How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study.

Jesper Schuster Brandt Frandsen, Adam Hulme, Erik Thorlund Parner, Merete Møller, Ida Lindman, Josefin Abrahamson, Nina Sjørup Simonsen, Julie Sandell Jacobsen, Daniel Ramskov, Sebastian Skejø, Laurent Malisoux, Michael Lejbach Bertelsen, Rasmus Oestergaard Nielsen

British journal of sports medicine8/26/2025·Read paper

Abstract

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. 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). 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. 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.

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