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Study Quality Poor Moderate Poor Poor Poor Poor Moderate Moderate Poor Moderate Poor Poor Poor

Injury Rate (injuries/1000 hr of training) 3.1 NR NR NR NR 2.71 NR NR 3.3 2.10 2.3 0.27 d 0.74 e 1.34

Injury Prevalence (%) 73.5 46 19.4 44.4 31.0 34.4 66.7 56.1 46.5 12.0 26.2 30.5 29.6

Proportion Male (%) 71 90 a 61 74 57 57 50 59 55 56 49 51 56

Sample Age, years (Mean or Mean ± SD) 32 27±6 33 c 25 b 31±7 39±9 Men 26±4 yr; women 27±2 yr 32±8 31 19 32±9 37±10 31±8

Reporting Period Since starting CrossFit training 6 months (duration of training program) 6 months Injuries while in CrossFit training Since starting CrossFit Since starting Iron Tribe Fitness training 4 months (duration of training program) Past year Past year 3 months (duration of training program) 6 months Past year Since started CrossFit training

Problem sustained during training which for any time ICD-9 codes 800-999 and 710-739 series from electronic medical records Condition relating to CrossFit training leading to inability to train ≥1 week, modified training >2 weeks, or visit to health professional Onset of harm to a joint sustained during CrossFit workout event relating to CrossFit training & leading to inability to train ≥1 week, modified training >2 weeks, or visit to heal

Injury Definition prevented training, working, or competing Musculoskeletal pain, feeling, or traumatic Conditions as a result of Iron Tribe Fitness missing or modifying ≥1 training session or personnel and reduced CrossFit training in Any condition or symptom that, as a result of CrossFit training, caused modification of training, loss of ≥1 day of training or visit

TABLE 1 Summary of Studies Examining Injuries during High Intensity Functional Training

Injury Recording Self-reported on on- line questionnaire Medical records Self-reported on on- line questionnaire Self-reported on on- line questionnaire Self-reported on on- line questionnaire Self-reported on on- line questionnaire Overuse injury score on OSTRCQ 67 Self-reported on on- line questionnaire Self-reported on on- line questionnaire Documented by CrossFit coach or researcher on injury reporting form Self-reported on

132 CrossFit athletes training in US and other countries Tactical Athlete Conditioning Program, 54 CrossFit athletes at the US Military Academy, West Point NY 566 CrossFit athletes training in affiliated CrossFit gyms in Brazil 247 athletes engaged in Iron Tribe Fitness routines in Birmingham AL 6 competitive CrossFit athletes CrossFit gyms in the Netherlands affiliated gyms in Costa Rica affiliated gyms in the UK CrossFit affiliated gyms i

Participants 1,032 infantry soldiers training in Advanced CrossFit, or Ranger Athlete Warrior program 386 CrossFit athletes training in US CrossFit 449 CrossFit athletes exercising in affiliated 159 CrossFit athletes exercising in CrossFit 117 CrossFit athletes exercising in CrossFit 191 CrossFit athletes exercising in affiliated 270 CrossFit athletes training ≥6 months in

Study Design Retrospective, Cross-Sectional Prospective Cohort Retrospective, gyms Cross-Sectional Retrospective, Cross-Sectional Retrospective Cross-Sectional Retrospective, Cross-Sectional Prospective Cohort Retrospective Cross-Sectional Retrospective, Cross-Sectional Prospective Cohort Retrospective, Cross-Sectional Retrospective countries Cross-Sectional Retrospective Cross-Sectional

Reference Hak et al. 2013 32 Grier et al. 2013 46 Weisenthal et al. 2014 22 Chachula et al. 2016 33 Sprey et al. 2016 23 Aune & Powers 2016 47 Williams et al. 2017 17 Mehrab et al. 2017 24 Escalante et al. 2017 25 Moran et al. 2017 34 Montalvo et al. 2017 35 Feito et al 2018 30, 31c Minghelli and Vicente 2019 26

124 | JSOM Volume 22, Edition 1 / Sping 2022