The University of Pretoria’s Sport, Exercise Medicine and Lifestyle Institute (SEMLI) has been at the forefront of developing global standards for recording and reporting on medical encounters (interactions between a healthcare provider and a patient) that occur at mass community-based endurance sports events such as the Cape Town Cycle Tour, marathon races and half-marathons. The new global standards are aimed at protecting the health of endurance athletes around the world.

SEMLI Director Professor Martin Schwellnus led a group of international researchers and clinicians in endurance race medicine, which includes three other SEMLI researchers: Dr Jill Borresen, Prof Dina Christina Janse van Rensburg and Dr Jannelene Killops.

As sports events of this nature have become more popular, there has been an uptick in the number of older participants as well as those who have not led a typically active lifestyle, which has increased the risk of injury or illness. 

Prior to the development of this consensus statement, comparing the incidence rate and prevalence of medical encounters between events proved challenging because standardisation was lacking. “Not having uniform definitions and data procedures questions the accuracy of a research report,” says Prof Schwellnus. One of his main objectives was to reduce the number of medical encounters and facilitate safer, and more enjoyable, participation worldwide. 

Medical encounters are broadly separated into injury-related and illness-related encounters. Injuries relate to anatomical regions being affected, such as an ankle sprains or stress fractures, while illness encounters relate to organ systems, such as cardiac, respiratory and endocrine conditions. “Documenting the timing the medical encounter took place is clinically important and will make valuable comparisons possible,” says Prof Schwellnus. For this reason, the encounters have been categorised into three time periods: during the event, immediately after the event, and up to 24 hours after the event. 

Bestmed TuksRace. Photo: Reg Caldecott  

The consensus statement developed by Prof Schwellnus and his team further defines everything from mass participation to community-based events and the classification of endurance sports events, offering clearer direction and guidance to race organisers. It also advises on diagnostic categories and all the factors that should be taken into account when collecting data, including pre-race medical history, weather conditions and performance experience. 

Furthermore, it lists the information that should be prioritised in the collection and reporting phases as essential data. “By separating the essential or minimum data with additional data, the statement ensures that race organisers, medical staff and researchers who are not able to collect all data can at least see in the consensus statement which data collection is essential to get,” says Prof Schwellnus.
To gain greater international uniformity in recording and reporting, the statement also prescribes a standardised format, which is why the team is aiming to make the implementation of the tool as easy as possible. It will soon become available online as a simplified standardised clinical data record form for easy accessibility. 

The International Institute for Race Medicine, the International Association of Athletics Federation, the Union Cycliste Internationale and the International Triathlon Union have all endorsed the statement. “International federations and organisations that have endorsed this consensus are encouraged to implement these data collection procedures,” says Prof Schwellnus. 

The international community of endurance sports, including international federations, event organisers and race medical directors, are recommended to adopt this consensus. “We prescribe that at the very least, the race day collection format and the standardised race medical encounter forms to collect the data are adopted,” adds Prof Schwellnus. 

This sort of reporting would need to become routine in order to track individual athlete data, as participants are often involved in multiple events or in the same event over a number of years ¬– having this information is vital, particularly if they encounter a medical problem. 

It is imperative to report on the number of medical encounters at sporting events and be categorised according to the severity of the encounter, whether it was organ or anatomically related, and what the final diagnosis was – this information should become more readily available as a result of this consensus statement being developed. 

The standardisation of definitions and the way data is collected will produce more accurate information of medical encounters during endurance sports events. High-quality data collection allows for dependable comparisons. “This will lead to more valuable research on medical disorders that occur at these endurance events,” says Prof Schwellnus. If these guiding principles are applied, race organisers and medical staff are also likely to see a significant reduction in medical encounters at these events. 

* This consensus forms the basis of expanding the Strategies to Reduce Adverse Medical Events for the ExerciseR (SAFER) studies to a SAFER International Million + Athlete Program.