Injury incidence, burden and associated risk factors in walking football players

Walking football (WF) is an effective activity for older adults to enhance cardiovascular, metabolic and psychosocial health. However, evidence on injury risks remains limited. This study aimed to describe the incidence and burden of injuries during a WF season and identify potential risk factors, including age, muscle function and blood biomarkers. Sixty-four male recreational WF players aged > 50 years participated. Baseline assessments included anthropometry, muscle strength and blood tests. A prospective follow-up recorded injuries and exposure during training (twice weekly, 1 h) and occasional matches. A total of 2,946 player-sessions were documented. Sixty-two injuries occurred (80.6% during training), with an overall incidence of 19.7 injuries per 1000 hours (95% CI: 15.3-25.2) and 892.4 days of injury burden. The most frequent were muscle injuries (64.5%), mainly in the hamstrings (29%) and calf muscles (25.8%). Most were acute (90.3%), non-contact (85.5%), and classified as moderate or severe. Older participants experienced a greater burden of injuries. Muscle functionality was not associated with muscle injury incidence. In contrast, higher incidence (p < 0.05) was observed among players with low HDL cholesterol, elevated triglycerides, high atherogenic index and elevated glucose. Despite the adapted rules, walking football in older adults is associated with an elevated risk of muscle injuries, particularly in the posterior leg compartment. Older age and adverse metabolic profiles appear to be important contributors. Future research should focus on evaluating the balance between health benefits and injury risks, optimizing warm-up routines and training load, and integrating screening for injuryrelated risk factors to enhance player safety.