Injury or Activity-Related Pain Sustained by a Population of At-Risk Women during a 6-Month Exercise Program

Abstract

Background: Exercise provides numerous cardiovascular (CV) benefits to women; however, identifying women who are likely to sustain musculoskeletal injury or discomfort is important when tailoring exercise activities. Purpose: To evaluate factors associated with the incidence of injury in women at risk for CV disease (CVD) during their participation in a structured exercise intervention for primary CVD prevention. Study Design: Retrospective comparative study. Methods: Baseline anthropometric measures, CV efficiency (via standardized submaximal treadmill testing), and questionnaire-based assessments of functional capacity (Duke Activity Status Index [DASI]), daytime sleepiness (Epworth Sleepiness Scale), and depression (9-item Patient Health Questionnaire) were compared between participants sustaining an injury or experiencing persistent pain, regardless of cause, with those reporting no such events. Results: Of 117 women enrolled in the study, 27 (23%) experienced an injury or activity-related musculoskeletal pain during the program (injured group). Baseline characteristics for the entire group were: age, 57.3 years; weight, 203 lb; body mass index, 34.8 kg/m2; and waist circumference, 39.9 in. Characteristics did not differ significantly between the injured and non-injured groups for baseline demographics (P > 0.05), but obesity incidence (body mass index ≥ 30 kg/m2) was more prevalent in the injured group (P = 0.02). On univariate analysis, 9-item Patient Health Questionnaire depression scores were higher for injured participants (5.6 vs 4.1, P = 0.16) and DASI activity scores were significantly lower for injured participants (31.3 vs 41.0, P = 0.004) despite there being no significant difference in baseline exercise capacity, expressed as metabolic equivalents (8.1 vs 7.5, P = 0.20) between groups. The DASI score was an independent predictor of injury by multivariate analysis (P = 0.0092). Conclusion: Women study participants who were injured or experienced activity-related pain during a 6-month structured exercise intervention (injured group) had similar waist measurements, lipid/lipoprotein level profiles, and hemodynamic responses compared with women study participants who were event free (non-injured group); however, injured-group participants were more obese, more depressed, and reported lower functional capacity. Women who have the characteristics of the injured-group participants may be at greater risk for activity-induced injury when participating in exercise-based prevention programs for CV health.