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Smith C, Sewry N, Nolte K, Swanevelder S, Engelke N, van Kamp C, Jordaan E, Schwellnus M. Do five screening tools identify the same number of runners who require pre-exercise medical clearance? SAFER XXXIV. PHYSICIAN SPORTSMED 2024; 52:77-83. [PMID: 36722299 DOI: 10.1080/00913847.2023.2176161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Currently, there are five international screening tools that are recommended to identify individuals who require pre-exercise medical clearance to reduce the risk of medical encounters during exercise. Therefore, the aim was to determine the percentage of race entrants who are advised to obtain pre-exercise medical clearance and the observed agreement between these five different international pre-exercise medical screening tools. METHODS In all, 76,654 race entrants from the Two Oceans Marathon (2012-2015) that completed an online pre-race screening questionnaire. Five pre-exercise medical screening tools (American Heart Association (AHA), pre-2015 American College of Sport Medicine (ACSM), post-2015 ACSM, Physical Activity Readiness Questionnaire (PAR-Q), and the European Association of Cardiovascular Prevention and Rehabilitation (EACPR)) were retrospectively applied to all participants. The % (95%CI) race entrants requiring medical clearance identified by each tool and the observed agreement between tools (%) was determined. RESULTS The % entrants requiring medical clearance varied from 6.7% to 33.9% between the five tools: EACPR (33.9%; 33.5-34.3); pre-2015 ACSM (33.9%; 33.5-34.3); PAR-Q (23.2%; 22.9-23.6); AHA (10.0%; 9.7-10.2); post-2015 ACSM (6.7%; 6.5-6.9). The observed agreement was highest between the pre-2015 ACSM and EACPR (35.4%), for pre-2015 ACSM and PAR-Q (24.8%), PAR-Q and EACPR (24.8%), and lowest between the post-2015 ACSM and AHA (4.1%). CONCLUSION The percentage of race entrants identified to seek medical clearance (and observed agreement) varied considerably between pre-exercise medical screening tools. Further research should determine which tool has the best predictive ability in identifying those at higher risk of medical encounters during exercise.
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Affiliation(s)
- Chanel Smith
- Division of Biokinetics and Sports Science, Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Kim Nolte
- Division of Biokinetics and Sports Science, Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nina Engelke
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - Calvin van Kamp
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
- Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
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Leppan J, Schwellnus M, Sewry N, Boulter J, van Rensburg D(CJ, Dyer M, Jordaan E. A comparison of two pre-race medical screening tools in 5771 running race entrants-SAFER XXVIII. Scand J Med Sci Sports 2023; 33:2360-2368. [PMID: 37534771 PMCID: PMC10946828 DOI: 10.1111/sms.14462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/21/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To determine if two pre-race screening tools (abbreviated tool of two open-ended pre-race medical screening questions [ABBR] vs. a full pre-race medical screening tool [FULL]) identify running race entrants at higher risk for medical encounters (MEs) on race day. METHODS 5771 consenting race entrants completed both an ABBR and a FULL pre-race screening questionnaire for the 2018 Comrades Marathon (90 km). ABBR tool questions were (1) allergies, and (2) known medical conditions and/or prescription medication use. The FULL tool included multiple domains of questions for chronic diseases including cardiovascular disease (CVD), symptoms, risk factors, allergies and medication use. ABBR responses were manually coded and compared to the FULL tool. The prevalence (%: 95%CI), and the test for equality of prevalence of entrants identified by the ABBR vs. FULL tool is reported. RESULTS The ABBR identified fewer entrants with allergies (ABBR = 7.9%; FULL = 10.4%: p = 0.0001) and medical conditions/medication use (ABBR = 8.9%; FULL = 27.4%: p = 0.0001). The ABBR tool significantly under-reported entrants with history of cardiovascular disease (CVD), CVD risk factors, other chronic diseases and prescription medication vs. the FULL tool (p = 0.0001). The ABBR tool identified fewer entrants in the "high" (ABBR = 3.4%; FULL = 12.4%) and "very high" risk (ABBR = 0.5%; FULL = 3.4%) categories for race day MEs (p = 0.0001). CONCLUSIONS An abbreviated pre-race screening tool significantly under-estimates chronic medical conditions, allergies, and race entrants at higher risk for MEs on race day, compared with a full comprehensive screening tool. We recommend that a full pre-race medical screening tool be used to identify race entrants at risk for MEs.
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Affiliation(s)
- Jordan Leppan
- Section Sports Medicine, Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
- IOC Research CentrePretoriaSouth Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
- IOC Research CentrePretoriaSouth Africa
| | | | | | - Marlise Dyer
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| | - Esme Jordaan
- Biostatistics Research UnitSouth African Medical Research Council (SAMRC)Cape TownSouth Africa
- Statistics and Population StudiesUniversity of the Western CapeCape TownSouth Africa
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Brill S, Schwellnus M, Sewry N, Janse Van Rensburg DC, Jansen Van Rensburg A, Jooste M, Leppan J, Boulter J, Seocharan I, Jordaan E. Pre-race self-reported medical conditions and allergies in 133 641 Comrades ultramarathon (90km) runners - SAFER XXIII. PHYSICIAN SPORTSMED 2023; 51:88-95. [PMID: 34751596 DOI: 10.1080/00913847.2021.2004080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine the prevalence of self-reported pre-race chronic medical conditions and allergies in ultramarathon race entrants and to explore if these are associated with an increased risk of race-day medical encounters (MEs). METHODS Data from two voluntary open-ended pre-race medical screening questions (Q1 - history of allergies; Q2 - history of chronic medical conditions/prescription medication use) were collected in 133641 Comrades Marathon race entrants (2014-2019). Race-day ME data collected prospectively over 6 years are reported as incidence (per 1000 starters) and incidence ratios (IR: 95%CI's). RESULTS Pre-race medical screening questions identified race entrants with a history of chronic medical conditions and/or prescription medication use (6.9%) and allergies (7.4%). The % entrants with risk factors for cardiovascular disease (CVD) was 30% and being older (>45 years) or male (27.5%) were the most frequent CVD risk factors. 0.3% of entrants reported existing CVD. The overall incidence of MEs was 20/1000 race starters. MEs were significantly higher in race entrants reporting a 'yes' to Q1 (allergies) (IR = 1.3; 1.1-1.5) (p = 0.014) or Q2 (chronic medical conditions and/or prescription medication use) (IR = 1.3; 1.1-1.5) (p = 0.0006). CONCLUSIONS Voluntary completion of two open-ended questions identified chronic medical conditions and/or prescription medication use in 6.9% and allergies in 7.4% of ultramarathon race entrants. This is lower than that reported for other races that implemented compulsory completion of a more comprehensive pre-screening questionnaire. Despite potential under-reporting, a pre-race self-reported history of chronic medical conditions and allergies was associated with a higher risk of race-day MEs.
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Affiliation(s)
- Stephan Brill
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Dina Christa Janse Van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Audrey Jansen Van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Marcel Jooste
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jordan Leppan
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Ishen Seocharan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
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Running for Your Life: Metabolic Effects of a 160.9/230 km Non-Stop Ultramarathon Race on Body Composition, Inflammation, Heart Function, and Nutritional Parameters. Metabolites 2022; 12:metabo12111138. [DOI: 10.3390/metabo12111138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Moderate endurance exercise leads to an improvement in cardiovascular performance, stress resilience, and blood function. However, the influence of chronic endurance exercise over several hours or days is still largely unclear. We examined the influence of a non-stop 160.9/230 km ultramarathon on body composition, stress/cardiac response, and nutrition parameters. Blood samples were drawn before (pre) and after the race (post) and analyzed for ghrelin, insulin, irisin, glucagon, cortisol, kynurenine, neopterin, and total antioxidant capacity. Additional measurements included heart function by echocardiography, nutrition questionnaires, and body impedance analyses. Of the 28 included ultra-runners (7f/21m), 16 participants dropped out during the race. The remaining 12 finishers (2f/10m) showed depletion of antioxidative capacities and increased inflammation/stress (neopterin/cortisol), while energy metabolism (insulin/glucagon/ghrelin) remained unchanged despite a high negative energy balance. Free fat mass, protein, and mineral content decreased and echocardiography revealed a lower stroke volume, left end diastolic volume, and ejection fraction post race. Optimizing nutrition (high-density protein-rich diet) during the race may attenuate the observed catabolic and inflammatory effects induced by ultramarathon running. As a rapidly growing discipline, new strategies for health prevention and extensive monitoring are needed to optimize the athletes’ performance.
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Sewry N, Wiggers T, Schwellnus M. Medical Encounters Among 94,033 Race Starters During a 16.1-km Running Event Over 3 Years in the Netherlands: SAFER XXVI. Sports Health 2022; 15:210-217. [PMID: 35384779 PMCID: PMC9950983 DOI: 10.1177/19417381221083594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are limited data on the medical encounters (MEs) occurring during mass community-based running events of shorter distances (10-21.1 km). The aim of this study was to determine the incidence and nature of MEs during the largest mass participation running event in the Netherlands. HYPOTHESIS We hypothesize that the incidence and nature of MEs will be similar to other running events. STUDY DESIGN Descriptive epidemiological study over 3 years of a 16.1-km (10-mile) running event. LEVEL OF EVIDENCE Level 4. METHODS We investigated a total of 94,033 race starters at the 2017-2019 Dam tot Damloop (16.1 km), a point-to-point road race from Amsterdam to Zaandam, the Netherlands. All MEs were recorded by race medical staff on race day each year. MEs were retrospectively coded by severity, organ system, and final specific diagnosis (2019 consensus statement definition on mass community-based events). Incidence (I) per 1000 starters (95% CIs) were calculated for all MEs and serious/life-threatening MEs. RESULTS The overall incidence (per 1000 starters) of all MEs was 2.75 (95% CI, 2.44-3.11), the overall incidence of serious/life-threatening MEs was 1.20 (95% CI, 1.00-1.45; 44% of MEs). Heat illnesses accounted for most MEs: hypothermia I = 0.54 (95% CI, 0.41-0.71) and hyperthermia I = 0.46 (95% CI, 0.34-0.62). Central nervous system MEs were also common (dizziness/nausea, I = 0.79; 95% CI 0.63-0.99), followed by the cardiovascular system MEs (exercise-associated postural hypotension, I = 0.36; 95% CI, 0.26-0.51). CONCLUSION The overall incidence of MEs was low compared with longer-distance races (21.1-90 km), but the incidence and relative frequency of serious/life-threatening MEs (44% of all MEs) was much higher. Heat illness (hypothermia and exertional heat stroke) accounted for most serious/life-threatening MEs. CLINICAL RELEVANCE There is a need to implement prevention strategies and interventions by specialized medical practitioners in this and similar events.
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Affiliation(s)
- Nicola Sewry
- Sport, Exercise Medicine and Lifestyle
Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South
Africa,International Olympic Committee (IOC)
Research Centre, South Africa,Nicola Sewry, PhD, Sport,
Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences,
University of Pretoria, South Africa, Sports Campus, Burnett Street, Hatfield,
Pretoria 0020, South Africa ()
(Twitter: @NSewry)
| | - Tom Wiggers
- Department of Sports Medicine,
TopSupport, Sint Anna Hospital, Geldrop, The Netherlands
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle
Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South
Africa,International Olympic Committee (IOC)
Research Centre, South Africa
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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