Fitness, not gender, predicts sports injury risk
By Alan Mozes
Women have appeared to be at greater
risk for sports injuries than men -- but a new study throws that theory a curve.
Physical fitness is a much better predictor for sports injury risk than the sex
of the athlete, according to US researchers.
Therefore, the higher injury rate among women suggests that they need more
conditioning training before engaging in rigorous physical activity, the study
authors suggest.
The research team looked at male and female US Army trainees to assess both
their overall fitness levels at the beginning of basic training, and the
frequency and degree of injuries during the training period. Researchers
suggested that examining this particular injury-prone non-civilian environment
was ideal in assessing the potential gender-injury relationship, in that both
sexes are exposed to identical training objectives and schedules, diet, living
situations, and healthcare access.
"The implications are that there shouldn't be 'one-training-fits-all.' By
throwing everybody into the same intensity of training right to begin with no
matter what the preparedness is, you run the risk of someone getting injured...
sometimes minor injuries, sometimes more serious ones," said study co-author Dr.
Thomas Mangione of the John Snow Inc. Research and Training Institute in Boston,
Massachusetts.
Mangione and colleagues followed 509 male and 352 female army trainees --
average age of 20 years -- from the beginning and throughout a standard 8-week
basic training regimen. All the trainees were tested for body composition and
fitness levels with regards to flexibility, muscle strength, endurance and
aerobic capacities. All the participants were divided into one of five groups
based on their fitness levels before training began. Throughout training, the
trainees medical records were reviewed and injuries noted.
The investigators found that with the exception of flexibility levels, the
men were generally much more physically fit than the women at the outset of
training, and that the women incurred 2 times the amount of overall injuries
throughout the regimen than the men. Additionally, the women were 2.5 times more
likely to incur serious injury -- resulting in lost training time -- than the
men.
However, researchers also found that within each of the five assigned
fitness level groups, the men and women did not differ in injury occurrence
levels, leading them to conclude that injury was related to fitness preparedness
-- particularly aerobic fitness -- rather than gender.
In addition, the women experienced much higher improvement than the men in
their fitness levels by the completion of the program -- with a 98% improvement
in sit-ups for the women compared with 44% for the men, a 156% improvement in
push-up scores for the women compared with 54% for the men, and a 23%
improvement in aerobic fitness for the women compared with 16% for the men. The
researchers noted that such differences have been attributed in earlier studies
as being a function of greater training benefit going to those starting at lower
fitness levels.
In an interview with Reuters Health, Mangione said that for the army in
particular, the study results suggested a need for a "change in perspective"
with regards to training protocol if injury rates are to be lowered. "The
implication is that there needs to be some kind of fitness assessment at the
beginning and maybe two tracks of training," he said. "Start them out more
slowly and build up their endurance and their cardiovascular abilities and then
put them into more vigorous training, and by doing so the armed forces would
avoid injuries (among trainees)."
Mangione pointed out that changing the military mode of physical training
was critical in a way that perhaps doesn't apply to civilians, since individuals
usually engage in "self-pacing" so that they only do what they feel capable of
doing. "Unlike in the case of someone wanting to start skiing or biking, in the
circumstances of the armed forces, basically people are being forced to exert
themselves at a level they may not be prepared to do and they are not allowed to
say, 'Gee I don't feel like going out for that 5-mile run today'. In training
for sports situations outside of the armed forces, this might not occur."
Mangione also noted that testing new army trainees for fitness levels need
not be viewed solely as a female issue. "Test results to determine physical
fitness before training begins could be gender neutral," he said. "You could
give it to both men and women -- and it wouldn't be that all women would fail.
It's just that it seems currently that women would probably benefit more as a
group to have this alternative mechanism."
