The Garmin-RUNSAFE Running Health Study on the aetiology of running-related injuries: rationale and design of an 18-month prospective cohort study including runners worldwide

Regular Running Is Related to the Knee Joint Cartilage Structure in Healthy Adults

PURPOSE

The purpose of this study was to determine whether regular running distance and biomechanics are related to medial central femur cartilage (MCFC) structure.

METHODS

The cross-sectional study sample consisted of 1164 runners and nonrunners aged 18-65 yr. Participants completed questionnaires on physical activity and their running history. We performed quantitative magnetic resonance imaging of knee cartilage-T2 relaxation time (T2) mapping (high T2 indicates cartilage degeneration)-and a running biomechanical analysis using a three-dimensional motion capture system. A 14-d monitoring of the physical activity was conducted.

RESULTS

Those aged 35-49 yr were at 84% higher odds of having MCFC T2 in the highest level (85th percentile, P < 0.05) compared with youngest adults indicating that MCFC structures may be altered with aging. Being male was associated with 34% lower odds of having T2 at the highest level ( P < 0.05) compared with females. Nonrunners and runners with the highest weekly running distance were more likely to have a high T2 compared with runners with running distance of 6-20 km·wk -1 ( P < 0.05). In addition, the maximal knee internal adduction moment was associated with a 19% lower odds of having T2 at the highest level ( P < 0.05).

CONCLUSIONS

Females compared with males and a middle-aged cohort compared with the younger cohort seemed to be associated with the degeneration of MCFC structures. Runners who ran 6-20 km·wk -1 were associated with a higher quality of their MCFC compared with highly active individuals and nonrunners. Knee frontal plane biomechanics was related to MCFC structure indicating a possibility of modifying the medial knee collagen fibril network through regular running.

Are Gait Patterns during In-Lab Running Representative of Gait Patterns during Real-World Training? An Experimental Study

Biomechanical assessments of running typically take place inside motion capture laboratories. However, it is unclear whether data from these in-lab gait assessments are representative of gait during real-world running. This study sought to test how well real-world gait patterns are represented by in-lab gait data in two cohorts of runners equipped with consumer-grade wearable sensors measuring speed, step length, vertical oscillation, stance time, and leg stiffness. Cohort 1 (N = 49) completed an in-lab treadmill run plus five real-world runs of self-selected distances on self-selected courses. Cohort 2 (N = 19) completed a 2.4 km outdoor run on a known course plus five real-world runs of self-selected distances on self-selected courses. The degree to which in-lab gait reflected real-world gait was quantified using univariate overlap and multivariate depth overlap statistics, both for all real-world running and for real-world running on flat, straight segments only. When comparing in-lab and real-world data from the same subject, univariate overlap ranged from 65.7% (leg stiffness) to 95.2% (speed). When considering all gait metrics together, only 32.5% of real-world data were well-represented by in-lab data from the same subject. Pooling in-lab gait data across multiple subjects led to greater distributional overlap between in-lab and real-world data (depth overlap 89.3-90.3%) due to the broader variability in gait seen across (as opposed to within) subjects. Stratifying real-world running to only include flat, straight segments did not meaningfully increase the overlap between in-lab and real-world running (changes of <1%). Individual gait patterns during real-world running, as characterized by consumer-grade wearable sensors, are not well-represented by the same runner's in-lab data. Researchers and clinicians should consider "borrowing" information from a pool of many runners to predict individual gait behavior when using biomechanical data to make clinical or sports performance decisions.

Association between fat and fat-free body mass indices on shock attenuation during running

High amplitudes of shock during running have been thought to be associated with an increased injury risk. This study aimed to quantify the association between dual-energy X-ray absorptiometry (DEXA) quantified body composition, and shock attenuation across the time and frequency domains. Twenty-four active adults participated. A DEXA scan was performed to quantify the fat and fat-free mass of the whole-body, trunk, dominant leg, and viscera. Linear accelerations at the tibia, pelvis, and head were collected whilst participants ran on a treadmill at a fixed dimensionless speed 1.00 Fr. Shock attenuation indices in the time- and frequency-domain (lower frequencies: 3-8 Hz; higher frequencies: 9-20 Hz) were calculated. Pearson correlation analysis was performed for all combinations of DEXA and attenuation indices. Regularised regression was performed to predict shock attenuation indices using DEXA variables. A greater power attenuation between the head and pelvis within the higher frequency range was associated with a greater trunk fat-free mass (r = 0.411, p = 0.046), leg fat-free mass (r = 0.524, p = 0.009), and whole-body fat-free mass (r = 0.480, p = 0.018). For power attenuation of the high-frequency component between the pelvis and head, the strongest predictor was visceral fat mass (β = 48.79). Passive and active tissues could represent important anatomical factors aiding in shock attenuation during running. Depending on the type and location of these masses, an increase in mass may benefit injury risk reduction. Also, our findings could implicate the injury risk potential during weight loss programs.

Running-Related Injuries Among More Than 7000 Runners in 87 Different Countries: The Garmin-RUNSAFE Running Health Study

OBJECTIVE: To describe the cumulative injury proportion after 1000 and 2000 km of running among runners from 87 countries worldwide using wearable devices. Secondly, examine if the cumulative injury proportion differed between runners from different countries. DESIGN: Cohort study with an 18-month follow-up. METHODS: Runners aged ≥18 years who were familiar with the English language, and who were using a Garmin sports watch that supported tracking of running were eligible for inclusion. The exposure was residential country; self-reported running-related injury was the primary outcome. A generalized linear model was used to estimate the cumulative injury proportion for each country and the cumulative risk difference between the countries (country with the lowest risk used as reference). Data were analyzed at 1000 and 2000 km. RESULTS: The proportions of injured runners among the 7605 included runners from 87 different countries were 57.6% [95% CI: 56.9%, 59.0%] at 1000 km and 69.8% [95% CI: 68.3%, 71.4%] at 2000 km. Runners from the Czech Republic (40.3% [95% CI: 28.7%, 51.9%]), Austria (41.1% [95% CI: 25.9%, 52.2%]), and Germany (41.9% [95% CI: 36.0%, 47.9%]) had the lowest cumulative injury proportions at 1000 km, whereas Ireland (75.4% [95% CI: 60.4%, 90.4%]), Great Britain and Northern Ireland (73.2% [95% CI: 69.3%, 77.1%]), and Finland (67.5% [95% CI: 47.2%, 87.7%]) had the highest proportions. At 2000 km, Poland (47.7% [95% CI: 36.0%, 59.4%]), Slovenia (52.2% [95% CI: 28.5%, 75.8%]), and Croatia (54.2% [95% CI: 35.6%, 72.7%]) had the lowest proportions of injured runners. The highest cumulative injury proportions were reported in Great Britain and Northern Ireland (83.6% [95% CI: 79.6%, 87.6%]) and the Netherlands (78.3% [95% CI: 70.6%, 85.9%]). CONCLUSION: More than half of the population of adult runners from 87 countries using wearable devices sustained a running-related injury during follow-up. There were considerable between-country differences in injury proportions. J Orthop Sports Phys Ther 2024;54(2):1-9. Epub 16 November 2023. doi:10.2519/jospt.2023.11959.

Running-Related Achilles Tendon Injury: A Prospective Biomechanical Study in Recreational Runners

There are relatively few running studies that have attempted to prospectively identify biomechanical risk factors associated with Achilles tendon (AT) injuries. Therefore, the aim was to prospectively determine potential running biomechanical risk factors associated with the development of AT injuries in recreational, healthy runners. At study entry, 108 participants completed a set of questionnaires. They underwent an analysis of their running biomechanics at self-selected running speed. The incidence of AT running-related injuries (RRI) was assessed after 1-year using a weekly questionnaire standardized for RRI. Potential biomechanical risk factors for the development of AT RRI injury were identified using multivariable logistic regression. Of the 103 participants, 25% of the sample (15 males and 11 females) reported an AT RRI on the right lower limb during the 1-year evaluation period. A more flexed knee at initial contact (odds ratio = 1.146, P = .034) and at the midstance phase (odds ratio = 1.143, P = .037) were significant predictors for developing AT RRI. The results suggested that a 1-degree increase in knee flexion at initial contact and midstance was associated with a 15% increase in the risk of an AT RRI, thus causing a limitation of training or a stoppage of running in runners.

Running on empty: a longitudinal global study of psychological well-being among runners during the COVID-19 pandemic

OBJECTIVES

There are indications that the COVID-19 pandemic has had a profound negative effect on psychological well-being. Here, we investigated this hypothesis using longitudinal data from a large global cohort of runners, providing unprecedented leverage for understanding how the temporal development in the pandemic pressure relates to well-being across countries.

DESIGN

Prospective cohort study.

SETTING

Global.

PARTICIPANTS

We used data from the worldwide Garmin-RUNSAFE cohort that recruited runners with a Garmin Connect account, which is used for storing running activities tracked by a Garmin device. A total of 7808 Garmin Connect users from 86 countries participated.

PRIMARY AND SECONDARY OUTCOME MEASURES

From 1 August 2019 (prepandemic) to 31 December 2020, participants completed surveys every second week that included the five-item WHO Well-Being Index (WHO-5). Pandemic pressure was proxied by the number of COVID-19-related deaths per country, retrieved from the Coronavirus Resource Centre at Johns Hopkins University. Panel data regression including individual- and time-fixed effects was used to study the association between country-level COVID-19-related deaths over the past 14 days and individual-level self-reported well-being over the past 14 days.

RESULTS

The 7808 participants completed a total of 125 409 WHO-5 records over the study period. We found a statistically significant inverse relationship between the number of COVID-19-related deaths and the level of psychological well-being-independent of running activity and running injuries (a reduction of 1.42 WHO-5 points per COVID-19-related death per 10 000 individuals, p<0.001).

CONCLUSIONS

This study suggests that the COVID-19 pandemic has had a negative effect on the psychological well-being of the affected populations, which is concerning from a global mental health perspective.

Impact of the bidirectional relationship between communication and cognitive efficacy on orthopedic patient adherence behavior

Background

There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examined the influence among constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. In addition, the moderating effect of hospital facility levels is examined.

Methods

A conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. Structural equation modeling was used to analyze the data in two steps that involved a measurement model and a structural model. The former was applied to estimate the Cronbach’s alphas, intercorrelations of factors, and descriptive statistics; the latter was used to test the hypothesized relationships of the constructs.

Results

The results identified three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influenced cognitive efficacy (β = 0.16, p < 0.001), and cognitive efficacy influenced physician-patient communication (β = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (β = 0.38, p < 0.001). The healthcare structure influenced healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center has greater influences by the structure and physician-patient communication than it was treated in the regional hospitals.

Conclusions

This study revealed a complex pattern in relationships among process constructs for healthcare services. The findings of this study acknowledge the important potential interrelationships among the healthcare service constructs to improve the quality of healthcare outcomes.

Trial registration

CRREC104107. Date: 22/01/2016. Prospectively Registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07575-5.

Nielsen R, Rasmussen J, Nielsen MS, Andersen CH, de Zee M. How Precisely Can Easily Accessible Variables Predict Achilles and Patellar Tendon Forces during Running?

Patellar and Achilles tendinopathy commonly affect runners. Developing algorithms to predict cumulative force in these structures may help prevent these injuries. Importantly, such algorithms should be fueled with data that are easily accessible while completing a running session outside a biomechanical laboratory. Therefore, the main objective of this study was to investigate whether algorithms can be developed for predicting patellar and Achilles tendon force and impulse during running using measures that can be easily collected by runners using commercially available devices. A secondary objective was to evaluate the predictive performance of the algorithms against the commonly used running distance. Trials of 24 recreational runners were collected with an Xsens suit and a Garmin Forerunner 735XT at three different intended running speeds. Data were analyzed using a mixed-effects multiple regression model, which was used to model the association between the estimated forces in anatomical structures and the training load variables during the fixed running speeds. This provides twelve algorithms for predicting patellar or Achilles tendon peak force and impulse per stride. The algorithms developed in the current study were always superior to the running distance algorithm.

How Has Workload Been Defined and How Many Workload-Related Exposures to Injury Are Included in Published Sports Injury Articles? A Scoping Review

OBJECTIVE

To describe how workload-related exposure variables have been defined in sports injury articles, and to identify the number of workload-related exposure variables included in comparative analyses.

DESIGN

Scoping review.

LITERATURE SEARCH

PubMed, SPORTDiscus, and Scopus were systematically searched on March 13, 2020. Two reviewers independently screened the retrieved literature and selected articles for inclusion.

STUDY SELECTION CRITERIA

Prospective cohort studies using workload-related variables as the primary exposure to sports injury were eligible for inclusion.

DATA SYNTHESIS

The type (eg, distance, balls bowled) and construct of workload-related exposure variables (eg, acute-chronic workload ratio) were extracted and summarized in frequency tables.

RESULTS

A total of 648 articles were identified, and 45 were eligible for inclusion. Workload definition differed greatly, as sports- and workload-related exposure variables could be, but were not limited to, distance, balls bowled, session rating of perceived exertion, accelerations, soreness, and sleep. Within and across articles, authors used different constructs for workload-related exposure variables. For example, distance was represented as total distance, distance per week, distance per 2 weeks, and acute-chronic workload ratio. The number of workload-related exposure variables included in comparative analyses ranged from 1 to 336.

CONCLUSION

Studies used different definitions of workload-related exposure variables. The number of workload-related exposure variables in a single study ranged from 1 to 336. J Orthop Sports Phys Ther 2020;50(10):538-548. doi:10.2519/jospt.2020.9766.

Use of Wearables: Tracking and Retraining in Endurance Runners

Wearable devices are ubiquitous among runners, coaches, and clinicians with an ever-increasing number of devices coming on the market. In place of gold standard measures in the laboratory, these devices attempt to provide a surrogate means to track running biomechanics outdoors. This review provides an update on recent literature in the field of wearable devices in runners, with an emphasis on criterion validity and usefulness in the coaching and rehabilitation of runners. Our review suggests that while enthusiasm should be tempered, there is still much for runners to gain with wearables. Overall, our review finds evidence supporting the use of wearables to improve running performance, track global training loads applied to the runner, and provide real-time feedback on running speed and run cadence. Case studies illustrate the use of wearables for the purposes of performance and rehabilitation.