Older people playing ball: What is the risk of falling and injury?
Introduction
Although a physically active lifestyle is important in the prevention of chronic disease,1 activity levels tend to decline with increasing age2 with almost half (46%) of Australian adults aged 60–75 years insufficiently active for a health benefit.3 Considering seniors generate the highest expenditures for medical care4 and the proportion and number of seniors in developed nations is expected to rise,5 increasing physical activity in this age group is an important strategy.
Yet guidance is needed as to which activities give the greatest health benefits while minimising injury risks6 as activities should be challenging but also safe.7 However there is a lack of research on sport and recreational injury generally,8 and for older adults particularly,9 and about activities that have low injury incidence or limited participation.10 In addition, most data lacks information as to how often the activity is undertaken,8, 11 meaning there is no ability to calculate ‘true’ risk.9, 10 There is a need for more studies12 to examine the relationship between ‘dose’ and safety of exercise.
While internationally recognised ball sports promote physical activity, they may not be appropriate or safe for seniors. One rapidly growing community team activity from Australia designed specifically to cater for the need of seniors is ‘Lifeball’. ‘Lifeball’ is a walking, team ball game developed for community dwelling seniors who enjoy the comradeship of team ball sports, but wish for a slower pace than the traditional basketball or netball. Lifeball was developed on the premises that walking is an exercise of choice for seniors13 and exercising with others in group programs is an important enabler to seniors’ activity participation.14
At the time of this study, Lifeball was played in three states of Australia (NSW, QLD and WA) by approximately 600 seniors per week in 47 groups.15 By mid-2007 this had increased to an average of 1000 per week playing in 73 groups in four states (Wilson-Lord 2007, Personal communication). Lifeball is played on a court (basketball, netball or tennis) with two opposing teams aiming to advance the ball to score a goal. It incorporates walking, passing and throwing to encourage physical movement and teamwork. Lifeball has modified rules and equipment designed to reduce injury risk, such as: no body contact, only walking forward, throwing no higher than opponents’ shoulders, and lower goal posts. It is played with six per team; although player number can be modified.15 This paper describes the incidence, nature and rate of falls and injuries experienced during Lifeball in regional and rural NSW, Australia.
Section snippets
Method
The study entailed a prospective cohort design. Men and women were recruited from community groups and from the general population in four participating Health Service Areas (in NSW) to join a Lifeball group with opportunity to play at least once per week. On the first day they registered to play during the recruitment period from 1st March to 30th October 2004, players were invited to consent (or if overlooked, at their next game). Players were eligible if they had minimal exposure to Lifeball
Results
A total of 284 completed the baseline (67.3%, 284/422). Consenters were similar to non-consenters in terms of gender (female consenters 83.8%, female non-consenters 86.4%, p = 0.56) and age (median age, consenters 67.0 and non-consenters 66.5, p = 0.49). Most were female (83.8%, 238/284) with age ranging from 40 to 96 years (mean 67). At baseline, the majority (79.9%, 227/284) rated their risk of falling as low, with 28.9% (82/284) reported having at least one fall in the previous 12 months, and
Discussion
This study is one of the few that provides a risk assessment of a team game and the only one focused on team game designed specifically for seniors (Lifeball). It is a unclear how generalisable this sample is; nevertheless the sample size is reasonable and subjects were drawn from a large diverse geographical region. Its strength is having frequency and duration of play.
Lifeball is not ‘risk free’ as falls and injuries did occur. Due to a lack of comparative data, it is difficult to draw firm
Limitations
As the CATI was self-report recall bias was possible, as participants were contacted after 1 year, and participants kept no diaries. Secondly, a range of other variables could have been examined for associations with falling. Lastly, intensity of play could not be documented.
Conclusion
This study has provided falls and injury information for a new and developing physical activity that has the potential to fill an important gap as a team-based option for seniors. Lifeball is not risk-free and it would be useful to explore circumstances around falls injuries more fully to know what else can be done to prevent falls. Further research is needed to provide accurate assessments of the influence of regular participation in Lifeball on a person's overall falls risk and on comparable
Practical implications
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Education (both initial and ongoing) and enforcement around existing Lifeball rules is recommended.
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Prior history of falls is not necessarily a basis on which to turn people away, and using a participant self-rated checklist to screen for falls risk may not be effective.
Acknowledgements
Australian Government Department of Veteran Affairs, NSW Health Department—Injury Prevention Policy Branch, Lifeball National Steering Committee, Healthy Lifestyle Health Promotion Services, Colleen Wilson-Lord OAM: Master trainer, participating health services and staff and most importantly, the Lifeball players.
Disclosures and copyright: The name Lifeball was trademarked in 2002 however concept and development started in 1998 by Colleen Wilson-Lord OAM and Dr Brian Lord. From 2002 to 2006
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