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Medical encounters, cardiac arrests and deaths during a 109 km community-based mass-participation cycling event: a 3-year study in 102 251 race starters—SAFER IX
  1. Jannelene Killops1,
  2. Martin Schwellnus1,2,
  3. Dina Christina Janse van Rensburg1,
  4. Sonja Swanevelder3,
  5. Esme Jordaan3,4
  1. 1 Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  2. 2 Research Centre, International Olympic Committee (IOC), Pretoria, South Africa
  3. 3 Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
  4. 4 Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
  1. Correspondence to Martin Schwellnus, Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Faculty of Health Sciences, Pretoria, ZA 0028, South Africa; mschwell{at}


Background There are few data on medical encounters, including deaths during mass-participation cycling events.

Objective To determine the incidence and nature of medical encounters during a community-based mass-participation cycling event.

Design Cross-sectional study across three annual events.

Setting 2012–2014 Cape Town Cycle Tour (109 km), South Africa.

Participants 102 251 race starters (male=80 354, female=21 897).

Methods Medical encounters (moderate, serious life-threatening, sudden cardiac arrest/death), using the 2019 international consensus definitions, were recorded on race day for 3 years as incidence rates (IR per 1000 starters; 95% CI). Overall illness-related (by organ system) or injury-related (by anatomical region) encounters, and severity were recorded.

Results We recorded 539 medical encounters (IR 5.3; 4.8 to 5.7). The IR was 3.2 for injuries (2.9 to 3.6), 2.1 for illnesses (1.0 to 2.4) and 0.5 for serious life-threatening medical encounters (0.4 to 0.7). In the 3-year study, we encountered three cardiac arrests and one death (2.9 and 1.0 per 100 000 starters, respectively). Injury IRs included upper limb (1.9; 1.6 to 2.1), lower limb (1.0; 0.8 to 1.0) and head/neck (0.8; 0.6 to 1.0). Illness IRs included fluid/electrolyte abnormalities (0.6; 0.5 to 0.8) and the cardiovascular system (0.5; 0.4 to 0.6).

Conclusion In a 109 km community-based mass-participation cycling event, medical encounters (moderate to severe) occurred in about 1 in 200 cyclists. Injury-related (1/300 cyclists) encounters were higher than illness-related medical encounters (1 in about 500). Serious life-threatening medical encounters occurred in 1/2000 cyclists. These data allow race organisers to anticipate the medical services required and the approximate extent of demand.

  • cycling
  • endurance sports
  • recreational
  • medical encounters
  • deaths
  • sudden cardiac death
  • epidemiology
  • safer study

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

  • Funding This study was funded by the IOC Research Center (South Africa) (partial funding) and the South African Medical Research Council (partial funding, statistical analysis).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Research Ethics Committee at the University of Pretoria (REC R430/2015).

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.