History of chronic disease is a novel intrinsic risk factor associated with gradual onset injuries in recreational road cyclists: A cross-sectional study in 21,824 cyclists - SAFER XIV.

Objectives: Risk factors related to Gradual onset injuries (GOIs) in cyclists need to be identified to enable effective injury prevention strategies. We aim to determine risk factors related to GOIs in cyclists participating in mass community-based events.
Design: Cross-sectional study.
Setting: Cape Town Cycle Tour.
Participants: Race entrants (n = 35,914) MAIN OUTCOME MEASURES: Completion of pre-race medical questionnaires. 21,824 consenting cyclists (60.8%) were studied. 617 cyclists reported GOIs. Selected risk factors associated with GOIs: demographics, training/racing history, chronic disease history, and medication use, were explored using multi-variate analyses.
Results: Prevalence ratio (PR) of GOIs was similar in males and females, but higher in older age categories [>50 yrs vs. categories: ≤30yrs (PR = 1.6); 31 to ≤40yrs (PR = 1.5); 41 to <50yrs (PR = 1.4)] (p < 0.0001). Intrinsic risk factors associated with GOIs (adjusted for gender and age) were: 1) increased weekly training/racing frequency (PR = 1.1, p = 0.0003), 2) chronic disease history [cardiovascular disease symptoms (PR = 2.3, p = 0.0026), respiratory disease (PR = 1.6, p < 0.0001), nervous system/psychiatric disease (PR = 1.5, p = 0.0082)], and 3) history of analgesic/anti-inflammatory medication (AAIM) used before/during racing (PR = 5.1, p < 0.0001).
Conclusion: Increased training frequency, chronic disease and AAIM use are risk factors associated with GOIs in cyclists. A novel finding is that in recreational cyclists, chronic disease history could be considered when managing GOIs and implementing prevention programs.
Competing Interests: Declaration of competing interest The authors declare that there are no competing interests.
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