{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T17:54:02Z","timestamp":1794592442677,"version":"4.9.1"},"reference-count":49,"publisher":"BMJ","issue":"17","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008368","name":"Danish Rheumatism Association","doi-asserted-by":"crossref","award":["R160-A5157"],"award-info":[{"award-number":["R160-A5157"]}],"id":[{"id":"10.13039\/100008368","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002739","name":"Aarhus University Research Foundation","doi-asserted-by":"crossref","award":["AUFF-E-2015-FLS-9-9"],"award-info":[{"award-number":["AUFF-E-2015-FLS-9-9"]}],"id":[{"id":"10.13039\/501100002739","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2025,6,11]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We explored whether a spike in running distance during a single session or over 1\u2009week, compared with the preceding period, was associated with increased risk of running-related overuse injury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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\u2009weeks 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) \u2018small spike\u2019 between &gt;10% and 30%\u2009increase; (3) \u2018moderate spike\u2019 between &gt;30% and 100%\u2009increase; and (4) \u2018large spike\u2019 &gt;100% increase. Outcome was self-reported overuse running-related injury. A multistate Cox regression model was used to estimate adjusted hazard rate ratios (HRR).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2009071 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&lt;0.01)) and large spikes (HRR=2.28 (95% CI: 1.50 to 3.48, p&lt;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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bjsports-2024-109380","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T08:30:13Z","timestamp":1751877013000},"page":"1203-1210","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study"],"prefix":"10.1136","volume":"59","author":[{"given":"Jesper","family":"Schuster Brandt Frandsen","sequence":"first","affiliation":[{"name":"Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Hulme","sequence":"additional","affiliation":[{"name":"Southern Queensland Rural Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia"},{"name":"Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik Thorlund","family":"Parner","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7514-0399","authenticated-orcid":false,"given":"Merete","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"},{"name":"Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1450-4114","authenticated-orcid":false,"given":"Ida","family":"Lindman","sequence":"additional","affiliation":[{"name":"General Practice\/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Research, Education, Development and Innovation, Primary Health Care, Region V\u00e4stra G\u00f6taland, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3949-0425","authenticated-orcid":false,"given":"Josefin","family":"Abrahamson","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Unit, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Health and Rehabilitation, University of Gothenburg Institute of Neuroscience and Physiology, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Sj\u00f8rup Simonsen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"},{"name":"Research Unit for General Practice, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Sandell Jacobsen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"},{"name":"Research Unit for General Practice, Aarhus, Denmark"},{"name":"Research Centre for Care and Rehabilitation, Faculty of Health and Society, VIA University College, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ramskov","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Skej\u00f8","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"},{"name":"Research Unit for General Practice, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6601-5630","authenticated-orcid":false,"given":"Laurent","family":"Malisoux","sequence":"additional","affiliation":[{"name":"Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Lejbach","family":"Bertelsen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"},{"name":"Department of Sports Science and Clinical Biomechanics, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5757-1806","authenticated-orcid":false,"given":"Rasmus Oestergaard","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"},{"name":"Research Unit for General Practice, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"2025082607201863000_59.17.1203.1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-015-0359-y"},{"key":"2025082607201863000_59.17.1203.2","doi-asserted-by":"publisher","DOI":"10.1177\/1012690213509807"},{"key":"2025082607201863000_59.17.1203.3","doi-asserted-by":"crossref","unstructured":"Scheerder J , Breedveld K , Borgers J . Running across Europe: the rise and size of one of the largest sport markets. Springer, 2015.","DOI":"10.1057\/9781137446374"},{"key":"2025082607201863000_59.17.1203.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0181167","article-title":"Who uses running apps and sports watches? Determinants and consumer profiles of event runners\u2019 usage of running-related smartphone applications and sports watches","volume":"12","author":"Janssen","year":"2017","journal-title":"PLoS One"},{"key":"2025082607201863000_59.17.1203.5","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-020-01412-7"},{"key":"2025082607201863000_59.17.1203.6","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-015-0333-8"},{"key":"2025082607201863000_59.17.1203.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2018.06.003"},{"key":"2025082607201863000_59.17.1203.8","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000002227"},{"key":"2025082607201863000_59.17.1203.9","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17176046","article-title":"Runner\u2019s Perceptions of Reasons to Quit Running: Influence of Gender, Age and Running-Related Characteristics","volume":"17","author":"Menheere","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025082607201863000_59.17.1203.10","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2014.5710"},{"key":"2025082607201863000_59.17.1203.11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0273401","article-title":"Going their own way-male recreational runners and running-related injuries: A qualitative thematic analysis","volume":"17","author":"Peterson","year":"2022","journal-title":"PLoS One"},{"key":"2025082607201863000_59.17.1203.12","doi-asserted-by":"publisher","DOI":"10.1123\/jsr.2021-0364"},{"key":"2025082607201863000_59.17.1203.13","doi-asserted-by":"publisher","DOI":"10.1111\/sms.12883"},{"key":"2025082607201863000_59.17.1203.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2014.07.014"},{"key":"2025082607201863000_59.17.1203.15","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096581"},{"key":"2025082607201863000_59.17.1203.16","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507307505"},{"key":"2025082607201863000_59.17.1203.17","doi-asserted-by":"publisher","DOI":"10.26603\/ijspt20180931"},{"key":"2025082607201863000_59.17.1203.18","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2014.5164"},{"key":"2025082607201863000_59.17.1203.19","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-095788"},{"key":"2025082607201863000_59.17.1203.20","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2014.0506"},{"key":"2025082607201863000_59.17.1203.21","doi-asserted-by":"publisher","DOI":"10.1123\/IJSPP.2017-0208"},{"key":"2025082607201863000_59.17.1203.22","doi-asserted-by":"publisher","DOI":"10.2519\/josptopen.2024.0075"},{"key":"2025082607201863000_59.17.1203.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-032627","article-title":"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","volume":"9","author":"Nielsen","year":"2019","journal-title":"BMJ Open"},{"key":"2025082607201863000_59.17.1203.24","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-103651"},{"key":"2025082607201863000_59.17.1203.25","doi-asserted-by":"publisher","DOI":"10.1519\/JSC.0000000000001244"},{"key":"2025082607201863000_59.17.1203.26","doi-asserted-by":"publisher","DOI":"10.1519\/JSC.0b013e3182711e3c"},{"key":"2025082607201863000_59.17.1203.27","first-page":"1101","article-title":"Preventing running injuries. Practical approach for family doctors","volume":"49","author":"Taunton","year":"2003","journal-title":"Can Fam Physician Med Fam Can"},{"key":"2025082607201863000_59.17.1203.28","doi-asserted-by":"publisher","DOI":"10.1055\/a-0955-5589"},{"key":"2025082607201863000_59.17.1203.29","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2012-091524"},{"key":"2025082607201863000_59.17.1203.30","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2015.5741"},{"key":"2025082607201863000_59.17.1203.31","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-016-0636-4"},{"key":"2025082607201863000_59.17.1203.32","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jshs.2020.06.006","article-title":"Risk factors for overuse injuries in short- and long-distance running: A systematic review","volume":"10","author":"van Poppel","year":"2021","journal-title":"J Sport Health Sci"},{"key":"2025082607201863000_59.17.1203.33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0114937","article-title":"Injuries in runners; a systematic review on risk factors and sex differences","volume":"10","author":"van der Worp","year":"2015","journal-title":"PLoS One"},{"key":"2025082607201863000_59.17.1203.34","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwk052"},{"key":"2025082607201863000_59.17.1203.35","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099408"},{"key":"2025082607201863000_59.17.1203.36","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-100000"},{"key":"2025082607201863000_59.17.1203.37","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2016.6510"},{"key":"2025082607201863000_59.17.1203.38","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2147\/OAJSM.S231405","article-title":"The Relationship Between Acute: Chronic Workload Ratios and Injury Risk in Sports: A Systematic Review","volume":"11","author":"Maupin","year":"2020","journal-title":"Open Access J Sports Med"},{"key":"2025082607201863000_59.17.1203.39","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-021-01483-0"},{"key":"2025082607201863000_59.17.1203.40","doi-asserted-by":"crossref","unstructured":"Joachim MR , Heiderscheit BC , Kliethermes SA . Week-to-week changes in training were not prospectively associated with injuries among Wisconsin high school cross-country runners. Inj Prev 2024;ip\u20132024. doi:10.1136\/ip-2024-045233","DOI":"10.1136\/ip-2024-045233"},{"key":"2025082607201863000_59.17.1203.41","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2017-000333","article-title":"Run Clever - No difference in risk of injury when comparing progression in running volume and running intensity in recreational runners: A randomised trial","volume":"4","author":"Ramskov","year":"2018","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2025082607201863000_59.17.1203.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2018.09.001"},{"key":"2025082607201863000_59.17.1203.43","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-105670"},{"key":"2025082607201863000_59.17.1203.44","doi-asserted-by":"publisher","DOI":"10.1111\/sms.13725"},{"key":"2025082607201863000_59.17.1203.45","doi-asserted-by":"publisher","DOI":"10.1002\/ejsc.12123"},{"key":"2025082607201863000_59.17.1203.46","doi-asserted-by":"publisher","DOI":"10.1080\/15438627.2018.1492399"},{"key":"2025082607201863000_59.17.1203.47","doi-asserted-by":"crossref","DOI":"10.1186\/s13102-022-00472-8","article-title":"Feasibility and usability of GPS data in exploring associations between training load and running-related knee injuries in recreational runners","volume":"14","author":"Cloosterman","year":"2022","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"2025082607201863000_59.17.1203.48","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-100245"},{"key":"2025082607201863000_59.17.1203.49","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.21383"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2024-109380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T14:21:03Z","timestamp":1756218063000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2024-109380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,7]]},"references-count":49,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,8,26]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bjsports-2024-109380"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2024-109380","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,7]]}}}