Activity Ratings Chart

O– Aquatic exercise refers to exercise activity that takes place in the water, usually in a pool. It’s a great way for people of all ages and fitness levels to stay active. Water supports your body, making movement easier and less painful, especially for those with painful or affected joints. Being in chest-deep water helps with balance and allows for more comfortable movement than on land. The natural resistance of water can help build muscle strength and improve heart health. Water workouts can also boost endurance, flexibility, and may help reduce body fat, all while being gentle on your joints. To make the exercises more challenging, you can use props like foam weights, kickboards, or hand paddles, which increase resistance and help strengthen muscles even more.1 2 3

R– Minimal risk.

S– Flotation devices can be used as needed. Consider taking a class or working with a certified instructor to learn correct form and avoid injury.

O– Archery is a sport or skill where participants use a bow to shoot arrows at a target. It can be enjoyed individually or as part of a team, whether for fun, training, or competition.

R– The overall injury rate is low. When they do occur, injuries are usually due to using poor form or overuse. Some injuries can happen while doing archery if you're not careful. Fingers might get cut if the arrow or finger is placed the wrong way. Serious hand injuries, like broken bones, can happen from poor hand placement while aiming. Repeating the movement without rest can also cause overuse injuries, such as blisters or sore tendons, especially around the elbow.4

S– Consider taking lessons from a trained coach to learn safe practice and form. Make sure your equipment fits well and is in good condition. Always follow safety rules to avoid injuries. Beginners should wear long armguards to protect their forearms from the bowstring. Strengthening your back, shoulder, and elbow muscles can also lower the risk of injury and improve your shooting technique.5

O- Backpacking typically involves a long walk on dedicated paths or trails that may have sharp inclines or varied, rugged terrain while carrying everything you need. Walking is one of the lowest impact activities, allowing the heart health benefits of other aerobic activities, without the stress, strain and pounding that come with high-impact activity. The gear you may need depends on how long you’ll be out, how far you’re going, what kind of land you’ll be on, and the weather or surroundings.6

R- Risks include getting lost, bad weather, tough or steep land to hike, altitude extremes, running into wild animals, falls, not having cell phone service, making poor decisions when tired, and unsafe drinking water. The challenges get harder with terrain, altitude, and the amount of weight in your backpack. Finally, people with bleeding disorders have the added risk of developing a bleed.

S- Plan ahead. Pace yourself. Remember to bring navigation supplies. Download offline and/or print paper maps so you don’t have to rely on cell reception. Bring or wear gear for both the expected and unexpected such as clothing for the weather, sturdy shoes/hiking boots, water bottles with purification system, food, camp kitchen supplies, shelter, sleeping bag, flashlight/headlamp, multitool/knife, emergency supplies including first aid kit, as well as bleeding disorder treatment supplies. Loaded backpacks should not weigh more than 20% of your body weight. Using trekking poles can help your stability. Have a contingency plan for returning to trail head in case of injury or bleed. For more details, see Recreation.Gov's Helpful Tips for Planning an Overnight Backpacking Trip .

O – Badminton is a racket sport played on a rectangular court divided by a net. Players score by hitting a shuttlecock (also called a birdie) with their racket so it passes over the net. It can be played as singles with one player per side or doubles with two players per side.

R - Eye injury is common in badminton.112 Other common injuries are sprains (36%) and muscle injuries (24%). More than half of all injuries, about 52 out of every 100, happen in the lower limbs, like the legs and feet.113

S - Only eyewear that meets the latest ASTM (American Society for Testing and Materials) safety has been shown to prevent eye injuries. This means wearing the right kind of protective glasses is very important for keeping your eyes safe.114 Make sure to wear the right shoes, ones that support your feet and are made for court sports.

O - Barre is a low-impact workout that combines ballet, Pilates, and strength training using a handrail for support. It uses small, controlled movements with high repetitions and holds to target the core, butt, thighs, and arms. The focus is on posture, flexibility, and muscle endurance and often includes stretching between sets to improve range of motion.

R: Barre is generally low risk, but beginners may struggle with balance during movements away from the handrail. Poor form, especially during small, controlled motions, can lead to joint or muscle strain.

S: To reduce the risk of injury, take classes from a qualified instructor, maintain good form, and listen to your body. If a movement feels painful or too challenging, ask for a modification.

O– Baseball and softball are fun team sports that are usually well-organized and have adult supervision. Playing these sports is good for your heart and helps you stay healthy. They also help you get better at using your eyes and hands together, which is called hand-eye coordination. Plus, you learn how to work well with others on a team. Tee-ball is a version of baseball for younger kids. Instead of hitting a ball that’s thrown, players hit a ball that sits still on a tee. It’s a great way for children to start learning the game.

R– Baseball and softball are generally safe sports. However, serious injuries can still happen, for example bleeding if a player is hit in the head, by a ball, bat, or another player. Joint injuries are also possible, especially from sliding into bases or colliding with other players. The position you play can affect your risks. For example, pitchers may suffer from joint overuse in the shoulder or elbow, and catchers face added risk of joint strain due to squatting. Tee-ball has a lower injury since players never pitch.7

S– Fatigue and overuse are the most common causes of injury in young baseball players, so it's important to take steps to stay safe. One way to help prevent injuries is to avoid specializing in just one position until high school, giving your body time to develop in different ways.8 Choose a position that matches your physical abilities and always wear the right protective gear. Pitchers should follow pitching rules and pitch count limits to avoid throwing too much, which can lead to serious arm injuries.9 Using “breakaway bases” instead of fixed ones can reduce the risk of injury when sliding. Batters should wear helmets that cover both ears, and for extra protection, consider helmets with a face guard, chin strap, and eye protection. Catchers need to wear full safety gear, including a helmet, face mask, and padding. Always be alert for early signs of a bleed or injury, and make sure to stay hydrated, especially during hot weather or long practices.

O – Basketball provides a good cardiovascular workout with a focus on agility. Intensity of play can vary. Players can choose to participate in casual games with limited physical contact or more intense, competitive games.

R– During competitive games, players are jumping, landing, pivoting, cutting, running forward and backward, changing directions and making physical contact with other players, all of which could lead to musculoskeletal injury. Sprained ankles and knee ligament tears can occur, and may be more serious in a player with a bleeding disorder.

S– Injury risk can be minimized by using eye protection, elbow and knee pads, mouth guards, athletic supporters (males) and proper footwear.

O– From tricycles to multispeed bicycles, biking is a fun, low-impact activity that helps build coordination and confidence. Most children can start with a balance bike or tricycle around age 3. By ages 3 to 5, they can usually ride a pedal bike with training wheels and foot brakes. Around ages 5 to 7, many are ready to ride without training wheels. As they grow and gain experience, kids 7 and older can start using bikes with gears for different types of terrain. Riding safely takes both physical and thinking skills, which develop over time.12

R– Many of the bicycle-related crashes resulting in serious injury or death occur because of the rider’s poor judgment or not following the rules of the road. Riding a bicycle in traffic adds additional risk. In general, children between 5 -14 years old are most at risk for bike injuries, including head injuries, the main cause of serious injury or death.13 14 15 16 17 This risk is even higher for riders with bleeding disorders. While recreational bicycle riding can be lower risk when safety rules are followed, distance riding and bicycle racing are higher risk. Bicycle racing has the highest risk due to the possibility of high-speed collisions and falls.

S– Riders need to remember basic safety rules. Riders of all ages should wear bicycle helmets that meet or exceed standards set by the American Society for Testing Materials (ASTM), the US Consumer Product Safety Commission (CPSC) and/or the Snell Memorial Foundation. While there is no federal law requiring the use of helmets, many states and local municipalities do have regulations. It is also important to have a properly fitting, well-maintained bicycle. Avoid risky situations such as riding in the dark, and near heavy traffic or road hazards. Consider bike accessories such as flashing lights, reflector strips and wearing a reflective vest to be more visible to cars. Riders less than 10 years old may be safer riding on sidewalks or bike paths rather than on the streets. Young bicycle or tricycle riders should be closely supervised at all times. They shouldn’t ride in traffic until they show they can control the bike, follow rules, and make safe choices. If you complete a long-distance ride, be sure to train for the event. Make sure you have a bicycle repair kit for breakdowns.

O– BMX stands for Bicycle Motocross. It’s a sport where people ride special bikes on dirt tracks or do cool tricks. There are two main types of BMX. Racing: Riders go fast on tracks with bumps and sharp turns. Freestyle: Riders do stunts and tricks in places like urban settings, skateparks or flat areas. BMX bikes are small, strong, and easy to control, which makes them great for both racing and doing tricks.18 19

R– This is a high-collision, competitive sport with the potential for serious traumatic injury, especially traumatic brain injuries (TBI). A TBI in people with bleeding disorders is serious, if not life-altering and life threatening. BMX is dangerous for all participants.

S–If you choose to participate, use appropriate safety equipment including a helmet, goggles, padding, and gloves. Participation is strongly discouraged.

O – These are muscle-toning classes that often include core strengthening. Some have a cardiovascular component. A variety of exercises may be done using equipment, such as small handheld weights or resistance bands.
R – Minimal risk.
S – There are usually beginner to advanced level classes. Participants can work out at their own pace.

O– Boot camp classes combine strength training with aerobic conditioning, featuring a variety of exercises performed in intervals. Typically, bodyweight movements are used alongside drills and sprints. High-intensity interval training (HIIT) is generally alternated with periods of lighter activity. HIIT improves heart health, boosts metabolism to help with weight control, improves mood, and may help manage chronic pain.53

R– HIIT involves fast, intense movements that can strain muscles and joints, leading to common injuries like sprains, strains, and stress fractures as well as overuse injuries due to inadequate recovery.

S– Maximize safety by focusing on proper technique, following instructor directions, and working at your own level and pace. Adjust workouts to match fitness level and how the body feels on any given day. Monitor heart rate during workouts and consider using wearable tech to help with tracking. Increase intensity gradually and vary workout intensity. Include rest days to prevent overtraining, Participants may benefit from activity modifications to protect problem joints.

O– A bounce house, also known as a bouncy house, bouncy castle, moonwalk, or jumper, is a springy, inflatable structure designed primarily for children to jump and play on for fun or exercise. These structures often look like four-sided buildings or castles and are made from durable materials that can hold up to frequent use and exposure to outdoor elements. They come in a variety of shapes and themes, including castles, obstacle courses, and slides, making them a popular feature at parties, festivals, and recreational events. 20 21

R– Bounce houses, while fun, can pose several safety risks for children. Common injuries include sprains, bruises, broken bones, and concussions, often caused by falls or collisions during play. In rare cases, these injuries can be severe, requiring surgery, or resulting in long-term harm. On hot days, the inside of a bounce house can become dangerously warm, increasing the risk of heat exhaustion or heat stroke. Unsafe play—such as flips, rough housing, or overcrowding—also raises the chance of accidents, making adult supervision essential. Additionally, bounce houses are vulnerable to weather conditions; strong winds can lift or tip them over, creating serious hazards for children inside.

S– To help keep kids safe, they should remove shoes, glasses, and jewelry before using the bounce house. Group children by size, and don’t allow anyone who exceeds the height or weight limit. An adult should provide close, direct supervision at all times.

O– Bowling is a game where players roll a heavy ball down a narrow lane to knock over pins arranged at the far end. Each player gets ten turns, called frames, with up to two chances per turn to knock down as many pins as possible. The player who knocks down the most pins overall wins the game. Bowling is popular as a recreational or competitive sport.

R– Bowling can result in shoulder, elbow, wrist, or finger injuries due to ball weight as well as slips or falls from wearing the wrong shoes or slippery floors. Back pain may be a result of repeated bending and twisting.22

S– Using the right gear and good form helps prevent injuries and improve your game. Wear well-fitted bowling shoes for smooth movement and control. Choose a ball that fits your strength: adults usually use 10–16 lbs, teens around 10 lbs, and kids 6–8 lbs. When lifting the ball, use both hands and bend your knees to protect your back. Using a firm grip and steady form can improve your aim. Always remain behind the foul line, as the lane beyond it is extremely slippery and can cause falls. Avoid any rough behavior like running or throwing the ball.

O– Boxing is a sport where two people compete by using their fists to land punches on each other while wearing padded gloves. They fight in a ring and take turns during short, timed rounds. The goal is to score points by landing clean, accurate punches or to win by knocking the other person down so they cannot continue. In amateur boxing, fighters wear extra safety gear and focus more on skill and scoring than on causing harm. To make matches fair, boxers are grouped by age, weight, and experience level.

R– Boxing is a high-contact sport with a high risk of injuries. The sport involves planned hits to the head and face, which can lead to serious, and sometimes fatal, injuries like concussions, brain damage, and spinal injuries.23 24

S–Boxers should always wear a helmet and protective gear. Even with safety gear, there is high potential for injury.

O– Canoeing and kayaking are fun water sports that can be done in calm lakes or in fast-moving rivers and oceans.

R– Canoeing and kayaking are usually safe in calm water, but they can be more dangerous in fast-moving rivers or the ocean. In kayaking, people can get hurt in the head, neck, or face. Shoulder dislocations are also common. Many kayakers complain about low back pain, which happens in about 15 out of every 100 kayakers. Some injuries happen slowly over time. These are called chronic injuries. Tendonitis, a condition where the connective tissues between your muscles and bones (tendons) become inflamed, is one example that is common in both kayakers and canoeists. Kayakers don’t often hurt their legs, but sitting on a hard seat for a long time can cause this inflammation. Canoeists who kneel while paddling sometimes get muscle strains in their hip or thigh muscles.106

S– To stay safe while canoeing or kayaking, sit in the middle of the boat and try not to make quick or jerky movements, these can cause the boat to tip over. Always wear a life vest that is approved by the U.S. Coast Guard. If you're paddling in white water (fast-moving water with waves), you must wear a helmet. Pay attention to how the water is moving, this can help you avoid floating farther than you want to. If you're in tidal or open water, check the tide schedule before you go. If the water starts moving too fast, or if you see rocks or fallen trees ahead, paddle away from them. Because accidents can happen, it’s important to learn basic rescue skills. Taking a paddler safety course is a smart way to learn how to stay safe on the water.

O– Classes combine cardio exercise with the agility, strength, balance and coordination that can be achieved through martial arts training. Techniques range from easy to hard, with low-impact movements (where at least one foot remains on the ground) to high-impact movements (where both feet leave the ground at the same time), and no contact to full contact.54

R– Full contact, high-impact cardio kickboxing carries greater risk of injury through contact and overuse. Low impact cardio kickboxing may be recommended for individuals with knee or back problems.

S– Full contact, high-impact cardio kickboxing is a demanding high intensity activity. To increase safety, make choices that reduce strain on your body—such as focusing on proper form, working at your own pace, modifying high-impact movements to lower-impact alternatives, and using proper gear and footwear.

O– Cheerleading is a high-energy sport that combines gymnastics, dance, acrobatics, and stunts. Cheerleaders train in tumbling, choreography, and strength to master difficult, physically demanding routines. The sport is divided into 2 categories: Sideline cheerleading is done at sports games to cheer on the team and get the crowd excited. Cheerleaders use chants, stunts, and short routines to support the players. Competitive cheerleading is performed at competitions, where teams do planned routines with tumbling, stunts, and movements that are timed and judged. 40 41

R– Basic cheerleading activities like cheers and jumps are generally safe. However, the risk of injury increases with more advanced stunts—such as building pyramids, lifting teammates, or performing tosses. Most injuries occur during stunting and tumbling, with falls being the leading cause. Stunts performed above shoulder level are particularly risky. Dismounts are also a common source of injury, especially when landing in a cradle versus on the floor. Bases experience the highest rate of injury, followed by flyers and spotters. The most frequently injured areas are the head and neck. While most injuries involve sprains, strains, or fractures, serious head or spinal injuries—though rare—can occur. Overuse injuries are widespread, accounting for more than 65% of cheer-related clinic visits. Head and spine injuries are especially dangerous in people with bleeding disorders.42

S– To help prevent injuries in cheerleading: Athletes need to train the right way before trying stunts. They should build strength, balance, and good form, and only practice stunts on safe, clear surfaces. It’s important to avoid hard, uneven, or slippery ground. When building pyramids, they should be no taller than two people, and spotters should always be there to help. Safety rules should match the age and needs of younger athletes. All events should follow the safety rules made by groups like USA Cheer or the US All Star Federation. Everyone should also know how to recognize and handle concussions. If someone might have a concussion, they must stop right away and see a doctor before they can return. It is not advised for people with bleeding disorders to participate in flyer roles.

O– Dance can be done alone or in a class with a teacher. There are many different styles of dance, and people can do it for fun, exercise, or to perform in shows. It’s a great way to stay active and express yourself.

R– Different types of dance forms have different levels of injury risk. However, dancers of all types often get injuries from doing the same movements too much (overuse injuries), primarily affecting the ankles, legs, feet, or lower back. Common problems include: kids and teens who are very active may have hip problems like popping, clicking, tightness, swelling, or pain. Foot and ankle issues can also happen, such as sore tendons, stiff toes, or pinching pain in the ankle. Knee pain is common too, especially around or behind the kneecap. Small bone cracks, called stress fractures, can happen in the foot, shin, or lower back from doing the same movements over and over. Over time, joints like the knees, hips, ankles, and feet can wear down, which may lead to arthritis. Adolescent dancers are at a markedly increased risk of injury as they experience growth spurts. Injury risk factors include footwear, dance surface, frequency and intensity of practice, strength and/or flexibility imbalances.43 44 45

S: Consider the type of dance you like. What are the physical demands of different dance styles: fusion, contemporary dance, hip hop, or tap? Dancers may consider taking classes to learn proper techniques. To increase safety, wear shoes appropriate for the style of dance. Consult with trained instructors before progressing to more advanced dance forms. For example, ballet dancers need several years of dance training as well as adequate strength before progressing to “en pointe” (toe shoes). Finally, consider cross training to minimize strength and/or flexibility imbalances.

O– Diving competitions have three events: 1-meter and 3-meter springboards and the platform (usually 10 meters). Athletes compete by gender and sometimes by age. Divers do a set number of dives with moves like flips and twists. Judges give a score out of 10 based on how they take off, how they move in the air, and how they enter the water, plus one extra point. The score is then multiplied by how hard the dive is. The diver with the highest total score wins.46

R– Competitive diving is a high-collision sport with potential for serious head and neck injury. A diver on a 10-meter platform enters the water at about 40 miles per hour. Injuries can occur from hitting the board/ platform and from overuse injuries, such as frequent jumping, back arching, bending, and twisting. They can also occur when divers enter the water. The most commonly reported injuries involve the lower back, shoulder, and wrist.47 48

S: Before diving, make sure the pool is deep enough and the water is clear. Check the board or platform for cracks or slippery spots. Warm up your whole body. Practice somersaults on land with mats before trying off a board/platform. Review your take-off and water entry. Do easier dives before progressing to harder ones . Keep your movements controlled—don’t twist or spin too much. Always know where first aid is and what to do in an emergency

O – Diving may help improve flexibility, strength, balance and overall fitness.

R – Recreational diving injuries often result from diving into shallow water.

S – Safety tips to minimize risk include never diving into shallow water or water that isn’t clear enough for you to see obstacles. If you’re unsure, always jump in feet first. Also, only allow one person on a diving board at a time.