For older adults, it’s important to stay active, but recreational activities come with a risk of injury: A new study finds that facial injuries are on the rise in adults ages 55 and up.

Facial fractures from recreational activities increased by more than 45 percent in older adults from 2011 to 2015, according to the study, published today (June 15) in the journal JAMA Facial Plastic Surgery.

The increase in these injuries is concerning because public health initiatives have encouraged older adults to be physically active, but there are no guidelines aimed at helping them to avoid getting hurt, the researchers wrote.

In the study, the researchers used data from the National Electronic Injury Surveillance System, a database with information on emergency-room visits caused by consumer products, sports and recreational activities. Because the database has information only from emergency-room visits, the study missed patients who were treated elsewhere, the researchers noted. [The 4 Types of Exercise You Need to Be Healthy]

Between January 2011 and December 2015, more than 20,000 older adults in the U.S. suffered facial fractures caused by injuries from recreational activities and were treated in ERs. The number of injuries increased each year over the study period, except for between 2014 and 2015. In 2011, there were more 3,100 recreational activity-related facial injuries, and in 2015, there were more than 4,600.

Biking was the most common source of injury, according to the study: More than 26 percent of the injuries occurred when a person was on a bike. Playing a team sport, such as softball or baseball, was the second most common source of injury. These injuries accounted for 15 percent of all facial fractures. Outdoor activities such as hiking or camping accounted for 10 percent of the injuries, and gardening accounted for 10 percent of the injuries. Walking and jogging accounted for 6 percent of the injuries.

Indeed, it’s important for doctors to be aware that lower-intensity activities such as walking and gardening (compared with biking or team sports) can still be a source of injury, the researchers wrote.

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