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Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants—SAFER Study VI

Rotunno, Adrian, MBBCh, MSc*; Schwellnus, Martin P., MBBCh, MSc, MD*,†,‡; Swanevelder, Sonja, MSc§; Jordaan, Esme, MSc§,¶; Janse Van Rensburg, Dina C., MBBCh, MMed, MD*; Derman, Wayne, MBBCh, PhD†,║

Clinical Journal of Sport Medicine: September 2018 - Volume 28 - Issue 5 - p 427–434
doi: 10.1097/JSM.0000000000000619
Original Research

Objective: Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use.

Design: Cross-sectional study.

Setting: 21.1-km and 56-km races.

Participants: Seventy-six thousand six hundred fifty-four race entrants.

Methods: Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history.

Main Outcome Measures: Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)].

Results: Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P < 0.0001). During races, nonsteroidal anti-inflammatory drugs (NSAIDs) (5.3%; 5.1-5.5) and paracetamol (2.6%; 2.4-2.7) were used mostly. Independent factors (adjusted PR for sex, age, and race distance; P < 0.0001) associated with AAIM use were running injury (2.7; 2.6-2.9), EAMC (2.0; 1.9-2.1), cardiovascular disease (CVD) symptoms (2.1; 1.8-2.4), known CVD (1.7; 1.5-1.9), CVD risk factors (1.6; 1.5-1.6), allergies (1.6; 1.5-1.7), cancer (1.3; 1.1-1.5), and respiratory (1.7; 1.6-1.8), gastrointestinal (2.0; 1.9-2.2), nervous system (1.9; 1.7-2.1), kidney/bladder (1.8; 1.6-2.0), endocrine (1.5; 1.4-1.7), and hematological/immune (1.5; 1.2-1.8) diseases.

Conclusions: 12.2% runners use AAIM before and/or during races, mostly NSAIDs. Factors (independent of sex, age, and race distance) associated with AAIM use were history of injuries, EAMC, and numerous chronic diseases. We suggest a pre-race screening and educational program to reduce AAIM use in endurance athletes to promote safer races.

*Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa;

International Olympic Committee (IOC) Research Centre, Pretoria, South Africa;

Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;

§Biostatistics Unit, South African Medical Research Council, Parow, South Africa;

Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa; and

Institute for Sport and Exercise Medicine, Faculty of Medicine & Health Sciences, University of Stellenbosch, Parow, South Africa.

Corresponding Author: Martin P. Schwellnus, Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Sports Campus, Burnett St, Hatfield, Pretoria 0020, South Africa (mschwell@iafrica.com).

The study was partially funded by a research grant from the International Olympic Committee (IOC) Research Centre (South Africa) at the University of Pretoria. The South African Medical Research Council (SAMRC) provided partial funding for the statistical analysis.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.cjsportmed.com).

A. Rotunno: data collection, data interpretation, manuscript (first draft), and manuscript editing. M. Schwellnus: principle investigator, responsible for the overall content as guarantor, study concept, study planning, data collection, data interpretation, manuscript (first draft), manuscript editing, and facilitating funding. S. Swanevelder: study planning, data analysis including statistical analysis, data interpretation, and manuscript editing. E. Jordaan: study planning, data analysis including statistical analysis, data interpretation, and manuscript editing. D. C. Janse Van Rensburg: data interpretation, manuscript (first draft), and manuscript editing. W. Derman: study concept, study planning, data collection, data interpretation, and manuscript editing.

Received February 13, 2018

Accepted May 01, 2018

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