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Cycling related injuries, especially those to the head, are common causes of morbidity, death, and disability and could largely be prevented by the proper use of hard shell helmets.1,2 Unfortunately, obvious evidence is often not acknowledged, and the use of such a valuable preventive measure has been too long ignored. Media coverage of elite competitions, showing most athletes racing without helmets, has unfavourably influenced amateur and young cyclists for a long time. However, owing to the progressive increase in severe and fatal injuries, especially involving elite cyclists, and the evidence that the outcome of most of these tragedies might have been prevented,1,2 the International Cycling Union announced that, from 5 May 2003, it is mandatory to wear a hard shell helmet in elite men’s events for classes 4 and above. This decision was taken in agreement with the Professional Riders Association, who supported the initiative despite some internal differences of opinion. Images transmitted world wide during the 2003 Tour de France, a sporting event second in popularity only to the Olympics, are encouraging, showing all athletes wearing helmets throughout most of the race. This is a valuable message for both amateur cyclists and adolescents, as awareness is often more productive than restrictive measures. In addition, individual persuasion to wear helmets does not have the side effect of reducing the incentive to do cycling. Less cycling, in reaction to restrictive legislation, may counterbalance the beneficial effects on head injury prevention, as regular recreational aerobic activity, such as cycling, has manifest benefits on health, preventing the development of chronic disorders, including atherosclerosis, diabetes, osteoporosis, obesity, depression, and cancer.3
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