The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Women's Injury Study (WIN)

The WIN Study

We recruited 918 community-dwelling women to report their physical activity behaviors and any musculoskeletal injuries incurred weekly via a secure Internet webpage. Baseline testing included an orthopedic examination conducted by licensed physical therapists to identify impairments in muscle strength and flexibility and biomechanical/structural abnormalities. A complete orthopedic and musculoskeletal injury history was obtained at baseline and 909 women began reporting data. At the end of data collection (nearly 3 years later), 731 women were still actively reporting physical activity data. More than 95% of the women remaining in the study at the end of data collection had reported =75% of the time. The average participant reported data for 1.89 years. Women were enrolled for nearly 90,000 person-weeks. More than 83,000 weeks of data were actually logged by the participants.

Women reporting a physical activity-related musculoskeletal injury were contacted by telephone within 48-72 hours to confirm the injury and provide a complete description of the injury, including impetus, surrounding characteristics, body part involved, and whether they were treated by a healthcare provider. Those seeing a healthcare provider were asked for contact information so that medical records could be requested. Medical records were requested but were often unavailable or not submitted. A post-study follow-up survey of muscle-strengthening, resistance exercises, and falls history was conducted. 609 of 731 women completed the on-line survey.

Numerous reports have been published in the peer-reviewed literature and presented at national scientific meetings. Importantly, this research provides nearly real-time assessment of physical activity behaviors and concurrent physical activity-related musculoskeletal injuries. Key findings are that the risk of musculoskeletal injury increases for those achieving the USDHHS Physical Activity Guidelines (=150 MVPA-minutes per week). However, the actual financial costs associated with these injuries are typically very small. The nature of the musculoskeletal injuries resulting from physical activity is generally consistent with those occurring as a result of non-physical activity behaviors. The best predictor of subsequent musculoskeletal injury is having a previous musculoskeletal injury. Biomechanical, muscular strength, and flexibility factors are generally unrelated to self-reported physical activity-related musculoskeletal injury.

Healthcare providers can feel comfortable recommending physically active lifestyle behaviors to community-dwelling women, knowing that there is a modest increase in risk of musculoskeletal injury, the actual medical costs are minimal, and that injury is generally unrelated to any specific musculoskeletal abnormality. The actual physical and financial costs associated with being physically active are small compared to the increased quality of life and positive health outcomes associated with a physically active lifestyle.


Authorship Publication  
Kaplan RM, Herrmann AK, Morrison JT, Defina LF, Morrow JR. Costs Associated with Women's Physical Activity Musculoskeletal Injuries: The Women's Injury Study. J Phys Act Health. 2013 Oct 31. PubMed PMID: 24187018. Read Abstract
Howard EN, DeFina LF, Leonard D, Custodio MA, Morrow JR. Physical activity and musculoskeletal injuries in women: the Women's Injury Study. J Womens Health (Larchmt). 2013 Dec;22(12):1038-42. doi: 10.1089/jwh.2013.4287. PubMed PMID: 24117001; PubMed Central PMCID: PMC3852605. Read Abstract
Vingren JL, Morrow JR, Trudelle-Jackson E, Mathew MT. Prevalence of muscle-strengthening activities in women: the WIN study. J Phys Act Health. 2013 Sep;10(7):1008-15. PubMed PMID: 23134841. Read Abstract
Morrow JR, Defina LF, Leonard D, Trudelle-Jackson E, Custodio MA. Meeting physical activity guidelines and musculoskeletal injury: the WIN study. Med Sci Sports Exerc. 2012 Oct;44(10):1986-92. PubMed PMID: 22525778; PubMed Central PMCID: PMC3445731. Read Abstract
Mathew M, Morrow JR, Frierson GM, Bain TM. Assessing digital literacy in web-based physical activity surveillance: the WIN study. Am J Health Promot. 2011 Nov-Dec;26(2):90-5. PubMed PMID: 22040389. Read Abstract
Trudelle-Jackson E, Jackson AW, Morrow JR. Relations of meeting national public health recommendations for muscular strengthening activities with strength, body composition, and obesity: the Women's Injury Study. Am J Public Health. 2011 Oct;101(10):1930-5. PubMed PMID: 21852647; PubMed Central PMCID: PMC3174351. Read Abstract
Trudelle-Jackson E, Ferro E, Morrow JR. Clinical Implications for Muscle Strength Differences in Women of Different Age and Racial Groups: The WIN Study. J Womens Health Phys Therap. 2011 Winter;35(1):11-18. PubMed PMID: 21666779; PubMed Central PMCID: PMC3111145. Read Abstract
Bain TM, Frierson GM, Trudelle-Jackson E, Morrow JR. Internet reporting of weekly physical activity behaviors: the WIN Study. J Phys Act Health. 2010 Jul;7(4):527-32. PubMed PMID: 20683095; PubMed Central PMCID: PMC2917263. Read Abstract
Morrow JR, Bain TM, Frierson GM, Trudelle-Jackson E, Haskell WL. Long-term tracking of physical activity behaviors in women: the WIN Study. Med Sci Sports Exerc. 2011 Jan;43(1):165-70. PubMed PMID: 20473221; PubMed Central PMCID: PMC2980794. Read Abstract