Trauma outcomes following exercise-related injury versus ground-level falls in the United States: A nationwide cross-sectional study

Physical activity confers both health benefits and injury risk, especially in old age. Risk-averse guidelines contribute to fear of injury and exercise avoidance, inadvertently reinforcing sedentary lifestyles. This study aimed to evaluate the balance of activity-related benefit and injury risk in older adults. This cross-sectional study analyzed injury-related healthcare encounters among patients aged 20 years and older during 2018–2021 from the National Trauma Data Bank. Patients injured while bicycling were compared with patients injured in ground-level falls. Outcomes (death, long-term healthcare, or discharge) were compared across 10-year age groups using multinomial logistic regression, adjusting for injury severity and other key confounders. A total of 1,722,834 records were analyzed (119,451 cycling; 1,603,383 falls). Injury severity was comparable between groups. In both groups, adjusted probabilities of death and requirement for long-term healthcare increased with age. Beyond age 30, fall patients experienced worse outcomes than cyclists in every age group, with disparities widening at older ages. After age 80, most fall patients required long-term healthcare (52.7%), whereas most cyclists were discharged (60.6%). Contrary to conventional assumptions, cycling injuries were associated with better outcomes than falls across the lifespan, with the largest protective association in older adults. Risk-averse constraints on physical activity in late life may be counterproductive, and fitness may explain the predictive gap in risk models among older adults. Promoting active lifestyles, including activities perceived as higher risk, may improve outcomes regardless of age.