The Effect of Combined Training and Racing High-Speed Exercise History on Musculoskeletal Injuries in Thoroughbred Racehorses: A Systematic Review and Meta-Analysis of the Current Literature

Fractures in Thoroughbred racing and the potential for pre-race identification of horses at risk

Risk rates for and predisposing factors to fractures occurring in Thoroughbred racing that have been published in peer reviewed journals are documented. The potential for currently available techniques to identify horses at increased risk for fracture is discussed on the bases of principles, practicalities, advantages, disadvantages and current data. All are reviewed in light of justifiable decision making and importance of fractures to horseracing's social license.

Anomalous Incidence of Fatal Musculoskeletal Injury in North American 2-Year-Old Thoroughbred Racehorses in the Year 2020

Racehorse training and racing schedules in many parts of the United States and Canada were interrupted or otherwise reduced during the first three to six months of 2020. This was an indirect consequence of mitigations to prevent the spread of the pandemic virus COVID-19. Data from the Equine Injury Database, a census-level survey of all race starts made in the USA and Canada, were used to analyse the incidence of fatalities in 2009-2022 among three age cohorts of racehorses within each year. There was a statistically significant increase in the incidence of musculoskeletal fatalities among 2-year-old Thoroughbreds in 2020, compared to the period 2009-2019. In 2021 and 2022, the training schedules of 2-year-old horses returned to pre-2020 levels, as did the incidence of fatalities. The delayed start to training for 2-year-old horses was associated with an increase in risk of fatal musculoskeletal injury for those horses during 2020, but the risk for the same horses in 2021-when they were 3 years old-was not significantly different to the risk for 3-year-olds in any other year. The increased risk of fatal musculoskeletal injury in 2020 was only found among horses that were 2 years old in 2020-horses aged 3 years or more in 2020 were not at increased risk.

Longitudinal Training and Workload Assessment in Young Friesian Stallions in Relation to Fitness: Part 1

Friesian stallions have to complete a 10-week studbook approval test (70-day test) consisting of dressage and driving training for acceptance as a breeding stallion. Training response of the horses to this approval program was evaluated. External workload (EW) of 16 stallions (3.2 ± 0.4 years old) was registered during the 9 weeks preceding the 70-day test (preparation period) and during 70-day test. Ridden indoor standardized exercise tests (SET), measuring heart rate (HR) and plasma lactate concentration (LA) at walk, trot and canter, were performed in week 1 (SET-I), 6 (SET-II) and 10 (SET-III) of the 70-day test. Linear mixed effect models were used to analyze HR and LA related to SETs and EW related to the phase of the study, using Akaike's information criterion for model reduction. EW was higher in the 70-day test compared to the preparation period, with longer duration of training sessions. Compared to SET-I, horses showed increased HR and LA after canter in SET-II and SET-III, indicating that they were more fatigued. The fact that the fitness of these Friesian stallions decreased during the 70-day test suggests overtraining. To optimize training effects and welfare of these horses, the workload of the training program needs to be adjusted.

Longitudinal Training and Workload Assessment in Young Friesian Stallions in Relation to Fitness, Part 2-An Adapted Training Program

Young Friesian stallions have to complete a 10-week training program (70-day test) for acceptance as a breeding stallion. Part one of this study showed that the 70-day test was too intense and led to reduced fitness. In the present (part two) study, the effects of an adapted training program were studied. Training frequency and minutes of cantering per week were lowered compared with part one. The external workload (EW) of sixteen stallions (3.4 ± 0.8 years) was monitored during the 6-weeks before testing (preparation period) as well as during the 70-day test. Standardized exercise tests (SETs) were performed in week 1 (SET-I), 6 (SET-II), and 10 (SET-III) of the 70-day test, measuring heart rate (HR) and plasma lactate concentration (LA). Linear mixed effect models were used to analyze the EW, and the HR and LA related to the SETs. The EW increased from the preparation period to the 70-day test; this increase in the EW was lower compared with the original training program. The horses showed lower HR and LA levels in SET-III compared with SET-I. The young Friesian horses were at risk to be overtrained in part one, but the adapted training program resulted in increased fitness. This study shows that a carefully chosen program is necessary to improve the performance and welfare of (young) horses.

Date of birth and purchase price as foals or yearlings are associated with Thoroughbred flat race performance in the United Kingdom and Ireland

Background

Methods

Results

Conclusions

Fifteen risk factors associated with sudden death in Thoroughbred racehorses in North America (2009-2021)

OBJECTIVE

To identify risk factors associated with race-related sudden death in Thoroughbred racehorses in the US and Canada.

ANIMALS

4,198,073 race starts made by 284,387 Thoroughbred horses at 144 racetracks in the US and Canada between 2009 and 2021.

PROCEDURES

Study data were extracted from the Equine Injury Database, which contains detailed records of 92.2% of all official race starts made in the US and Canada during the study period. Forty-nine potential risk factors were analyzed using univariable and multivariable logistic regression. Cases were defined as race starts that resulted in fatality within 3 days of racing, in which at least 1 of 5 codes relating to sudden death was recorded. Fatalities due to catastrophic musculoskeletal injury were omitted from the study cohort.

RESULTS

536 race starts resulted in sudden death, an incidence rate of 0.13/1,000 starts. Fifteen risk factors were significantly associated with sudden death, including horse age and sex, season and purse of race, race distance, and horses' recent history of injury and lay-up. Horses racing while on furosemide medication were at 62% increased odds of sudden death.

CLINICAL RELEVANCE

Associations found between previous injury and sudden death suggests preexisting pathology could contribute in some cases. The association between furosemide and sudden death prompts further study to understand which biological processes could contribute to this result.

Risk Factors for Exercise-Associated Sudden Cardiac Death in Thoroughbred Racehorses

Cardiac arrhythmias resulting in sudden cardiac death (SCD) are an important cause of racehorse fatalities. The objective of this study was to determine risk factors for SCD in Thoroughbreds by evaluating a sample with a policy of mandatory post-mortem following racing or training fatalities. Risk factors were compared between case horses with SCD (n = 57) and control horses with other fatal injury (OFI, n = 188) by univariable and multivariable logistic regression. Survival in years for horses with SCD was compared to OFI using the Kaplan−Meier method with log rank test. The following variables were most important in the multiple logistic model: Horses with SCD were more likely to die during training than during racing, SCD (42/57, 74%) vs. OFI (82/188, 44%; odds ratio [OR], 95% confidence interval [CI], 2.5, 1.2−5.4; p = 0.01), had fewer lifetime starts, median (interquartile range [IQR]), SCD (3.0 [0.0−9.0]) vs. OFI (9.0 [0.0−22.8]; OR, 95% CI, 0.96, 0.9−1.0; p = 0.02 and were less likely to be entire (uncastrated) males, SCD 9/57 (16%) vs. OFI (46/188, 25%; OR, 95% CI, 0.47, 0.1−0.9; p = 0.03). Survival in years (median (IQR)) for horses with SCD was 3.6 (3.1−4.4), which was shorter than OFI (4.5 [3.1−6.0], hazard ratio, 95%CI, 1.6,1.2−2.3; p < 0.001). SCD occurs more commonly in training than racing, which suggests exercise intensity is less important in precipitating this fatality. In this study, SCD occurred early in the careers of affected horses.

Factors Associated with Fatality in Ontario Thoroughbred Racehorses: 2003-2015

Simple Summary

Ontario’s Alcohol and Gaming Commission records equine racing fatalities through its Equine Health Program. This study examines the 695 Thoroughbred occurrences from 2003 to 2015 with the aim of identifying associations. Deaths occurred within 60 days of a horse racing or being entered or qualified to race. Calculated on the most commonly adopted basis, rates for Ontario Thoroughbreds are high—2.94/1000 starts (all fatalities) and 1.96/1000 (breakdowns only), compared with a global industry breakdown range of 0.29–2.36/1000 starts. The study revealed several significant risk factors, including workload, stage of training, age, sex, stage of career, finish position, race field size, and day of week. Among fatalities were groups where combinations of these risk factors were important, such as being a two-year-old male, un-castrated, and in early training. Probability of fatality fell over the study period in response to increasing awareness through existence of the Program and adoption of new regulations, but remains of concern. All identified associations represent aspects of management and industry structure that are amenable to change with a view to reducing fatalities. A link between fatality and cumulative, non-fatal outcomes should also be considered. An overall approach might view associated factors as sources of physical and psychological stress that, acutely and cumulatively, may influence the liability for adverse outcomes in training and racing.

Abstract

Ontario’s Alcohol and Gaming Commission records equine racing fatalities through its Equine Health Program. The present study examined all Thoroughbred fatalities from 2003 to 2015, inclusive, to identify associations. Official records and details of fatalities were combined in multivariable logistic regression modelling of 236,386 race work-events (433 fatalities), and 459,013 workout work-events (252 fatalities). Fatality rates were 2.94/1000 race starts (all fatalities) and 1.96/1000 (breakdowns only) with an overall rate of 2.61% or 26.1 fatalities/1000 horses. Comparison with published reports reveals rates to be high. Musculoskeletal injury was the predominant complaint and there was a high incidence of horses dying suddenly. Liability was high for young horses early in the season with a differential according to sex and whether a male horse was gelded. Horses undertaking repeated workouts had a higher liability and liability was higher in workouts for horses switching from dirt/synthetic to turf racing and for young horses in sprints. Race distance was not significant but high fatality rates in some large field, distance races combined with effects of age and workload identified groups at particular risk. As field size increased, fatality liability increased for early-finishing horses. Findings suggest jockey strategy could be an important factor influencing fatalities. Probability of fatality declined over the study period. Findings indicate that rapid accumulation of workload in animals early in their preparation is likely to be damaging. Fatality fell toward the end of a season and for horses with a long career history of successful performance; however, horses not exhibiting this robustness and staying power represent the population of greatest concern. Associations may be characterised as representing sources of stress, current or cumulative, and identifying at-risk animals on this basis may be as productive as targeting specific, discrete mechanisms suspected to contribute to individual fatalities.

Factors Associated with Mortality in Ontario Standardbred Racing: 2003-2015

Simple Summary

Racing provides employment and career engagement, is passionately pursued, and helps sustain our close relationship with horses, but it can also be associated with injury and losses. Fatalities occur on and off racetracks, involving welfare concerns, economic impact, and damage to racing’s public profile and social license. Musculoskeletal injury, the most visible loss, represents only one source and remains poorly understood, while for other losses and off-track mortality little is known. In 2003, the Province of Ontario, Canada introduced a registry for racehorse mortalities, providing opportunities to better understand losses and contributing factors. Following an earlier publication describing losses across all breeds, this paper presents analysis of standardbred mortality and relationships with routine management and competition. Results reveal that aspects of industry structure may contribute to mortality, and that the impact might be anticipated by close monitoring of a horse’s profile and performance. The immediate circumstances precipitating any specific fatality should be seen as separate from this underlying environmental liability. This has implications for how future research might be conducted and findings interpreted. It is hoped the present study can be used to decrease mortality and cumulative injury so as to reduce losses and strengthen societal support for racing.

Abstract

Factors associated with mortality in standardbred racehorses were assessed through a retrospective annualized cohort study of all-cause mortality from 2003–2015 (n = 978) (identified in the Ontario Racehorse Death Registry). Race and qualifying data for official work-events were also gathered (1,778,330 work-events, 125,200 horse years). Multivariable logistic regression analysis revealed sex, age, and indices of workload and intensity and their interactions to be strongly associated with mortality. Track class, race versus qualifying performance, and work-event outcome (finish position, scratched, or failed to finish) also influenced mortality odds, which increased as performance slowed. Intense competition at higher performance levels and qualifying races at lower levels carried particularly high odds. Though occurring frequently, musculoskeletal injury was less frequent than all other presenting problems combined. Industry structure contributes to mortality through interaction between horse characteristics and the competition environment. This substrate may be amenable to management to minimize liability, but incident-specific triggers may represent chance factors and be relatively difficult to identify or control. Differentiating between substrate and trigger when studying specific clinical problems may provide greater clarity and yield in identifying underlying causes. Mortality may reflect a continuum of circumstances, cumulative impacts of which might be identified before a fatal event occurs.