Author(s): JAMES, C., KILLOUGHERY, I., GIBSON, O.R., WILLMOTT, A.G.B., BANDIERA, D., IHSAN, M., Institution: HONG KONG BAPTIST UNIVERSITY, Country: HONG KONG, Abstract-ID: 1964

INTRODUCTION:
Exertional heat illness (EHI) remains a leading medical problem in endurance sports, with risk amplified by increasing heat stress driven by climate change and the growing scale of mass‑participation events. In Hong Kong, 30–50 runners are hospitalised annually during the Hong Kong Marathon, with the majority of cases attributed to EHI. While the physiological basis and practical application of heat‑adaptation strategies are well characterised, effective knowledge translation to the general public remains limited. Even among elite athletes, substantial gaps in heat‑preparation knowledge and implementation persist, with 43% reporting no specific heat preparation and 83% unaware of specific educational resources at a recent World Athletics championship (Galan-Lopez et al., 2023). There is therefore a need to evaluate heat illness knowledge and familiarity with prevention strategies in mass participation events.
METHODS:
A cross sectional survey was conducted among participants in the 2025 Hong Kong Marathon (10 km [n = 40], half marathon [n = 54], marathon [n = 38]). The questionnaire assessed heat illness knowledge, perceived risk and sensitivity, heat preparation behaviours (prior heat exposure, cooling, hydration planning), and intention to adopt preventive measures.
RESULTS:
Valid responses were obtained from 132 runners (mean age 38 ± 12 y). Participants demonstrated moderate heat‑illness knowledge (mean 13.1 ± 3.3 out of 19; range 2–19), with substantial variability across individuals. Overall, 59% reported knowing the expected environmental temperature and humidity for the race. Most participants reported at least some concern regarding heat illness (50% concerned or very concerned), while 42% considered themselves “sensitive” (28%) or “very” sensitive (14%) to exercising in the heat. Although 94% agreed that heat acclimation should precede competition in hot conditions, only 49% reported undertaking specific heat training, predominantly in natural hot environments (95%), and 52% did not plan a cooling strategy. Most runners planned low (52%) or moderate fluid intake (34%), while 8% were unsure of their hydration strategy. Heat‑illness knowledge was higher in runners intending to take preventive measures compared with those unwilling or unsure (13.8 ± 2.7 vs 9.5 ± 4.0; p<0.001). In multivariable analysis, heat‑illness knowledge independently predicted preventive intention (OR 1.47 per point increase; p<0.001), whereas perceived concern and heat sensitivity were not significant predictors.
CONCLUSION:
At a major public marathon with a consistent history of EHI, preventive intent was primarily linked to heat‑illness knowledge rather than perceived risk or sensitivity. Targeted, scalable education addressing EHI risk factors and mitigation measures may represent a meaningful approach to improving safety and preparedness in mass‑participation endurance events.