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Table S2. Description of Physical Activity-related Injuries reported by Prospective Study Design

AUTHOR/COUNTRY/STUDY DESIGN / OBJECTIVE / POPULATION/ INCLUSION AND EXCLUSION CRITERIA / METHODS / OUTCOMES / Comments/Conclusions
Andrew et al[18]
2008
Australia / Describe and identify predictors of 12-month outcomes following serious orthopaedic injury associated with sport and active recreation participation / Total
n= 530
Age: median=31 years (15-74)
Older
65-74
n= 3.3
Inclusion Criteria
Admitted between 2003-2006 for coded sport or active recreation activity / Hospital admission records, VOTOR
Activity
Sport or active recreation activity
Injury
Various / For every 1 year increase in age, there was a 0.1 unit decrease in the physical component summary score.
Greatest rate in ice and snow sport categorization of injury. / Age and injury group were significant predictors of 12 month physical outcomes.
Barnett et al[19]
2009
Australia / Describe the injuries related to Lifeball in regional and rural NSW, Australia.
(Senior specific team sport) / Total
n= 263
Age: 67years (40-96)
Older
Follow-up
n= 263
Baseline
M=26 ; F=238
Inclusion Criteria
Men, women novice Lifeball players / Community-based
Activity
Lifeball
Injury
Various Injuries, falls
Injury Definition
Any pain or discomfort that was felt during or soon after playing a Lifeball game that required medical attention. / Number of Injuries: 27
Rate/100: 10.3
Rate/100 hours: 3.3
Number of Falls: 23
Rate/100: 8.7
Rate/100 hours: 2.8 / 6.1% reported injury requiring medical attention.
Knee injury most common.
All were acute injuries.
Injuries often result of fall.
Falls not associated with age or gender.
Trip, stumble, walking backwards, and overextending common causes of falls.
Dickson et al[20]
2008
Australia / Explore snow sport-related injuries. / Total
n= 497
Age: 18-83, mean33years
Older (65years+)
n= 11
Inclusion Criteria
All non-critical patients 18y+ presenting with injury from an on-snow incident / Medical Practices
Activity
Alpine skiing, Snowboarding
Injury
Various / All older injuries were due to alpine skiing.
18-24 years- 33%
25-35- 31%
35-44- 13%
45-54- 14%
55-64- 6%
65+- 2.2%
Girardi et al[21]
2010
Italy / Evaluate risk factors associated with skiing and snowboarding injuries presenting to emergency department / Total
n= 2511(ski); 843(board)
Age: 60 years+
Older
n= n/a
Inclusion Criteria
Patient referred to emergency department after a skiing or snowboarding accident from 2002-2005 / Emergency Department, Recreational, four ski resorts.
Activity
Skiing and snowboarding
Injury
Various / Injury Severity Score
0-20: 3.1
21-30: 3.1
31-40: 2.9
41-50: 3.2
51-60: 3.7
60+: 4.6 / The ISS was significantly higher (p,0.001) for people aged 60 years+.
Higher severity in snowboarders overall.
Haapasalo et al[22]
2007
Finland / Assess and compare the risks of knee injuries in various physical activities practiced in a representative population cohort / Total
n= 3058
Age: 15-74 years
Older
n= n/a
Inclusion Criteria
All available to participate / Population based, prospective 1 year
Activity
Various sport and recreational
Injury
Knee injury
Definition
Any new acute trauma or overuse injury that caused a significant complaint to the subject. / Commuting activities, injury risk significantly decreased with age
Lifestyle activities, injury significantly increased with age-relative risk was 2.5x higher in 45-74years group versus 25-44 years
Recreational/competitive sports, risk significantly decreased with age / Overall injury incidence in all types of sports and in both genders seems to be the highest among subjects under 25 years.
Hootman et al.[23]
2001
USA / Determine relation among physical activity type and duration, fitness, and musculoskeletal injury in adults participating in the ACLS. / Total
n=M, 4,034 ; F, 967
Age:20-85years
Older
n= n/a
Inclusion criteria
Healthy adults who attended the Cooper Clinic, underwent baseline physical exam, and returned a survey / Self-reported questionnaire (12mo)
Activity
Various
Injury
Various
Definition
Any self-reported muscle, tendon, bone, ligament, or joint injury occurring in the 12 months before mailed survey / Activity Related Injury
Men
20-40years=13%
41-60= 71%
>60= 16%
Women
20-40years=27%
41-60= 90%
>60= 16% / As age increased among men and women, the prevalence of activity related injury decreased.
Hootman et al.[24]
2002
USA / To describe prevalence of all cause and activity related musculoskeletal injuries among sedentary and active adults enrolled in the ACLS. / Total
n=6,311
Age:20-85years
Older
n=1,569
M=1,303; F=266
Inclusion criteria
Healthy adults who attended the Cooper Clinic, underwent baseline physical exam, and returned a survey / Self-reported questionnaire (12months)
Activity
All-cause; activity-related
Injury
Various
Definition
All-cause musculoskeletal injuries=any self reported muscle, tendon, bone, joint, or ligament injury; Activity related injuries= any injury attributed to participation in running, walking, jogging, or strenuous sports program that resulted in medication need, surgery, consulting physician, stopping or reducing activity / Activity related Injuries
Men
20-40years= 26%
40-60years= 22%
60+= 16%
Women
20-40years= 20%
40-60years= 22%
60years += 15% / For men, those who were younger, fitter, more physically active, and had previous injury were more likely to be injured.
For women, more fit, active, and previously injured women were more likely to be injured.
Hootman et al.[25]
2002
USA / Identify gender specific predictors of lower extremity injury among a sample of adults engaging in running, walking, or jogging and part of the ACLS. / Total
n=3090
M=1,303; F=609
Age: 20-85years
Older
n= M, 667; F, 112
Inclusion criteria
Healthy adults who attended the Cooper Clinic, underwent baseline physical exam, and returned a survey; participated for at least 1 year in running/walking/jogging program / Self-reported questionnaire 5 years, 12 months
Activity
Run, walk, jog
Injury
Lower extremity )foot, ankle, leg, knee, hip)
Definition
Any self-reported lower extremity injury that required a consultation with a physician. / Injured
Men
20-40years= 9.8%
40-60years= 68.8%
60years+= 21.4%
Women
20-40years= 18%
40-60years= 68.7%
60 years+= 13.3%
Age had lowest hazard ratios of predictor variables: Men, HR=0.88; Women, HR=0.74. / In final adjusted Cox prediction models, older age, previous lower extremity injury, and running, walking, jogging mileage over 20miles/week predicted lower extremity injury in both men and women.
Hopkins et al.[26]
2011
USA / Examine outcomes of a relatively active cohort of elderly trauma patients who presented with skiing injuries sustained at winter resorts. / Total
n= 693
Age: 12years+
Older 65+
n= 67
M= 48; F=19
Inclusion Criteria
Skiing injury
Aged 12years+ / Trauma registry data from emergency department; Cases identified by research assistant, 6 month.
Population based
Activity
Skiing
Injury
Various
Classification with ICD-9; study limited to patients who acutely presented to and were primarily treated at the study center. / Mechanism of injury for older was fall (64%) versus jump or fall from height for younger (49%).
Lower extremity fracture was most common type of injury for older (37%) and younger (26%).
Injury patterns were similar in both age groups with exception of trend toward more upper extremity dislocations and lower extremity fractures in older skiers. / Older patients injured during skiing had higher inpatient admission rates and longer hospital length of stay versus younger patients, despite lower injury severity scores and comparable discharge rates.
Kannus et al.[27]
1989
Finland / Compare sports injuries among older and younger athletes. / Total
n=514
Young age range 21-25years
Older
n=57 (83% male)
Age: 66± 5 years. (range 60-78years.)
Inclusion criteria
Elderly athletes / Outpatient sports medicine clinic
Competitive
Activity
Various sports
Injury
Various
Definition
Overuse injury = longstanding or recurring orthopedic abnormality and pain in musculoskeletal system which started without acute injury. / Knee was most affected joint: Older 21%; Younger 36%; Shoulder (18%) and Achilles tendon (20%) more common vs. young; In older, 70% were overuse injuries vs. 41% in young. / Older athlete’s sport injuries occurred more frequently in endurance sports, more overuse related, and more commonly have a degenerative basis.
Kujala et al.[28]
1995
Finland / To characterize the type and severity of acute injuries occurring in Finnish orienteers. / Total
n=2189
Age: Varied years
Older
n=M, 24; F, 25
Inclusion criteria
Active Finnish orienteers from orienteering license insurance records / Insurance Records, 4 yr. (1987-1991)
Competitive
Activity
Orienteering
Injury
Acute, Various
Definition
Acute injury with sudden onset, including no clear external accidental cause (e.g. muscular distensions) / Yearly Injury Rates
Men
20-24years= 0.073, 15%
35-34years= 0.049, 18%
35-49years= 0.027, 20%
50-64 years=0.026, 8%
65 years+= 0.023, 1%
Women
20-24years= 0.072, 21%
35-34years= 0.049, 23%
35-49years= 0.026, 24%
50-64 years= 0.026, 9%
65 years+= 0.023, 1% / No difference between males and females.
Injury rates highest in 20-24y age group.
64 years+ age group had lowest number of person-years of exposure.
Little et al[29]
2013
Canada / Evaluate the 12 month incidence of exercise-related injuries to community-dwelling older adults / Total
n= 167
Age: 695years
Older
n= 167
M= 63; F=104
Inclusion Criteria
Participants
completing an older
adult
exercise/educational
program. / Various locations- free-living physical activity participation.
Activity
Various
Injury
Various
Analysis / Injury rate: 14% (23/167)
Lower extremity most
common body part.
Most common type was
muscle strain. Most
common cause was
overexertion.
Sex, age, and exercise
volume were not
significantly associated
with injury occurrence. / Older adults taking up
exercise are not at an
increased risk of injury,
and participation in an
intervention – where
the instruction of safe
participation is taught –
might confer some
“protective” effect.
McHardy et al[30]
2007
Australia / To describe 1 year follow-up analysis of golfers / Total
n= 588
Age: 59.1±12.9years
Older (60 years+)
n= 301
Inclusion Criteria
Golfers at 6 golf clubs / Recreational, self-reported survey
Activity
Golf
Injury
Golfing Injuries
Injury Definition
Any condition sustained during the playing/practicing of golf that stopped play/practice, impeded normal performance, or required medical treatment. / % Injured:
0-39 years: 13.3%
40-49: 6.4%
50-59: 15.6%
60-69: 13.3%
70+: 13.3%
Mechanism of injury most commonly during golf swing.
Lower back and forearm most common anatomical location. / Age was significant risk factor for univariate analysis, but not for multivariate
Parkkari et al.[31]
2004
Finland / Describe risk and severity of injuries in various commuting and lifestyle activities in Finnish population. / Total
n=3055
Age: 15-74years.
Older
n=319
M=139; F=180
Inclusion criteria
Randomly selected Finnish population / Assisted telephone interview, 1yr
Population-based
Activity
All
Injury
Various
Definition
A new acute trauma or overuse injury that caused a significant complaint to the subject. / Incidence per 1000 hours of participation
Lifestyle Activities
Men
25-34 years=0.6
35-44=0.6
45-54=0.7
55-64=0.5
65-74= 26/131 injuries; 0.5
Women
25-34=1.3
35-44=1.2
45-54=0.5
55-64=0.8
65-74= 20/157 injuries; 0.7
Recreational/Competitive Sports
Men
25-34=4.1
35-44=3.1
45-54=1.9
55-64=0.8
65-74= 1.0; 20/139 injuries
Women
25-34=3.0
35-44=2.5
45-54=1.5
55-64=1.1
65-74= 1.2; 20/139 injuries / In recreational and competitive sports, injury incidence decreased by age.
Team sports and ball games yielded highest incidence rates for older adults.
Pollock et al.[32]
1991
USA / Determine adherence and injury rate of 70-79yrs old men and women while participating in walking, walking-jogging, or strength training programs. / Total
n=57
Age: 70-79years.
Older
n=57
M=25 ; F=32
Inclusion criteria
Healthy previously sedentary elderly volunteers / 26 week training study
Experimental
Supervised
Activity
Walking/jogging, resistance training programs
Injury
Various
Definition
If training had to be stopped or significantly altered for at least 1 week. / Initial 1 Repetition max testing: 11/57 (19.3%) incurred injury.
Strength training group: 2/23 (8.6%)
Walking group: 1/21 (14%)
Walk/Jog group: 9/21 (M=2, F=7; 43%)
All Injuries occurred in the lower extremity.
All females who jogged had injury.
Only 1 dropout due to injury. / Only 1 of 9 injuries in walk=jog group sustained injury in first 13 weeks, rest occurred after training intensity was increased.
Pattern of increased injury to women vs. men in jogging activity.

M=males; F=females; VOTOR= Victorian Orthopaedic Trauma Outcomes Registry; NSA; n/a= not available;

ISS= Injury Severity Score; ACLS = Aerobics Center Longitudinal Study; HR= heart rate; and ICD-9=International Classification of Diseases-9.