Medical Encounters in a 90-km Ultramarathon Running Event: A 6-year Study in 103 131 Race Starters—SAFER XVII

Abstract

Objective: To determine the incidence and nature of illness-related medical encounters (MEs) at a 90-km, ultramarathon, mass, community-based, endurance running event. Design: Retrospective, descriptive epidemiological study. Setting: Comrades Marathon (90 km), South Africa. Participants: One lakh three thousand one hundred thirty-one race starters over 6 years (2014)(2015)(2016)(2017)(2018)(2019). Independent Variables: Incidence of moderate and serious/life-threatening MEs. Main Outcome Measures: All MEs were recorded by race medical doctors on race day each year. Medical encounters were recorded by severity, organ system, and final specific diagnosis (2019 consensus statement definition on mass community-based events). Incidences (I: per 1000 starters; 95% confidence intervals) were calculated for MEs. Results: There were 1971 illness-related MEs, with an overall incidence of 19.1 (range, 18.3-20.0). The incidence for serious/life-threatening MEs was 1.8 (range, 1.6-2.1). Incidences of MEs by organ systems affected were as follows: fluid/electrolyte (8.8; 8.3-9.4), central nervous system (4.0; 3.7-4.5), and gastrointestinal system (2.9; 2.6-3.2). Dehydration (I 5 7.5: 7.0-8.1) and exercise-associated muscle cramping (I 5 3.2: 2.9-3.6) were the 2 most common specific diagnoses. Conclusion: The incidence of MEs in the 90-km Comrades Marathon was one of the highest incidences of MEs reported in an endurance running event (1 in 52 starters and 1 in 556 starters for serious/life-threatening MEs). Preventative measures to reduce MEs are needed, and further investigations into the risk factors associated with MEs could assist in managing the risk and better prepare athletes, race organizers, and medical directors.

Medical Encounters Among 94,033 Race Starters During a 16.1-km Running Event Over 3 Years in the Netherlands: SAFER XXVI

“…18 In a recent study on the Comrades Marathon, a 90-km road race in South Africa, the overall incidence MEs was 19.1 per 1000 starters, and the incidence of serious/life-threatening MEs was reported at 1.8 per 1000 starters (9% of all MEs). 22 Although in the Dam tot Damloop the overall incidence of MEs was lower (2.8 per 1000 starters), the proportion of serious/life-threatening MEs in the Dam tot Damloop was higher (44% of all MEs). This illustrates how high a proportion of MEs are serious/life-threatening in the Dam tot Damloop compared with other races.…”

A comparison of two pre‐race medical screening tools in 5771 running race entrants—SAFER XXVIII

“…Entrants with these underlying risk factors and chronic medical conditions are at higher risk of a ME on race day. CVD risk factors, history of CVD, respiratory disease and medication use are the most important risk factors and medical conditions in screening tools 15,16,20 . The most significant under‐reporting was in the CVD risk factors category (10.3% lower using the ABBR tool) followed by prescription medication use (6.5% less) and respiratory disease (5.7% less).…”

“…The race is run between the cities of Durban and Pietermaritzburg (in Kwa‐Zulu Natal province of South Africa), alternating directions each year. We recently reported that the incidence of MEs during this event is one of the highest, compared with other marathon and ultra‐marathon races, with 1 in 556 race starters developing a serious/life‐threatening ME 16 …”

“…We recently reported that the incidence of MEs during this event is one of the highest, compared with other marathon and ultramarathon races, with 1 in 556 race starters developing a serious/life-threatening ME. 16 In an attempt to reduce serious MEs during physical activity, various international guidelines have been created to screen individuals deemed to be at higher risk of having a ME when engaging in moderate-to highintensity physical activity. 2,7,15,[17][18][19][20][21] These guidelines were used as a framework to develop a comprehensive pre-race medical screening and educational intervention tool for race entrants to identify risk factors for cardiovascular disease (CVD), symptoms of CVD, known CVD, and other chronic diseases.…”

“…We recently reported that the incidence of MEs during this event is one of the highest, compared with other marathon and ultra‐marathon races, with 1 in 556 race starters developing a serious/life‐threatening ME. 16 …”