Oral non-steroidal anti-inflammatory drug use in amateur runners: a cross sectional survey of Parkrun UK participants

A. R. Cox¹, F. L. Morley¹, I. Ahmed¹, C. J. Rosenbloom². ¹School of Pharmacy, University of Birmingham, Birmingham, United Kingdom,²Centre for Sports and Exercise Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used by professional athletes.(1) They increase the risk of adverse drug reactions (ADRs) such as acute kidney damage, hyponatraemia, and gastrointestinal harm during exercise.(2,3) This study aimed to examine the use of NSAIDs, and the behaviour, knowledge, and attitudes towards the use of NSAIDs in an amateur running population.

Method: A self-completed online questionnaire of amateur runners participating in Parkrun UK (who organise free 5 km runs every Saturday in the UK) was distributed in November 2016. Inclusion criteria were Parkrun UK runners over the age of 18 residing in the UK. Ethical approval was granted by Queen Mary’s University and the University of Birmingham.

Results: 806 valid questionnaires were received. Mean age of respondents was 48 years of age (SD=12.39, range of 18-82 years), with 51% female. The majority (87.8%, n=708) indicated the use of oral NSAIDs in the past 12 months. Ibuprofen was the most commonly used NSAID (81%). Oral NSAID use in the past 12 months was associated with a sporting injury (χ²= 10.89, df=1, n=797, p<0.001). 3.4% self-reported exceeding the recommended daily dose. Pre-existing contra-indications to NSAIDs included asthma (n=115), and a history of GI bleeding or ulcers (n=30). Fifty-seven percent of respondents had taken NSAIDs before a run/race, 11% during, and 67.7% afterwards. Use of an NSAID during running was statistically associated with runners of longer duration events (χ²= 53.32, df=5, n=800, p<0.001). (Table 1) A quarter of respondents experienced an ADR as a result of NSAID use, largely as a result of gastrointestinal ADRs. A third had received professional advice on NSAID use. A majority of respondents (795, 94.2%) indicated that they would read information about NSAIDS and exercise if provided to them.

Conclusion: Use of NSAIDs in amateur runners is high. Injury is a predictor of NSAID use, with a high rate of use before and after races to increase pain tolerance. Runners engaged in longer endurance events had concerning levels of NSAID use during events. Limited evidence for benefits of NSAIDs, and risks of harms, suggests clearer advice on NSAIDs by athletes is required.

References

1. Thuyne, WV and Delbeke FT (2008). Clin J Sport Med 18(2): 143-7

2. Ziltener JL et al (2010). Ann Phys Rehabil Med 53(4): 278-288

3. Wharam PC et al (2006). Med. Sci. Sports Exerc 38(4): 618-622

Table 1: NSAID use during an event, by longest race distance of respondent.