Predictors of Lower Extremity Injury Among Recreationally Active Adults

ObjectiveTo identify gender-specific predictors of lower extremity injury among a sample of adults engaging in running, walking, or jogging (RWJ) for exercise. DesignProspective cohort study. SettingCooper Clinic Preventive Medicine Center, Dallas, Texas. ParticipantsParticipants were 2,481 men and 609 women who underwent a physical examination between 1970 and 1981 and returned a follow-up survey in 1986. Predictor variables measured at baseline included height, weight, and cardiorespiratory fitness. At follow-up, participants recalled information about musculoskeletal injuries, physical activity levels, and other predictors for lower extremity injury over two time periods, 5 years and 12 months. Main Outcome MeasuresAn injury was defined as any self-reported lower extremity injury that required a consultation with a physician. Cox proportional hazards regression (HR) was used to predict the probability of lower extremity injury for the 5-year recall period, and unconditional logistic regression was used for the 12-month recall period. ResultsAmong men, previous lower extremity injury was the strongest predictor of lower extremity injury (HR = 1.93–2.09), regardless of recall period. Among women, RWJ mileage >20 miles/wk was the strongest predictor for the 5-year period (HR = 2.08), and previous lower extremity injury was the strongest predictor for the 12-month period (HR = 2.81). ConclusionsFor healthy adults, walking at a brisk pace for 10–20 miles per week accumulates adequate moderate-intensity physical activity to meet national recommendations while minimizing the risk for musculoskeletal lower extremity injury. Clinicians may use this information to provide appropriate injury prevention counseling to their active patients.

[1]  B BALKE,et al.  An experimental study of physical fitness of Air Force personnel. , 1959, United States Armed Forces medical journal.

[2]  J. Ayres,et al.  A comparative analysis of four protocols for maximal treadmill stress testing. , 1976, American heart journal.

[3]  R. B. Johnson,et al.  Effects of frequency and duration of training on attrition and incidence of injury. , 1976, Medicine and science in sports.

[4]  S. James,et al.  Injuries to runners , 1974, The American journal of sports medicine.

[5]  R. Mann,et al.  Biomechanics of walking, running, and sprinting , 1980, The American journal of sports medicine.

[6]  C. Gudas Patterns of lower-extremity injury in 224 runners. , 1980, Comprehensive therapy.

[7]  K. Powell,et al.  An epidemiologic study of the benefits and risks of running. , 1982, JAMA.

[8]  M. Pollock,et al.  Comparative analysis of physiologic responses to three different maximal graded exercise test protocols in healthy women. , 1982, American heart journal.

[9]  S. Blair,et al.  Physical fitness and incidence of hypertension in healthy normotensive men and women. , 1984, JAMA.

[10]  D. Siscovick,et al.  The risks of exercise: a public health view of injuries and hazards. , 1985, Public health reports.

[11]  L Y Hughes,et al.  Biomechanical analysis of the foot and ankle for predisposition to developing stress fractures. , 1985, The Journal of orthopaedic and sports physical therapy.

[12]  Stephen J. Jacobs,et al.  Injuries to runners: A study of entrants to a 10,000 meter race , 1986, The American journal of sports medicine.

[13]  K. McQuade A Case-Control Study of Running Injuries: Comparison of Patterns-of Runners With and Without Running Injuries. , 1986, The Journal of orthopaedic and sports physical therapy.

[14]  C. Caspersen,et al.  Physical activity and the incidence of coronary heart disease. , 1987, Annual review of public health.

[15]  H. Kohl,et al.  Rates and Risks for Running and Exercise Injuries: Studies in Three Populations , 1987 .

[16]  B. Marti,et al.  On the epidemiology of running injuries , 1988, The American journal of sports medicine.

[17]  B. Marti Benefits and Risks of Running Among Women: An Epidemiologic Study , 1988, International journal of sports medicine.

[18]  S. Walter,et al.  The Ontario cohort study of running-related injuries. , 1989, Archives of internal medicine.

[19]  R S Paffenbarger,et al.  Physical fitness and all-cause mortality. A prospective study of healthy men and women. , 1989, JAMA.

[20]  K. Jackson,et al.  Predicting lower-extremity injuries among habitual runners. , 1989, Archives of internal medicine.

[21]  G. Matheson,et al.  Musculoskeletal injuries associated with physical activity in older adults. , 1989, Medicine and science in sports and exercise.

[22]  David W. Hosmer,et al.  Applied Logistic Regression , 1991 .

[23]  P. Hølmich,et al.  Non-elite marathon runners: health, training and injuries. , 1989, British journal of sports medicine.

[24]  H. Kohl,et al.  Age, physical activity, physical fitness, body composition, and incidence of orthopedic problems. , 1989, Research quarterly for exercise and sport.

[25]  J. Hoeberigs,et al.  Occurrence of running injuries in adults following a supervised training program. , 1989, International journal of sports medicine.

[26]  S. Blair,et al.  Patterns of non-response to a mail survey. , 1990, Journal of clinical epidemiology.

[27]  K. Jackson,et al.  Postrace morbidity among runners. , 1991, American journal of preventive medicine.

[28]  S. Messier,et al.  Etiologic factors associated with patellofemoral pain in runners. , 1990, Medicine and science in sports and exercise.

[29]  A. Klein,et al.  Structural measures as predictors of injury basketball players. , 1991, Medicine and science in sports and exercise.

[30]  J. Hoeberigs Factors Related to the Incidence of Running Injuries , 1992, Sports medicine.

[31]  B. Jones,et al.  Foot morphologic characteristics and risk of exercise-related injury. , 1993, Archives of family medicine.

[32]  F. Gutzwiller,et al.  Jogging or walking--comparison of health effects. , 1994, Annals of epidemiology.

[33]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[34]  R. Rothenberg,et al.  The natural history of exercise: a 10-yr follow-up of a cohort of runners. , 1995, Medicine and science in sports and exercise.

[35]  D. Kleinbaum,et al.  Survival Analysis: A Self-Learning Text. , 1996 .

[36]  M. McHugh,et al.  Flexibility and Its Effects on Sports Injury and Performance , 1997, Sports medicine.

[37]  M. A. Caselli,et al.  Lower extremity injuries at the New York City Marathon. , 1997, Journal of the American Podiatric Medical Association.

[38]  J. Després,et al.  American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. , 1998, Medicine and science in sports and exercise.

[39]  H. P. Hopp,et al.  Cardiorespiratory fitness and cardiovascular disease risk factors in postmenopausal women. , 1998, Medicine and science in sports and exercise.

[40]  Catherine Busseuil,et al.  Rearfoot-Forefoot Orientation and Traumatic Risk for Runners , 1998, Foot & ankle international.

[41]  H. Kohl,et al.  Lower extremity morphology and alignment and risk of overuse injury. , 1998, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[42]  R S Paffenbarger,et al.  Influences of cardiorespiratory fitness levels and other predictors on cardiovascular disease mortality in men. , 1998, Medicine and science in sports and exercise.

[43]  A S Jackson,et al.  Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. , 1999, The American journal of clinical nutrition.

[44]  M. Whaley,et al.  Physical fitness and clustering of risk factors associated with the metabolic syndrome. , 1999, Medicine and science in sports and exercise.

[45]  A. Manley Physical Activity And Health: A Report Of The Surgeon General , 2004 .