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No Effect of a Graded Training Program on the Number of Running-Related Injuries in Novice Runners: A Randomized Controlled Trial

Authors:
  • University Medical Center Groningen/University of Groningen

Abstract and Figures

Although running has positive effects on health and fitness, the incidence of a running-related injury (RRI) is high. Research on prevention of RRI is scarce; to date, no studies have involved novice runners. A graded training program for novice runners will lead to a decrease in the absolute number of RRIs compared with a standard training program. Randomized controlled trial; Level of evidence, 1. GRONORUN (Groningen Novice Running) is a 2-armed randomized controlled trial comparing a standard 8-week training program (control group) and an adapted, graded, 13-week training program (intervention group), on the risk of sustaining an RRI. Participants were novice runners (N = 532) preparing for a recreational 4-mile (6.7-km) running event. The graded 13-week training program was based on the 10% training rule. Both groups registered information on running characteristics and RRI using an Internet-based running log. The primary outcome measure was RRIs per 100 participants. An RRI was defined as any musculoskeletal complaint of the lower extremity or back causing a restriction of running for at least 1 week. The graded training program was not preventive for sustaining an RRI (chi(2) = 0.016, df = 1, P = .90). The incidence of RRI was 20.8% in the graded training program group and 20.3% in the standard training program group. This randomized controlled trial showed no effect of a graded training program (13 weeks) in novice runners, applying the 10% rule, on the incidence of RRI compared with a standard 8-week training program.
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Medicine
American Journal of Sports
DOI: 10.1177/0363546507307505
2008; 36; 33 originally published online Oct 16, 2007; Am. J. Sports Med.
Ida Buist, Steef W. Bredeweg, Willem van Mechelen, Koen A. P. M. Lemmink, Gert-Jan Pepping and Ron L. Diercks
Runners: A Randomized Controlled Trial
No Effect of a Graded Training Program on the Number of Running-Related Injuries in Novice
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Running is a sport practiced by many individuals to
improve cardiorespiratory function, health, and well-being.
In conjunction with the positive effects of running on
health and fitness, it is important to consider the risk of a
running-related injury (RRI). Research has shown that the
incidence of RRI is high; incidence rates of RRI vary from
30% to 79%,
3,11-14,24,28
and from 7 to 59 RRIs per 1000 hours
of running.
3,11,12,19
Most RRIs are overuse injuries of the lower extremity.
8
The causes of these overuse RRIs are multifactorial.
8
Four
factors have been related consistently to running injuries: (1)
lack of running experience, (2) previous injury, (3) running to
compete, and (4) excessive weekly running distance.
26
It is
estimated that 60% of all RRIs can be attributed to training
errors, that is, running too much too soon.
8
Little research has been performed on the prevention of
RRI in the running population. Several controlled studies on
No Effect of a Graded Training Program on
the Number of Running-Related Injuries
in Novice Runners
A Randomized Controlled Trial
Ida Buist,*
†‡
MSc, Steef W. Bredeweg,
†‡
MD, Willem van Mechelen,
§
MD, PhD,
Koen A. P. M. Lemmink,
†¶
PhD, Gert-Jan Pepping,
†‡¶
PhD, and Ron L. Diercks,
†‡
MD, PhD
From the
University Center for Sport, Exercise and Health, and
Center for Sports Medicine,
University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
§
Department of Public and Occupational Health/EMGO Institute, VU University Medical Center,
Amsterdam, The Netherlands, and
Center for Human Movement Sciences, University Medical
Center Groningen, University of Groningen, Groningen, The Netherlands
Background: Although running has positive effects on health and fitness, the incidence of a running-related injury (RRI) is high.
Research on prevention of RRI is scarce; to date, no studies have involved novice runners.
Hypothesis: A graded training program for novice runners will lead to a decrease in the absolute number of RRIs compared with
a standard training program.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: GRONORUN (Groningen Novice Running) is a 2-armed randomized controlled trial comparing a standard 8-week
training program (control group) and an adapted, graded, 13-week training program (intervention group), on the risk of sustain-
ing an RRI. Participants were novice runners (N = 532) preparing for a recreational 4-mile (6.7-km) running event. The graded 13-
week training program was based on the 10% training rule. Both groups registered information on running characteristics and
RRI using an Internet-based running log. The primary outcome measure was RRIs per 100 participants. An RRI was defined as
any musculoskeletal complaint of the lower extremity or back causing a restriction of running for at least 1 week.
Results: The graded training program was not preventive for sustaining an RRI (χ
2
= 0.016, df = 1, P = .90). The incidence of RRI
was 20.8% in the graded training program group and 20.3% in the standard training program group.
Conclusions: This randomized controlled trial showed no effect of a graded training program (13 weeks) in novice runners,
applying the 10% rule, on the incidence of RRI compared with a standard 8-week training program.
Keywords: running-related injuries; incidence; prevention; training program; novice runners
33
*Address correspondence to Ida Buist, MSc, University Center for Sport,
Exercise and Health, University Medical Center Groningen, University of
Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands (e-mail:
i.buist@sport.umcg.nl).
No potential conflict of interest declared.
The American Journal of Sports Medicine, Vol. 36, No. 1
DOI: 10.1177/0363546507307505
© 2008 American Orthopaedic Society for Sports Medicine
© 2008 American Orthopaedic Society for Sports Medicine. All rights reserved. Not for commercial use or unauthorized distribution.
at University of Groningen on April 29, 2008 http://ajs.sagepub.comDownloaded from
34 Buist et al The American Journal of Sports Medicine
the prevention of RRI exist.
2,5,7,15,17,18,21-23,27
However, to our
knowledge, there are no studies that have examined the
effect of a preventive intervention on RRI in novice runners.
The principle that the volume of exercise should be
increased gradually over time is widely regarded as criti-
cal for reducing the risk of an overuse injury.
25
This gen-
eral principle is also applicable in running. To minimize
the risk of RRI, an increase in training volume by no more
than 10% a week is mentioned; this is called the 10%
rule.
10
In a training program based on the 10% rule, the
body is thought to adapt more gradually to the external
impact forces of running. However, so far no studies have
examined the effect of such a modified training program on
the injury incidence in novice runners.
Therefore, the aim of the Groningen Novice Running
(GRONORUN) study was to determine the effect of a mod-
ified (ie, graded) training program for novice runners,
based on the 10% rule, on the incidence of RRI. We hypoth-
esized that when the human body gets more time for adap-
tation to running, the incidence of RRI will decrease.
METHODS
Design
The GRONORUN study is a randomized controlled trial
with a 13-week follow-up (ISRCTN37259753). A description
of the design of the GRONORUN trial is published else-
where.
4
Participants were randomized into an intervention
group (13-week graded training program) or a control group
(an 8-week standard training program). The study design,
procedures, and informed consent procedure were approved
by the Medical Ethics Committee of the University Medical
Center Groningen, The Netherlands. All participants pro-
vided written informed consent. Guidelines according to the
Consort Statement were followed.
16
Participants and Randomization
Recruitment was assisted by advertisements in local
media to enlist participants who wanted to start a “begin-
ners program” in preparing for the Groningen 4-mile recre-
ational running event. To participate in the beginners
program, it was not necessary to ultimately participate in
the 4-mile running event itself. Healthy participants
between 18 and 65 years of age, who had not sustained an
injury of the lower extremity in the last 3 months before
inclusion and who had not been running in the previous 12
months, were eligible for inclusion in the study.
Participants were excluded if there were absolute con-
traindications for vigorous physical activities according to
the American College of Sports Medicine,
1
or in case of
unwillingness to keep a running log.
After baseline measurements and informed consent,
participants were assigned to the graded training program
or the standard training program. To ensure that both
training groups were equal in terms of a priori injury risk,
a stratified randomization was performed. Participants
were stratified for current sporting activities status (no
sport, axial loading sports, nonaxial loading sports), previ-
ous injury (none, 3-12 months ago, >12 months ago), and
gender. From each stratum, participants were allocated to
the graded training program or standard training program
group by drawing a sealed opaque envelope.
Baseline Measurements
The baseline questionnaire covered demographic variables
such as age, gender, body weight, and height. Previous mus-
culoskeletal complaints of the lower extremity and back
were assessed per anatomical site. Current sports participa-
tion was assessed by questions concerning type of sport and
mean hours of sports participation. Furthermore, a question
on running experience in the past (“Have you ever partici-
pated in running on a regular basis?”) was used to assess
the novelty to running.
Training Program
All participants received the same general written and
oral information. They were instructed to walk for 5 min-
utes as a warm-up and cool-down. Both groups trained
individually 3 times a week, on a self-chosen course and
surface. All were advised to run at a comfortable pace at
which they could converse without losing breath. The
graded training group and the standard training group
started, respectively, 13 and 8 weeks before the Groningen
4-mile run. In training sessions, combinations of running
and walking were used (Table 1).
Outcome Measures
The primary outcome measure of the GRONORUN trial is
the absolute number of RRIs, expressed per 100 runners.
An RRI was defined as any musculoskeletal complaint of
the lower extremity or back causing a restriction of run-
ning for at least 1 week. The effect of the graded training
program was evaluated by the differences between propor-
tions of injured runners in both groups. Additional analy-
ses were done on the time until an event (RRI), the number
of RRIs per 1000 hours of exposure in both groups, and the
anatomical distribution of RRIs. Information on RRI and
exposure data was collected using an Internet-based run-
ning log. If an RRI was the reason for not adhering to the
training program, information on anatomical site and
severity was asked. When participants did not enter their
Internet-based training log after 1 week, a reminder was
send by e-mail automatically. Participants who dropped
out of the program and who did not complete their entire
running log were contacted by a research assistant to
ensure that RRI was not the reason for dropping out.
Statistics
A power calculation was carried out for the main outcome
variable RRI using a logistic rank survival power analysis.
For the GRONORUN trial, we expected a baseline injury
incidence of 30%.
4
With a hypothesized 25% reduction of
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Vol. 36, No. 1, 2008 Graded Training and Running-Related Injuries 35
RRI in the graded training program group compared with
the standard training program group, a total of 436 run-
ners (2 × 218) were needed for a power of 80% and an alpha
of 0.05.
4
Assuming an attrition of 15% in the intervention
period, a total of 512 (2 × 256) novice runners were needed
to detect an effect of the intervention.
Baseline characteristics of participants in the graded
training program group and standard training program
group were compared using 2-tailed t tests for normally
distributed continuous variables. The χ
2
statistic was used
for discrete variables. To evaluate the effect of the graded
training program on RRI, a χ
2
test was used. The log-rank
test is used to compare the Kaplan-Meier curves of the
graded training program group and the standard training
program group, analyzing the difference between the
training groups in the probability of an RRI at any time
point. Cox proportional hazards regression analysis was
performed to correct for differences in body mass index
(BMI) between randomized groups at baseline. All analy-
ses were performed following the “intention to treat” prin-
ciple. Differences were considered statistically significant
at P < .05. All analyses were performed using SPSS version
12.0 (SPSS Inc, Chicago, Ill).
RESULTS
Randomization/Sample Attrition
The flow of participants is shown in Figure 1. An informa-
tion pack about the GRONORUN study and an appoint-
ment for a baseline assessment were sent to a total of 603
volunteers. Twenty-three (3.8% of 603) did not react on the
invitation and another 25 (4.1% of 603) failed to attend the
baseline assessment. Among those participants who
attended the baseline assessment, 23 of 555 (4.1%) were
excluded because they did not meet the study eligibility
criteria. Thus, 532 novice runners were randomized into
the graded training program group and the standard
training program group. A participant was lost to follow-up
(ie, excluded from the final analysis) if she or he did not
start running or if no exposure data were available.
Significantly more participants of the standard training
program group were lost to follow-up because they did not
start running—32 of 268 (11.9%) versus 14 of 264 (5.3%) of
the graded training program group.
The baseline characteristics of participants in the graded
training program group and the standard training program
group, including the variables that were used for stratifica-
tion, are provided in Table 2. Of the 532 randomized partic-
ipants, 306 (57.5%) were female. Forty-seven percent of all
randomized participants had never run on a regular basis
before. Randomization groups were not similar in BMI. The
graded training program group showed a small (25.2 vs 24.4
kg/m
2
), but significantly higher (P < .05), difference in BMI.
As shown in Table 2, running experience and activity
level were not the same in all participants but were
equally distributed over both training groups.
Effect of the Graded Training Program
The incidence of RRI was 20.8% (52 of 250) in the graded
training program group and 20.3% (48 of 236) in the standard
training program group. The graded training program was
not preventive for sustaining an RRI (χ
2
= 0.016, df = 1, P =
.90). Because the exposure to running in both training groups
was not equal, survival curves (ie, Kaplan-Meier curves) were
made for both training groups (Figure 2A). Figure 2B shows
the survival curves of injured participants in the standard
training group and the graded training group. The mean sur-
vival time of injured runners in the graded training group
was 212 minutes (standard deviation [SD] = 160), compared
with 167 minutes in the standard training group (SD = 153).
The log-rank test showed no difference between the graded
training program group and the standard training program
group (P = .18). Cox regression analyses, adjusted for BMI,
revealed no significant effect of the graded training program
on injury risk (odds ratio [OR] = 0.8; 95% confidence interval
[CI], 0.6-1.3).
Occurrence of Running-Related Injuries
Altogether 100 RRIs were recorded: 52 in the graded train-
ing program group and 48 in the standard training program
group. A summary of injury incidence is provided in Table 3.
The absolute number of RRIs per week in each training
group is illustrated in Figure 3. In the first 7 weeks of the
standard training program, 47 RRIs were registered, com-
pared with 34 in the graded training program (relative
risk [RR] = 1.38). Most of the RRIs in the graded training
program group were seen in the fifth week of the program.
In this training week, the participants ran 44 minutes (see
Table 1). In the standard training program group, most of
the injuries were seen in the second week, when partici-
pants had to run 46 minutes. Descriptive information on
RRIs is shown in Table 4. The most frequently injured body
parts were the lower leg (40%) and the knee (37%).
TABLE 1
Training Program in Minutes Per Week for
the Graded Training Program Group and the Standard
Training Program Group
Graded Standard
Training Group Training Group
Run Walk Run Walk
(min/wk) (min/wk) (min/wk) (min/wk)
Week 1 30 30
Week 2 34 25.5
Week 3 36 24
Week 4 40 20
Week 5 44 22
Week 6 48 16 Week 1 30 30
Week 7 54 18 Week 2 46 22
Week 8 56 18 Week 3 60 18
Week 9 64 14 Week 4 50 16
Week 10 72 18 Week 5 74 16
Week 11 80 15 Week 6 90 21
Week 12 90 0 Week 7 95 5
Week 13 30 0 Week 8 30 0
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36 Buist et al The American Journal of Sports Medicine
Randomization
Stratified by injury history, gender and sporting activities
(N=532)
Requests for participation and available for inclusion
(N=603)
Baseline assessment
(N=555)
Appointment for baseline assessment
(N=580)
23 were excluded:
8 were not novice runners
13 were injured (<3 months) at
baseline
2 had contraindications for
vigorous physical activity
25 failed to attend baseline
assessment
Allocated to graded training
program (n = 264)
32 Did not start running
14 Did not start running
236 Included in Analysis250 Included in Analysis
Allocated to standard training
program (n = 268)
23 did not react on
invitation
Invitations for novice runners to participate in the GRONORUN trial in
local media
Figure 1. The flow of participants through each stage of the GRONORUN (Groningen Novice Running) trial.
TABLE 2
Baseline Characteristics of Participants in Graded Training Program and Standard Training Program Groups
a
Characteristic Dimension/Qualifier Graded Training Program Standard Training Program Total
n 264 (113 men, 151 women) 268 (113 men, 155 women) 532 (226 men, 306 women)
Age
b
Years 40.4 (10.0) 39.2 (10.2) 39.8 (10.1)
Weight
b
Kg 78.7 (13.9) 77.0 (14.2) 77.8 (14.0)
BMI
bc
kg/m
2
25.2 (3.7) 24.6 (3.2) 24.9 (3.5)
Running experience No 131 (49.6%) 119 (44.4%) 250 (47.0%)
Yes 133 (50.4%) 149 (55.6%) 282 (53.0%)
Previous injury No 131 (49.6%) 127 (47.4%) 258 (48.5%)
>3, 12 months ago 69 (26.1%) 66 (24.6%) 135 (25.4%)
>12 months ago 64 (24.2%) 75 (28.0%) 139 (26.1%)
Sporting activities No 130 (49.2%) 119 (44.4%) 249 (46.8%)
With axial load 70 (26.5%) 79 (29.5%) 149 (28.0%)
Without axial load 64 (24.2%) 70 (26.1%) 134 (25.2%)
a
BMI, body mass index.
b
Values are mean ± standard deviation (in parentheses)
c
P < .05
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Vol. 36, No. 1, 2008 Graded Training and Running-Related Injuries 37
Compliance With the Program
Compliance with the program was expressed in the pro-
portion of recommended training sessions. The graded
training program group completed 24.6 ± 11.2 training ses-
sions during the intervention period (66.4% of the recom-
mended volume). The compliance in the standard training
program group (64.5% of the recommended volume) was
comparable with that of the graded training program
group. Compliance with the program was 70.6% in the
graded training program group and 69.0% in the standard
training program group if only the noninjured participants
were taken into account.
DISCUSSION
The GRONORUN trial was designed to study the effect of
a graded (ie, 10%) training program on the incidence of
RRIs. The results showed no significant effect of the more
gradual increase of running on the number of RRIs per 100
runners at risk compared with a standard 8-week training
program. On the basis of these results, our hypothesis—
that when the human body gets more time for adaptation
to running, the incidence of RRIs will decrease—should be
rejected.
To explain the absence of an effect, a variety of reasons
are discussed. A dose-response relationship has been
described between running (duration, intensity), recovery
time (frequency per week), and strengthening (or, when the
load is too much, weakening) of the musculoskeletal sys-
tem.
6
Repeatedly applied stress leads to positive remodel-
ing of musculoskeletal tissue if sufficient time is provided
between stress applications. Adequate recovery time (ie,
time between the training sessions) will result in a positive
adaptation of the musculoskeletal system to an adequate
stress stimulus of running. Hreljac
9
called this phenome-
non the stress-frequency relationship. Given this relation-
ship, various reasons for the absence of an effect in the
current study are conceivable.
First, the contrast in duration of running (ie, minutes
per week) between the 2 training programs (graded vs
standard) may have been too small to cause an effect. This
is a hypothesis that can be studied by adapting (lengthen-
ing) the graded training program in a future study. On the
other hand, if participants who are allocated to the control
group have to wait too long to start running, the number of
participants lost to follow-up probably would become too
high. Second, the intensity of running might have been a
confounding factor. Although the participants in both
groups were advised to run only at a comfortable pace at
which they could converse without breathlessness, we did
not measure the intensity of running. Third, the absence of
an effect may have been caused by the similarity of weekly
running frequency in both groups. With reference to the
dose-response relationship in running, it may not only be
the absolute training duration per week but also the inten-
sity of the training sessions as well as the frequency that
need to be taken into consideration. When there is inade-
quate time between stress applications, an overuse injury
can occur.
8,20
Additional analyses showed that the number of RRIs per
1000 hours of running exposure was 30 (95% CI, 22-38) in
the graded training program group versus 38 (95% CI, 27-
49) in the standard training group. Even though this seems
TABLE 3
Incidence of RRI per 100 Runners at Risk and per 1000
Hours of Running Exposure in Graded and Standard
Training Program Groups
a
Graded Standard
Training Training
Program Program Total
(n = 250) (n = 236) (N = 486)
Absolute number 52 48 100
of RRIs
RRI/100 runners 20.8 20.3 20.6
at risk
b
(15.8-25.8) (15.2-25.4) (17.0-24.2)
RRI/1000 hours 30 38 33
of exposure
b
(22-38) (27-49) (27-40)
a
RRI, running-related injury.
b
Numbers in parentheses represent 95% confidence interval.
Figure 2. A, Kaplan-Meier plot of RRI (running-related injury)
survival between all participants of the graded training program
group and standard training program group. Approximately
80% in both groups stayed injury free. B, Kaplan-Meier plot
of RRI survival between injured participants of the graded
training program group and standard training program group.
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38 Buist et al The American Journal of Sports Medicine
a disparity, the number of RRIs per 1000 hours of exposure
was not significantly different. Care should be taken when
interpreting this result as the study was not set up in a way
that could identify such an effect size. It takes many more
participants than we had to identify an effect expressed in the
number of RRIs per 1000 hours of exposure to running. The
results of the additional analyses on survival time also
showed no differences between the graded training program
group and the standard training group. Although the mean
time to the occurrence of an RRI was 45 minutes longer (212
vs 167 minutes) in participants of the graded training pro-
gram, this difference in exposure time was not significant.
In the literature, little information is available on the inci-
dence of RRI in novice runners. In the GRONORUN trial,
the overall incidence of RRI was 20.6 per 100 runners.
Differences in the definition of RRI, as well as the way of
collecting information on RRI, make it difficult to compare
the GRONORUN study with another. Furthermore, only
few of the studies in the literature followed runners for a
comparable short period of time.
The “Vancouver Sun Run” study
24
showed an injury inci-
dence of 29.5 per 100 runners at risk in a group of novice
runners following a 13-week training program, preparing
for a 10-km running event. The training program of the
Vancouver Sun Run
24
was designed by sports physicians to
minimize the risk of sustaining an injury during the train-
ing period. The recommended running frequency was iden-
tical to that used in the GRONORUN trial, that is, 3 times
a week. Unfortunately, neither the content nor the ration-
ale for the program was reported.
Comparison of the incidence of RRI in the GRONORUN
study to the Vancouver Sun Run study is complicated by
differences in definition of an RRI. In the Vancouver Sun
Run study, a runner was defined injured in case of report-
ing running-related pain during or after running. In our
trial, severity (ie, restriction of running) and a minimal
duration of 1 week was added. If our definition was
changed in to the definition used by Taunton et al,
24
the
number of RRIs would be 34.3 per 100 runners at risk—
higher than in the Vancouver Sun Run study.
A second study that also involved runners with little or no
running experience showed an incidence of 58 RRIs per 100
runners at risk.
3
In this study, participants trained for a 15-
km run during the first period of 28 weeks. Any running-
related pain causing restriction in running distance, speed,
duration, or frequency was considered to be an injury. When
the overall incidence per 1000 hours of running exposure is
compared with data from the literature, it can be concluded
that the incidence was higher (33/1000 hours) than that
reported in the literature (12/1000 hours).
3
A significant dif-
ference between this study and the GRONORUN trial is that
participants were intending to run a marathon at the end of
TABLE 4
Absolute Number and Percentage of RRIs
per Anatomical Site per Group
a
Graded Training Standard Training
Program, n = 250 Program, n = 236 Total N = 486
(% of injuries) (% of injuries) (% of injuries)
Hip/back 6 (11.5%) 3 (6.3%) 9 (9%)
Upper leg 2 (3.8%) 2 (4.2%) 4 (4%)
Knee 17 (32.7%) 20 (41.7%) 37 (37%)
Lower leg 22 (42.3%) 18 (37.5%) 40 (40%)
Ankle/foot 5 (9.6%) 5 (10.4%) 10 (10%)
Total 52 (100%) 48 (100%) 100 (100%)
a
RRIs, running-related injuries.
Figure 3. The absolute number of new running-related injuries (RRIs) per group in each week of the training program.
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Vol. 36, No. 1, 2008 Graded Training and Running-Related Injuries 39
the training period of 20 months. In the GRONORUN trial,
participants were recruited only to train for a 4-mile run.
As shown in other studies, over 75% of the RRIs were
localized from the knee and below.
3,14,24
The anatomical
distribution of RRIs in the GRONORUN trial was in agree-
ment with these findings, that is, the knee (37%) and the
lower leg (40%) were the most injured body parts.
Prevention of RRIs is an important issue in sports medi-
cine. Running, as a form of recreational exercise, is a sport
practiced by many individuals to improve cardiorespiratory
function and health. Novice runners are often physically inac-
tive before they start to run. In the Vancouver Sun Run
study
24
and our study, almost half of the participants were
primarily sedentary and deconditioned people. On the
Internet and in running stores and running magazines, many
so-called “training programs for novice runners” preparing for
a 5-km or 10-km running event in a relatively short period of
time can be found. To prevent RRIs, which still happen in 20%
to 50% of the novice runner population, the current results
show that more research is needed on the relationship
between intensity, frequency, and the duration of training and
injury risk, and other potentially possible modifiable risk fac-
tors. In a future study, the intervention duration should be
lengthened, taking the increase of weekly product of running
frequency, intensity, and duration into careful consideration.
CONCLUSIONS
This study showed that there is no effect of a graded “10%
rule” training program for novice runners on the number
of RRIs per 100 runners at risk, compared with a standard
training program. We hypothesized that novice runners
need adequate time for the musculoskeletal system to
adapt to running. Preparing to participate in a 4-mile run,
it does not matter how you get there (either fast or slow)—
the risk of sustaining an RRI is the same. Future research
should focus on the dose-response relationship between
running and the development of RRIs in (novice) recre-
ational and competitive runners.
ACKNOWLEDGMENT
This study was funded by the Netherlands Organisation
for Health Research and Development (ZonMW), grant
number 750-10-003.
REFERENCES
1. Balady GJ, Chaitman B, Driscoll D, et al. Recommendations for car-
diovascular screening, staffing, and emergency policies at health/fit-
ness facilities. Circulation. 1998;97:2283-2293.
2. Bengal S, Lowe J, Mann G, Finsterbush A, Matan Y. The role of the
knee brace in the prevention of anterior knee pain syndrome. Am J
Sports Med. 1997;25:118-122.
3. Bovens AMP, Janssen GME, Vermeer HGW, Hoeberigs JH, Janssen
MPE, Verstappen FTJ. Occurrence of running injuries in adults following
a supervised training-program. Int J Sports Med. 1989;10:S186-S190.
4. Buist I, Bredeweg SW, Lemmink KAPM, et al. The GRONORUN
study: is a graded training program for novice runners effective in pre-
venting running related injuries? Design of a randomized controlled
trial. BMC Musculoskeletal Disorders. 2007;8:24.
5. Fauno P, Kalund S, Andreasen I, Jorgensen U. Soreness in lower
extremities and back is reduced by use of shock absorbing heel
inserts. Int J Sports Med. 1993;14:288-290.
6. Gilchrist J, Jones BH, Sleet DA, Kimsey CD. Exercise-related injuries
among women: strategies for prevention from civilian and military
studies. MMWR Recomm Rep. 2000;49:15-33.
7. Hartig DE, Henderson JM. Increasing hamstring flexibility decreases
lower extremity overuse injuries in military basic trainees. Am J Sports
Med. 1999;27:173-176.
8. Hreljac A. Etiology, prevention, and early intervention of overuse
injuries in runners: a biomechanical perspective. Phys Med Rehabil
Clin N Am. 2005;16:651-667, vi.
9. Hreljac A. Impact and overuse injuries in runners. Med Sci Sports
Exerc. 2004;36:845-849.
10. Johnston CA, Taunton JE, Lloyd-Smith DR, McKenzie DC. Preventing
running injuries: practical approach for family doctors. Can Fam
Physician. 2003;49:1101-1109.
11. Lun V, Meeuwisse WH, Stergiou P, Stefanyshyn D. Relation between
running injury and static lower limb alignment in recreational runners.
Br J Sports Med. 2004;38:576-580.
12. Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med. 1987;
15:168-171.
13. Macera CA, Pate RR, Powell KE, Jackson KL, Kendrick JS, Craven
TE. Predicting lower-extremity injuries among habitual runners. Arch
Intern Med. 1989;149:2565-2568.
14. Marti B, Vader JP, Minder CE, Abelin T. On the epidemiology of run-
ning injuries: the 1984 Bern Grand-Prix study. Am J Sports Med.
1988;16:285-294.
15. Milgrom C, Finestone A, Shlamkovitch N, et al. Prevention of overuse
injuries of the foot by improved shoe shock attenuation: a randomized
prospective-study. Clin Orthop Rel Res. 1992;281:189-192.
16. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised
recommendations for improving the quality of reports of parallel-
group randomised trials. Lancet. 2001;357:1191-1194.
17. Pollock ML, Gettman LR, Milesis CA, Bah MD, Durstine L, Johnson
RB. Effects of frequency and duration of training on attrition and inci-
dence of injury. Med Sci Sports Exerc. 1977;9:31-36.
18. Pope RP, Herbert RD, Kirwan JD, Graham BJ. A randomized trial of
preexercise stretching for prevention of lower-limb injury. Med Sci
Sports Exerc. 2000;32:271-277.
19. Rauh MJ, Koepsell TD, Rivara FP, Margherita AJ, Rice SG.
Epidemiology of musculoskeletal injuries among high school cross-
country runners. Am J Epidemiol. 2006;163:151-159.
20. Rolf C. Overuse injuries of the lower extremity in runners. Scand
J Med Sci Sports. 1995;5:181-190.
21. Rudzki SJ. Injuries in Australian army recruits: decreased incidence
and severity of injury seen with reduced running distance. Mil Med.
1997;162:472-476.
22. Schwellnus MP, Jordaan G, Noakes TD. Prevention of common over-
use injuries by the use of shock absorbing insoles: a prospective-
study. Am J Sports Med. 1990;18:636-641.
23. Smith W, Walter J, Bailey M. Effects of insoles in Coast Guard basic
training footwear. J Am Podiatr Med Assoc. 1985;75:644-647.
24. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR,
Zumbo BD. A prospective study of running injuries: the Vancouver
Sun Run “In Training” clinics. Br J Sports Med. 2003;37:239-244.
25. Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity
in the prevention and treatment of atherosclerotic cardiovascular dis-
ease: a statement from the Council on Clinical Cardiology (Subcommit -
tee on Exercise, Rehabilitation, and Prevention) and the Council on
Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical
Activity). Circulation. 2003;107:3109-3116.
26. van Mechelen W. Running injuries: a review of the epidemiological lit-
erature. Sports Med. 1992;14:320-335.
27. van Mechelen W, Hlobil H, Kemper HC, Voorn WJ, de Jongh HR.
Prevention of running injuries by warm-up, cool-down, and stretching
exercises. Am J Sports Med. 1993;21:711-719.
28. Walter SD, Hart LE, McIntosh JM, Sutton JR. The Ontario cohort
study of running-related injuries. Arch Intern Med. 1989;149:
2561-2564.
© 2008 American Orthopaedic Society for Sports Medicine. All rights reserved. Not for commercial use or unauthorized distribution.
at University of Groningen on April 29, 2008 http://ajs.sagepub.comDownloaded from
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• This prospective study of 583 habitual runners used baseline information to examine the relationship of several suspected risk factors to the occurrence of running-related injuries of the lower extremities that were severe enough to affect running habits, cause a visit to a health professional, or require use of medication. During the 12-month follow-up period, 252 men (52%) and 48 women (49%) reported at least one such injury. The multiple logistic regression results identified that running 64.0 km (40 miles) or more per week was the most important predictor of injury for men during the follow-up period (odds ratio=2.9). Risk also was associated with having had a previous injury in the past year (odds ratio = 2.7) and with having been a runner for less than 3 years (odds ratio=2.2). These results suggest that the incidence of lower-extremity injuries is high for habitual runners, and that for those new to running or those who have been previously injured, reducing weekly distance is a reasonable preventive behavior.(Arch Intern Med. 1989;149:2565-2568)
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Running is one of the most popular leisure sports activities. Next to its beneficial health effects, negative side effects in terms of sports injuries should also be recognised. Given the limitations of the studies it appears that for the average recreational runner, who is steadily training and who participates in a long distance run every now and then, the overall yearly incidence rate for running injuries varies between 37 and 56%. Depending on the specificity of the group of runners concerned (competitive athletes; average recreational joggers; boys and girls) and on different circumstances these rates vary. If incidence is calculated according to exposure of running time the incidence reported in the literature varies from 2.5 to 12.1 injuries per 1000 hours of running. Most running injuries are lower extremity injuries, with a predominance for the knee. About 50 to 75% of all running injuries appear to be overuse injuries due to the constant repetition of the same movement. Recurrence of running injuries is reported in 20 to 70% of the cases. From the epidemiological studies it can be concluded that running injuries lead to a reduction of training or training cessation in about 30 to 90% of all injuries, about 20 to 70% of all injuries lead to medical consultation or medical treatment and 0 to 5% result in absence from work. Aetiological factors associated with running injuries include previous injury, lack of running experience, running to compete and excessive weekly running distance. The association between running injuries and factors such as warm-up and stretching exercises, body height, malalignment, muscular imbalance, restricted range of motion, running frequency, level of performance, stability of running pattern, shoes and inshoe orthoses and running on 1 side of the road remains unclear or is backed by contradicting or scarce research findings. Significantly not associated with running injuries seem age, gender, body mass index, running hills, running on hard surfaces, participation in other sports, time of the year and time of the day. The prevention of sports injuries should focus on changes of behaviour by health education. Health education on running injuries should primarily focus on the importance of complete rehabilitation and the early recognition of symptoms of overuse, and on the provision of training guidelines.
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• A cohort of 1680 runners was enrolled through two community road race events and monitored during a 12-month follow-up period for the occurrence of musculoskeletal injuries. Fortyeight percent of the runners experienced at least one injury, and 54% of these injuries were new; the remainder were recurrences of previous injuries. The risk of injury was associated with increased running mileage but was relatively unassociated with other aspects of training, such as usual pace, usual running surface, hill running, or intense training. Injury rates were equal for all age-sex groups and were independent of years of running experience. Runners injured in the previous year had approximately a 50% higher risk for a new injury during follow-up.(Arch Intern Med. 1989;149:2561-2564)
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Using a survey questionnaire design, we investigated the incidence, site, and nature of jogging injuries among all participants of a popular 16 km race. The response rate was 83.6%. Of 4,358 male joggers, 45.8% had sustained jogging injuries during the 1 year study period, 14.2% had required medical care, and 2.3% had missed work because of jogging injuries. Occur rence of jogging injuries was independently associated with higher weekly mileage (P < 0.001), history of previous running injuries (P < 0.001), and competitive training motivation (P = 0.03). Higher mileage was also associated with more frequent medical consultations due entirely to jogging-related injuries. In 33 to 44 year olds (N = 1,757), the number of years of running was inversely related to incidence of injuries (P = 0.02). Injuries were not significantly related to race running speed, training surface, characteristics of running shoes, or relative weight. Achillodynia and calf muscle symptoms were the two most common overuse injuries and occurred significantly more often among older run ners with increased weekly mileage. We conclude that jogging injuries are frequent, that the number of firmly established etiologic factors is low, and that, in recom mending jogging, moderation should be the watchword.
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Eighty-seven male inmates from a state prison and 70 inmates from a county jail volunteered as subjects. The subjects, age 20 to 35 yrs, were assigned randomly into a control or exercise group. Their Vo2max and treadmill performance values were determined before and after a 20 week jogging program. Training intensity was between 85 and 90 percent of maximum heart rate and involved workouts 3 days/ week for 15, 30, or 45-min duration at the state prison and for 30-min 1, 3, or 5 days/week at the country jail. Cardiorespiratory fitness improved in direct proportion to frequency and duration of training. Injury, occurred in 22%, 24% and 54% of the 15, 30, and 45-min duration groups and in 0%, 12%, and 39% of the 1, 3, and 5-day/week groups, respectively. Attrition resulting from injury occurred in 0%, 0%, and 17% and in 0%, 4%, and 6% of the same respective groups. Attrition due to lack of interest was similar for all training groups (25%), but was significantly lower in the control groups (10%). Although the results showed a greater increase in cardiorespiratory fitness for the 45-min duration and 5-day/week groups, these programs are not recommended for beginning joggers because of the significantly greater percent of injuries. (C)1977The American College of Sports Medicine
Article
Eighty-seven male inmates from a state prison and 70 inmates from a county jail volunteered as subjects. The subjects, age 20 to 35 yrs, were assigned randomly into a control or exercise group. Their Vo2max and treadmill performance values were determined before and after a 20 week jogging program. Training intensity was between 85 and 90 percent of maximum heart rate and involved workouts 3 days/week for 15, 30, or 45-min duration at the state prison and for 30-min 1, 3, or 5 days/week at the country jail. Cardiorespiratory fitness improved in direct proportion to frequency and duration of training. Injury, occurred in 22%, 24% and 54% of the 15, 30, and 45-min duration groups and in 0%, 12%, and 39% of the 1, 3, and 5-day/week groups, respectively. Attrition resulting from injury occurred in 0%, 0%, and 17% and in 0%, 4%, and 6% of the same respective groups. Attrition due to lack of interest was similar for all training groups (25%), but was significantly lower in the control groups (10%). Although the results showed a greater increase in cardiorespiratory fitness for the 45-min duration and 5-day/week groups, these programs are not recommened for beginning joggers because of the significantly greater percent of injuries.
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In a randomized prospective study among 390 recruits, the hypothesis that improved shoe shock attenuation could lessen the incidence of overuse injuries was tested. During the 14 weeks of training, 90% of the recruits sustained overuse injuries. Recruits training in a modified basketball shoe had a statistically significant lower incidence of metatarsal stress fractures and foot overuse injuries, compared with standard infantry boots, but their overall incidence of overuse injuries was not reduced. The effect of improved shoe shock attenuation was limited to those overuse injuries resulting from vertical impact loads.
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Running is one of the most popular leisure sports activities. Next to its beneficial health effects, negative side effects in terms of sports injuries should also be recognised. Given the limitations of the studies it appears that for the average recreational runner, who is steadily training and who participates in a long distance run every now and then, the overall yearly incidence rate for running injuries varies between 37 and 56%. Depending on the specificity of the group of runners concerned (competitive athletes; average recreational joggers; boys and girls) and on different circumstances these rates vary. If incidence is calculated according to exposure of running time the incidence reported in the literature varies from 2.5 to 12.1 injuries per 1000 hours of running. Most running injuries are lower extremity injuries, with a predominance for the knee. About 50 to 75% of all running injuries appear to be overuse injuries due to the constant repetition of the same movement. Recurrence of running injuries is reported in 20 to 70% of the cases. From the epidemiological studies it can be concluded that running injuries lead to a reduction of training or training cessation in about 30 to 90% of all injuries, about 20 to 70% of all injuries lead to medical consultation or medical treatment and 0 to 5% result in absence from work. Aetiological factors associated with running injuries include previous injury, lack of running experience, running to compete and excessive weekly running distance. The association between running injuries and factors such as warm-up and stretching exercises, body height, malalignment, muscular imbalance, restricted range of motion, running frequency, level of performance, stability of running pattern, shoes and inshoe orthoses and running on 1 side of the road remains unclear or is backed by contradicting or scarce research findings. Significantly not associated with running injuries seem age, gender, body mass index, running hills, running on hard surfaces, participation in other sports, time of the year and time of the day. The prevention of sports injuries should focus on changes of behaviour by health education. Health education on running injuries should primarily focus on the importance of complete rehabilitation and the early recognition of symptoms of overuse, and on the provision of training guidelines.