Older people playing ball: What is the risk of falling and injury?

https://doi.org/10.1016/j.jsams.2007.12.007Get rights and content

Summary

Increasing physical activity amongst seniors is important for public health, yet guidance is needed to minimise injury risks. To describe the incidence of falls/injuries in a walking team ball game (Lifeball) designed for seniors, a prospective cohort study was undertaken amongst community dwelling Lifeball participants in Australia. Players completed a telephone survey soon after commencing Lifeball (2004) and 12 months later (2005). Attendance and incident records were audited for the period. Subjects joined a Lifeball group with opportunity to play at least once per week. Baseline was completed by 284 players aged between 40 and 96 years (mean 67 years), with most (83.8%, 238/284) female. Of 263 followed up, the average attendances was 25, with 19.3% attending on fewer than 4 occasions and 14.3% attending 52 or more times. Most (93.9%) reported no injuries requiring medical attention. However, 16 (6.1%) had injuries requiring medical attention and their 27 injuries represent an injury rate of 3.3 per 1000 hours of participation. Twenty participants (7.6%) had a Lifeball fall equating to a fall rate of 2.8 per 1000 hours of participation. Falls in Lifeball were not associated with measured predictors (age, gender, falls history, perceived falls risk or hours played). Incident records showed a trip/stumble involving rushing, walking backwards, or overextending (all against rules) as common falling causes. Lifeball is not ‘risk free’ however due to a lack of comparative data it is difficult to compare injury rate to relevant activities. Prevention of injury should concentrate on enforcing safety rules.

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

  • Education (both initial and ongoing) and enforcement around existing Lifeball rules is recommended.

  • 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

References (29)

  • L.W. Gerson et al.

    Recreational injuries among older Americans, 2001

    Inj Prev

    (2004)
  • J.F. Kraus et al.

    Mortality and morbidity from injuries in sports and recreation

    Annu Rev Public Health

    (1984)
  • R.J. Shephard

    Can we afford to exercise, given current injury rates?

    Inj Prev

    (2003)
  • E.V. Cyarto et al.

    Updating the evidence relating to physical activity intervention studies in older people

    J Sci Med Sport

    (2004)
  • Cited by (7)

    • A systematic review on research into the effectiveness of group-based sport and exercise programs designed for Indigenous adults

      2016, Journal of Science and Medicine in Sport
      Citation Excerpt :

      Collectively anthropometric outcomes significantly improved across all six reviewed articles29–34 in BW,29–32 BMI,29–32,34 WC30–32 and WHR32 in contrast to a significant initial improvement in BMI that was not sustained for a longer term.34 Results were consistent with contemporary research in Indigenous adults15,16 and non-Indigenous adult men17 demonstrating significant improvements in BW15,17 with further significant improvements in BMI and WC.6,13 While non-sustained results were reported in BMI34 at 12 months, a further non-significant modest improvement in BMI29 was reported at the three month follow-up which possibly suggests that a maintenance program may be appropriate in preserving BMI gains over the long term29 which is consistent with contemporary research16 and reinforced in one intervention that has a maintenance program underway.31

    • Falls count and counting falls: Making sense of data about falls

      2016, Medication-Related Falls in Older People: Causative Factors and Management Strategies
    • The pragmatic approach

      2010, Sports Injury Research
    View all citing articles on Scopus
    View full text