Mass participation endurance sports events are popular but a large number of participants are older and may be at risk of medical complications during events. Medical encounters (defined fully in the statement) include those traditionally considered ‘musculoskeletal’ (eg, strains) and those due to ‘illness’ (eg, cardiac, respiratory, endocrine). The rate of sudden death during mass endurance events (running, cycling and triathlon) is between 0.4 and 3.3 per 100 000 entrants. The rate of other serious medical encounters (eg, exertional heat stroke, hyponatraemia) is rarely reported; in runners it can be up to 100 times higher than that of sudden death, that is, between 16 and 155 per 100 000 race entrants. This consensus statement has two goals. It (1) defines terms for injury and illness-related medical encounters, severity and timing of medical encounters, and diagnostic categories of medical encounters, and (2) describes the methods for recording data at mass participation endurance sports events and reporting results to authorities and for publication. This unifying consensus statement will allow data from various events to be compared and aggregated. This will inform athlete/patient management, and thus make endurance events safer.

Background: Personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There are limited data on the prevalence of unhealthy lifestyle habits among medical students and the impact of acquired health knowledge throughout the curriculum. The aim of this study was to determine and compare the prevalence of modifiable behavioural NCD risk factors of medical students in different academic years at a South African tertiary institution. Methods: A cross-sectional observational study of 532 consenting medical students was conducted. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep). Results: Lifestyle-related risk factors with the highest prevalence were poor sleep quality (66.0%), low levels of habitual physical activity (55.8%) and low-to-moderate diet quality (54.5%). There were no differences between academic years for all risk factors measured. Over 60% of the cohort had two or more NCD risk factors and this prevalence did not differ across the degree program with the acquisition of more health knowledge. Conclusion: Medical students have a high prevalence of poor sleep quality, low levels of physical activity and low-to-moderate diet quality, which does not appear to change over the course of their academic career. Sleep hygiene, regular physical activity and healthy nutrition should be targeted in intervention programmes and be more prevalent in the medical curriculum.

Background. The personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There is limited evidence on the prevalence of modifiable NCD risk factors among medical students in South Africa (SA). Objectives. To determine the prevalence of modifiable behavioural and metabolic NCD risk factors in first-year medical students at a SA university. Methods. This cross-sectional observational study included 256 first-year students. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep quality). NCD-related metabolic markers including body composition, blood pressure, total cholesterol and random glucose concentrations, were measured. The prevalence of risk factors was calculated using internationally accepted criteria, and sex differences were reported using one-way ANOVA or χ2 test (p<0.05). Results. The prevalence of poor sleep quality was 79.7%, followed by low-to-moderate diet quality (66.8%), low levels of physical activity (64.1%), overweight/ obesity (26.2%), current/past smoking (13.3%) and harmful use of alcohol (12.5%). Most (88.3%) participants had two or more NCD-related risk factors. The prevalence of multiple NCD risk factors differed significantly between male and female participants, with more male participants having ≥2. Conclusions. This study found that first-year medical students at a South African university have a high prevalence of lifestyle-related risk factors, specifically poor sleep quality, low levels of physical activity and low-to-moderate diet quality. Sleep hygiene, regular activity and good nutrition should be promoted, and interventions focusing on nutrition, smoking cessation and alcohol consumption could be targeted by sex.

This conceptual, implementation-oriented paper proposes a framework for precision prevention centred on physical activity promotion and early risk mitigation, aiming to support a shift from reactive disease management toward proactive prevention. The proposed framework focuses on the early identification of risk trajectories by integrating biological, environmental, and social determinants of health through systems thinking, multi-omics technologies, digital health, and behavioural science. It aims to inform tailored, context-sensitive interventions that will help to mitigate chronic non-communicable diseases (NCDs), while supporting lifelong resilience. Within this framework, physical activity is positioned as the central, modifiable anchor behaviour through which personalised prevention strategies may be operationalised. Building on the 2025 Hamburg Declaration and the Global Alliance for the Promotion of Physical Activity’s (GA@PA) mission, this conceptual paper proposes a multidimensional model, combining personalised strategies for physical activity, nutrition, sleep, and mental health with contextual environmental adaptations. By bringing together stakeholders across multiple sectors, including healthcare, education, urban planning, sport organisations, industry, and community groups, GA@PA aims to strengthen global collaboration and to accelerate the implementation of evidence-based strategies for physical activity promotion. Emerging technologies, including digital twins, wearable biosensors and artificial intelligence (AI)-driven analytics, are discussed as potential enabling tools for real-time monitoring and for providing input for adaptive interventions, while mobile health platforms may extend access to underserved populations. Rather than providing prescriptive solutions, the paper outlines key implementation fundamentals. These include technological infrastructure with interoperable biosensors and AI aligned with prevailing ethical frameworks such as the AI Act and UNESCO recommendations; interdisciplinary research on resilience and outlier populations; policy and education reform, including routine assessment of physical activity as a vital sign within healthcare encounters; and cross-sector collaboration spanning urban design to sport-for-development initiatives such as the International Olympic Committee (IOC)’s Olympism365. Sports organisations may support broader participation through sport-for-all programmes. The framework emphasises equity, cultural adaptation, and community co-design as critical features for scalability across diverse global contexts, highlighting the role of sport, fitness, and public health partnerships in creating a context where healthy choices become accessible and sustainable. Overall, this conceptual paper outlines a practice-informed framework proposing precision prevention as an evolving and testable implementation framework for supporting sustainable and equitable prevention systems. By integrating science, technology and policy through a multisectoral lens, precision prevention is proposed as a testable pathway to reduce the NCD burden, to enhance the health span and to foster resilient societies.