Accepted Manuscript
Title page
Regular Article
Title: Assessment of adverse events and near-misses during voluntary sports by Japanese
middle-aged and older adults: A 14-month prospective study

Author(s): Akihiro Hirata1,2,3 Yuko Oguma2,3* and Takeshi Hashimoto2,3

Affiliation(s):1Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
2

Sports Medicine Research Center, Keio University, 4-1-1 Hiyoshi, Kohoku-ku,

Yokohama, Kanagawa 223-8521, Japan
3

Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa,

Kanagawa 252-0883, Japan

Mailing address(es): Akihiro Hirata: akihirohirata@keio.jp, Yuko Oguma:
yoguma@keio.jp, Takeshi Hashimoto: hashimotot@keio.jp

1Number of Figures: 1

Number of Tables: 4

Running Title: Adverse events during community sports in JapaneseCorresponding Author:
Yuko Oguma
Sports Medicine Research Center, Keio University, Graduate School of HealthManagement, Keio University,
Phone: +81-(0)45-566-1090
Fax: +81-(0)45-566-1067
E-mail address: yoguma@keio.jp2

Abstract
This study aimed to prospectively record the occurrence of adverse events and nearmisses during sports in middle-aged and older adults who voluntarily engaged in sports
in the community and to clarify the frequency and characteristics of such events.
The participants comprised 14 groups (14 sports) of middle-aged and older adults
who voluntarily played sports in Sakae Ward, Yokohama. The follow-up period was 14
months (November 1, 2022, to December 31, 2023). Representatives of the target
groups reported once a month to Sakae Ward via postcards regarding the status of theiractivities and the occurrence of adverse events and near-misses. The survey items
included the age of the main participants in each group, number of activities during themonth, duration of each activity, number of participants per activity, adverse events, andnear-misses during sports.
During the 14-month observation, eight adverse events and two near-misses werereported in the 14 groups, mainly comprising middle-aged and older adults. Of the eight
adverse events, four were falls, all occurring in those aged ≥70 years and triggered byenvironmental problems. In this study, there were only two near-misses compared toeight adverse events, suggesting that the participants may have been unaware of nearmisses. Therefore, even for sports played by groups of residents, it is important to3

identify risks by assessing health conditions prior to exercise and to implement
initiatives to foster safety awareness among participants, such as hazard prediction
training.

Keywords
athletic injuries, accidental falls, recreation, exercise, incidence4邦題
日本人中高年者が自主的に実施するスポーツ中の有害事象やヒヤリハットの評
価：14 ヶ月間の前向き研究

著者
平田昂大 1, 2, 3 、小熊祐子 2, 3,*、橋本健史 2, 3

所属
1

日本学術振興会、 2 慶應義塾大学スポーツ医学研究センター、 3 慶應義塾大学大学院健康マネジメント研究科

要旨
本研究は、地域で自主的にスポーツを実施している中高年者集団を対象に、ス
ポーツ中の有害事象・ヒヤリハットの発生状況を前向きに記録し、その発生頻度と内容を明らかにすることを目的とした。
本研究の対象は、横浜市栄区において、中高年者が自主的にスポーツを実施
している 14 グループ（14 スポーツ）を対象とした。追跡期間は、2022 年 11 月
1 日から 2023 年 12 月 31 日までの 14 ヶ月間であった。対象グループの代表者

5

は、1 ヶ月に 1 回、活動状況と有害事象・ヒヤリハットの発生状況について、ハガキを用いて栄区に報告した。なお、本研究開始前に各グループの代表者を対象に研究の趣旨や有害事象・ヒヤリハットの定義について対面で説明する機会を設けた。調査項目は、各グループで活動している主なスポーツ参加者の年代、今月の活動回数、1 回あたりの活動時間、1 回あたりの参加人数、スポーツ中の有害事象およびヒヤリハットとした。
14 ヶ月間の観察期間中に、主に中高年者が参加している 14 グループで有害事
象は 8 件、ヒヤリハットは 2 件の報告があった。有害事象 8 件のうち、4 件が転倒であり、すべて対象は 70 歳以上、環境的な問題を契機に発生していた。本研
究では、8 件の有害事象に対してヒヤリハットは 2 件しかなく、スポーツ参加者がヒヤリハットを認識していない可能性が示唆された。したがって、住民集団で行うスポーツであっても、運動前の健康状態の把握などでリスクを把握するとともに、危険予知トレーニングの様な参加者の安全意識を醸成する取り組みを実施することが重要である。

キーワード
スポーツ外傷・障害、転倒、レクリエーション、運動、発生率

61Introduction

2

Physical activity has various health benefits, and efforts have been made to promote

3physical activity.1) Physical activity can include work or household chores, transportation,4

as well as walking, cycling, sports, and recreational activities (such as dance, yoga, and5

tai chi) in a variety of ways.1)

6
7

Generally, the benefits of physical activity outweigh the risks; however, considerations

8

should be made depending on the physical activity status and health of the participant.

9

For example, reports indicate that individuals with no daily physical activity habits have10

a higher risk of acute myocardial infarction during exercise if they engage in sudden,

11strenuous exercise.2) Moreover, coronary artery disease is a common cause of sudden

12

cardiac death during exercise.3) The current authors reported falls as a relatively common

13

adverse event during sports performed by community residents.4) The risk of falls

14

increases with age,5) and the number of people visiting medical facilities for certain

15

diseases also increases with age group.6) In Japan, which is currently experiencing a

16

rapidly aging population, it is necessary to create an environment in which people can17continue to enjoy sports by implementing safety measures tailored to the characteristics

18

of local sports types and participants.

7

19
20

It is important to understand the current situation and analyze the causes of adverse events

21

to prevent them during sports.7) To date, reports on adverse events in community sports

22

are limited. In Europe and the United States, Lindqvist et al.8) and Conn et al.9) reported

23

the occurrence of adverse events in community residents of a wide age range and in24

multiple sports disciplines. In Japan, the current authors reported the occurrence of25

adverse events among active sports leaders and directors during sports voluntarily

26

performed by residents of Sakae Ward, Yokohama City.4) However, both studies

27

conducted in Europe and the United States only included injuries that had been attended

28

to by a health care provider, which does not capture all adverse events. 8,9) And, as the29

frequency of adverse events during sport is expected to be lower in residents compared30

to athletes, it is desirable to understand more minor cases and those that trigger serious

31

accidents in order to take preventive measures. In a study of Sakae Ward residents

32

reported by the authors, leaders and directors were asked about adverse events and near-33

misses they had experienced in the past three years in an online questionnaire using a

34

recall method.4) This previous study was able to identify the environment for the35

implementation of sport in residents. However, the study did not target sports participants

36

themselves, and there was an issue of recall bias in the study design. To address these8

37

issues, prospective studies are needed on the occurrence of adverse events and near-38

misses among residents participating in sports.

39
40

Therefore, this study aimed to prospectively record the occurrence of adverse events and41

near-misses during sports in a group of middle-aged and older adults who voluntarily

42

perform sports in the community and to determine the frequency and characteristics of

43such events.

44
45

Methods

46

This was a descriptive epidemiological study that summarized the outcomes of a 14-

47

month prospective observation of adverse events and near-misses during activities

48

conducted by residents in a sports group. This study complied with the STROBE

49

statement, a set of guidelines to improve the transparency and quality of reporting on

50

observational studies.

51
52

Description of the target population

53

Sakae Ward, Yokohama City, has been certified as a Safe Community and has received

54

international certification since October 2013 (The term expired in October 2023.). A Safe

9

55

Community is a program in which communities take steps to prevent accidents and56

injuries through cross-sectoral collaboration based on the idea that fatal accidents and57

injuries can be prevented by identifying their causes. Certification is granted after an58

assessment based on indicators presented by the International Nongovernmental

59

Organization (NGO) Safe Communities Certification Center (formerly the World Health60

Organization [WHO] Collaborating Center on Community Safety Promotion). In Sakae

61

Ward, subcommittees have been established for eight themes: (i) child safety, (ii) sports

62

safety, (iii) traffic safety, (iv) child abuse prevention, (v) safety for the elderly, (vi) disaster

63

safety, (vii) suicide prevention, and (viii) crime prevention.10) Since 2019, the authors,64

commissioned by Sakae Ward, Yokohama City, have cooperated with the Taskforce

65

Committee for Sports Safety, Sakae Ward Safe Community, Yokohama City, to66

investigate adverse events and implement safety measures during voluntary sports

67

activities by Sakae Ward residents.

68
69

Participants

70

The target groups were members of the Sakae Ward Sports Association, one of the71

organizations of the Task Force Committee for Sports Safety, Sakae Ward Safe

72

Community, Yokohama City. The member organizations of the Taskforce Committee for

10

73

Sports Safety were as follows: the Sakae Ward Sports Association, Sakae Ward Sports

74

Promotion Committee, Sakae Ward Youth Instructors Council, Sakae Ward Sawayaka

75

Sports Promotion Committee, Nonprofit organization (NPO) Sakae Sports Club, and76

Sakae Sports Center (Facilitated by Yokohama City Sports Association.).

77
78

The 22 groups (22 sports each) were affiliated with the Sakae Ward Sports Association.

79

The target population for this study comprised 14 groups whose main sports participants

80

were middle-aged or older. Groups whose main participants were juveniles or mature (n81= 6) and those with no activity during the follow-up period (n = 2) were excluded from82

the analysis [Fig. 1]. The follow-up period was 14 months, from November 1, 2022, to83

December 31, 2023. Representatives of the target groups reported once a month to Sakae

84

Ward by postcard on the status of their activities, the occurrence of adverse events, and85

near-misses. An opportunity to explain the study aim and the definitions of adverse events

86and near-misses was provided and discussed with representatives from each group. At the87

meeting, specific examples of adverse events were given as “injuries or illnesses that88

occurred during the activity, feeling sick, physical pain, falls”. Specific examples of near-89

misses were given as “almost falling over, almost colliding with people or objects, finding

90

damaged facilities or equipment”. Any uncertainties or questions were discussed at the

11

91

meeting to ensure consistency in the standards between the researchers and participants.

92

A delegate from one group asked the following striking question, "In our own sport, due

93

to the nature of the sport, falls and bruises are common, do we have to report them all?".

94

In response to this question, we replied: 'What normally happens during sport is not

95

subject to reporting. However, unintentional falls and bruises, e.g. falls or person-to-

96

person collisions that occur without proper equipment or compliance with the rules,

97

should be reported."

This was shared with representatives of all groups.

98
99

Fig. 1: Flowchart for the selection of target groups.

100
101

Survey items

102

The survey items included the age of the main participants in each sports group, number

103

of activities during the month, duration of each activity, number of participants per

104

activity, adverse events, and near-misses during sports (date and time of occurrence, sex

105

and age of the parties, circumstances at the time of occurrence, and response after

106

occurrence). The research team received 14 months of follow-up data from Sakae Ward107

for analysis.

108

12

109

Sports in this study refers to leisure-time physical activities performed by each group.

110

Adverse events and near-misses that occurred during sports activities (including the time111

between competitions and the time for clean-up and preparation before and after the112

competition) were recorded. In this study, the appearance of pain after sports activities,

113

for example, was not ascertained. Considering the age (middle-aged or older) group of114

the subjects, we considered falls as adverse events regardless of whether there was an

115

injury after the fall. Adverse events were defined as any unfavorable events, such as

116

accidents, injuries, or illnesses, that occurred physically or mentally during exercise or117

physical activity. Furthermore, near-misses were defined as incidents that did not cause

118

physical or mental harm to participants but caused a “near miss” or “aha” experience for

119

instructors or supporters in the field of practice.4)

120
121

This study was approved by the Ethical Review Committee of the Sports Medicine

122

Research Center of Keio University (approval number: 2022-08).

123
124

Statistical analysis

125

The proportionality scale is expressed as mean (M) ± standard deviation (SD). The

126

frequency of adverse events and near-misses was calculated from the number of reported

13

127

activities (times), number of hours per activity (hours), and number of participants per

128

activity (persons). Microsoft Excel (Microsoft Corp., Redmond, WA, USA) and IBM

129

SPSS Statistics ver. 29 (IBM Corporation, Armonk, NY, USA) were used for the analysis.

130
131

Results

132

Attributes of the target groups

133

Fourteen Sakae Ward Sports Association member groups whose main sports participants134

were middle-aged or older were involved in the study. The attributes of each group135(sports) are presented in [Table 1]. The average follow-up period for the 14 groups was

136

12.6 ± 2.3 (range 5.0–14.0) months. The groups with the shortest observation periods was

137

gateball, which lasted for 5 months. The group for tug-of-war, kendo, Japanese archery138(kyudo), and target bird golf had the longest observation period of 14 months. The mode139

was 13 months for all seven groups.

140
141

The group with the highest number of activities per month was kendo, with 20.8 activities

142

per month; the group with the lowest number of activities per month was table tennis,

143bowling, and soft tennis, with 1.0 activities per month. The three groups with the lowest

144

number of activities per month were table tennis, bowling, and soft tennis.

14

145
146

The average duration per sport activity was 3.8 ± 2.1 (range 1.4–8.0) hours. The group147

with the longest average duration per activity was tennis at 6.9 hours per activity; the148group with the shortest average duration per activity was kendo at 1.4 hours per activity.

149
150

The group with the highest average number of participants per sporting activity was151

softball, with 92.5 participants per activity. The group with the lowest average number of152

participants per session was volleyball, with 8.8 participants per session.

153
154

Table 1: Status of the sports groups’ activities.

155
156

Adverse events

157

Eight adverse events were reported during the 14-month observation period in the 14

158

groups. Five of the 14 target groups reported adverse events. There were 3 adverse events

159

in target bird golf, 2 in walking, and 1 each in kyudo, volleyball, and tennis.

160
161

For the 14 groups in this study, the total observation period was 181 months, the total

162

number of activities was 983, the total duration of activities was 2487.8 hours, and the

15

163

total number of participants was 33771. The following table shows the frequencies of164

adverse events reported for each group [Table 2]. Concerning the number of occurrences165

per 1000 person-hours calculated from the number of participants and activity duration,

166

tennis was 0.017 events/person-hours, walking was 0.013 events/person-hours, volleyball167

was 0.008 events/person-hours, target bird golf was 0.001 events/person-hours, and168

kyudo was 0.0003 events/person-hours.

169
170

Table 2: Incidence of adverse events (November 1, 2022 to December 31, 2023).

171
172

Four of the eight adverse events were falls, and none involved fractures. Three of the four

173

falls resulted in skin wounds, one of which required medical attention and wound suturing.

174

All participants who fell were between 70 and 90 (mean 80.8 ± 14.7) years of age. Other

175

than falls, there was one case each of a sprain, muscle spasm, contusion, and wound.

176[Table 3]177
178

Table 3: Description of adverse events.

179
180

Two near-misses were reported during the observation period, both during gateball. The

16

181

contents were: (1) “Participant swung the stick around 2–3 times when hitting the ball.

182

As a result, there was a risk of the sticks hitting people around them.” and (2) “Participant

183

forgot to include a necessary item (e.g. drink, medicine.)" [Table 4].

184
185

Table 4: Description of near-misses.

186
187

Discussion

188

In this study, the occurrence of adverse events during sports voluntarily performed by

189

community residents was prospectively recorded for 14 months, from November 1, 2021,

190

to December 31, 2022. The group consisted of 14 sports, with the participants being191

middle-aged or older. Eight adverse events and two near-misses occurred during the study

192

period. Of the eight adverse events, four were falls.

193
194

All falls in this study occurred in those aged 70 years or older. The incidence of fall-

195

related injuries has been reported to increase with age.11) Fall-related fractures in the196elderly are a significant cause of death12) and are independent predictors of nursing home

197

placement.13) Thus, fall prevention is important in sports. The risk factors for falls in

198

community-dwelling older adults have been reported to include age (older), sex (female),

17

199

and medication.14) Therefore, especially in older age groups, it is necessary to identify

200

and consider high-risk individuals by checking the risk factors for falls, such as a history

201

of falls, underlying medical conditions, and medication status, before the start of sports.

202

All falls in the present study were caused by environmental factors (tripping over mats,203

poles on the road surface, and tree roots). In the field of occupational safety,

204

environmental factors, including the inclination of support surfaces, lighting, and floor

205

conditions, are considered fall prevention factors. In sports for middle-aged and older

206

adults, environmental considerations are necessary for events that occur in parks or

207

sidewalks.

208
209

There were only two near-misses in this study (gateball): “Participant swung the stick210

around 2–3 times when hitting the ball. As a result, there was a risk of the sticks hitting

211

people around them.” and “Participant forgot to include a necessary item (e.g. drink,212

medicine.)”. Forgetfulness is unique to the elderly, and it is necessary to take measures

213

such as making a list of belongings for the day, informing family members who live with214

them where to go, and wearing items with identifying information. However, in cases

215

where participants break the rules and safety checks of the sports field, it is important to216

regularly check the rules and precautions within the exercise group and to share cases

18

217

where a minor incident (near miss) leads to an adverse event so that the danger is known

218

to all. In fact, there was an adverse event in a different sport (target bird golf) in which a

219

participant hit another participant with a ball during a competition.

220
221

Heinrich’s Law15) and Bird’s Law16), which are well-known in the safety management

222

field, indicate that there are more near-misses than major accidents and minor adverse

223

events. However, in this study, there were only two near-misses compared to eight adverse

224

events, suggesting that the workers may not have been aware of near-misses. Hazard

225

prediction training and occupational health and safety training have been reported to be226

effective in improving awareness of health and safety in the fields of medicine17) and227

occupational health and safety.18) We believe that by implementing such initiatives to228

foster safety awareness at sports sites, it will be possible to maintain a high level of safety,

229

even when there is a turnover of participants or a change in group representatives.

230
231

In terms of the frequency of adverse events based on the number of adverse

232

events/number of participants × exposure (hours), the lowest frequency was 0.0003

233

events/1000 person-hours in kyudo, and the highest frequency was 0.017 events/1000

234

person-hours in tennis. In a cohort study of 3657 individuals in Finland, all physical

19

235

activities (including recreational and competitive sports) were considered, and the236

occurrence of sports injuries was ascertained via telephone.19) This previous study

237

reported a higher number of occurrences per 1000 person-hours in sports such as soccer

238

and tennis than in walking and golf. This difference in the frequency of occurrence by239

sports discipline shows a trend similar to that observed in this study. However, regarding240

the number of occurrences per 1,000 person-hours, this study differed significantly from

241

previous studies. This may be because the previous study included young people (15–75

242

years old) and “competitive sports” in its sample. However, Parkkari et al.19) reported in243

a similar paper that the incidence of adverse events was higher in team sports and contact244

sports, but the absolute number of adverse events was higher in relatively low-risk sports

245such as walking. Because walking and other low-risk sports are relatively widely246

practiced by a large number of people, efforts to prevent injuries associated with these247

sports are important. In this study, the number of participants in tennis, the sport with the248highest frequency of occurrence, was 58300 person-hours, or 2.6 times higher than the249

number of participants-activity times in walking (156330 person-hours).

250
251

The current authors report the results of a survey conducted by Sakae Ward and its sports

252

safety subcommittee in 2017.20) This previous study (a mixed study) qualitatively and

20

253

quantitatively analyzed the “efforts that exercise participants believe are necessary to254

prevent adverse events.” From the results, the following initiatives were identified:255“appropriate warm-up efforts prior to exercise,” “daily physical activity and256

understanding one’s own physical function and condition,” and “creating and preparing

257

an emergency response plan. However, according to a survey4) conducted by the Sakae

258

Ward in 2020 on exercise instructors and supporters of the Sports Safety Subcommittee,259

only 32% (35 of 108 eligible participants) had taken a lifesaving course. Therefore, in

260

addition to creating EAPs, it is necessary to promote education regarding

261

cardiopulmonary resuscitation and the use of automated external defibrillators.

262
263

Strengths and limitations

264

The strengths of this study are twofold. First, this is the first prospective observational

265

study in Japan to target sports voluntarily played by residents. It is difficult to grasp the266

actual situation of sports played voluntarily by residents because they are played in

267

various places and forms. Second, activities, adverse events, and near-misses were268

recorded using uniform standards. As described above in Methods, the representatives of269

each group were given an opportunity to explain the purpose of the study and the270

definitions of specific adverse events and near-misses in person before the study began.

21

271

The results are expected to contribute to the development of safe and secure community

272

exercise environments.

273
274

This study has five notable limitations. First, the individual attributes such as age, sex,

275

exercise intensity, and activity time of each participant were not ascertained because it is276

difficult to ascertain each individual participant in exercises in which residents participate

277

freely because of the large number of participants and the frequent comings and goings278

of participants. Second, the number of reported adverse events and near-misses was low.

279

An omission in the reporting of adverse events and near-misses would significantly affect280

the overall trend. In this study, representatives from each group were given a forum to281

explain the purpose of the study and the definitions of adverse events and near misses to282gain a common understanding. However, compliance within each group was not

283

ascertained. They were left to the representatives of each group. Therefore, it cannot be284

ruled out that adverse events and near-misses on activity days when the representative285

was absent may not have been reported. Third, the novel coronavirus infection may have286

had an impact on the findings. During the observation period (November 1, 2022, to287

December 31, 2023), there were no emergency restrictions or restrictions on priority

288

measures by the Japanese government, such as preventing the spread of the disease.

22

289

However, a decrease in physical activity was noted in elderly Japanese after the290

coronavirus pandemic compared to before the pandemic.21) It is unclear whether the291

subjects in this study recovered to their pre-pandemic activity levels. Therefore, if there

292

were fewer sports participants than usual, there may have been fewer accidents and other293

adverse events due to crowding. Fourth, the type of activity in the target group was not294

uniform and varied among the population. Some groups reported only one-off events,

295

whereas others reported regular practice and other activities. However, reported of one-296

off competitions were excluded from this study. Therefore, comparisons were not made297

between the groups (sporting events). Fifth, the present study does not adequately

298

distinguish between 'triggers', such as collisions with people, objects or falls, and299'consequences', such as fractures, sprains, etc. Studies using sports injuries in athletes or300

the development of death or disease in the general population as outcomes have used clear

301

criteria such as interruption of practice or diagnosis by a doctor; it is difficult to establish

302

such a clear criterion in this research area. Therefore, when using the current definition

303

of adverse events, it will be necessary in the future to consider both the trigger and the304

outcome along with their description, respectively. In addition, given the goal of fulfilling305

the establishment of a safe condition corresponding to the attributes of the sports

306

participant and the nature of the activity, it is important to describe and organize them as

23

307

accurately as possible as the 'undesirable events: adverse events' and 'near-misses' that the308

subject has experienced.

309
310

Based on this study, we propose the following suggestions for creating a safer sports

311

environment. First, even for sports played by groups of residents, initiatives to foster

312

safety awareness among participants, such as hazard prediction training, are crucial.

313

Second, recording and sharing the occurrences of adverse events and near-misses should314

be implemented on an ongoing basis in community sports. Third, in small groups and for315

one-off sporting events associated with each athletic organization in this study, adverse

316

events, and near-misses should be recorded and measures should be taken and updated

317

regularly.

318
319

Conclusion

320

This study prospectively investigated the occurrence of adverse events and near-misses

321

during sports voluntarily conducted by residents of Sakae Ward, Yokohama, Japan. Eight322

adverse events and two near-misses were reported during a 14-month observation period

323

across the 14 groups, mainly involving middle-aged and older residents. Of the eight324

adverse events, four were falls, all of which occurred in those aged 70 years or older and

24

325

were triggered by environmental issues. In the target population of this study,

326

preparedness for falls, such as pre-exercise health checks and environmental

327

modifications, is necessary.

328
329

Acknowledgments

330

We express our gratitude to Sakae Ward, Yokohama City, for its cooperation in this study.

331

This study was conducted in response to data provided by the “Project for the Promotion332

of Measures to Prevent Injuries and Accidents During Exercise” conducted by Sakae

333

Ward, Yokohama City. We would like to thank Editage (www.editage.jp) for the English

334

language editing. This work was supported by JSPS KAKENHI (grant number

335

JP23KJ1892).

336
337

Conflict of Interest

338

The authors declare that there are no conflicts of interest.

339
340

Author Contributions

341

AH and YO designed this study. AH analyzed the data and drafted the manuscript. YO

342

and TH edited and revised the manuscript. All authors have approved the final version of

25

343

the manuscript for submission.

344
345

Data Statement346

The datasets generated and analyzed in the current study are available from the347

corresponding author upon reasonable request.

26

348

References

349

1.

World Health Organisation. 2019. Global Action plan on physical activity 2018-

350

2030: more active people for a healthier world. World Health Organization.

351

https://www.who.int/publications/i/item/9789241514187

352

2.

Franklin BA. 2014. Preventing exercise-related cardiovascular events: Is medical

353

examination more urgent for physical activity or inactivity? Circulation 129: 1081-

354

1084. doi: 10.1161/CIRCULATIONAHA.114.007641.

355

3.

Sollazzo F, Palmieri V, Gervasi SF, Cuccaro F, Modica G, Narducci ML, Pelargonio

356

G, Zeppilli P, Bianco M. 2021. Sudden cardiac death in athletes in Italy during 2019:

357

Internet-based epidemiological research. Medicina (Kaunas) 57: 61. doi:358

10.3390/medicina57010061.

359

4.

Hirata A, Oguma Y, Hashimoto T. 2024. Assessment of adverse events and near-360

misses during voluntary community-driven sports activities by community residents:361

a cross-sectional study (in press). J Phys Fit Sports Med 13.

362

5.

Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. 2010. Risk

363

factors for falls in community-dwelling older people: a systematic review and meta-364

analysis. Epidemiology 21: 658-668. doi: 10.1097/EDE.0b013e3181e89905.

365

6.

Ministry of Health, Labor, and Welfare. 2023. Comprehensive Survey of Living

27

366

Conditions, 2022. Article in Japanese. https://www.mhlw.go.jp/toukei/list/20-

367

21.html. Accessed December 10, 2023.

368

7.

van Mechelen W, Hlobil H, Kemper HC. 1992. Incidence, severity, etiology, and369

prevention of sports injuries. A review of concepts. Sports Med 1992; 14: 82-99. doi:370

10.2165/00007256-199214020-00002.

371

8.

Lindqvist KS, Timpka T, Bjurulf P. 1996. Injuries during leisure physical activity in

372

a

373

10.1177/140349489602400409.

374

9.

Swedishmunicipality.

Scand

J

Soc

Med.

24:

282-292.

doi:

Conn JM, Annest JL, Gilchrist J. 2003. Sports and recreation-related injury episodes

375

in the US population, 1997-99. Inj Prev 9: 117-123. doi: 10.1136/ip.9.2.117.

376

10. What constitutes a safe community? 2021. Article in Japanese. Yokohama, Japan:

377

Sakae Ward.

378

https://www.city.yokohama.lg.jp/sakae/shokai/safe/safecommunitytowa.html.

379

Accessed February 7, 2023.

380

11. Peel NM, Kassulke DJ, and McClure RJ. 2002. Population-based study of381

hospitalized older adults with fall-related injuries Inj Prev 8: 280-283. doi:382

10.1136/ip.8.4.280.

383

12. Scuffham P, Chaplin S, Legood R. 2003. Incidence and costs of unintentional falls in

28

384

older people in the United Kingdom. J Epidemiol Community Health 57: 740-744.

385

doi: 10.1136/jech.57.9.740.

386

13. Gaugler JE, Duval S and Anderson KA. 2007. Predicting nursing home admissions

387

in the U.S: A meta-analysis. BMC Geriatr 7: 13. doi: 10.1186/1471-2318-7-13.

388

14. Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. 2010. Risk

389

factors for falls in community-dwelling older people: a systematic review and meta-390

analysis. Epidemiology 21: 658-668. doi: 10.1097/EDE.0b013e3181e89905.

391
392
393
394

15. Heinrich HW. 1931. Industrial accident prevention: a scientific approach. McGraw
Hill. New York.
16. Bird FE Jr., Germain GL. 1996. Practical loss control leadership, the conservation ofpeople, property, process and profits, Det Norske Veritas (U.S.A.), 452 p.

395

17. Hiyamizu I, Yukioka T, Saeki E et al. 2021. The effect of “Before-work KYT

396

conference” by nurses in the critical care field and its factors. Journal of the Japanese

397

Society398

10.11240/jsem.24.9

forEmergency

Medicine.

24:

9-15. Article

inJapanese.

doi:

399

18. Robson LS, Stephenson CM, Schulte PA, Amick BC 3rd, Irvin EL, Eggerth DE, Chan

400

S, Bielecky AR, Wang AM, Heidotting TL, Peters RH, Clarke JA, Cullen K, Rotunda

401

CJ, Grubb PL. 2012. A systematic review of the effectiveness of occupational health

29

402

and safety training. Scand J Work Environ Health 38: 193-208. doi:403

10.5271/sjweh.3259.

404

19. Parkkari J, Kannus P, Natri A, Lapinleimu I, Palvanen M, Heiskanen M, Vuori I,

405

Järvinen M. 2004. Active living and injury risk. Int J Sports Med 25: 209-216. doi:406

10.1055/s-2004-819935.

407

20. Hirata A, Oguma Y, Manabe T, Hashimoto T. Adverse events during community

408

residents’ independent physical activity and sports: a questionnaire survey conducted409

by Safe Community Sports Safety Subcommittee in Sakae ward Yokohama city (in410press). Research in Exercise Epidemiology 25. Article in Japanese. doi:

411

https://doi.org/10.24804/ree.2208

412

21. Yamada M, Kimura Y, Ishiyama D, Otobe Y, Suzuki M, Koyama S, Kikuchi T,

413

Kusumi H, Arai H. 2021. The influence of the COVID-19 pandemic on physical414

activity and new incidence of frailty among initially non-frail older adults in Japan:

415

a follow-up online survey. J Nutr Health Aging 25: 751-756. doi: 10.1007/s12603-

416

021-1634-2.

417

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The organizations that make up the Taskforce Committee for Sports Safety, Sakae Ward Safe Community, Yokohama City.
Sakae Ward Sports Association

Sakae Ward Sawayaka Sports Promotion Committee

Sakae Ward Sports Promotion Committee

NPO Sakae Sports Club

Sakae Ward Youth Instructors Council

Yokohama City Sports Association

Survey Requested Subject

Sakae Ward Sports Association
22 groups (sports)
・Groups whose main participants are NOT middle-aged or older
Exclude6 groups (sports)

・Group with no activity during the observation period

2 groups (sports)
Analysis subject
Sakae Ward Sports Association
Groups where the main participants are middle-aged or older
Sakae Ward Table Tennis Association
Sakae Ward Tug-of-War Federation
Sakae Ward Kendo Federation
Sakae Ward Kyudo Association
Sakae Ward Bowling Association
Sakae Ward Volleyball Association
Sakae Ward Badminton Association1

NPO: Nonprofit organization

2

Fig. 1: Flowchart for the selection of the target groups.

14 groups (sports)
Sakae Ward Tennis Association
Sakae Ward Dance Sports Federation
Sakae Ward Target Bird Golf Association
Sakae Ward Softball Association
Sakae Ward Soft Tennis Federation
Sakae Ward Gateball Association
Sakae Ward Walking Association

31

3

Table 1: Status of sports group’s activities.

Sport Name

Tracking period(group)(months)

Months with

Average number ofactivity

activities per month(months)(times/month)

Average time per activity(hours/activity)

Average number ofparticipants per activity(persons/activity)

Table tennis

13

2

1.0

3.8

57.0

Tug of war

14

9

1.7

2.1

29.5

Kendo

14

13

20.8

1.4

60.0

Kyudo

14

14

13.2

3.1

30.1

Bowling

13

13

1.0

2.7

43.5

Volleyball

13

13

6.7

2.0

8.8

Badminton

12

12

2.2

3.0

26.6

Tennis

12

7

2.3

6.9

33.1

Dance sports

13

13

3.9

1.5

13.3

Target Bird Golf

14

14

17.1

2.8

19.4

32

Softball

13

5

3.4

5.8

92.5

Soft tennis

13

3

1.0

6.0

76.7

Gate ball

5

5

6.0

3.0

10.0

Walking

13

13

2.1

5.0

42.9

Average12.6±2.3

9.7±4.4

5.9±6.5

3.5±1.838.8±25.2

All ages of the main participants in the target groups are middle-aged or older
Average number of activities per month (total number of activities/ number of months with activities)
Average time per activity (total activity time/ total number of activities)
Average number of participants per activity (total participants/ total number of activities)
Mean±SD (standard deviation)

4
5

33

6

Table 2: Incidence of adverse events (November 1, 2022 to December 31, 2023).
AdverseTotal number

Total time of

Total number of

Number of participants ×

Number of participants ×

Incidence rate

Incidence rate

eventsof activities

activity

participants

activity duration

activity time(cases/1000 persons-(cases/1000(cases)(times)(hours)(persons)(person-activities)(person-hours)

activities)

persons-hours)

Sport Name

(Group)

Kyudo

1

185

572.5

5574

103119031911150.001

0.0003

Volleyball

1

87

171.0

766

66642

130986

0.015

0.008

Tennis

1

16

110.0

530

8480

58300

0.118

0.017

Target bird golf

3

240

673.5

4650

1116000

3131775

0.003

0.001

Walking

2

27

135.0

1158

31266

156330

0.064

0.013

Total number of activities = Total number of activities reported each month

Total activity hours = Average activity hours per reported activity × Number of activities

34

Total number of participants = Average number of participants per reported activity × Number of activities

Number of participants × Activity hours = Total activity hours × Total number of participants

Incidence rate (cases/1000 participants/activity)= number of adverse events/ (total number of participants × total number of activities × 1000)

Incidence rate (cases/1000 person-hours) = number of adverse events/ (total number of participants × total activity hours × 1000)

7
8

35

9

Table 3: Description of adverse events.
AdverseAgeSports (Group)

eventsBody

Adverse event

Sex
(y)

part

classification

85

-

Falls

Description of adverse events

Onsite response to adverse events

Stumbled over a dustproof mat and fell.

-(cases)
Kyudo

1

Male

The participant was transported
Lower
Volleyball1

Female51

Injury sustained when stepping hard during
SprainsLeg

home by a family member due tovolleyball.
difficulty walking.

Lower
Tennis

1

Male

50

Muscle spasms

Cramped leg during exercise.

-

Leg

36

FemaleTarget bird golf

3

FemaleMale

FemaleWalking

78

90

78

72

Back

Face

Finger

Knee

Struck on the back by a ball hit by another

The patient improved with follow-

person.

up.

Stumbled over a tree root and fell. Hit the

A medical facility was consulted,

forehead on the ground.

and the wound was sutured.

Stabbed left index finger with a wire while

Sterilized and bandaged the woundstowing a rope.

on site.

Stumbled over a bump in the road and fell,

Sterilized and bandaged the woundscraping the knee.

onsite.

Hit a pole on the sidewalk and fell, scraping theSterilized and bandaged the wound

hand.

onsite.

Bruises

Falls

Wounds

Falls

2
Male

76

Hand

Falls

A blank column means no response was received (Not completed in the report).

10
37

11

Table 4: Description of near-misses.
Near-misses

AgeSports (Group)Sex(cases)Description of near-misses(yrs)
Participant swung the stick around 2–3 times when hitting the ball. As a result,

Male
Gateballthere was a risk of the sticks hitting people around them.

2
Male

80 Participant forgot to include a necessary item (e.g. drink, medicine.)

A blank item means no response was received (Not completed in the report).

1238