TY - JOUR
T1 - How much running is too much?
T2 - Identifying high-risk running sessions in a 5200-person cohort study
AU - Schuster Brandt Frandsen, Jesper
AU - Hulme, Adam
AU - Parner, Erik Thorlund
AU - Møller, Merete
AU - Lindman, Ida
AU - Abrahamson, Josefin
AU - Sjørup Simonsen, Nina
AU - Sandell Jacobsen, Julie
AU - Ramskov, Daniel
AU - Skejø, Sebastian
AU - Malisoux, Laurent
AU - Bertelsen, Michael Lejbach
AU - Nielsen, Rasmus Oestergaard
N1 - Funding:
The study is supported by unconditional grants from Aarhus University
Research Foundation (grant number: AUFF-E-2015-FLS-9- 9) and the Danish
Rheumatism Association to RON (grant number: R160-A5157). The contribution
made by AH was supported by an Australian Research Council DECRA Fellowship:
DE240100095.
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025/8/26
Y1 - 2025/8/26
N2 - OBJECTIVES: We explored whether a spike in running distance during a single session or over 1 week, compared with the preceding period, was associated with increased risk of running-related overuse injury.METHODS: Adult runners were recruited for an 18-month cohort study. Three training-related exposures were defined based on a relative change in running distance, using data collected via Garmin devices: (1) session-specific running distance relative to the longest distance run in the past 30 days; (2) 1-week period relative to the preceding 3 weeks using the acute:chronic workload ratio (ACWR); (3) 1-week period using a week-to-week ratio. Runners were categorised into one of four time-varying states: (1) regression, or up to 10% increase (reference); (2) 'small spike' between >10% and 30% increase; (3) 'moderate spike' between >30% and 100% increase; and (4) 'large spike' >100% increase. Outcome was self-reported overuse running-related injury. A multistate Cox regression model was used to estimate adjusted hazard rate ratios (HRR).RESULTS: Among 5205 runners (mean age 45.8 years, SD=10.4; 22% female), a total of 1820 (35%) sustained a running-related injury during 588 071 sessions. Significantly increased rates were identified for small spikes (HRR=1.64 (95% CI: 1.31 to 2.05, p=0.01)), moderate spikes (HRR=1.52 (95% CI: 1.16 to 2.00, p<0.01)) and large spikes (HRR=2.28 (95% CI: 1.50 to 3.48, p<0.01)) in single-session running distance. A negative dose-response relationship was observed for the ACWR. No relationship was identified for the week-to-week ratio.CONCLUSION: A significant increase in the rate of running-related overuse injury was found when the distance of a single running session exceeded 10% of the longest run undertaken in the last 30 days.
AB - OBJECTIVES: We explored whether a spike in running distance during a single session or over 1 week, compared with the preceding period, was associated with increased risk of running-related overuse injury.METHODS: Adult runners were recruited for an 18-month cohort study. Three training-related exposures were defined based on a relative change in running distance, using data collected via Garmin devices: (1) session-specific running distance relative to the longest distance run in the past 30 days; (2) 1-week period relative to the preceding 3 weeks using the acute:chronic workload ratio (ACWR); (3) 1-week period using a week-to-week ratio. Runners were categorised into one of four time-varying states: (1) regression, or up to 10% increase (reference); (2) 'small spike' between >10% and 30% increase; (3) 'moderate spike' between >30% and 100% increase; and (4) 'large spike' >100% increase. Outcome was self-reported overuse running-related injury. A multistate Cox regression model was used to estimate adjusted hazard rate ratios (HRR).RESULTS: Among 5205 runners (mean age 45.8 years, SD=10.4; 22% female), a total of 1820 (35%) sustained a running-related injury during 588 071 sessions. Significantly increased rates were identified for small spikes (HRR=1.64 (95% CI: 1.31 to 2.05, p=0.01)), moderate spikes (HRR=1.52 (95% CI: 1.16 to 2.00, p<0.01)) and large spikes (HRR=2.28 (95% CI: 1.50 to 3.48, p<0.01)) in single-session running distance. A negative dose-response relationship was observed for the ACWR. No relationship was identified for the week-to-week ratio.CONCLUSION: A significant increase in the rate of running-related overuse injury was found when the distance of a single running session exceeded 10% of the longest run undertaken in the last 30 days.
KW - Athletic Injuries
KW - Running
KW - Sporting injuries
KW - Sports medicine
KW - Physical Conditioning, Human/adverse effects
KW - Athletic Injuries/epidemiology
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Proportional Hazards Models
KW - Male
KW - Running/injuries
KW - Cumulative Trauma Disorders/epidemiology
KW - Time Factors
KW - Female
KW - Adult
KW - Cohort Studies
UR - https://pubmed.ncbi.nlm.nih.gov/40623829/
U2 - 10.1136/bjsports-2024-109380
DO - 10.1136/bjsports-2024-109380
M3 - Article
C2 - 40623829
SN - 0306-3674
VL - 59
SP - 1203
EP - 1210
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 17
ER -