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A Randomized Study of a Strength Training Program to Prevent Injuries in Runners of the New York City Marathon.

ABSTRACT: BACKGROUND:Lower extremity overuse injuries are common among runners, especially first-time marathoners. Hip abductor and quadriceps strengthening is often recommended to reduce running-related injuries. HYPOTHESIS:A 12-week strength training program would decrease the rate of overuse injuries resulting in marathon noncompletion and improve race finishing time. STUDY DESIGN:Randomized trial. LEVEL OF EVIDENCE:Level 2. METHODS:Twelve weeks before the New York City Marathon, first-time marathon runners age 18 years and older were randomized into a strength training group or an observation group. The strength training group was instructed to perform a 10-minute program 3 times weekly using written and video instruction. This program targeted the quadriceps, hip abductor, and core muscle groups. Injuries were self-reported through biweekly surveys, with major injuries being those that resulted in marathon noncompletion and minor injuries being those that impaired training or race performance. RESULTS:A total of 720 runners were enrolled (mean age, 35.9 ± 9.4 years; 69.4% female), of whom 583 runners started the marathon and 579 completed it. The incidence of major injury was 8.9% and minor injury was 48.5%. Fifty two of 64 major injuries were overuse, of which 20 were bone stress injuries. The incidence of overuse injury resulting in marathon noncompletion was 7.1% in the strength training group and 7.3% in the observation group (risk ratio, 0.97; 95% CI, 0.57-1.63; P = 0.90). The mean finishing time was 5 hours 1 ± 60 minutes in the strength training group and 4 hours 58 ± 55 minutes in the observation group (P = 0.35). CONCLUSION:There is a high prevalence of injury among first-time marathon runners, but this self-directed strength training program did not decrease overuse injury incidence resulting in marathon noncompletion. CLINICAL RELEVANCE:Prevention strategies such as strength training need to be developed and evaluated through clinical trials to reduce the high prevalence of overuse injuries in runners, especially for high-risk populations such as first-time marathon runners.

SUBMITTER: Toresdahl BG

PROVIDER: S-EPMC6931177 | biostudies-literature | 2020 Jan/Feb

REPOSITORIES: biostudies-literature

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A Randomized Study of a Strength Training Program to Prevent Injuries in Runners of the New York City Marathon.

Toresdahl Brett G BG McElheny Kathryn K Metzl Jordan J Ammerman Brittany B Chang Brenda B Kinderknecht James J

Sports health 20191023 1

<h4>Background</h4>Lower extremity overuse injuries are common among runners, especially first-time marathoners. Hip abductor and quadriceps strengthening is often recommended to reduce running-related injuries.<h4>Hypothesis</h4>A 12-week strength training program would decrease the rate of overuse injuries resulting in marathon noncompletion and improve race finishing time.<h4>Study design</h4>Randomized trial.<h4>Level of evidence</h4>Level 2.<h4>Methods</h4>Twelve weeks before the New York C ...[more]

PMID: 31642726

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Project description:BACKGROUND:Besides the beneficial health effects of being active, running is associated with a risk of sustaining injuries. Runners need to change their behavior to increase the use of effective measures and subsequently reduce the number of running-related injuries. OBJECTIVE:The RunFitCheck intervention was developed according to an evidence- and practice-based approach to stimulate injury-preventive behavior among novice runners. This paper describes the study design in detail. METHODS:A randomized controlled trial with a follow-up period of 5 months will be conducted. The participants will be novice runners. At enrollment, participants will be asked to report injury-preventive measures they usually take during their running activities. After completing the enrollment questionnaire, participants will be randomized to intervention and control groups. The intervention group will have access to the RunFitCheck intervention; the control group will perform their running activities as usual. Participants will be asked to report retrospectively in detail what they have done regarding injury prevention during their running activities at 1, 3, and 5 months after enrollment. Descriptive analyses will be conducted for different baseline variables in the intervention and control group. Relative risks and 95% CIs will be used to analyze behavioral changes according to the intention-to-treat principle. RESULTS:The project was funded in 2016 and enrollment was completed in 2017. Data analysis is currently under way and the results are expected to be submitted for publication in 2019. CONCLUSIONS:To nullify the negative side effects of running, prevention of training errors is desirable. As the use of injury prevention measures is not compulsory in running, a behavioral change is necessary to increase the use of effective injury-preventive measures and to prevent running-related injuries. TRIAL REGISTRATION:Netherlands Trial Register NTR6381; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6381 (Archived by WebCite at http://www.webcitation.org/736Xjm5jv). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR1-10.2196/9708.

Project description:Introduction:Marathon, as a long-distance aerobic exercise, has become a fashionable or popular sport. However, little is known about the holistic metabolic changes occurring within the serum metabolome of athletes after the completion of a marathon. Objectives:The goal of current study was to have an in-depth understanding of the impact of marathon on human metabolomics as well as the relationships among a variety of metabolites. Methods:The 20 studied subjects were all adult males who participated in a marathon. The serum samples of these participants were collected before and after the marathon and the biochemical metabolites in the serum were identified by an untargeted two-dimensional gas chromatography time-of-flight mass spectrometry. Results:All participants completed the marathon within 3?h. Compared to those before exercise, serum urea and creatine kinase, as well as cortisol, elevated significantly (p?<?0.05), whereas testosterone decreased significantly (p?<?0.01). Metabolomic analysis showed that, compared to those before the competition, metabolites pyruvic acid, glyceric acid, malic acid, cis-aconitic acid, galacturonic acid, methyl fumaric acid, maltotriose, and others increased significantly after the competition (p?<?0.05), but glucosamine and O-succinyl-L-homoserine decreased significantly (p?<?0.05). Amino acid indexes, such as alanine, L-tyrosine and phenylalanine, increased significantly after exercise compared with those before exercise (p?<?0.05), whereas serine, valine and asparagine decreased significantly (p?<?0.05). Lipid metabolism indexes, glycerol, glyceric acid, octanoic acid, and quinic acid increased significantly (p?<?0.05). Theophylline, xanthine and other indicators of caffeine metabolism increased significantly (p?<?0.05). Furthermore, marathon performance, fat percentage, VO2max, and hemoglobin were correlated with the serum metabonomic indicators, so were serum testosterone and cortisol. Conclusion:These results illustrate that the metabolism of glucose and lipid of the athletes was enhanced following the marathon match. In addition, the metabolism of glucosamine was decreased and the metabolism of caffeine was increased. Our data provide new insights for marathon performance and nutritional status.

Project description:BackgroundSpinal manipulation is the primary therapy utilised by chiropractors in the management of their patients. The skills required may feel foreign to chiropractic students as they need strength and endurance in movement patterns they may not have otherwise been exposed to. This may lead to injury while learning manipulative techniques. It is plausible to suggest that the implementation of a strength and conditioning program early in a practitioner's career could reduce the incidence and progression of injuries. The study aims to test the effectiveness of a strength and conditioning program in reducing the risk of chiropractic students' acquiring injuries while learning the skill of spinal manipulation.MethodsThis study will involve a prospective cohort of chiropractic students who are currently learning manual therapy at an undergraduate level. Participants will be eligible for inclusion if they are enrolled in 3rd or 4th-year chiropractic manual therapy units at Murdoch University chiropractic course. The intervention group will follow a 12-week strength and conditioning program comprised of preventative exercises that address each body region previously identified as being prone to injury. The control group will complete a 12-week walking program. The primary outcome is injury rate, measured via a short questionnaire. The secondary outcome will be strength, measured via submaximal strength tests.DiscussionThe prescribed exercises are aimed at improving the strength and endurance of those muscle groups involved in commonly taught manual therapy tasks. The resistance bands have been chosen as they are inexpensive, simple to implement for the purposes of the study, and acceptably safe. A video format was selected to allow ease of access for participants, provide a detailed description and a visual representation of the exercises to be performed. A questionnaire was designed as a means to assess the influence of the strength and conditioning program on injury rate and the impact this may have on the students' ability to continue practicing. The International Physical Activity Questionnaire has been chosen to measure the participants level of activity before beginning the exercise program.ConclusionThis research protocol will be the first large-scale study to investigate the effectiveness of a strength and conditioning program to reduce injuries within chiropractic students learning manual therapy.Trial registrationAustralia New Zealand Clinical Trials Registry (ACTRN12617001638325p).

Project description:BackgroundNo studies have focused on magnetic resonance imaging (MRI) of the hips of marathoners, despite the popularity and injury risks of marathon running.PurposeTo understand the effect of preparing for and completing a marathon run (42 km) on runners' hip joints by comparing MRI findings before and after their first marathon.Study designCase-control study; Level of evidence, 3.MethodsA total of 28 healthy adults (14 males, 14 females; mean age, 32.4 years) were recruited after registering for their first marathon. They underwent 3-T MRI of both hips at 16 weeks before (time point 1) and 2 weeks after the marathon (time point 2). After the first MRI, 21 runners completed the standardized, 4 month--long training program and the marathon; 7 runners did not complete the training or the marathon. Specialist musculoskeletal radiologists reported and graded the hip joint structures using validated scoring systems. Participants completed the Hip disability and Osteoarthritis Outcome Score (HOOS) at both imaging time points.ResultsAt time point 1, MRI abnormalities of the hip joint were seen in 90% of participants and were located in at least 1 of these areas: labrum (29%), articular cartilage (7%), subchondral bone marrow (14%), tendons (17%), ligaments (14%), and muscles (31% had moderate muscle atrophy). At time point 2, only 2 of the 42 hips showed new findings: a small area of mild bone marrow edema appearance (nonweightbearing area of the hip and not attributable to running). There was no significant difference in HOOS between the 2 time points. Only 1 participant did not finish the training because of hip symptoms and thus did not run the marathon; however, symptoms resolved before the MRI at time point 2. Six other participants discontinued their training because of non-hip related issues: a knee injury, skin disease, a family bereavement, Achilles tendon injury, illness unrelated to training, and a foot injury unrelated to training.ConclusionRunners who completed a 4-month beginner training program before their first marathon run, plus the race itself, showed no hip damage on 3-T MRI scans.

Project description:BACKGROUND:Investigation into strenuous activity and kidney function has gained interest given increasing marathon participation. STUDY DESIGN:Prospective observational study. SETTING & PARTICIPANTS:Runners participating in the 2015 Hartford Marathon. PREDICTOR:Completing a marathon. OUTCOMES:Acute kidney injury (AKI) as defined by AKI Network (AKIN) criteria. Stage 1 AKI was defined as 1.5- to 2-fold or 0.3-mg/dL increase in serum creatinine level within 48 hours of day 0 and stage 2 was defined as a more than 2- to 3-fold increase in creatinine level. Microscopy score was defined by the number of granular casts and renal tubular epithelial cells. MEASUREMENTS:Samples were collected 24 hours premarathon (day 0), immediately postmarathon (day 1), and 24 hours postmarathon (day 2). Measurements of serum creatinine, creatine kinase, and urine albumin were completed, as well as urine microscopy analysis. 6 injury urine biomarkers (IL-6, IL-8, IL-18, kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, and tumor necrosis factor ?) and 2 repair urine biomarkers (YKL-40 and monocyte chemoattractant protein 1) were measured. RESULTS:22 marathon runners were included. Mean age was 44 years and 41% were men. 82% of runners developed an increase in creatinine level equivalent to AKIN-defined AKI stages 1 and 2. 73% had microscopy diagnoses of tubular injury. Serum creatinine, urine albumin, and injury and repair biomarker levels peaked on day 1 and were significantly elevated compared to day 0 and day 2. Serum creatine kinase levels continued to significantly increase from day 0 to day 2. LIMITATIONS:Small sample size and limited clinical data available at all time points. CONCLUSIONS:Marathon runners developed AKI and urine sediment diagnostic of tubular injury. An increase in injury and repair biomarker levels suggests structural damage to renal tubules occurring after marathon. The results of our study should be validated in larger cohorts with longer follow-up of kidney function.

Dataset Information

A Randomized Study of a Strength Training Program to Prevent Injuries in Runners of the New York City Marathon.

Publications

A Randomized Study of a Strength Training Program to Prevent Injuries in Runners of the New York City Marathon.

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