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ORIGINAL ARTICLE
Year : 2022  |  Volume : 22  |  Issue : 1  |  Page : 30-37

Prevalence and type of injuries among gym members in Saudi Arabia


1 Department of Family Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
2 Department of Plastic Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
3 Department of Family Medicine, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia

Date of Submission31-Dec-2021
Date of Acceptance02-Feb-2022
Date of Web Publication4-Apr-2022

Correspondence Address:
Suhad Alnasser
Department of Family Medicine, King Fahad Medical City, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjsm.sjsm_36_21

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  Abstract 


Introduction: Strenuous exercise and misuse of fitness machines can lead to injury. We conducted this study to better understand the extent of the problem and identify the causes of injuries, so we can develop and implement preventive measures to reduce the risk of injuries.
Methods: A cross-sectional study was conducted through a self-filled online questionnaire prepared in Arabic. The questionnaire was distributed through social media to gym members between 18 and 55 years old.
Results: In this study, we were able to collect 285 responses to our questionnaire. Most of the participants were females (71.6%) and more than half of the respondents were between 25 and 34 years of old (54.4%). The reliability results of the questionnaire showed that Cronbach's alpha was 0.749. Considering the prevalence of injuries among gym members in this study, we found that 29.2% of participants reported having injuries that were related to the gym with a mean frequency of 2.13 times. Moreover, the main affected body part because of injuries was the shoulder (40.5%), followed by foot (32.4%) and back (25.7%). Among 83 members who indicated having injuries at the gym, 58.1% of them reported visiting a hospital because of the injuries and 11.6% of them reported the need for surgical intervention. Moreover, the incidence of injuries was significantly higher in males than females (53.1%, 19.6%, P = 0.000) and obese participants rather than normal-weight participants (48.4%, 28.9%, P = 0.024).
Conclusion: We had developed a validated questionnaire with good reliability to assess the prevalence of gym-related injuries, their causes, and type. Our results showed that the prevalence of injuries among gym members was 29.2%. This prevalence of our study was lower than reported in other studies. However, most of the reported injuries were among males. The most common sites of injury were the shoulder, foot, and back. The most common causes of injury were torsion, severe stress, and iron weights. Moreover, our data confirmed the previous literature that injuries caused by gym exercise could lead to serious consequences that lead to lower quality of life.

Keywords: Gym, injury, prevalence


How to cite this article:
Alnasser S, Alyamani A, AlDawod I, Almujil A. Prevalence and type of injuries among gym members in Saudi Arabia. Saudi J Sports Med 2022;22:30-7

How to cite this URL:
Alnasser S, Alyamani A, AlDawod I, Almujil A. Prevalence and type of injuries among gym members in Saudi Arabia. Saudi J Sports Med [serial online] 2022 [cited 2022 Sep 25];22:30-7. Available from: https://www.sjosm.org/text.asp?2022/22/1/30/342529




  Introduction Top


It is widely accepted that physical activity can enhance overall health and prevent chronic illnesses.[1],[2] Physical activity also has a great psychological impact on improving self-esteem and body image. As per Saudi Arabia's vision, the goal is to increase the ratio of individuals exercising at least once a week from 13% of the population to 40%.[3] The national focus on this goal has resulted in increased numbers of gyms, with different types of exercises and programs, targeting both genders and all ages. Unfortunately, with all forms of physical activity, there is a risk of injury.[2] Sports injuries are defined by McGuine et al., as any damage of the tissues of the body that occurs because of sport or exercise.[4] Recent studies have found that athletes sustain 4 million sports-related injuries annually and require approximately 2.6 million emergency room visits at a cost of nearly $2 billion.[4] A study done by Montalvo et al. showed that 50 of 191 athletes sustained a total of 62 injuries during CrossFit participation in a 6-month duration.[5] Very few studies exist which investigate the injuries sustained during fitness activities in Saudi Arabia. Bakhamees et al. conducted a study to measure the prevalence of sports-related injuries among athletes in Jeddah, which showed that 50% of injuries were related to soccer and 34% to basketball. Moreover, another study was conducted by Alaqil et al. among members of fitness centers in Riyadh region, Saudi Arabia, in which the prevalence of injuries was 43.4%. To date, the literature review shows that there are still no available epidemiological studies measuring gym-related injuries in Saudi Arabia. To design an injury prevention program and reduce the future risk of such injuries, it is important to be aware of the injury rate and factors associated with such injuries.[6],[7] Consequently, this study aims at measuring the prevalence, type, and severity of gym-related injuries in Saudi Arabia.


  Methods Top


Study design and setting: This was an observational cross-sectional study that depended on a self-filled online questionnaire that was distributed through social media.

Participants

Sample size

A total of 285 gym members were needed to estimate gym-related injury. The sample size was estimated for a cross-sectional study, the following formula was used to calculate sample size = Z1−ᾳ/2 2 SD2/d2, where Z1−α/2 is standard normal variate (5% Type 1 error), SD is the standard deviation of the variable, and d = absolute error.

Inclusion criteria

Adults aged from 18 to 55 years and both genders who agree to participate were included in the study.

Exclusion criteria

Unrelated gym injuries, as well as injuries that occur in the gym but are not related to training, participants with musculoskeletal/neurological disease, participants on steroids, age below 18 years and above 55 years due to fragility, risk of fall, and osteoporosis were excluded from the study.

Data collection methods

Due to the rarity of such studies in Saudi Arabia, it is important to develop/adapt a new questionnaire in the Arabic language that focuses on demographics, type of exercise was done, site of the body affected by the injury, measures taken in the gym if any, and the chronicity of the injury. The reliability of the questionnaire showed that Cronbach's alpha score of 0.749 is acceptable. The Arabic version of the questionnaire was distributed through online forms completed by the participants using different available social media. The questionnaire was distributed to friends and family members who were asked to share the questionnaire among their relatives and friends who used to practise sports at the gym.

Statistical methods

All statistical analysis was carried out using IBM SPSS Statistics for Windows, Version 23.0. (IBM Corp, Armonk, NY, USA, Released 2015). Frequency and percentage were used for describing the categorical variables including age, gender, and other sociodemographic factors, while mean and SD were used for describing ongoing variables as weight and height. In this study, we assessed the body mass index (BMI) through the equation of weight in kg/height in m2, while categories of BMI are as follow: underweight if BMI is lower than 25 18.5, normal weight (18.5–24.9), overweight (25–29.9), and 26 obese if BMI is higher than 30 kg/m2. Chi-test and t-test were used to assess the difference in the prevalence of incidence of gym-related injuries with sociodemographic factors. All statements would be considered significant if the P value is lower or equal to 0.05.

Data and safety monitoring plan

The study was conducted after gaining approval from the ethics committee of the research center at King Fahad Medical City (IRB00010471). A consent letter was distributed with each survey, explaining the purpose of the study and reassuring respondents of the confidentiality of the survey.


  Results Top


We were able to collect 285 responses for our questionnaire. Most of the participants were females (71.6%). More than half (54.4%) of the respondents were between 25 and 34 years of old, and 38.2% of them were between 18 and 24 years old. The mean weight, height, and BMI were 66.2 kg, 164 cm, 24.5 kg/cm2, respectively. According to BMI, we found that 50.4% of participants had normal weight, while the prevalences of underweight, overweight, and obesity were 7.1%, 31.6%, and 11.0% respectively. About 67.0% of participants had an education level of university with 18.2% had education above university [Table 1].
Table 1: Sociodemographic factors of participants (n=285)

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Furthermore, we found that 50.9% of the participants reported that they had joined the gym <1 year ago, and 27.4% had joined a gym two or more years ago. About 27.4% of participants reported visiting the gym 5 days/week, 8.1% visited the gym 7 days/week, and 4.6% visited the gym 1 day/week. About 47% of participants spent between 30 and 60 min at the gym, 45.6% of participants spent between 60 and 120 min at the gym, and 1.1% of participants spent more than 120 min at the gym [Table 2].
Table 2: Frequency of visiting of gym

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The primary exercises practised at the gym as indicated by participants were resistance exercises in the form of barbell or lifting weights (71.9%) and cardio training (71.1%), followed by team sports classes (49.2%), swimming (22.7%), and freestyle sports such as squash and volleyball (1.20%) [Figure 1].
Figure 1: Type of exercise practised

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Considering the prevalence of injuries among gym members in this study, we found that 29.2% of participants reported having injuries that were related to the gym with a mean frequency of 2.13 times (48% had been injured once, 44% had been injured for 2 or 3 times, and the rest had been injured for more than 3 times). We did not find a relation between specific training type and increased incidence of injuries; however, a higher prevalence of injuries was noticed in participants who practise freestyle sports (66.7%) and resistance exercises (30.1%), while 24.1% of participants who practised swimming had been reported injuries [Table 3].
Table 3: Prevalence of injury in gym, frequency of injuries, and the relation between type of exercise and incidence of injury

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[Figure 2] shows the main causes of injuries sustained by participants in the gym. The causes of those injuries were torsion (45.9%), injuries due to severe stress (44.6%), iron weights (31.1%) exercise equipment (18.9%), falls (16.2%), injury by others (6.8%), and pool injury (1.4%).
Figure 2: The causes of injuries in gym (multi response)

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[Figure 3] shows both the most common site of injury as well as the site at which participants most feared sustaining an injury. Site of injury from most common to least common was shoulder (40.5%) followed by foot (32.4%), back (25.7%), leg (23%), hand (17.6%), knee (14.9%), neck (10.8%), thigh (10.8%), arm (10.8%), abdomen (6.80%), and head (4.10%). However, according to participants who reported that they did not have previous injuries, we found that injuries at the shoulder (39.7%), back (28.7%), and head (23.6%) were the injuries they most feared sustaining [Figure 3].
Figure 3: Site of injury (multi answers)

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Moreover, we had found that 28.8% of the sample reported that they had either visited the hospital because of an injury they had sustained at the gym or visited the hospital to see a friend who had sustained an injury at the gym. Among the 83 participants who indicated having injuries at the gym, 58.1% of them reported visiting a hospital because of the injuries and 11.6% of them reported the need for surgical intervention because of their injuries. About 35.1% of them reported that they had to take rest from work for a mean duration of 15.92 days, whereas some participants had to take 3 months of rest from work because of injuries, while 74.3% of the participants who had injuries reported that they take time away from the gym because of injuries for a mean duration of 56.9 days where some participants reported a maximum duration of 1 year.

We found that 73% of participants thought that injuries in the gym during training could be serious. Almost 85.3% attributed the incidence of injuries to be a result of the absence of a coach during training. About 79.3% of participants felt that the quality of the coach providing training could reduce the incidence of injuries. Participants who had not sustained a gym injury were more likely than their injured counterparts to believe that the presence of a coach and the quality of a coach could help reduce the likelihood of an injury. Moreover, only 25.6% of participants thought that injuries in the gym could be avoided [Table 4].
Table 4: Outcomes of injury in gym according to participants

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Considering the relation between sociodemographic factors and the incidence of injuries, we found a significant difference between the two genders concerning the prevalence of gym injuries. Males were significantly more likely (53.1% P = 0.000) to sustain an injury at the gym than females (19.6%, P = 0.000). Moreover, we found that age did not appear to be a significant factor for sustaining a gym-related injury. On the other hand, we found that obesity was significantly related to a higher incidence of gym-related injuries with 48.4% of obese participants reporting injuries, while only 28.9% of normal weight participants reported injuries (P = 0.024). We did not find a significant difference in the incidence of injuries among participants as it pertains to the frequency of gym visits. However, our data showed that increased duration of time spent at the gym increased the likelihood of injury significantly (P = 0.001), as shown in [Table 5].
Table 5: The relation between demographic factors and incidence of injuries

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  Discussion Top


Gym injuries are common in both orthopedic emergencies in addition to outpatient clinics, and those injures range from mild (do need medical intervention) to critical or severe (those who need intervention including surgical intervention). The risk of injury because of physical activity had a negative impact on the enjoyment of participation and reduced the long-term health benefits that these physical activities could provide. These injuries could result in negative changes in patients' daily activities, loss of time needed for work, poor quality of life, and disability in some cases, with the potential to even lead to death. Therefore, in this study, we aimed to measure the prevalence, type, and severity of gym injuries in Saudi Arabia. In this study, we used a self-reported prepared questionnaire which was designed in the Arabic language to be suitable for an Arabic population. The reliability results of the questionnaire showed that Cronbach's alpha was 0.749 which is quite good. Therefore, we recommend using the same or similar Arabic language questionnaires in other studies as a tool for assessing the prevalence of gym injuries. In this study, the prevalence of injuries among gym members was 29.2%. This prevalence of our study was lower than reported in other studies including the study of Alaqil et al., among members of fitness centers in Riyadh region, Saudi Arabia, in which the prevalence of injuries was 43.4%.[7] Moreover, another study was conducted by Almalki et al. among high school male students to assess the prevalence of ankle injuries in physical education and sports classes where the reported prevalence of ankle injuries at the study time, last month, last 6 months, last 12 months, and high school time was 14%, 21.1%, 30.3%, 31.7%, and 34.7%, respectively.[8] Furthermore, in another study conducted by Alwabli et al., among female gym members, the prevalence of gym injuries was 49%.[9] Moreover, our prevalence of gym injuries was nearly similar to the result of another study conducted by Feito et al., where the prevalence of gym injuries was 30.5%[10] and higher than the prevalence reported by Shinde and Sahasrabuddhe, who reported a prevalence of gym injuries of 16%.[11] This difference may be attributed to the difference in the age group and the data collection site.

In addition, we found a higher prevalence of injuries among participants whose main exercises practised at the gym were barbell or lifting weights, followed by cardio training, then team sports classes and swimming. We documented a higher prevalence of injuries among participants who practise freestyle sports (66.7%) and resistance exercises (30.1%). In the study of Gray and Finch, the authors found that resistance exercises including lifting weight account for half of the gym injuries.[2] The injuries that are related to resistance or weight training could be due to the inability of participants to handle the amount of weight they are choosing or training with (mainly because it could bestow a sense of achievement) and that lack of knowledge of proper technique could increase the incidence of injury. Moreover, our study showed that the main causes of injury are torsion (45.9%), severe stress (44.6%), iron weights (31.1%), and exercise equipment (18.9%). Pool injuries, fall, and injuries caused by others represented 1.4%, 16.2%, and 6.8% of injuries, respectively. According to a previous study by Gray and Finch,[12] and study of Kerr et al.,[13] falling, including falls throughout the facility and awkward landings, or twisting motions during exercise, is considered the main cause of gym injuries.

The most common site of injury was the shoulder (40.5%), followed by the foot (32.4%) and the back (25.7%). Similar to our results, we found that the study conducted by Shinde and Sahasrabuddhe also reported the shoulder as the most commonly affected site for gym injuries, followed by the lower back and knee.[11] The study of Feito et al. also reported that the shoulder was the most commonly affected site followed by the back, and knee.[10] Furthermore, we found that of injuries reported in this study requiring a hospital visit, with 11.6% of patients needing surgical intervention, 35.1% needed rest from work (mean: 15.92 days), and 74.3% needed rest from exercise (mean: 56.9 days). These results confirmed the idea that gym injuries could lead to serious consequences which could negatively affect their patients' quality of life and quality of work.

Moreover, in this study, we found that there is a significant difference between the two genders considering the prevalence of gym injuries where the incidence of injuries was significantly higher in males than females, while age is not a significant factor. In a study by Feito et al., the authors found a significantly higher prevalence of injuries in males than females;[10] however, many other studies showed no significant difference between males and females considering the rate of injuries.[2],[14],[15] Moreover, we found that the high prevalence of gym-related injuries was significantly related to obese participants. In the study of Alwabli et al., the authors found that BMI was linked to the frequency of injuries, indicated that an increase in BMI leads to an increase in injury rate.[9] In another study conducted by Richmond, the authors found that there is a higher risk of gym injuries in obese adolescents compared to healthy ones.[16] Finally, we did not find a significant difference in the incidence of injuries among participants based on the frequency of gym visits. However, as the duration of training per day increased, we noticed that the prevalence of injuries significantly increased. In a study conducted by Ristolainen et al., the authors showed that the more sports participation, the more injury related to such sport in adults and adolescents,[17] while a study by Lauersen et al. reported similar results to ours in which that there is an increased number of injuries with increased playing hours.[18]

This study had some limitations. One of these limitations is depending on self-reporting which can lead to some personal bias as some participants may not be completely honest in completing the questionnaire. Moreover, the questionnaire depended on some questions which require participants to remember previous events which can lead to some recall bias.


  Conclusion Top


In conclusion, our questionnaire made it possible for us to assess with a high level of reliability, the prevalence of gym-related injuries, its causes, and most prevalent types. From our results, we found that the prevalence of injuries among gym members was 29.2%. This prevalence of our study was lower than reported in other studies. However, most of the reported injuries were among males, and those injuries most commonly occur in the shoulder, foot, and back, with the main causes of injury being torsion, severe stress, and iron weight. Moreover, our data confirmed the previous literature that injuries caused by gym exercise could lead to serious consequences that lead to lower quality of life. This study can be a foundation for further studies which can identify suitable prevention measures and risk factors. We need to raise the level of awareness among gym members regarding gym-related injuries. Moreover, first aid availability must be insured and gym staff should be trained to use it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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McGuine T. Sports injuries in high school athletes: A review of injury-risk and injury-prevention research. Clin J Sport Med 2006;16:488-99.  Back to cited text no. 4
    
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Alaqil S, Alzahrani A, Alahmari S, Alqarni F, Alqahtani S, Kazi A. Prevalence of sports injury and its association with warm-up in males visiting the fitness centers in Riyadh, Saudi Arabia. J Nat Sci Med 2021;4:135-41.  Back to cited text no. 7
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Almalki M, Alowaime N, Alanazi A, Alamri M, Alaqil M, Masuadi E, et al. Prevalence of ankle injuries in physical education and sports classes among Saudi high school male students in Riyadh, Saudi Arabia. J Musculoskelet Surg Res 2018;2:16.  Back to cited text no. 8
    
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Alwabli Y, AlRuwaili K, Alghadoni M, Alsaleh L. Exercise-related injuries among female gym members in Qassim 2019. Int J Med Dev Ctries 2020;4:883-8.  Back to cited text no. 9
    
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Gray SE, Finch CF. Epidemiology of hospital-treated injuries sustained by fitness participants. Res Q Exerc Sport 2015;86:81-7.  Back to cited text no. 12
    
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Kerr ZY, Collins CL, Comstock RD. Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med 2010;38:765-71.  Back to cited text no. 13
    
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Ristolainen L, Heinonen A, Turunen H, Mannström H, Waller B, Kettunen JA, et al. Type of sport is related to injury profile: A study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study. Scand J Med Sci Sports 2010;20:384-93.  Back to cited text no. 17
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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