Does the Elevation Matter? 1-year Prospective Cohort Study

Trail running is defined by significant elevation changes and diverse, uneven terrain. This activity naturally occurs outdoors on off-road paths, often in remote or rugged areas, and has experienced a remarkable rise in popularity in recent years. That could explain why runners of various levels incorporate trail running into their training routine. However, a high risk of running-related injury (RRI) is still present. PURPOSE: To investigate the associations between RRI incidence (total and specific body regions) and elevation gain in running. METHODS: A subsample of 581 participants was derived from the 4HAIE study database (program 4 HAIE CZ.02.1.01/0.0/0.0/16_019/0000798). The inclusion criteria for our subsample comprised the VO2max test completion during a baseline measurement, running volume higher than 6 kilometers weekly, and a minimum of 3 months of the Fitbit data reports. The RRI data were collected through weekly self-reported injury via a mobile app over a one-year follow-up period following the baseline assessment (total, foot, ankle, calf, shin, knee, thigh, lower back regions RRI). Elevation gain, weekly distance, and average velocity were derived using a custom script in Python from the Fitbit Charge 3 and Charge 4 fitness tracker based on minute-to-minute accelerometer and barometer data. Binary logistic regression was used to determine the relationship between injury incidence and elevation. The alpha level was set at P ≤ 0.05. RESULTS: There were 219 RRI in total. RRI distributed over body regions were: 71 foot, 44 ankle, calf 67, knee 81, thigh 69, glutes 23, and 58 lower back. The logistic regression model for total RRI was significant (x2(4) = 14.16, P = 0.007), however, the elevation gain was not a significant predictor. The model for ankle RRI was also significant (x2(4) = 17.50, P = 0.002) indicating that participants with bigger elevation gain had significantly higher odds of having ankle RRI (OR: 1.24, 95% CI, 0.80-0.343; P = 0.002). Other models were not significant. All models were controlled for age, weight, and average velocity. CONCLUSION: The findings from binary logistic regression suggest that higher elevation gain appears as a risk factor for RRI in the ankle region. Supported by: This abstract has been produced with the financial support of the European Union under the LERCO project (CZ.10.03.01/00/22_003/0000003) via the Operational Programme Just Transition.