Physical Activity Guidelines and Musculoskeletal Injury
Physical Activity Guidelines and Musculoskeletal Injury
Introduction: The United States Department of Health and Human Services disseminated physical activity (PA) guidelines (PAGs) for Americans in 2008. The guidelines are based on appropriate quantities of moderate-to-vigorous aerobic PA and resistance exercise (RE) associated with decreased morbidity and mortality risk and increased health benefits. However, increases in PA levels are associated with increased risk of musculoskeletal injuries (MSIs). We related the amount and type of PA conducted on a weekly basis with the risk of MSI.
Methods: A prospective, observational study using weekly Internet tracking of moderate-to-vigorous PA and RE behaviors and MSIs in 909 community-dwelling women for up to 3 yr was conducted. The primary outcome was self-reported MSIs (total, PA related, and non–PA related) interrupting typical daily work and/or exercise behaviors for ≥2 d or necessitating health care provider visit.
Results: Meeting versus not meeting PAGs was associated with more MSIs during PA (HR = 1.39, 95% confidence interval [CI] = 1.05–1.85, P = 0.02) but was not associated with MSIs unrelated to PA (HR = 0.99, 95% CI = 0.75–1.29, P = 0.92) or with MSIs overall (HR = 1.15, 95% CI = 0.95–1.39, P = 0.14).
Conclusions: The results illustrate the risk of MSI with PA. MSI risk rises with increasing PA. Despite this modest increase in MSIs, the known benefits of aerobic and resistance PAs should not hinder physicians from encouraging patients to meet current PAGs for both moderate-to-vigorous exercise and RE behaviors with the intent of achieving health benefits.
Evidence supports the relation between physical activity (PA), energy expenditure, physical fitness, and health outcomes. In addition, because obesity and its complications are increasing in the United States, the emphasis on PA to improve fitness and weight management for health reasons increases. The American College of Sports Medicine initiated Exercise is Medicine, a campaign "calling on all health care providers to assess and review every patient's PA program at every visit." The goal is to encourage physicians to make PA and exercise a standard part of disease prevention and medical treatment. Physicians recommending PA to their patients appear to improve initiation and compliance with an exercise program. National PA guidelines (PAGs) were developed in 2008, which recommend ≥150 min of moderate-to-vigorous aerobic PA (MVPA) per week and two or more resistance exercise (RE) sessions per week to achieve health benefits. Additional health benefits are observed with increasing amounts of PA (i.e., ≥300 min of MVPA per week). Combinations of moderate and vigorous PA are accomplished with 1 min of vigorous PA equating to 2 min of moderate PA. Evidence of the importance of PA's effect on health is the inclusion of PA objectives in Healthy People 2020. Although the PAGs indicate the benefits of PA, they also illustrate the potential of increased musculoskeletal injuries (MSI) for those engaging in PA. Adverse events generally increase with the amount of PA engagement. The PAGs Committee Report Figure G10-1 suggests a linear increase in MSI with increased mileage or MET-minutes per week of PA for recreational runners and walkers. Reported prevalence of injuries range from <10% to [almost equal to]40% with a median of approximately 20% in recreational runners and walkers. MSI studies have been conducted on sport participants and military personnel. We identified no studies in general community-dwelling individuals or settings addressing the risk of MSI when conducting PA sufficient for health benefits as defined by the US Department of Health and Human Services' PAG. Interest lies in MSI occurrence for individuals meeting the 2008 PAGs.
Reports relating MSI to PA generally use historical recall of injury. Military studies of injury have been conducted with medical records, concurrent training logs, and objective measures of injury and PA. Our objective was to obtain concurrent real-time PA and MSI. The Women's Injury (WIN) Study is a 5-yr prospective observational study designed to determine the incidence and predictors of MSI in a cohort of community-dwelling women during which participants reported PA behaviors and MSI weekly via a secure Web site for up to 3 yr. The purpose of the current analysis was to relate PA sufficient for meeting PAG to the risk of MSI.
Abstract and Introduction
Abstract
Introduction: The United States Department of Health and Human Services disseminated physical activity (PA) guidelines (PAGs) for Americans in 2008. The guidelines are based on appropriate quantities of moderate-to-vigorous aerobic PA and resistance exercise (RE) associated with decreased morbidity and mortality risk and increased health benefits. However, increases in PA levels are associated with increased risk of musculoskeletal injuries (MSIs). We related the amount and type of PA conducted on a weekly basis with the risk of MSI.
Methods: A prospective, observational study using weekly Internet tracking of moderate-to-vigorous PA and RE behaviors and MSIs in 909 community-dwelling women for up to 3 yr was conducted. The primary outcome was self-reported MSIs (total, PA related, and non–PA related) interrupting typical daily work and/or exercise behaviors for ≥2 d or necessitating health care provider visit.
Results: Meeting versus not meeting PAGs was associated with more MSIs during PA (HR = 1.39, 95% confidence interval [CI] = 1.05–1.85, P = 0.02) but was not associated with MSIs unrelated to PA (HR = 0.99, 95% CI = 0.75–1.29, P = 0.92) or with MSIs overall (HR = 1.15, 95% CI = 0.95–1.39, P = 0.14).
Conclusions: The results illustrate the risk of MSI with PA. MSI risk rises with increasing PA. Despite this modest increase in MSIs, the known benefits of aerobic and resistance PAs should not hinder physicians from encouraging patients to meet current PAGs for both moderate-to-vigorous exercise and RE behaviors with the intent of achieving health benefits.
Introduction
Evidence supports the relation between physical activity (PA), energy expenditure, physical fitness, and health outcomes. In addition, because obesity and its complications are increasing in the United States, the emphasis on PA to improve fitness and weight management for health reasons increases. The American College of Sports Medicine initiated Exercise is Medicine, a campaign "calling on all health care providers to assess and review every patient's PA program at every visit." The goal is to encourage physicians to make PA and exercise a standard part of disease prevention and medical treatment. Physicians recommending PA to their patients appear to improve initiation and compliance with an exercise program. National PA guidelines (PAGs) were developed in 2008, which recommend ≥150 min of moderate-to-vigorous aerobic PA (MVPA) per week and two or more resistance exercise (RE) sessions per week to achieve health benefits. Additional health benefits are observed with increasing amounts of PA (i.e., ≥300 min of MVPA per week). Combinations of moderate and vigorous PA are accomplished with 1 min of vigorous PA equating to 2 min of moderate PA. Evidence of the importance of PA's effect on health is the inclusion of PA objectives in Healthy People 2020. Although the PAGs indicate the benefits of PA, they also illustrate the potential of increased musculoskeletal injuries (MSI) for those engaging in PA. Adverse events generally increase with the amount of PA engagement. The PAGs Committee Report Figure G10-1 suggests a linear increase in MSI with increased mileage or MET-minutes per week of PA for recreational runners and walkers. Reported prevalence of injuries range from <10% to [almost equal to]40% with a median of approximately 20% in recreational runners and walkers. MSI studies have been conducted on sport participants and military personnel. We identified no studies in general community-dwelling individuals or settings addressing the risk of MSI when conducting PA sufficient for health benefits as defined by the US Department of Health and Human Services' PAG. Interest lies in MSI occurrence for individuals meeting the 2008 PAGs.
Reports relating MSI to PA generally use historical recall of injury. Military studies of injury have been conducted with medical records, concurrent training logs, and objective measures of injury and PA. Our objective was to obtain concurrent real-time PA and MSI. The Women's Injury (WIN) Study is a 5-yr prospective observational study designed to determine the incidence and predictors of MSI in a cohort of community-dwelling women during which participants reported PA behaviors and MSI weekly via a secure Web site for up to 3 yr. The purpose of the current analysis was to relate PA sufficient for meeting PAG to the risk of MSI.
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