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Prerace medical screening and education reduce medical encounters in distance road races: SAFER VIII study in 153 208 race starters
  1. Martin Schwellnus1,2,3,
  2. Sonja Swanevelder4,
  3. Wayne Derman2,5,
  4. Mats Borjesson6,7,8,
  5. Karen Schwabe9,
  6. Esme Jordaan4,10
  1. 1 Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, University of Pretoria, Pretoria, South Africa
  2. 2 International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
  3. 3 Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  4. 4 Biostatistics Unit, South African Medical Research Council, Parow, South Africa
  5. 5 Institute of Sport and Exercise Medicine, Stellenbosch University, Stellenbosch, South Africa
  6. 6 Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Goteborg, Sweden
  7. 7 Institute of Food, and Nutrition and Sports Science, Goteborg University, Goteborg, Sweden
  8. 8 Sahlgrenska University Hospital/Östra, Göteborg, Sweden
  9. 9 Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
  10. 10 Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
  1. Correspondence to Professor Martin Schwellnus, Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, University of Pretoria, Pretoria 0020, South Africa; mschwell{at}


Objectives To examine the efficacy and feasibility of an online prerace medical screening and educational intervention programme for reducing medical complications in long-distance races.

Methods This was an 8-year observational study of medical encounter rates among 153 208 Two Oceans race starters (21.1 and 56 km) in South Africa. After the first 4-year control (CON) period, we introduced an online prerace medical screening (based on European pre-exercise screening guidelines) and an automated educational intervention programme. We compared the incidence of medical encounters (per 1000 starters; all and serious life threatening) in the CON versus the 4-year intervention (INT) period.

Results In comparison to the CON period (2008–2011: 65 865 starters), the INT period (2012–2015: 87 343 starters) had a significantly lower incidence (adjusted for age group, sex, race distance) of all medical encounters by 29% (CON=8.6 (7.9–9.4); INT=6.1 (5.6–6.7), p<0.0001), in the 21.1 km race by 19% (CON=5.1 (4.4–5.9); INT=4.1 (3.6–4.8), p=0.0356) and in the 56 km race by 39% (CON=14.6 (13.1–16.3); INT=9.0 (7.9–10.1), p<0.0001). Serious life-threatening encounters were significantly reduced by 64% (CON=0.6 (0.5–0.9); INT=0.2 (0.1–0.4); p=0.0003) (adjusted for age group and sex). Registration numbers increased in the INT period (CON=81 345; INT=106 743) and overall % race starters were similar in the CON versus INT period. Wet-bulb globe temperature was similar in the CON and INT periods.

Conclusion All medical encounters and serious life-threatening encounters were significantly lower after the introduction of a prescreening and educational intervention programme, and the programme was feasible.

  • endurance
  • recreational
  • marathon
  • epidemiology

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  • Contributors MS: responsible for the overall content as the study and database guarantor, study concept, study planning, data collection, data interpretation, manuscript (first draft), manuscript editing, facilitating funding. SS and EJ: study planning, data analysis including statistical analysis, data interpretation, manuscript editing. WD and KS: study planning, data collection, data interpretation, manuscript editing. MB: data interpretation, manuscript editing.

  • Funding Partial funding for the study was received from the IOC Research Centre (South Africa).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Research Ethics Committee of the University of Cape Town (REC 009/2011 and REC R030/2013) and the Research Ethics Committee of the University of Pretoria (REC 433/2015)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.