Prerace medical screening and education reduce medical encounters in distance road races: SAFER VIII study in 153 208 race starters

Br J Sports Med. 2019 May;53(10):634-639. doi: 10.1136/bjsports-2018-099275. Epub 2018 Nov 9.


Objectives: To examine the efficacy and feasibility of an online prerace medical screening and educational intervention programme for reducing medical complications in long-distance races.

Methods: This was an 8-year observational study of medical encounter rates among 153 208 Two Oceans race starters (21.1 and 56 km) in South Africa. After the first 4-year control (CON) period, we introduced an online prerace medical screening (based on European pre-exercise screening guidelines) and an automated educational intervention programme. We compared the incidence of medical encounters (per 1000 starters; all and serious life threatening) in the CON versus the 4-year intervention (INT) period.

Results: In comparison to the CON period (2008-2011: 65 865 starters), the INT period (2012-2015: 87 343 starters) had a significantly lower incidence (adjusted for age group, sex, race distance) of all medical encounters by 29% (CON=8.6 (7.9-9.4); INT=6.1 (5.6-6.7), p<0.0001), in the 21.1 km race by 19% (CON=5.1 (4.4-5.9); INT=4.1 (3.6-4.8), p=0.0356) and in the 56 km race by 39% (CON=14.6 (13.1-16.3); INT=9.0 (7.9-10.1), p<0.0001). Serious life-threatening encounters were significantly reduced by 64% (CON=0.6 (0.5-0.9); INT=0.2 (0.1-0.4); p=0.0003) (adjusted for age group and sex). Registration numbers increased in the INT period (CON=81 345; INT=106 743) and overall % race starters were similar in the CON versus INT period. Wet-bulb globe temperature was similar in the CON and INT periods.

Conclusion: All medical encounters and serious life-threatening encounters were significantly lower after the introduction of a prescreening and educational intervention programme, and the programme was feasible.

Keywords: endurance; epidemiology; marathon; recreational.

Publication types

  • Observational Study

MeSH terms

  • Female
  • Health Education
  • Humans
  • Incidence
  • Male
  • Mass Screening*
  • Program Evaluation
  • Risk Factors
  • Risk Reduction Behavior
  • Running*
  • South Africa
  • Sports Medicine / methods*