Table S3. Description of Physical Activity-Related Injuries Reported Byretrospective Studies

Table S3. Description of Physical Activity-related Injuries reported byRetrospective Studies

AUTHOR/
COUNTRY/
STUDY DESIGN / OBJECTIVE / POPULATION/ INCLUSION AND EXCLUSION CRITERIA / METHODS / OUTCOMES / Comments/
Conclusions
Antoun et al[33]
2008
New Zealand / Investigate prevalence of sports-related maxillofacial fractures in New Zealand / Total
n=561
Age: 6-82years; mean 26years
Older
n= 18
Inclusion Criteria
Presenting to oral and maxillofacial hospital unit. / Hospital admission records, 1996-2006
Activity
Various
Injury
Maxillofacial fractures / n/a for age groups. / Lowest rate of trauma in 61years+ group = 1.6%
Barr et al[34]
2010
United Kingdom / Evaluate acute injuries sustained at temporary ice rinks. / Total
n= 85
Age: mean 35years, 5-71
Older
n= 6
Inclusion Criteria
Medical record coding for “fall/ice/sports/other/skating” / Recreational, retrospective Nov 2007-Jan 2008, Emergency department visits
Activity
Ice-rink skating
Injury
Acute, various / # Injuries
0-16 years: 27
17-30: 10
31-40: 12
41-50: 20
51-60: 10
>60: 6
Most common injury for all, including >60years group was fracture of the distal radius
Carlson et al.[35]
2006
USA / Compare incidence of self-report all-cause injury and activity injuries in adults with differing physical activity levels. / Total
n=54,763
Age: 18-65+years
Older 65+ years
n=11,385
Inclusion criteria
Adults from 2000-2002 National Health Interview Survey / Self-Report Survey (3mo)
Activity
All-cause
Injury
Various
Definition:
Injury serious enough for medical advice or attention in past 3 months
Categories included sport and leisure activities / Adjusted Odds Ratios
Sport or Leisure Activity
Age Group (yeas)
18-24=1.00
25-34=0.61
35-44=0.40
45-64=0.39
65+ =0.41
Carpintero et al.[36]
1997
Spain / To analyze the frequency of fatigue fractures in elderly presenting at orthopedic unit. / Total
n=6650
Age: mean 64.63years (range 60-72years)
Older
n=6650
Inclusion criteria
Elderly patients; 6650 outpatients referred to clinic during 6 year. period / Retrospective analysis of patient case histories
Setting
Outpatient Clinic
Activity
Marching or brisk walking, running, hunting
Injury
Fatigue fractures diagnosis by radiography or scintigraphy / Incidence
n=30
M=13
F=17
All lower body.
Tibia, n=14/30
Marching/Brisk Walking, n=17; Running, n=10. / Physicians should be aware of this type of fracture to ensure early diagnosis and appropriate treatment. Important to not mistake for other conditions.
Colbert et al.[37]
2000
USA
Nested Case Control / To compare the relationship between reported injuries and physical activity among persons participating in regular walking programs versus running or jogging in nested case control of ACLS. / Total
n=3,293
Age: varied years
Older (45+ years)
n=2,099
M=1,703; F=396
Inclusion criteria
5,327 who underwent medical exam at Cooper Clinic between 1987-1995 / Self-reported questionnaire, 12 months.
Activity
Walking or jogging/running
Injury
Various
Definition
Injury related to physical activity during 12 months preceding survey that necessitated a physician visit. / Injury Rates
Men
<45years= 23%
>45years= 23%
Women
<45years= 21%
>45years= 18%
Lower risk of injury among older male walkers (36%) vs runners.
Risk of Injury-Odds Ratio associated with walking versus running
Men
<45years= 0.75
>45years= 0.64
Women
<45years= 0.73
>45years= 0.72 / Age was not statistical effect modifier of the association between dose of walking/running and activity-related injury.
Low risk of MSK injury suggests walking can be safely recommended to improve health and fitness.
Dempsey et al.[38]
2005
USA / Describe incidence/patterns of sports and recreation injuries resulting in hospitalization in Wisconsin. / Total
n=1,714
Age: <5 to 65+ years
Older 65+
n=61 injuries
Inclusion criteria
Inpatients to acute care non-federal hospitals in Wisconsin / Retrospective 1 year, hospital admissions records
Activity
Sports, recreation-related
Injury
Various, resulting in hospitalization
Definition
ICD-9-CM external cause of injury code (E) / Injury Rate (/100 000)
65+=9
20-34=33
35-54=24
55-64=25 / Pedal cycling had highest rate of injury (4.4 per 100 000) for 65 years+.
No difference in rate between males and females for 65 years+ category.
Ekman et al.[39]
2001
Sweden / To describe pattern/trends of bicycle related injuries among elderly in Sweden / Total
n= n/a
Age: >14 to 65+ years
Inclusion criteria
The elderly / Hospital discharge data and Mortality data (30years)
Activity
Bicycle
Injury
Head; all diagnoses
Definition
ICD-9-CM external cause of injury code (E) / Risk of dying due to cycling was 3.7 times greater among elderly vs. children 14 yearsor under.
Risk of injury for elderly is 3 times greater than average bicyclist and 6 times higher for the 75-84years age group.
Fradkin et al.[40]
2006
Australia / Describe golf participation injuries resulting in emergency department visit / Total
n=547
Age: Varied years
Older 60+ years
n=101
Inclusion criteria
Presentation to emergency department over 5 yr period / Hospital emergency records 5 years
Activity
Golf
Injury
Various / Data not available for age groups / Golfers older than 65years sustained a higher proportion of injuries related to falls and a higher than expected proportion of lower extremity injuries.
Gerson et al.[41]
2004
USA / Describe non-fatal recreational injuries among older adults treated in emergency departments. / Total
n=62,164
Age: 65+ years
Older
n=62,164
Inclusion criteria
Older adults treated in US emergency departments / NEISS_AIP 2001 data
Activity
Various sports
Injury
Various
Definition
Recreational Injury= occurring during organized and unorganized activity whether or not work or product related. / Overall injury rate was 177.3/100 000:
Men, 242.5; F, 151.3
10% were hospitalized.
Rates for both sexes decreased as age increased. / Overall injury rate for men was 60% higher than females.
Bicycling and exercise were most frequent cause.
Fractures (women) and sprains (men) most common type.
Jones et al.[42]
2000
USA / To identify weight lifting injury trends from weight training and weight training equipment presenting to US emergency departments. / Total
n=980,173
Age: 0-65+years (median: 22.9 years)
Older
n=6,303
Inclusion criteria
Treated in US emergency departments from 1978-1998, identified by NEISS / NEISS , 20y (1978-1998) emergency department reports
Activity
Weight training
Injury
Various: soft tissue; lacerations; fractures and dislocations; other. / Weight Training Injuries
15-24 years= 19%
25-44= 44%
45-64= 33%
65+= 4.1% / People 65 years+ were at slightly higher risk for experiencing injuries in the home compared with younger age groups (OR=1.25)
Percent change in injury rates per 100 000 over the 20years period was highest in males over the age of 65 years.
Jones et al.[43]
2005
USA / Estimate the relative frequency, types of injury, types of exercise, and mechanisms of non-equipment exercise related injury among women 65 years+. / Total
n=37,729
Age: 65+years (median: 72 yrs)
Older
n=851
Sex: Female
Inclusion criteria
Older women that were treated at ED’s, identified by NEISS / NEISS emergency departments (7years, 1994-2001)
Activity
Non-equipment-related exercise (e.g. walk, jog, aerobic, yoga, karate, judo)
Injury
Various: soft tissue; lacerations; fractures and dislocations; other. / Overall prevalence=27% per 100 000.
Requiring admittance =12%.
Age group 65-74years accounted for most injuries at 60%
Lower trunk and ankle area most common site (17%); Most common diagnosis was sprains and strains (36%);
Activities at time of injury: walking or hiking =58%; exercise or calisthenics =23%. / Non-equipment related injuries had 30% annual increase on average. Walking was a major risk factor for falling.
Kallinen et al.[44]
1994
Finland / Describe frequency, mechanisms and nature of sports-related injuries in elderly men over 70y still active in competitive sports. / Total
n=97
Age: 70-81years.
Older
n=97
Sex: Male
Inclusion criteria
Elderly male athletes drawn from sport organizations / Self-Report, 10y (1977-1987)
Competitive
Activity
Sports (strength/power; endurance)
Injury
Various / 81% had a least one injury
273 injuries: 169=acute; 104=overuse.
75% occurred in lower extremity.
Most commonly injured body part was knee (20%).
Sprains of thigh and knee were most frequent types of acute injury. / One in five injuries lasted over several years causing some disability during sporting activities
Kerr et al[45]
2010
United States / Examine weight training related injuries in patients presenting to US emergency departments / Total
n= 25 335presenting to emergency departments; estimated 970 801 injuries nationwide
Age: 27.6 years (6-100)
Older
n= >55years; estimated 35 043nationally
Inclusion Criteria
NEISS weight training injuries from 1990-2007 / Hospital Emergency Department- NEISS
Activity
Weight training
Injury
Various, specific to weight training / National Injury Estimates
19-24years: 200 129
25-34: 252 191
35-44: 145 056
45-54: 63 141
>55: 35 043
Upper trunk most common body region injured.
Sprains/strains most common injury diagnosis
Most common mechanism of injury was dropped weights. / Proportion of overexertion injuries and lifting/pulling increased significantly as age category increased.
Higher proportion of machine injuries versus free weights.
Older persons had highest increase in injury incidence.
Kerr et al.[46]
2011
U.S.A / Examine bowling related injuries across the lifespan. / Total
n= 8754, estimated 375 468 nationally
Age: 33 ±20years, 3-94
Older
>65years
n= estimated 36 069
Inclusion Criteria
Bowling related injuries from NEISS 1990-2008 / Emergency Department Records, NEISS
Activity
Bowling
Injury
All bowling related / Seniors sustained greater proportion of shoulder/upper arm (10.2%) and leg injuries (9.1%) versus <65years.
Seniors sustained higher proportion of fractures/dislocations (27.2%) versus younger.
Seniors sustained greater proportion of injuries related to falling/slipping/tripping (72.4%) / Recommended that older individuals engage in conditioning exercises to help maintain balance and reduce injury.
Future research to examine specific movements associated with injuries in older adults.
Matheson et al.[47]
1989
Canada / Document clinical pattern of overuse injuries in physically active individuals over age of 50+ compared to younger age group. / Total
n=1,407
Age (young):
30.4±8.1years
Older
n=685
M=471; F=214
Age: 56.9±6.1years
Inclusion criteria
Athletes that were referred to outpatient sports med clinic / Chart examination of outpatient sports medicine clinic (1981-1986) 5y.
Activity
Various sports
Injury
Various musculoskeletal / Running was most common activity resulting in injury for both age groups. Older =32%; M=25%, F=7%.
Racquet sports, walking and low intensity sports were more common in the older groups.
Knee and foot were most common site for both age groups, with greater frequency in the foot in the older group.
Frequency of tendinitis was similar in both age groups. Tendinitis was most frequent diagnosis for both older males and females. Second was patellofemoral pain syndrome for both older males and females. / Approximately 85% of diagnoses in older group were associated with overuse syndromes known to respond favorably to conservative treatment.
Evidence of osteoarthritis does not necessarily indicate that the joint disease is cause of activity-related pain and other soft tissue injuries should be considered.
Mummery et al.[48]
1998
Canada / To describe the incidence, type and extent of injuries occurring as a result of sport or recreational involvement in Alberta, Canada. / Total
n=3,790
Age: 6-93years
Older
n=228
M=98; F=130
Inclusion criteria
Participating households in Alberta of telephone surveys / Telephone assisted self- report, 12 month.
Population based.
Activity
Sports/recreation
Injury
Various / -no descriptive info broken down by age-group.
Mummery et al.[49]
2002
Australia
Retrospective / Describe the incidence of medically attended injuries arising from sport and recreational activity involvement in Queensland, Australia. / Total
n=1,337
Age: 45.03years (range 18-94years)
Older
n=297
Inclusion criteria
Participating households in Queensland of telephone surveys / Telephone assisted self- report, 12 month.
Activity
Sports/recreation
Injury
Various, medically attended / -no descriptive info broken down by age-group.
Number of injuries Total:
222, in those 60+ = 22.
Injury rate (/100)
<30years= 33.3
30-39= 17.5
40-49= 12.5
50-59= 12.7
60+= 7.4 / Respondents aged 60 years and over displayed an injury rate significantly lower than those under 40 years of age.
Palmer et al.[50]
2003
Canada / To describe profiles of senior golfers with and without musculoskeletal conditions. / Total
n=100
Age: mean 69.9±8.7years
Older
n=100
M=55 ; F=45
Inclusion criteria
Volunteers from two local golf courses / Self-report questionnaire, 3years.
Community Based
Activity
Golf
Injury
Various / 50/100 reported a MSK condition in past 3 years affecting their game.
32M, 18 females.
46% upper extremity; 40% lower extremity; 34% spine. / 50% of recreational golfers sampled reported a MSK condition that interfered with their golf participation.
Many did not spend adequate time in warm-up or stretching.
42% had experienced symptoms of low back pain after playing golf.
Highlighted need for physiotherapy research on preventative and therapeutic programs.
Powell et al.[51]
1998
U.S.A / To estimate frequency of injuries associated with five commonly performed moderately intense activities (walking for exercise, gardening and yard work, weightlifting, aerobic dance, and outdoor bicycling. / Total
n=5,238
Age: 18years
Older
n= n/a / Self-reported National survey (ICARIS 1994) (past 30 days)
Population based
Activity
Walking, gardening, weightlifting, outdoor bicycling, and aerobics
Injury
Various
Definition
For each activity, respondent was asked “During the past 30 days on how many occasions when you were <activity> were you injured severely enough that you went for medical care or missed one-half day or more of work, housework or school. / Due to low 30day prevalence rates, age group specific injury rates were calculated for walking and gardening.
Participant-Prevalence of Injury; Percent of participants injured:
Gardening
18-44years= 2.0%
45+=0.9%
Walking
18-44years= 1.8%
45+= 0.9% / Persons over the age of 45years were significantly less likely to be injured than younger persons while walking or gardening.
Ready et al.[52]
1999
Canada / To compare effects of weekly walking volume and of prior MSK conditions on the incidence and severity of injuries in women. / Total
n=50
Age: mean 60.9years (range 51.2-74.6years)
Older
n=50
Sex: Female
Inclusion criteria
Older women who completed a 24-week walking intervention / Supervised and Unsupervised Walking program, 24 weeks.
Community/Experimental
Activity
Walking
Injury
Various / 28/50 (56%) reported injury.
Foot sprain was most common type of injury.
50% of injuries were reported in the first 4 weeks.
12% reported injuries necessitating program withdrawal.
18% reported minor injuries.
26% reported injury requiring medical attention. / Age, weight, fitness, and walking volume were not related to injuries.
Prior MSK injury was sig related to sustained injuries requiring medical treatment.
Requa et al.[53]
1996
USA / Total
n=41,349
Age: Varied (median=33years)
Older
n=1,161
Inclusion criteria
Treated for sports injuries at sports medicine outpatient clinic from 1979-1995 / Outpatient Sports Medicine Clinic, chart review 1979-2005
Clinical setting
Activity
Various sports
Injury
Various / Rates of injury increased in 65 years+ age group from 6.2% to 16.5% over time period.
However, few constants in patterns of injury across all sports as age increased. / Age may be a significant qualifier, but injury pattern seems to be influenced by sporting activity itself.
Trend for accumulation of chronic and acute injuries over the years resulting in a greater proportion of impingement and degenerative problems and fewer acute injuries.
Schneider et al.[58]
2006a
Germany
Scheider et al. 2006b / Generate representative national sports injury incidence rates for Germany / Total
n=6,911
Age: 18-79years
Older
n= n/a
Inclusion criteria
Participants of the national health survey / Population based, self report National survey (1year)
Activity
Various sports, Recreational
Injury
Various
Definition
Response to “During past 12 months, did you experience any injury or poisoning requiring medical treatment?) / Odds ratio for incidence and risk sports injury adjusted for sex, age, and time spent exercising
Under 30=1.0
30-39 years=0.58
40-49 years =0.57
50-59 years =0.58
60-69 years =0.13
70-79 years=0.15 / Risk of injury correlates closely with the extent of individual sporting activity.
In all age groups, male athletes with at least 1 hour of recreational activity per week had the highest incidence of injury versus non-athletes.
Schmikli et al.[54]
2009
Netherlands / Identify high-risk age, gender, and sport specific subgroups eligible to receive special attention in injury prevention programs. / Total
n= 1397
Age: 4-55years+
Older
n= 93
M=63 ; F=30
Inclusion Criteria
Community dwelling, 1 family member per household. / Population based national survey (IPAN), 3 month recall
Activity
Various
Injury
Various
Definition
Sports injury=physical damage of a musculoskeletal nature, sustained in the recall period as a result of a sudden event during a sports activity or as a result of a gradual process related to sports activity / %Injured
4-17years: 23
18-34years; 26
35-54years: 16
55+years=7 / No age-specific difference in the percentage of medical treatment was found.
55year + group made only minor contribution to sports injuries in absolute numbers and had low incidence rates and low percentages of medically treated injuries.
Stathokostas et al[55]
2012
Canada / To describe exercise-related injury in older adults participating in supervised exercise programmes. / Total
n= 110
Age: mean 72.3±7.8years
Older
n= 110
M=45 ; F=65
Inclusion Criteria
All willing participants of an older adult fitness facility / Single older adult community fitness facility-12 month incidence
Activity
Group fitness classes comprised of aerobics, strength training, flexibility and balance.
Injury
Various
Defined as any self-reported muscle, tendon, bone, ligament or joint injury.
Regression analysis was conducted for age, sex, type of exercise class and frequency of attendance per week on injury occurrence. / 16% (n=18) reported having an injury.
The lower extremities were the most common site of exercise-related injury.
Overexertion or strenuous movements was the most common cause of injury resulting mostly in an acute muscle strain. Injury was most often incurred during strength training exercises.
Males had twice as many injuries as females, with the main difference being the increased number of injuries occurring as a result of strength training for the men. / Age was not a significant predictor in injury risk.
It does not appear that older adults are at an increased risk of injury from participation in general multicomponent fitness group classes.
Walker et al[56]
2010
New Zealand / Describe injuries for cricket players resulting in hospitalization in New Zealand / Total
n= 498
Age: mean 27 (2-80years)
Older
n= 16
Inclusion Criteria
Identified sport activity code of hospitalized patients, cricket related injuries. / Hospital Records, Retrospective 5-year, ICD-10 Sport and recreational activities data set
Activity
Cricket
Injury
Various / % Injuries
0-9- 8%
10-19- 28%
20-29- 23%
30-39- 21%
40-49- 12%
50-59- 4%
60+- 3%
Trunk and back most common body site of injury for 60years+
Xiang et al.[57]
2005
USA / Characterize skiing- and snowboarding injuries treated in hospital emergency rooms in the U.S. / Total
n=139,300
Age: 0 to 70+years
Older
n= n/a
Inclusion criteria
NEISS data; treated in US emergency departments in 2002 / NEISS 2002 data (1year)
Activity
Skiing, snowboarding
Injury
Various / Age groups with the highest skiing related injuries per 1000:
55-64years=29
65+years=22
45-54years+=16
Traumatic brain injuries were higher among older skiers 55-64 (2.15 per 1000) vs. younger 10-13years (1.69) / Older skiers are at higher risk for injury

M=males; F=females; n/a= not available; ACLS=Aerobics Center Longitudinal Study; MSK= musculoskeletal; ICD-9-CM = International Classification of Diseases-9-Centres for Medicare; NEISS= National Electronic Injury Surveillance System; AIP= All Injury Program; OR= odds ratio; ED=emergency department; est= estimated; ICARIS= Injury Control and Risk Factor Surveillance System; sig= significant, IPAN= Idaho Physical Activity and Nutrition Program; and ICD-10 =International Classification of Diseases-10.