{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark"
      ],
      "name": "Jesper Schuster Brandt Frandsen"
    },
    {
      "affiliations": [
        "Southern Queensland Rural Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia",
        "Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia"
      ],
      "name": "Adam Hulme"
    },
    {
      "affiliations": [
        "Department of Public Health, Aarhus University, Aarhus, Denmark"
      ],
      "name": "Erik Thorlund Parner"
    },
    {
      "affiliations": [
        "Department of Sports Science and Clinical Biomechanics, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark",
        "Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway"
      ],
      "name": "Merete Møller"
    },
    {
      "affiliations": [
        "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden",
        "Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden"
      ],
      "name": "Ida Lindman"
    },
    {
      "affiliations": [
        "Orthopaedic Research Unit, Sahlgrenska University Hospital, Gothenburg, Sweden",
        "Department of Health and Rehabilitation, University of Gothenburg Institute of Neuroscience and Physiology, Gothenburg, Sweden"
      ],
      "name": "Josefin Abrahamson"
    },
    {
      "affiliations": [
        "Department of Public Health, Aarhus University, Aarhus, Denmark",
        "Research Unit for General Practice, Aarhus, Denmark"
      ],
      "name": "Nina Sjørup Simonsen"
    },
    {
      "affiliations": [
        "Department of Public Health, Aarhus University, Aarhus, Denmark",
        "Research Unit for General Practice, Aarhus, Denmark",
        "Research Centre for Care and Rehabilitation, Faculty of Health and Society, VIA University College, Aarhus, Denmark"
      ],
      "name": "Julie Sandell Jacobsen"
    },
    {
      "affiliations": [
        "Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark"
      ],
      "name": "Daniel Ramskov"
    },
    {
      "affiliations": [
        "Department of Public Health, Aarhus University, Aarhus, Denmark",
        "Research Unit for General Practice, Aarhus, Denmark"
      ],
      "name": "Sebastian Skejø"
    },
    {
      "affiliations": [
        "Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg"
      ],
      "name": "Laurent Malisoux"
    },
    {
      "affiliations": [
        "Department of Public Health, Aarhus University, Aarhus, Denmark",
        "Department of Sports Science and Clinical Biomechanics, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Michael Lejbach Bertelsen"
    },
    {
      "affiliations": [
        "Department of Public Health, Aarhus University, Aarhus, Denmark",
        "Research Unit for General Practice, Aarhus, Denmark"
      ],
      "name": "Rasmus Oestergaard Nielsen"
    }
  ],
  "title": "How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study",
  "uid": "a245f093-6363-51a2-b618-9da27e0278e5"
}