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Less experience and running pace are potential risk factors for medical complications during a 56 km road running race: a prospective study in 26 354 race starters—SAFER study II
  1. Karen Schwabe1,
  2. Martin P Schwellnus1,2,
  3. Wayne Derman1,2,
  4. Sonja Swanevelder3,
  5. Esme Jordaan3,4
  1. 1Clinical Sport and Exercise Medicine Research Group, UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  2. 2International Olympic Committee (IOC) Research Centre, University of Cape Town, Cape Town, South Africa
  3. 3Biostatistics Unit, Medical Research Council of South Africa, Parow, South Africa
  4. 4Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
  1. Correspondence to Professor Martin P Schwellnus, Clinical Sport and Exercise Medicine Research Group, UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa, 3rd Floor, Sports Science Institute of South Africa, Boundary Road, Newlands, Cape Town 7700, South Africa; mschwell{at}iafrica.com

Abstract

Background It is important to identify risk factors associated with medical complications during ultra-marathons so that prevention programmes can be developed.

Objective To determine risk factors for medical complications during ultra-marathons.

Design Prospective study.

Setting Two Oceans ultra-marathon (56 km) races.

Participants 26 354 race starters.

Methods Medical complications (defined as any runner requiring assessment by a doctor at the race medical facility or a local hospital on race day) were recorded over 4 years. Complications were subdivided according to the system that was affected and by final diagnosis. A Poisson regression model was used to determine risk factors for any medical complication and for more common specific complications.

Results Risk factors for medical complications during 56 km road races were less running experience (≤1 medal vs 2–4 medals, p=0.0097), and both fastest (<6 vs 6–7 min/km, p=0.0051) and slowest (>7 vs 6–7 min/km, p<0.0001) running pace category. Year of observation was also associated with risk of complications (2009 vs 2008, p=0.0176; 2009 vs 2010, p=0.0007; 2010 vs 2011, p=0.0112). Risk factors for specific common medical complications were: postural hypotension (slowest pace), serious exercise-associated muscle cramping (older age, fastest pace), gastrointestinal complications (slowest pace) and dermatological complications (fastest pace).

Conclusions Less experience and running at either a slow or a fast pace were risk factors for complications during 56 km road running. Annual variation may also affect risk. Risk factors for specific medical complications were also identified. These data form the basis of further studies to assist medical staff to plan appropriate care at races.

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