Background: Exercise associated muscle cramping (EAMC) is a common medical condition encountered by endurance athletes, yet information regarding EAMC in cyclists in lacking. Aim of the study: To determine the epidemiology, clinical characteristics, and independent risk factors associated with EAMC in cyclists participating in a mass participation cycling event. Design: Cross-sectional study Setting: 2016 Cape Town Cycle Tour (CTCT), South Africa Participants: 22560 consenting cycle race entrants Methods: Epidemiological data (lifetime prevalence and annual incidence) and clinical characteristics (main muscle groups affected, timing of onset, severity [mild - severe] and frequency of serious forms of EAMC [sEAMC]) in cyclists with a history of EAMC (hEAMC) are reported on. A multiple regression analysis was applied in order to determine if the following factors were associated risk factors for EAMC in cyclists with a hEAMC: chronic disease composite score, cycling training / racing history (years of recreational cycling, years of participation in distance cycling events > 2 hours, average number of training sessions per week, average weekly cycling distance in the last 12 months, and average training speed), history of chronic disease (history of cardiovascular disease [CVD], risk factors for CVD, symptoms of CVD, metabolic/hormonal disease, respiratory disease, gastrointestinal disease, nervous system/psychiatric disease, kidney/bladder disease, haematological/immune system disease, and cancer) and allergies, and history of cycling injuries. Results: A total of 35914 cyclists entered the race, 27349 completed the online pre-race medical screening questionnaire, and 22560 gave informed consent for the use of their data in this study (62.82% of all race entrants). The lifetime prevalence of EAMC was 30.6%, with an annual incidence of 18.7%. The quadriceps muscle group was the most commonly affected muscle group (47.7%), the most common time period for the onset of EAMC was during the fourth quarter of the race (63.0%), and mild (less than 5 minutes) EAMC occurred more frequently (67.0%) than other forms of EAMC. Serious EAMC was reported by 5.6% of the study population, and included whole body EAMC (3.2%) and EAMC associated with dark urine (2.2%). Novel independent risk factors associated with an increased risk of hEAMC in cyclists were: a higher chronic disease composite score (PR=1.34 per 2 unit increase; p<0.0001), a history of any allergies (PR=1.17; p<0.0001), a history of an acute onset injury (PR=1.31; p<0.0001), a history of a gradual onset injury (PR=1.29; p<0.0001), and increased number of years participating in cycling events of > 2 hours (PR=1.34 per 2 unit increase, p<0.0001). Increased number of years as a recreational cyclist (PR=0.96 per 5 unit increase, p=0.0012) and increased average weekly training/racing frequency in the last 12 months (PR=0.95 per 2 unit increase, p=0.0015) were associated with a decreased risk of EAMC. From the univariate analysis, we identified a significantly higher prevalence of lifetime hEAMC in male cyclists (PR=2.16; p<0.0001), and a higher prevalence of hEAMC in the ≥51-year age category (37.6%). Conclusion: One in three cyclists report a lifetime hEAMC. In cyclists with a hEAMC, the quadriceps muscle group is the most commonly affected muscle group, EAMC commonly occurs in the last quarter of the race, most EAMC cases are reported as mild, and sEAMC is not common. The results from this study could influence the future prevention and management programmes of EAMC in recreational cyclists, and assist medical personnel in the planning and implementation of medical care at mass participation cycling events. A higher chronic disease composite score, a history of allergies, a history of injury (acute onset or gradual onset) and training / racing variables are novel independent risk factors associated with a hEAMC in cyclists taking part in a mass participation cycling event. Risk factors for EAMC need to be taken into consideration when implementing prevention and management programmes of EAMC in cyclists. Clinicians should also consider that in some cases, EAMC may be associated with underlying chronic diseases or allergies, and/or the medications used to treat such conditions. In addition, injury history and training variables need to be considered in the prevention and management of EAMC in cyclists. Keywords: muscle cramping, exercise associated muscle cramping, EAMC, cyclists, clinical characteristics, epidemiology, risk factors, chronic disease / Dissertation (MPhysiotherapy)--University of Pretoria, 2020. / Physiotherapy / MPhysiotherapy / Restricted

The purpose of this study was to assess the effect of performance feedback on Athletic Trainers’ (ATs) perceived knowledge (PK) and likelihood to pursue continuing education (CE). The investigation was grounded in the theories of “the definition of the situation” (Thomas & Thomas, 1928) and the “illusion of knowing,” (Glenberg, Wilkinson, & Epstein, 1982) suggesting that PK drives behavior. This investigation measured the degree to which knowledge gap predicted CE seeking behavior by providing performance feedback designed to change PK. A pre-test post-test control-group design was used to measure PK and likelihood to pursue CE before and after assessing actual knowledge. ATs (n=103) were randomly sampled and assigned to two groups, with and without performance feedback. Two independent samples t-tests were used to compare groups on the difference scores of the dependent variables. Likelihood to pursue CE was predicted by three variables using multiple linear regression: perceived knowledge, pre-test likelihood to pursue CE, and knowledge gap. There was a 68.4% significant difference (t101= 2.72, p=0.01, ES=0.45) between groups in the change scores for likelihood to pursue CE because of the performance feedback (Experimental group=13.7% increase; Control group= 4.3% increase). The strongest relationship among the dependent variables was between pre-test and post-test measures of likelihood to pursue CE (F2,102=56.80, p<0.01, r=0.73, R2=0.53). The pre- and post-test predictive relationship was enhanced when group was included in the model. In this model [YCEpost=0.76XCEpre-0.34 Xgroup+2.24+E], group accounted for a significant amount of unique variance in predicting CE while the pre-test likelihood to pursue CE variable was held constant (F3,102=40.28, p<0.01,: r=0.74, R2=0.55). Pre-test knowledge gap, regardless of group allocation, was a linear predictor of the likelihood to pursue CE (F1,102=10.90, p=.01, r=.31, R2=.10). In this investigation, performance feedback significantly increased participants’ likelihood to pursue CE. Pre-test knowledge gap was a significant predictor of likelihood to pursue CE, regardless if performance feedback was provided. ATs may have self-assessed and engaged in internal feedback as a result of their test-taking experience. These findings indicate that feedback, both internal and external, may be necessary to trigger CE seeking behavior.