Hazards of Physical Activity and Exercise

Answer: These rates are likely to underestimate the true rates of injury since many injuries are treated on site or in other settings besides the ER.

1) How accurate do you think the CDC injury estimates on the prior slides are compared to actual injury rates?

males

About 70% of all injuries occurred in ________.

30 150

An estimated ___ million US children and adolescents participate in organized sports and approximately ____ million adults engage in some form of non-work physical activity.

stroke heart attack sudden cardiac death.

Another severe complication of vigorous intensity physical activity is an increased risk of ____ + ____ + ______

Chronic Traumatic Encephalopathy (CTE).

One significant concern about repetitive concussions is the apparent link with ______

tennis risk factors

Shoulder strength Muscle imbalance Playing surface

16% 70%

____ of all unintentional injury-related visits in ER nearly ____ of those injured are 5-24 years old

4.3 million

approximately_______ someone's injured every year.

host agent environment

parts of the epidemiologic triangle

Epidemiologic triangle vs running injuries

(1) disease state, training status, age/sex (2) duration, speed, stretching (3) uphill, flat, rocky, cold, hot, windy

Physical Activity Guidelines Advisory Committee report

(Risk of sudden adverse cardiac event by level of activity slide) It shows that while the risk of a sudden death event does increase during vigorous intensity physical activity, this increased risk is transient and is much higher among those who are typically inactive. These results help explain why shoveling snow after a blizzard is a much riskier endeavor for inactive men compared to habitually active men (or women!).

What factors might account for the higher rates during games? in high school and community sports

- developing bones - stronger muscles than bone

how should injury rates be expressed

-Total # exposed - Total amount of activity exposed (Time or Kcal per week)

Answer - Need to account for the number of men who play basketball versus other sports, as well as the duration and frequency of play.

2) Can we use the estimates from the Gotsch study to compare the risk of participating in different sports? For example, is basketball the riskiest sport for men?

Answer - No, we can't. Once again, we need to account for the number of participants in each age category and the duration and frequency of play.

3) Can we make conclusions about risk differences by age and sex? For example, based on the figure on slide #2, it looks like teens are ~15-20 times more likely to be injured than other ages. Can we conclude they are at higher risk - perhaps because they are clumsier or because they engage in higher risk sports?

Chronic Traumatic Encephalopathy (CTE).

A progressive degenerative disease found in persons w/ history of multiple concussions

King County Washington

A study conducted in _______ also found a much higher hourly death rate during intense physical activity. In this study, physical activity histories prior to and during a fatal heart attack were obtained by interview from the wives of 133 men aged 25 to 75 who experienced sudden cardiac death. Wives of a group of apparently healthy men were similarly questioned to provide denominator information.

6 24

Among habitually active men, the rate of heart attack increased _____ fold during exercise. However, the overall ____-hour rate of death was two times higher among sedentary men compared to those who were vigorously active . Thus, even though exercise has short term risks, these risks are outweighed by the long-term benefits of vigorous intensity physical activity.

25 83

Approximately ______% reported a musculoskeletal injury and ____% of these were activity related (mainly sports).

open peoples eyes to common

Cases of sudden cardiac death during exercise often get significant media attention. How might this prominent coverage influence public perceptions regarding the risks of exercise?

Chronic Traumatic Encephalopathy (CTE).

Characteristics included loss of brain tissue and accumulation of tau protein

example of hazards of exercise

For example, 12 men ages 30 to 64 years died while jogging in Rhode Island during a five-year period. To express these deaths as an incidence rate, an appropriate denominator was needed so investigators surveyed the state using random telephone sampling and determined that approximately 7 .4% of men aged 30 to 64 reported jogging at least twice a week. This allowed them to estimate that 13/100,000 male joggers experienced sudden cardiac death while jogging.

American Football Ice hockey Rugby

High risk competitive sports and annual rate of concussion: • _____: 4-20% _____: ~7% _____: ~6%

congenital abnormalities.

In young adults the risk of cardiovascular complications is low and mainly due to _________ Risk are substantially higher (but still relatively low) for middle aged men.

knee foot back

Most common injuries to _____ (23%) _____ (14%) _____ (10%)

Chronic Traumatic Encephalopathy (CTE).

Most commonly found among professional athletes in contact sports

cardiac arrhythmias

Most severe events are due to __________ secondary to underlying coronary artery disease.

epidemiological triangle model

One useful tool in this regard is the ________ which considers factors related to the: - host (i.e., the person) - the environment (e.g., physical and social milieus) - the agent (e.g., physical activity, sport, or exercise)

Chronic Traumatic Encephalopathy (CTE).

Only diagnosed post-mortem

Equestrian sport Skateboarding Downhill skiing Bicycling

Other sporting activities with concussion stuff: ___________: 46,000 ER visits/yr; ~20% w/ head/neck injury ___________: ~ 7 fatalities/year (90% due severe head injury)• ___________: ~ 32 fatalities/year (most severe head injury)• ___________: 1000-1300 fatalities/yr (1/2 children/adolescents)

hospitalization

Overall 2.3% of injuries resulted in __________.

Chronic Traumatic Encephalopathy (CTE).

Potential symptoms: memory loss, aggression, confusion, depression

Gymnastics risk factors

Previous injury High lumbar curvature Protection

soccer risk factors

Previous injury Player's position Playing surface

stretching strength training

Some evidence of decreased injury risk with ____ and __________

skiing

Sports Specific Injury Rates (Netherlands): However, if we instead calculate injury rates per 1000 hours of participation in each sport, ______ is by far the riskiest sport followed by volleyball and ice skating.

Karate/Taekwondo risk factors

Technique Opponent Skill level

unknown denominator

The 1994 Injury Control and Risk Survey (ICARIS) addresses, at least in part, the _______ issue affecting the Gotsch results.

ACLS and Musculoskeletal injury

The figure compares injury rates across level participation in physical activity, stretching, and weightlifting.

weightlifting

The highest overall injury rate was for ________ followed by gardening and walking. _______ also had the highest proportion of injuries that required medical care or missed work/school .

15.4

The overall injury rate was ____ per thousand persons but the rate varied substantially by age and was highest among 10-14 year-olds.

rates become much closer together or farther apart

This slide shows results from a year-long random survey of the general population in Finland (aged 15 to 74 years). Injury rates are shown across a range of physical activities per 1000 hours of participation and per 1000 persons. How do the rates differ when different denominators are used?

Injury Control and Risk Survey (ICARIS)

This study was a national random phone survey of 5000 adults. Subjects were asked about their participation in five common physical activities in the past 30 days, any injuries related to participation in these activities, and the consequences of injury. Data were weighted to generate national injury estimates.

appropriate denominator

To demonstrate the importance of using an _______, we can look at the results from a study conducted in the Netherlands which used national electronic hospital records to examine injury rates by type of sport.

300,000

Up to ________ sports-related concussions per year in U.S.

appropriate denominator to use?

When comparing injury rates in men and women, or across sports, we could divide the total number of injuries by the number participating in organized sports. Using this approach, we see higher injury rates in men (20%) compared to women (11%) and among basketball players (15%) compared to skateboarders (2%). These estimates are more meaningful than looking at the number of injury cases alone. However, this approach may still produce imprecise estimates of risk as the frequency and duration of sport/exercise participation - which could vary substantial by sex or across different sports - are still not accounted for.

activity exposure

Whenever possible, a measure of ________ should be used as the denominator.

300,000 1/3 **However, most of these are mild to moderate concussions.

While estimates vary, up to ______ sports-related concussions occur each year in the United States. It is estimated that these account for _______ of all sports-related deaths.

28

_____% of those injured reported permanently stopping their exercise program

Sports Specific Injury Rates (Netherlands)

______ had, by far, the highest number of associated injuries and the greatest number of injuries requiring medical treatment. Based on this information alone, one might conclude that _______ is the most dangerous sport.

Epidemiologic triangle vs swimming injuries

consider.... 1) the age , sex, and ear morphology of the host 2) attributes of the activity itself such as the swimming stroke, frequency, speed, distance, and warm-up routine 3) the environment in which the activity occurs, including water temperature and quality.

ACLS and Musculoskeletal Injury

examined the issue of injury risks in their more active cohort of 5000 men and 1000 women aged 20-85 yrs. The study assessed self-reported soft tissue or bone injury over the past 12 months and asked participants to specify whether the injury was due to physical activity.

head injury sudden myocardial infarction.

most serious risks associated with sports and exercise: _____ + ______

ACLS study

only 10% of the sample were 20 to 40 years of age. How might this fact influence the results?

Mild concussions

seldom fatal although they can lead to neurological and cognitive impairment if repeated.

commonly

site of injury, with injuries to the ankle, finger, face, head, and knee being the most ______ occurring.

appropriate denominator

t is impossible to draw valid conclusions about the risks associated with exercise by looking only at the number of cases. It is vital that we use an _____________ to estimate the true risks associated with exercise and sports participation. Otherwise a distorted picture can result.

true

t/f: As expected, the activities engaged in during injury varied by sex and across the lifespan.

true

t/f: if we are encouraging exercise as health promoting, we are obliged to provide the public with a balanced view of both the benefits and risks.

true

t/f: in order to estimate the independent risk associated with physical activity, we need to consider other factors that may either confound or modify the association between physical activity and adverse outcomes.

true

t/f: it's clear that when evaluating the risks associated with physical activity we cannot simply count the number of injuries or use simple population estimates in the denominator.

true

t/f: risk factors tend to be unique to each sport.

- strains and sprains, - followed by fractures and superficial injuries such as contusions and abrasions.

the most frequent injury diagnoses:

twice

when comparing sport/rec related injury ER visits to non-sport related ER visits, youth ages 5-24 are ____ as like to have a - fracture -injuries to skull/brain - injuries to lower extremities