The acute-to-chronic workload ratio: An inaccurate scaling index for an unnecessary normalisation process?

An important question for researchers and practitioners is whether an individual’s risk of injury increases if they make prior changes to their training load.1 In this field of research, ‘load’ typically refers to in-training distances covered, speed and accelerations.1 Attention has generally focused on whether a person’s acute (eg, 7 day) increase in load, normalised to that person’s prior ‘baseline’ of chronic (eg, 28 day) load, predicts injury.1 To obtain this normalised predictor, acute load is typically divided by chronic load to provide the acute-to-chronic workload ratio (ACWR).1 Fundamentally, simple ratios (Y/X) are formulated to ‘ control for ’ a denominator variable (eg, preceding chronic load) that is perceived to have an important biological influence on the numerator variable (eg, acute load).2 Within this notion of ‘ control for ’,3 it is generally posited that the denominator is a ‘nuisance’ variable that is associated with the numerator of interest.2 Logically, a simple ratio index provides meaningful relative measures for clinical and prognostic purposes only if (1) there is a ‘true’ and ‘proportional’ association between numerator and denominator in the first place, and (2) the ratio normalises for the denominator in a consistent manner for all individuals in the measurement range.2 We have demonstrated recently that the typical practice in the current literature1 of including, …