Article Text

Download PDFPDF
A prospective cohort study of 7031 distance runners shows that 1 in 13 report systemic symptoms of an acute illness in the 8–12 day period before a race, increasing their risk of not finishing the race 1.9 times for those runners who started the race: SAFER study IV
  1. Anri Van Tonder1,
  2. Martin Schwellnus2,3,4,
  3. Sonja Swanevelder5,
  4. Esme Jordaan5,6,
  5. Wayne Derman3,7,
  6. Dina C Janse van Rensburg2
  1. 1UCT 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. 2Faculty of Health Sciences, Institute for Sport, Exercise Medicine and Lifestyle Research, Section Sports Medicine, University of Pretoria, Pretoria, South Africa
  3. 3International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
  4. 4Emeritus Professor, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
  5. 5Biostatistics Unit, South African Medical Research Council of South Africa, Tygerberg, South Africa
  6. 6Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
  7. 7Faculty of Medicine and Health Sciences, Institute for Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
  1. Correspondence to Professor Martin P Schwellnus, Faculty of Health Sciences, Institute for Sport, Exercise Medicine and Lifestyle Research, University of Pretoria, South Africa, Sports Campus, Burnett Street, Hatfield, Pretoria 0020, South Africa; mschwell{at}


Background Data on the prevalence of acute illness in the period prior to a distance running race are limited. Currently, the presence of systemic symptoms (failed ‘neck check’) is used to advise athletes on participation.

Aim To determine (1) the period prevalence of pre-race acute illness symptoms before a distance running event, (2) if symptomatic runners receiving educational material on acute illness did not start (DNS) the race and (3) if symptomatic runners who chose to start the race, did not finish (DNF) the race.

Methods 7031 runners completed an online pre-race acute illness questionnaire in the 3–5 day period prior to a race. Symptomatic runners received educational information on exercise and acute illness. Runners were followed prospectively to determine DNS and DNF risk.

Results 1338 runners (19.0%) reporting symptoms (7.5% reporting systemic symptoms—failed ‘neck check’) and receiving educational information had a higher DNS frequency (11.0%) compared to controls (6.6%)(p=0.0002). Symptomatic runners who started the race had a higher DNF frequency (2.1%) compared to controls (1.3%) (p=0.0346), particularly runners with systemic symptoms (2.4%; RR=1.90).

Conclusions In summary, 19% (1 in 5) runners reported pre-race acute illness symptoms, with 7.5% (1 in 13) reporting systemic symptoms. Although runner education reduced the percentage symptomatic race starters, the majority of them still chose to race, resulting in a two times higher risk of not finishing in those with systemic symptoms. Pre-race acute illness symptoms are common; an educational intervention affects an athlete's decision to compete yet most symptomatic runners still competed, and systemic symptoms negatively affect performance, with possible health implications.

  • Running
  • Illness
  • Infection
  • Epidemiology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles