Pre-race medical screening and harm reduction approaches in ultra-endurance racing: A descriptive pilot study of global practice

Background: The rapidly expanding popularity of ultra-endurance racing warrants an analysis of current safety protocols. The literature highlights various risks linked to participating in these events, including sudden cardiac death, electrolyte imbalance, kidney injury and exertional heat stroke. Where guidelines recommend exercise pre-screening, global implementation has not yet been described. This study aims to explore the prevalence of pre-race screening and harm reduction across the global ultra-racing industry. Methods: This pilot observational study audited 200 ultra-races across 67 countries, spanning all continents and five race modalities. A comprehensive search strategy examined publicly available information, gathering 40 data points per race, including 22 pre-race screening and harm reduction metrics, as communicated at the point of registration. Results were then reviewed for concordance with relevant international guidelines. Results: This study found that a quarter (24 ​%) of ultra-races did not employ any medically relevant pre-race screening or harm reduction strategies (point of registration). A strong bias was identified favouring individual assumption of liability. Where screening occurred, approaches were generally inconsistent with guidelines and did not account for the specific risks imposed by race location, climate or duration. Less than one third (29 ​%) of ultra-races specified endurance experience as an entry requirement. More comprehensive screening was observed in South America and among high-altitude races (>2500 ​m). Conclusions: This study highlights opportunities to improve athlete safety broadly across ultra-racing. Such events carry unique physiological risks. Here, existing pre-race approaches seemingly fall short of recommended practice. By establishing clearer benchmarks, targeted improvements will become possible. This will promote sustainable practices in what promises to remain a popular exercise industry in the future.