Infographic. ‘As easy as riding a bike’ - a narrative review of injuries and illness in road cycling

The World Health Organisation (WHO) recommends that adults should do at least 150 19 minutes of moderate-intensity physical activity or 75 minutes of vigorous physical activity 20 per week (1). Despite this, recent statistics show that one in four adults do not meet the 21 recommended physical activity guidelines (2). Road cycling is an effective form of exercise 22 that can help overcome the population’s failure to meet physical activity guidelines. In 23 addition, the popularity of cycling at an elite level continues to grow. Injuries sustained during road cycling can act as a deterrent to future participation; both at amateur and 25 professional levels. Whilst studies have described the most common types of injuries 28 during road cycling at both amateur and professional levels (5). The systematic review was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta- 30 analyses (PRISMA) guidance (6). Knowledge of road cycling injuries will allow 31 implementation of preventative measures, improving the safety of road cycling. This will 32 increase the likelihood that the general population will pursue road cycling as a form of 33 physical activity whilst also maximising competition availability for elite road cyclists. 34 Further, it is vital that we have information regarding the rate of illness amongst road 35 cyclists and the factors that need to be addressed to reduce this risk. 36 37 FIGURE 1 HERE 38 39 Results of our review indicated that the injury type with the highest incidence were 40 abrasions, lacerations and haematomas, accounting for 40-60% of the total injuries https://mc.manuscriptcentral.com/bjsm Confidential: For Review Only Page 5 of 6 British Journal of Sports Medicine 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 47 19 recorded. Fractures (6-15%) were the second most common type of injury, with the clavicle being the most common fracture site. Head injuries (including concussions) accounted for 2- 15% of injuries with musculotendinous injuries accounting for 2-18%. Upper limb injuries were more common than lower limb injuries, and amateurs appeared to be at higher risk of injury/illness than professionals. Patellofemoral pain syndrome was the most common overuse injury. Illness was a common cause of withdrawal from cycling events and the rate of illness increased with age. For instance, amongst professional cyclists, 47% of race withdrawals were due to non-traumatic causes such as medical illness. Importantly, our review highlights that the incidence rate reported in prior studies varies widely and this can be largely explained by inconsistencies in the recording and reporting of injuries. Accordingly, it highlights the need for a standardised method when conducting future research, such as that outlined by the International Olympic Committee, to allow direct comparison to other sports using the same method of injury classification (7). Our study has identified unique injury patterns related to road cycling. As such, unique harm minimisation strategies are required to improve rider safety. Amateurs appear to have a higher risk of injury compared to professional cyclists, and this may require specific prevention strategies targeted to this group, such as bike handling skill courses. The results, summarised in our infographic, can help guide these measures that will minimise drop-out from competitive cycling events and cycling as a recreational activity.