Skip to main content Accessibility help

Mandatory Rest Stops Improve Athlete Safety during Event Medical Coverage for Ultramarathons

  • Jeremy Joslin (a1), Joshua Mularella (a1), Allison Bail (a1), Susan Wojcik (a1) and Derek R. Cooney (a1)...



Provisions of medical direction and clinical services for ultramarathons require specific attention to heat illness. Heat stress can affect athlete performance negatively, and heat accumulation without acclimatization is associated with the development of exertional heat stroke (EHS). In order to potentially mitigate the risk of this safety concern, the Jungle Marathon (Para, Brazil) instituted mandatory rest periods during the first two days of this 7-day, staged, Brazilian ultramarathon.


Race records were reviewed retrospectively to determine the number of runners that suffered an emergency medical complication related to heat stress and did not finish (DNF) the race. Review of records included three years before and three years after the institution of these mandatory rest periods.


A total of 326 runners competed in the Jungle Marathon during the 2008-2013 period of study. During the pre-intervention years, a total of 46 athletes (21%) DNF the full race with 25 (54.3%) cases attributed to heat-related factors. During the post-intervention years, a total of 26 athletes (24.3%) DNF the full race with four (15.4%) cases attributed to heat-related factors.


Mandatory rest stops during extreme running events in hot or tropical environments, like the Jungle Marathon, are likely to improve athlete safety and improve the heat acclimatization process.

Joslin J , Mularella J , Bail A , Wojcik S , Cooney DR . Mandatory Rest Stops Improve Athlete Safety during Event Medical Coverage for Ultramarathons. Prehosp Disaster Med. 2016;31(1):4345.


Corresponding author

Correspondence: Derek R. Cooney, MD, FF/NREMT-P, FACEP Department of Emergency Medicine 550 East Genesee Street/EMSTAT Center SUNY Upstate Medical University Syracuse, New York 13202 USA E-mail:


Hide All
1. Ong, JC, Hoffman, MD, Wang, G. Historical analysis of participation in 161 km ultramarathons in North America. Int J Hist Sport. 2010;27(11):1877-1891.
2. Hoffman, MD, Pasternak, A, Rogers, IR, et al. Medical services at ultra-endurance foot races in remote environments: medical issues and consensus guidelines. Sports Med. 2014;44(8):1055-1069.
3. Lipman, GS, Eifling, KP, Ellis, MA, Gaudio, FG, Otten, EM, Grissom, CK. Wilderness Medical Society practice guidelines for the prevention and treatment of heat-related illness. Wilderness Environ Med. 2013;24(4):351-361.
4. Costa, RJS, Crockford, MJ, Moore, JP, Walsh, NP. Heat acclimation responses of an ultra-endurance running group preparing for hot desert-based competition. Eur J Sport Sci. 2014;14(Suppl 1):S131-141.
5. American College of Sports Medicine, Armstrong, LE, Casa, DJ, Millard-Stafford, M, et al. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39(3):556-572.
6. Jungle Marathon Web site. Accessed March 30, 2015.
7. Tutiempo Network, SL Web site. Accessed March 30, 2015.
8. Joslin, J, Mularella, J. Worthing R. Heat-related illness: time to update our lexicon. Wilderness Environ Med. 2014;25(2):249-251.
9. Noakes, TD. A modern classification of the exercise-related heat illnesses. J Sci Med Sport. 2008;11(1):33-39.
10. Joslin, J, Worthing, R, Black, T, Grant, WD, Kotlyar, T, Wojcik, SM. Analysis of weight change and Borg rating of perceived exertion as measurements of runner health and safety during a 6-day, multistage, remote ultramarathon. Clin J Sport Med. 2014;24(3):245-250.
11. Army USDOT. Heat Stress Control and Heat Casualty Management. Memphis, Tennessee USA: Books LLC; 2012: 15-18.
12. Casa, DJ, Csillan, D, Inter-Association Task Force for Preseason Secondary School Athletics Participants et al. Preseason heat-acclimatization guidelines for secondary school athletics. J Athl Train. 2009;44(3):332-333.


Mandatory Rest Stops Improve Athlete Safety during Event Medical Coverage for Ultramarathons

  • Jeremy Joslin (a1), Joshua Mularella (a1), Allison Bail (a1), Susan Wojcik (a1) and Derek R. Cooney (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed