcoming injury processes’ Do you mean recovery after injury/return to play?

AUTHORS: Thank you for your comment. We extended the information in order to improve text’s meaning. We added “, i.e. recovery after injury” Line 338.

EDITOR: Line 324-326 “In addition, controlling for training frequency and duration, as well as nutrition, hydration, and some physiological and contextual aspects would help to gain a better understanding of the relationship between personal psychological variables and the number of injuries sustained.”

How do you expect nutrition, hydration etc to influence the relation of motivation and injuries.

AUTHORS: Thank you for your comment. We do not expect that nutrition, hydration or another variable to influence directly in the relation between motivation and injuries, but those variables could be directly related to the incidence of injury of athletes, and controlling them, we could get a more accurate information about the association between the number of injuries and motivational aspects of amateur runners. Line: 373-376.

EDITOR: line 326-330. “To conclude, an interesting line of research in the future would be to assess external motivation among amateur and professional athletes, in an attempt to see how external motivation differs according to the athletes’ level, their salary and the effect that television and social media have on them.” This comes a bit out of the blue for me. Please explain.

AUTHORS: Thank you for your comment. Seeing that contextual aspects do have influence on athletes’ personal variables. Line: 116 [31,32] (Hosseini and Besharat, 2010; Sarkar and Fletcher, 2014). Line: 125,126 [41,42] (Pedro and Veloso, 2018; Wagstaff, Chris, Hings, Larner, and Fletcher, 2018). Looking ta future research lines, we would like to link and asses till what extend, some of these contextual variables can effect on the association between athlete’s motivation and their number of injuries, since the number of injuries of athletes can be associated to athletes’ stress levels, and to their psychological resilience. Line: 376

6. Conclusion

EDITOR: Line 336-339. Your conclusion that high resilience levels reduce injury rates implies a causal relationship. As you already described in the limitations section, causality cannot be established. Please rephrase.

AUTHORS: Thank you for your comment. We rephrased the sentences, using association instead of causality, thus being coherent with this cross sectional study. Lines: 389, 390

EDITOR: Line 337. How could you improve resilience? Could you provide an example?

AUTHORS: Thank you for your comment. We changed resilience improvement by “being more resilient”, since psychological interventions can be planned with high performance athletes in order to improve this personal variable (Codonhato, R., Rubio, V., Oliveira, P. M. P., Resende, C. F., Rosa, B. A. M., Pujals, C., and Fiorese, L. 2018). In our case, as we are analysing amateur athletes, we considered mor appropriate to talk about just resilience level of participants. Line: 388.

Finally, and after having made all the modifications and comments discussed above, the authors appreciate the contributions made by the reviewers, as they help us improve the quality of the article. We hope that the comments regarding the contributions of the reviewers have been made correctly and that the work may be of interest for later publication.

Please, if further changes are needed, just let us know and we would try to correct them as soon as possible.

We thank you in advance for your attention and treatment,

Sincerely

Dr. Pedro Antonio Sánchez Miguel

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

10 Feb 2020

PONE-D-19-21930R1

The relationship of recreational runners’ motivation and resilience levels to the incidence of injury: A mediation model

PLOS ONE

Dear Dr. Tapia Serrano,

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Reviewers' comments:

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Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for addressing all the comments. In my opinion the changes you made in this manuscript lead to a good qualitative study. I have a few small comments left.

AUTHORS: Thank you for your comment. We were looking at differences between male

and female athletes since women’s participation is significantly lower at this race, and the

number of research is lower for women [3].

[3] Mujika Alberdi, A., García Arrizabalaga, I., and Gibaja Martíns, J. J. (2018). Impact

of the behobia-san sebastián race on promoting healthy lifestyles. [Incidencia de la

carrera Behobia-San Sebastián en el fomento de estilo de vida saludable]

Apunts.Educacion Fisica Y Deportes, (131), 34-48. doi:10.5672/apunts.2014-

0983.es.(2018/1).131.03

Please also mention this paper and explanation in the manuscript

AUTHORS: Thank you for your comment. For instance, we find that intrinsic motivation

is associated with a higher incidence of injury. Therefore, it would be important that very

intrinsically motivated amateur athletes, having a good training plan, and being leaded by

professionals, so that, the association between their intrinsic motivation and incidence of

injury will be weaker, even when they push themselves hard

Thank you for the explanation. Could you please change this in the abstract as well?

Reviewer #2: The cross-sectional manuscript The relationship of recreational runners’ motivation and resilience levels to the incidence of injury: A mediation model concerns the relationship between resilience, motivation and injury rates. It is a current topic of interest in sports science and their writing, sample size and study-desing are generally sound. However, I recommend it to be rejected for publication for the following reasons:

The correlations observed in the study are not scientifically explained. Scientific evidence is lacking to support the assumption that matters in the present article (the enlightenment of how these physiological variables relate to injuries). Correlation does not mean causality. In my humble opinion, the discussion section does not meet the requirements and high standards of quality for a prestigious journal such as PlosOne.

**********

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Reviewer #1: No

Reviewer #2: No

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17 Feb 2020

Cáceres, February, 17th 2020

Dear Daniel Boullosa,

The authors appreciate the time you spent to reading our manuscript and helping us to craft an improved version of the investigation. We are pleased to clarify your concerns, which we believe have improved the quality and applicability of this work. Please, find below our responses to each of your observations. We have made a concerted attempt to systematically address the specific concerns raised for this revision and we have highlighted the alterations to this revision within the manuscript in red for your convenience.

REVIEWER: “Thank you for your comment. We were looking at differences between male and female athletes since women’s participation is significantly lower at this race, and the number of research is lower for women [3]. Mujika Alberdi, A., García Arrizabalaga, I., and Gibaja Martíns, J. J. (2018). Impact of the behobia-san sebastián race on promoting healthy lifestyles. [Incidencia de la carrera Behobia-San Sebastián en el fomento de estilo de vida saludable] Apunts.Educacion Fisica Y Deportes, (131), 34-48. doi:10.5672/apunts.2014-0983.es.(2018/1).131.03.” Please also mention this paper and explanation in the manuscript.

AUTHORS: Thank you so much for your comment. We mentioned this paper (Lines: 47, 103) and we added the explanation in Lines: 102-104 “,and taking into account that women’s participation is significantly lower at the Behobia-San Sebastian race, and the number of research is lower for women [3] differences between male and female athletes will be considered”.

REVIEWER: “For instance, we find that intrinsic motivation

is associated with a higher incidence of injury. Therefore, it would be important that very

intrinsically motivated amateur athletes, having a good training plan, and being leaded by

professionals, so that, the association between their intrinsic motivation and incidence of

injury will be weaker, even when they push themselves hard”

Thank you for the explanation. Could you please change this in the abstract as well?

AUTHORS: We appreciate very mucho this indication and therefore, we have changed the information in the abstract section, and we have added the following information: “, i.e., it was found that intrinsic motivation was associated with a higher incidence of injury,” Lines 37,38, and in Lines 42-45: “Moreover, it is considered important that very intrinsically motivated amateur athletes, having a good training plan, and being leaded by professionals, therefore, the association between their intrinsic motivation and incidence of injury would be weaker, even when they push themselves hard”, completing thus the abstract.

REVIEWER: The cross-sectional manuscript. The relationship of recreational runners’ motivation and resilience levels to the incidence of injury: A mediation model concerns the relationship between resilience, motivation and injury rates. It is a current topic of interest in sports science and their writing, sample size and study-desing are generally sound. However, I recommend it to be rejected for publication for the following reasons:

The correlations observed in the study are not scientifically explained. Scientific evidence is lacking to support the assumption that matters in the present article (the enlightenment of how these physiological variables relate to injuries). Correlation does not mean causality. In my humble opinion, the discussion section does not meet the requirements and high standards of quality for a prestigious journal such as PlosOne.

AUTHORS: Thank you for your comment. Since the research line is very new, we are afraid that there is not easy to support scientific evidence about the obtained results in the literature, however, we added a paragraph in the limitation section. Lines: 291-293 “Likewise, another limitation was that scientific evidence was lacking due to the novelty of this topic, and physiological variables related to injuries were not considered." Previous research had associated psychological variables such as resilience or anxiety, or competitive level with athletes’ injuries [16,41], and these investigations have been considered during this manuscript.

16.Zurita-Ortega F, Chacón-Cuberos R, Cofre-Bolados C, Knox E, Muros JJ. Relationship of resilience, anxiety and injuries in footballers: Structural equations analysis. Ewen HH, editor. PLoS One. 2018;13: e0207860. doi:10.1371/journal.pone.0207860

44.Castro Sánchez M, Chacón Cuberos R, Zurita-Ortega F, Espejo Garcés T. Levels of resilience based on sport discipline, competitive level and sport injuries. RETOS-Nuevas Tendencias En Educ Fis Deport Y Recreacion. 2016; 162–165.

On other hand, we agree that correlation does not mean causality, in fact, we have corrected the manuscript in the previous review, changing causalities for associations, “We have revised the language of the manuscript and we have removed causalities, using instead associations, in line with the cross-sectional design of the study.” e.g. Lines:154-155, 313, 318-319, 365,366. Nevertheless, and following your concern, the cross-sectional design was considered a limitation of the study. Lines 291-293 “The cross-sectional study design was another limitation, as it did not allow causal relationships between the study variables to be established”.

Regarding the discussion section, we do not understand what we are supposed to improve, since we used the latest publications in prestigious journals like PLOS One, and we followed the way the discussion is organized in them. E.g: 12. van der Worp MP, ten Haaf DSM, van Cingel R, de Wijer A, Nijhuis-van der Sanden MWG, Staal JB. Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences. Zadpoor AA, editor. PLoS One. 2015;10: e0114937. doi:10.1371/journal.pone.0114937, 16.Zurita-Ortega F, Chacón-Cuberos R, Cofre-Bolados C, Knox E, Muros JJ. Relationship of resilience, anxiety and injuries in footballers: Structural equations analysis. Ewen HH, editor. PLoS One. 2018;13: e0207860. doi:10.1371/journal.pone.0207860, or 43. Codonhato R, Rubio V, Oliveira PMP, Resende CF, Rosa BAM, Pujals C, et al. Resilience, stress and injuries in the context of the Brazilian elite rhythmic gymnastics. Bergamini E, editor. PLoS One. 2018;13: e0210174. doi:10.1371/journal.pone.0210174

With respect to correlations comments’, the author would like to thank reviewers´ contributions, and we have decided to modify the redaction of correlations by: “In model 1, the number of injuries was not significant associated with resilience levels after being controlled for sex and age (β = -0.063; p = 0.089). However, in model 2 the number of injuries was positively associated with intrinsic motivation after being controlled for sex, age and resilience (β = 0.123; p < 0.05). In the other hand, there were not significant associations between the number of injuries and extrinsic motivation after the additional adjustment for intrinsic motivation in model 3 (β = -0.102; p = 0.072)”.

Thus, we hope that the information added is consistent with a scientific explanation. Please, if further information is needed, let us know, and we will attempt to include more scientific information.

Finally, and after having made all the modifications and comments discussed above, the authors appreciate the contributions developed by the reviewers, as they have helped us to improve the quality of the article. We hope that the comments regarding the contributions of the reviewers have been conducted correctly and the work may be of interest for later publication.

Please, if further changes are needed, just let us know and we would try to correct them as soon as possible.

We thank you in advance for your consideration,

Sincerely

Dr. Pedro Antonio Sánchez Miguel

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

30 Mar 2020

The relationship of recreational runners’ motivation and resilience levels to the incidence of injury: A mediation model

PONE-D-19-21930R2

Dear Dr. Tapia Serrano,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. While addressing those items, please also address the editorial requests outlined below.

When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

With kind regards,

Daniel Boullosa

Academic Editor

PLOS ONE

Editorial requests

==============

Abstract – please remove references to 'effect' from the abstract, given that the study can only establish associations. Also the last fragment in the abstract is unclear and the potential benefits of having a trainer have not been evaluated in the study, please revise that fragment for clarity and to ensure conclusions align to what can be supported by the data.

Please carefully check the written language one more time to ensure it is at publication standard.

Lines 226-227 Please revise ‘In model 1, the number of injuries did not associate significant with resilience levels after controlling for sex and age’ to ‘In model 1, the number of injuries did not show a significant association with resilience levels after controlling for sex and age’

Lines 229-231 – this fragment is unclear please revise it for clarity ‘In the other hand, the did not find associations significant between number of injuries and extrinsic motivation after additional adjustment for intrinsic motivation in model 3’

Line 305 ‘ this fragment is unclear, recommend deleting the fragment ‘scientific evidence was lacking due to the novelty of this topic’

Discussion – please include among the limitations that the information on injuries was self-reported.

Lines 320-326 this paragraph appears to be duplicated, also the last sentence in the paragraph follows a circular argument, can that be revised or deleted.

20 Apr 2020

PONE-D-19-21930R2

The relationship of recreational runners’ motivation and resilience levels to the incidence of injury: A mediation model

Dear Dr. Tapia Serrano:

I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

For any other questions or concerns, please email plosone@plos.org.

Thank you for submitting your work to PLOS ONE.

With kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Daniel Boullosa

Academic Editor

PLOS ONE