Risk factors for the occurrence of cramps during the Ironman Triathlon: a longitudinal study

Abstract Introduction Exercise-associated muscle cramps (EAMC) are a significant concern due to the discomfort caused and their negative effects on athletic performance and recovery. Given the uncertainties in the literature regarding risk factors and effective preventive strategies, the determinants of EAMC remain unclear. This study aimed to identify potential risk factors associated with the occurrence of EAMC in triathletes. Methods The study participants comprised 136 triathletes who completed an Ironman Triathlon race. Pre-race questionnaire collected data on anthropometric measurements (height, weight), demographics (age, sex), training variables (training duration, flexibility training), history and frequency (none, infrequent, or frequent) of cramps, and race planning details (expected race time, hydration and nutrition strategies). Triathletes were contacted post-race to report EAMC occurrence during or immediately after the race. Results Exploratory modeling suggested associations between EAMC occurrence, history of cramps, perceived cramp frequency, and adherence to hydration plans. Triathletes who perceived EAMC as infrequent had 3.2-fold higher odds (95% confidence interval [CI]: 1.3; 8.1) of experiencing EAMC compared to those with no prior history of cramps. Those who reported frequent EAMC had 19.7-fold higher odds (95% CI: 3.2; 122.7) compared to those without prior cramps. Furthermore, triathletes who did not adhere to their hydration plan had 3.0-fold higher odds (95% CI: 1.1; 8.3) of developing EAMC compared to those who followed their plan. Conclusion The findings suggest that a history of frequent cramps and non-adherence to hydration strategies may be associated with increased odds of EAMC in long-distance triathletes. However, the modest number of EAMC cases warrants cautious interpretation.