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Women, older age, faster cycling speed and increased wind speeds are independent risk factors for acute injury-related medical encounters during a 109 km mass community-based participation cycling event: a 3-year study in 102251 race starters—SAFER XII
Abstract
Background
There are limited data on acute injury-related medical encounters (injuries) in endurance cycling events.
Objective
To determine the risk factors for injuries during a mass community-based endurance cycling event.
Design
Retrospective, cross-sectional study.
Setting
Cape Town Cycle Tour (109 km), South Africa.
Participants
102 251 race starters.
Methods
All injuries for 3 years were recorded by race medical doctors and nurses. Injuries were grouped into main anatomical area of injury, and a Poisson regression model was used to determine the risk factors associated with injuries.
Results
The four injury risk factors associated with all injuries during an endurance cycling event were sex (women vs men, p<0.0001), older age (p=0.0005), faster cycling speed (p<0.0001) and higher average individualised Wind Speed (aiWindSpeed, p<0.0001). The only risk factor for serious/life-threatening injuries was women (p=0.0413). For specific main anatomical areas: head/neck (women), upper limb (women, older age, faster cyclists), trunk (women, higher aiWindSpeed), and lower limb (higher aiWindSpeed).
Conclusion
Women, older age, faster cycling speed and higher aiWindSpeed were all risk factors for acute injuries during a mass community-based endurance cycling event. These risk factors should help inform race organisers and medical teams on race day to ensure the best medical care is given, and effective acute injury prevention programmes are disseminated.
... The results of the conducted analysis allowed to state that the probability of serious or fatal injuries by a bicyclist increases by as much as 84% in a situation where the bicyclist exceeded speed = 30 km/h. Similar research results were also obtained by J. Killops et al. [52] and E. Macioszek and A. Kurek [53]. ...
Transportation and technological development have for centuries strongly influenced the shaping of urbanized areas. On one hand, it undoubtedly brings many benefits to their residents. However, also has a negative impact on urban areas and their surroundings. Many transportation and technological solutions lead, for example, to increased levels of pollution, noise, excessive energy use, as well as to traffic accidents in cities. So, it is important to safe urban development and sustainability in all city aspects as well as in the area of road transport safety. Due to the long-term policy of sustainable transport development, cycling is promoted, which contributes to the increase in the number of this group of users of the transport network in road traffic for short-distance transport. On the one hand, cycling has a positive effect on bicyclists’ health and environmental conditions, however, a big problem is an increase in the number of serious injuries and fatalities among bicyclists involved in road incidents with motor vehicles. This study aims to identify factors that influence the occurrence and severity of bicyclist injury in bicyclist-vehicle crashes. It has been observed that the factors increasing the risk of serious injuries and deaths of bicyclists are: vehicle driver gender and age, driving under the influence of alcohol, exceeding the speed limit by the vehicle driver, bicyclist age, cycling under the influence of alcohol, speed of the bicyclist before the incident, vehicle type (truck), incident place (road), time of the day, incident type. The obtained results can be used for activities aimed at improving the bicyclists’ safety level in road traffic in the area of analysis.
... This information may be added to answer specific research questions. [12][13][14] There are currently no recommendations on the assessment of environmental conditions in sport. Cycling is not the only sport that is undertaken outdoors, and universal recommendations should be developed to support a uniform registry of these factors. ...
In 2020, the IOC released a consensus statement that provides overall guidelines for the recording and reporting of epidemiological data on injury and illness in sport. Some aspects of this statement need to be further specified on a sport-by-sport basis. To extend the IOC consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sports and to meet the sport-specific requirements of all cycling disciplines regulated by the Union Cycliste Internationale (UCI). A panel of 20 experts, all with experience in cycling or cycling medicine, participated in the drafting of this cycling-specific extension of the IOC consensus statement. In preparation, panel members were sent the IOC consensus statement, the first draft of this manuscript and a list of topics to be discussed. The expert panel met in July 2020 for a 1-day video conference to discuss the manuscript and specific topics. The final manuscript was developed in an iterative process involving all panel members. This paper extends the IOC consensus statement to provide cycling-specific recommendations on health problem definitions, mode of onset, injury mechanisms and circumstances, diagnosis classifications, exposure, study population characteristics and data collection methods. Recommendations apply to all UCI cycling disciplines, for both able-bodied cyclists and para-cyclists. The recommendations presented in this consensus statement will improve the consistency and accuracy of future epidemiological studies of injury and illness in cycling.
Background
Information on acute traumatic cycling injuries (ATCIs) in the 12 months prior to entry in a cycling race and the predisposing factors have not been well-researched.
Objective
Determine factors associated with a history of ATCIs sustained in the previous 12 months by race entrants of a 109 km cycling race.
Methods
Descriptive, cross-sectional study on 60 941 Cape Town Cycle Tour race entrants from 2016 to 2020. Data on a history of ATCIs sustained in the previous 12 months were obtained through an online pre-race medical screening questionnaire (mandatory in 2016, and voluntary in 2017–2020). Factors investigated were demographics, cycling/training history and history of chronic disease, collapse, cramping, allergies and regular chronic prescription medication usage. We calculated the prevalence ratio (PR) for reporting a history of an ATCI in the previous 12 months for each category (multiple regression model).
Results
Factors associated with an increased PR for a history of ATCIs gathered from race entrants (34% of the total entrants) were: increased years of participation in distance cycling events >2 hours (PR=1.05 per 5 years of distance cycling, p<0.0001), increased weekly average training/racing distance of a cyclist in the past 12 months (PR=1.11 per 50 km increase in weekly cycling). Other factors were: increased number of chronic diseases reported (PR=1.53, per two additional chronic diseases reported, p<0.0001), history of collapse (PR=1.75, p=0.0005), history of cramping (PR=1.65, p<0.0001) and history of allergies (PR=1.49, p<0.0001).
Conclusions
Subgroups of recreational cyclists at higher risk for ATCIs were identified. This information could assist in developing and implementing future strategies to mitigate ATCIs.
Objective:
Systematic review of possible long-term effects of sports-related concussion in retired athletes.
Data sources:
Ten electronic databases.
Study selection:
Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae defined as >10 years after the injury.
Data extraction:
Study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, neuroimaging findings and neuropathology results. Risk of bias and level of evidence were evaluated by two authors.
Results:
Following review of 3819 studies, 47 met inclusion criteria. Some former athletes have depression and cognitive deficits later in life, and there is an association between these deficits and multiple prior concussions. Former athletes are not at increased risk for death by suicide (two studies). Former high school American football players do not appear to be at increased risk for later life neurodegenerative diseases (two studies). Some retired professional American football players may be at increased risk for diminishment in cognitive functioning or mild cognitive impairment (several studies), and neurodegenerative diseases (one study). Neuroimaging studies show modest evidence of macrostructural, microstructural, functional and neurochemical changes in some athletes.
Conclusion:
Multiple concussions appear to be a risk factor for cognitive impairment and mental health problems in some individuals. More research is needed to better understand the prevalence of chronic traumatic encephalopathy and other neurological conditions and diseases, and the extent to which they are related to concussions and/or repetitive neurotrauma sustained in sports.
The half-marathon (21 km) race is a very popular mass community-based distance running event. It is important to determine risk factors for medical complications during these events, so that prevention programmes can be developed.
To determine risk factors associated with medical complications during 21 km road running events.
Prospective study.
Two Oceans half-marathon (21 km) races.
39 511 starters in the 21 km race.
Medical complications (defined as any runner requiring assessment by a doctor at the race medical facility or a local hospital on race day) were recorded over a 4-year study period. Medical complications were subdivided according to the system affected and by final diagnosis. A Poisson regression model was used to determine risk factors for any medical complication and more common specific complications.
Independent risk factors for medical complication during 21 km running were older female runners (women >50 vs ≤50 years; p<0.0001) and year of observation (2008 vs 2011; p=0.0201: 2009 vs 2011: p=0.0019; 2010 vs 2011: p=0.0096). Independent risk factors for specific common medical complications were: postural hypotension (women, slow running pace), musculoskeletal complications (less running experience, slower running pace) and dermatological complications (women).
Older female runners are at higher risk of developing medical complications during 21 km road running races. Environmental conditions in a particularly cold climate may also play a role. Less running experience and slower running pace are associated with specific medical complications. Medical staff can now plan appropriate care on race days, and interventions can be developed to reduce the risk of medical complications in 21 km races.
Regular participation in physical activity is well established as an important component of a comprehensive lifestyle intervention programme for primary, secondary and tertiary prevention of chronic non-communicable disease.1-3 Recreational distance running, as one form of regular physical activity, is popular globally. Data published in the 2013 Running USA Annual report indicates that there are over 50 million runners in the USA, of which >29 million run for more than 50 days/annum, and >9 million runners run for more than 110 days/annum (2013 Running USA Annual report: http://www.runningusa.org). Furthermore, almost 75% of male and female runners indicated that the main motivation to continue to run is to stay healthy. The half marathon race is the most popular event and participation in this race has also experienced the greatest growth between 2000 and 2012. Apart from the general increase in the number of runners, there is also a concomitant increase in participation in mass community-based distance running events globally. In 2012 there were more than 30 half-marathon races and more than 10 marathon races that attracted >20 000 runners (2013 Running USA Annual report: http://www.runningusa.org). However, it is also well documented that vigorous (high intensity) physical activity, such as distance running, is associated with medical complications that can affect a variety of organ systems.4 Of particular interest is the fact that vigorous exercise may act as a trigger for cardiac arrest and sudden death as a result … [Full text of this article]
Physical inactivity is the fourth leading cause of death worldwide. We summarise present global efforts to counteract this problem and point the way forward to address the pandemic of physical inactivity. Although evidence for the benefits of physical activity for health has been available since the 1950s, promotion to improve the health of populations has lagged in relation to the available evidence and has only recently developed an identifiable infrastructure, including efforts in planning, policy, leadership and advocacy, workforce training and development, and monitoring and surveillance. The reasons for this late start are myriad, multifactorial, and complex. This infrastructure should continue to be formed, intersectoral approaches are essential to advance, and advocacy remains a key pillar. Although there is a need to build global capacity based on the present foundations, a systems approach that focuses on populations and the complex interactions among the correlates of physical inactivity, rather than solely a behavioural science approach focusing on individuals, is the way forward to increase physical activity worldwide.
Bicycle use has increased in some of France's major cities, mainly as a means of transport. Bicycle crashes need to be studied, preferably by type of cycling. Here we conduct a descriptive analysis.
A road trauma registry has been in use in France since 1996, in a large county around Lyon (the Rhône, population 1.6 million). It covers outpatients, inpatients and fatalities. All injuries are coded using the Abbreviated Injury Scale (AIS). Proxies were used to identify three types of cycling: learning = children (0-10 years old); sports cycling = teenagers and adults injured outside towns; cycling as means of transport = teenagers and adults injured in towns. The study is based on 13,684 cyclist casualties (1996-2008).
The percentage of cyclists injured in a collision with a motor vehicle was 8% among children, 17% among teenagers and adults injured outside towns, and 31% among those injured in towns. The percentage of serious casualties (MAIS 3+) was 4.5% among children, 10.9% among adults injured outside towns and 7.2% among those injured in towns. Collisions with motor-vehicles lead to more internal injuries than bicycle-only crashes.
The description indicates that cyclist type is associated with different crash and injury patterns. In particular, cyclists injured in towns (where cycling is increasing) are generally less severely injured than those injured outside towns for both types of crash (bicycle-only crashes and collisions with a motor vehicle). This is probably due to lower speeds in towns, for both cyclists and motor vehicles.
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.
Mass participation endurance sports events are popular but a large number of participants are older and may be at risk of medical complications during events. Medical encounters (defined fully in the statement) include those traditionally considered ‘musculoskeletal’ (eg, strains) and those due to ‘illness’ (eg, cardiac, respiratory, endocrine). The rate of sudden death during mass endurance events (running, cycling and triathlon) is between 0.4 and 3.3 per 100 000 entrants. The rate of other serious medical encounters (eg, exertional heat stroke, hyponatraemia) is rarely reported; in runners it can be up to 100 times higher than that of sudden death, that is, between 16 and 155 per 100 000 race entrants. This consensus statement has two goals. It (1) defines terms for injury and illness-related medical encounters, severity and timing of medical encounters, and diagnostic categories of medical encounters, and (2) describes the methods for recording data at mass participation endurance sports events and reporting results to authorities and for publication. This unifying consensus statement will allow data from various events to be compared and aggregated. This will inform athlete/patient management, and thus make endurance events safer.
Objective:
To describe the incidence and patterns of injury and illness of male and female participants during a 94.7 km distance cycling event.
Design:
Descriptive study.
Setting:
Momentum 94.7 Cycle Challenge 2014.
Participants:
All 23 055 race starters (males = 17 520, females = 5236, not specified = 299).
Main outcome measures:
The incidence and type of all medical complaints and difference between sexes.
Results:
Incidence (per 1000 race starters) of all medical complaints was 38.69 (males = 36.52, females = 38.39), adverse medical events 11.88 (males = 10.73, females = 16.42) and serious adverse events 1.3 (males = 0.86, females = 2.67). The incidence of nontraumatic medical complaints was 32.49 (males = 33.39, females = 31.32) and of traumatic injuries was 3.99 (males = 3.14, females = 7.07). Females compared to males had a higher risk of sustaining traumatic injuries (P < 0.001), central nervous system, (P = 0.0062) and eye complaints (P = 0.0107). Most complaints (80.6%) were reported for the musculoskeletal system. Males 10-15 years (P = 0.0013) and females 23-39 years (P = 0.0336), and older than 50 years (P = 0.0002) had a higher than expected risk for traumatic injuries.
Conclusions:
Medical complaints ratio reported was 1:26 (males = 1:28, females = 1:26) in all starters during the cycling event. Cyclists that did not finish the race (adverse events) were 1:84 (males = 1:93, females = 1:61). Serious adverse events that required hospitalization were 1:769 (males = 1:1163, females = 1:374). The majority of admissions were for traumatic injuries, followed by cardiovascular complaints. Results from this study indicated that a wide spectrum of medical complaints can be expected during such an event with a higher risk for females to sustain traumatic injuries and to encounter central nervous system and eye complaints. Information regarding the pattern and type of medical encounters can prove useful during planning and management of similar future events.
Objective:
Recreational multiday cycling events have grown popular in the United States; however, little has been published regarding the injuries and illnesses that occur during these events. The objective of this study was to describe injuries and illnesses that occur in the Great Ohio Bicycle Adventure (GOBA) and to examine associated risk factors.
Methods:
Injury and illness data collected from an on-site medical clinic during the 2013 and 2014 GOBA tours were merged with rider registration data for analysis. Diagnoses were classified as acute injury, overuse injury, or medical illness. The odds ratios of sustaining at least 1 injury/illness, as well as sustaining an acute injury, were assessed adjusting for riders' demographics.
Results:
A total of 4005 (2172 in 2013 and 1833 in 2014) cyclists participated in GOBA, with an an age of 50.7±17.6 (2-86) years (mean±SD [range]), of whom 59.8% were male. During the tours, 143 (3.6%) riders reported at least 1 injury/illness, which resulted in 220 clinical diagnoses, including 114 (51.8%) acute injuries, 27 (12.3 %) overuse injuries, and 79 (35.9%) medical illnesses. The lower extremities were the most commonly injured body site (n=71, 50.4%)."Superficial/Abrasions/Contusions" was the most common injury/illness type (n=68, 30.9%). Riders who had no previous tour experience or who were at least 50 years old had a greater risk of injury/illness than their counterparts.
Conclusions:
The prevalence of injury and illness is relatively low in multiday recreational cycling events. Our findings provide important data for planning and preparing for medical coverage at mass recreational cycling events.
Background
Mass participation in recreational sport (such as cycling) is part of a healthy lifestyle, and is an important component in the primary and secondary prevention of non-communicable diseases (NCD's). However, there is a risk of acute traumatic injuries and acute medical complications during community mass participation cycling races, but this has not been well documented.
Objective
The objective of this study was to document the incidence of acute traumatic injuries and acute non-traumatic medical complications in a community mass participation cycling race.
Design
Retrospective cohort study.
Setting
109 km cycling race.
Participants
All 34 033 race starters (males=26 835, females=7 198) to the 2014 Cape Town Cycle Tournament.
Assessment
Pre-race entry demographic data and race-day medical complications data (all incidents that required assessment by the medical team on race day) were collected.
Main Outcome Measurements
The incidence (per 1000 race starters) of all complications, acute traumatic injuries and non-traumatic medical complications and serious life threatening complications were determined for all cyclists, and male and female cyclists.
Results
The incidence (per 1000 starters) of all complications was 6.35, and this was significantly higher in females vs. males (male=5.78, female=8.47; p=0.014). The incidence of serious life-threatening complications was 0.5, and there was a trend toward a higher incidence in female cyclists (female=0.97, males=0.37; p=0.06). Female cyclists also had a significantly higher (p=0.027) incidence of acute traumatic injuries (females=6.53, males=4.47; p=0.027). The incidence of acute non-traumatic medical complications was 1.44 (males=1.30, females=1.94; p=0.203).
Conclusions
1/157 race starters (males: 1/173; females: 1/118) at a community based cycling event were injured or developed a medical complication during the race, and the risk is significantly higher in female cyclists. These data indicate the need to develop and implement prevention strategies to reduce the risk of medical complications, specifically traumatic injuries, in female cyclists.
The unique quality of the bicycle is its ability to accommodate a wide variety of injuries and disabilities. Cycling for recreation, transportation, and competition is growing nationwide, and has proven health and societal benefits. The demands of each type of cycling dictate the necessary equipment, as well as potential for injury. Prevention of cycling-related injury in both the athlete and the recreational cyclist involves understanding the common mechanisms for both traumatic and overuse injury, and early correction of strength and flexibility imbalances, technique errors, and bicycle fit.
The overwhelming majority of sports-related sudden deaths occur among those older than 35 years of age. Because increasing numbers of older people are participating in organized endurance and competitive sporting events, the incidence of sports-related sudden death in older adults is expected to rise. Older athletes will approach clinical cardiologists for advice regarding their fitness for participation. It is important to recognize both that strenuous exercise is associated with a transient elevation in risk of sudden cardiac death and that appropriate training substantially reduces this risk. The approach to pre-participation screening for risk of sudden death in the older athlete is a complex issue and at present is largely focused on identifying inducible ischemia due to significant coronary disease. In this brief review, we summarize the current state of knowledge in this area with respect to epidemiology, mechanisms, and approaches to risk stratification, as viewed from the perspective of the consulting clinical cardiologist.
Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Objective To analyze the unique factors involved in providing medical support for a long-distance, cross-border, cycling event, and to describe patient presentations and event characteristics for the British Columbia (BC) Ride to Conquer Cancer from 2010 through 2012.Methods This study was a 3-year, descriptive case series report. Medical encounters were documented, prospectively, from 2010-2012 using an online registry. Data for event-related variables also were reported.Results Providing medical support for participants during the 2-day ride was complicated by communication challenges, weather conditions, and cross-border issues. The total number of participants for the ride increased from 2,252 in 2010 to 2,879 in 2011, and 3,011 in 2012. Patient presentation rates (PPRs) of 125.66, 155.26, and 198.93 (per 1,000 participants) were documented from 2010 through 2012. Over the course of three years, and not included in the PPR, an additional 3,840 encounters for “self-treatment” were documented.Conclusions The Ride to Conquer Cancer Series has shown that medical coverage at multi-day, cross-national cycling events must be planned carefully to face a unique set of circumstances, including legislative issues, long-distance communication capabilities, and highly mobile participants. This combination of factors leads to potentially higher PPRs than have been reported for noncycling events. This study also illuminates the additional workload “self-treatment” visits place on the medical team.
A Lund, SA Turris, P Wang, J Mui, K Lewis, SJ Gutman. An analysis of patient presentations at a 2-day mass-participation cycling event: The Ride to Conquer Cancer Case Series, 2010-2012. Prehosp Disaster Med. 2014;29(4):1-8
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Hintergrund
Über Risiken und Verletzungen des Radsports ist in der Literatur wenig berichtet. Ziel vorliegender Studie war es, alle Verletzten der 182 Profi- und 18.788 Amateurradfahrer der Hamburger „Cyclassics“ 2006 zu erfassen.
Patienten und Methode
Die Verletzten wurden durch Daten des Rettungsdienstes, des Veranstalters und der Kliniken erfasst und in einem Fragebogen befragt.
Ergebnisse
70 Verletzte mit 193 Verletzungen wurden verzeichnet, die Verletzungsrate betrug 0,37%. Das mittlere Alter lag bei 44 (19–72) Jahren. Die Extremitäten waren in 94,4% der Fälle betroffen, häufigste Lokalisation war in 54,7% der Schultergürtel (32 Frakturen wurden registriert). Der „mittlere Abbreviated Injury Score“ (MAIS) betrug 1,34±0,73 (Spanne 1–4), der „Injury Severity Score“ (ISS) 2,86±3,61 (Spanne 1–20). 10% der Teilnehmer erlitten ernste Verletzungen (AIS≥3), statistisch signifikant häufiger bei Frauen als bei Männern (p
Self-reported rates of participation in sport vary by country. In the UK, about 40% of men and women aged 16 years or older participate in at least one sport every week. Although few data exist to assess trends for participation in sport, there is little evidence of change in the past decade among adults. Large cohort studies suggest that such participation in sport is associated with a 20-40% reduction in all-cause mortality compared with non-participation. Randomised trials and crossover clinical studies suggest that playing sport is associated with specific health benefits. Some sports have relatively high injury risk although neuromuscular training programmes can prevent various lower extremity injuries. Clinicians can influence a large number of patients through brief interventions that promote physical activity, and encouragement toward participation in sport for some physically inactive patients qualifies as evidence-based therapy. Exercise might also be considered as a fifth vital sign and should be recorded in patients' electronic medical records and routine histories.
Objective:
The popularity of mountain bicycle (MTB) riding has increased significantly since its inception in the 1970s, as have injuries from MTB riding. As MTB stage racing is a relatively new segment of MTB racing, the purpose of this study was to evaluate the injury and illness patterns associated with MTB stage racing to assist future medical providers in covering events.
Methods:
The Trans-Sylvania Mountain Bike Epic Race consisted of 7 stages. An onsite medical team of physicians, nurses, and paramedics provided medical coverage. The providers logged each medical encounter on a medical form. The log included the location where the treatment was provided (on course, at the finish or after the race), a description of the injury/illness, treatment that was rendered, the supplies needed for treatment, and the disposition of the patient (continue, withdraw but continue the next day, withdraw, or transfer to the hospital).
Results:
A total of 52 athletes competed in the inaugural edition of the race. There were 30 separate medical encounters, with a total of 34 injuries/illnesses. Of these, 22 (65%) were classified as injury, and 12 (35%) were classified as illness. Four athletes withdrew from the race, 1 from injury and 3 from illness. Skin and soft tissue injuries/illnesses were the most prevalent.
Conclusions:
Injury and illness patterns of MTB stage racing are similar to those of other wilderness sporting events and prior data on MTB-related injuries. Minor skin, soft tissue, and orthopedic injuries are the most common. Illness accounts for the majority of withdrawals.
Notwithstanding the healthy influence of sporting activities on risk factors, in particular those of cardiovascular disease, it is becoming increasingly apparent that sports can present a danger to health in the form of sports injuries. The extent of the sports injury problem calls for preventative action based on the results of epidemiological research. For the interpretation of these facts uniform definitions are needed and limitations of research designs should be known. Measures to prevent sports injuries form part of what is called the ‘sequence of prevention’. Firstly the extent of the sports injury problem must be identified and described. Secondly the factors and mechanisms which play a part in the occurrence of sports injuries have to be identified. The third step is to introduce measures that are likely to reduce the future risk and/or severity of sports injuries. This measure should be based on the aetiological factors and the mechanism as identified in the second step. Finally the effect of the measures must be evaluated by repeating the first step.
In this review some aspects of the first and second step of the sequence of prevention are discussed.
The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. per 1000 hours of sports participation) in order to facilitate the comparability of research results. However, one should realise that the outcome of research applying this definition of sports injury incidence is highly dependent on the definitions of ‘sports injury’ and ‘sports participation’.
The outcome of such research also depends on the applied research design and research methodology. The incidence of sports injuries depends on: the method used to count injuries (e.g. prospective vs retrospective); the method used to establish the population at risk; and on the representativeness of the sample.
Severity of sports injuries can be described on the basis of 6 criteria: the nature of the sports injury; the duration and nature of treatment; sporting time lost; working time lost; permanent damage; and cost. Here also uniform definitions are important and necessary in order to enhance the comparability of research data. In the second step of the ‘sequence of prevention’ the aetiological factors that play a role in the occurrence of a sports injury have to be identified by epidemiological studies. Epidemiological research on the aetiology of sports injuries requires a conceptual model. The most commonly applied model is a stress/capacity model in which internal (personal) and external (environmental) aetiological factors are identified. In this model stress and capacity must be in balance and preventative measures must be designed to achieve or maintain this balance. However, merely to establish the aetiological factors is not enough; the mechanism by which sports injuries occur must also be identified. Athletes are in constant interaction with their environment and aetiological factors must be approached from this point of view. In a second, more dynamic, conceptual model on the aetiology of sports injuries, the importance of the determinants of sports behaviour, as well as the interaction between the various aetiological factors, is discussed. Whether or not a sports injury results from sports behaviour largely depends on the extent to which ‘prevention’ is incorporated in the determinants of sports behaviour. The drawback of both conceptual models is the fact that neither of them incorporate a time perspective. They can therefore not be applied to research on the aetiology of overuse injuries. In this perspective the application of a stress/strain/capacity model can be useful. This is a more dynamic and time-based 3-phase sequential model in which behaviour, amongst other aetiological factors, plays an important role. In this model an athlete is seen as an active manipulator of stress by whom the amount of strain evoked by sports participation can be altered, thereby influencing the capacity to perform in a certain sports situation, but also influencing the risk to sustain a sports injury, either acute or long term.
Finally, despite the importance of the model of choice in studying the aetiology of sports injuries one should realise that again the choice of research design influences the outcome of such research. Case series usually give no information on the underlying population at risk, so they are of no value in drawing valid conclusions on the risk factors of injuries. Only by relating the injuries to corresponding population denominators can one estimate injury rates and identify important risk factors and high risk sportspeople. As in research on sports injury incidence; research on risk factors should be undertaken on groups that are homogeneous with regard to age, sex, level of competition and type of sport.
To assess the incidence of and risk factors for injuries in a group of bicyclists with a well-defined exposure to bicycling, we conducted a prospective study of 1638 recreational bicyclists who rode in the 6-day 339-mile Cycle Across Maryland tour in 1994. The mean age of participants was 39 years (range, 7 to 79), and two-thirds were male. All riders wore helmets. During the tour there were 85 acute traumatic injuries (15.4 per 100,000 person-miles), 76 overuse injuries (13.7 per 100,000 person-miles), and 37 other medical problems (6.7 per 100,000 person-miles). Acute traumatic injuries were associated with a history of racing versus none (relative risk = 2.2, 95% confidence limits = 1.3, 3.7) and with inexperience, no previous Cycle Across Maryland tours versus one or more (relative risk = 1.7, 95% confidence limits = 1.04, 2.8), but not with sex, training, or prior injuries. Inexperience and lack of preride conditioning were risk factors for overuse injuries. The most common overuse injuries and medical problems were knee pain, hand or wrist numbness, foot blisters, insect stings and bites, and heat and dehydration. Study results provide exposure-based incidence rates of bicyclist injuries and suggest overuse injuries may be reduced by increased preride conditioning.
Providing medical care at special events is a growing area of concern of emergency physicians. Little information has been published on events in which participants outnumber spectators. We describe such an event at which the medical encounters far outnumbered any previously published report.
The California AIDS Ride 3 bicycle ride took place June 1-8, 1996, and covered 547 miles of highway between San Francisco and Los Angeles. One hundred five volunteer staff members provided medical care. Extensive patient encounters were recorded on a one-page form; all other encounters were recorded as hash marks by the provider. Two physicians reviewed the medical records and categorized each encounter.
Of the 25,379 patient encounters recorded over the 8 days of the event, 509 were triaged as greater severity (requiring an examination by a physician); 31% of these involved heat-related illnesses. Fifty-five patients required transport to local emergency departments by the local EMS systems; 7 of these patients required hospital admission.
The California AIDS Ride 3 required more medical personnel and resulted in more patient encounters than any similar event previously described. We describe the medical care team and patient encounters to facilitate planning for medical care at future class 3 events.
Study objective: To describe injuries during a 1-day urban cycling tour.
During the May 1996 "Bike New York" tour, we monitored EMS calls to identify injuries in a cohort of helmeted cyclists shielded from traffic. We collected demographic information from entry records, injury data from ambulance call reports, and follow-up on transported patients from telephone interviews with emergency physicians. Data were summarized using proportions, relative risks (RRs), 95% confidence intervals (CIs), and chi2
Approximately 28,000 cyclists participated, of which 23,502 (84%) were officially registered. Sixty-eight percent of registered bicyclists were male, and 92% were between 18 and 55 years old. Of the 140 EMS calls made during the tour, 136 (97%) involved participants; this yielded an injury incidence of 5 per 1,000 riders, or 12 to 13 per 100,000 person-miles. Injury was more common among younger cyclists (RR=1.4 for age </=35 years versus age >35 years; 95% CI, 1.0 to 2.0; P <.05), and possibly women (RR=1.3; 95% CI,.9 to 1.8; P =.11). Injuries were mostly minor, but there were 7 concussions and 6 clavicle fractures; none of the 140 injuries was fatal. Thirty-eight calls resulted in ED transport, and 5 of these patients were admitted. Although EMS units were evenly distributed along the route, most EMS calls occurred in only 3 of the 7 zones (P <.001).
Injuries during the largest 1-day US cycling tour were uncommon. More data are needed to determine the relative importance of injury risk factors. Data collection during mass events may help guide distribution of EMS personnel.
To describe the incidence and types of injury and illness treated during a multiday recreational bicycling tour.
In July 2001, 2100 bicyclists rode 520 miles from Minneapolis, MN, to Chicago, IL, during the 2001 Heartland AIDS Ride. A volunteer medical staff provided medical care along the route. All patient encounters were recorded in an injury and illness log. Information from the log was used to describe the incidence and types of injury and illness treated during the event.
A total of 2100 riders participated, with 244 patient encounters recorded. The 2 most common reasons for requiring medical care were dehydration (35%) and orthopedic injuries (27%). Forty patients were transferred to the hospital and 7 required admission.
Individuals charged with providing medical care for recreational bicycling events should be prepared to treat a wide variety of injuries and illnesses. In this and other studies, dehydration, heat illness, and overuse injuries were the most common reasons to require medical care. The results of this study suggest that implementation of prevention strategies before and during bicycling events may significantly reduce the requirement for on-site medical care.
Few data on risks and injury patterns of road cycling events are available. The aim of our study was to evaluate all injured participants in the 2006 Hamburg "Cyclassics".
Injuries of the 182 professional and 18,788 recreational participants were registered with the help of the emergency medical services, the promoter and the hospitals.
A total of 193 injuries were registered in 70 participants; the mean age was 44 years (range: 19-72). The injury rate amounted to 0.37%. Extremities were affected in 94.4%, and 32 fractures were registered. The MAIS amounted to 1.34+/-0.73 (range: 1-4), and the mean ISS was 2.86 +/- 3.61 (range: 1-20). The region affected most frequently was the shoulder girdle. Of the participants, 10% sustained serious injuries (AIS> or =3), which were significantly more frequent in women than in men (p<0.01). Based on 100,000 km most accidents occurred in the 55-km distance (p<0.01); 84.4% of the accidents occurred in groups. The mean speed at the time of the crash was 37.3 km/h (range: 0-57).
In conclusion, accidents were more likely to occur in inexperienced drivers, in the shortest distance, with straight conditions and in well-known dangerous areas.