Planning Inclusive Mass Participation Endurance Events for Athletes with Impairment: The ACES Framework

Participation of athletes with impairment (AWI) in mass-participation endurance events is rapidly expanding, necessitating tailored logistical and medical planning to ensure safety, equity, and competitive integrity. Here we outline key considerations for event organizers and medical teams to prepare for and support AWI. Although AWI often share similar injury patterns with able-bodied athletes, they also present unique medical and logistical challenges, including accessibility barriers, equipment-specific issues, and specialized medical needs. We propose the "ACES" framework-"A": Access and Accommodations, "C": Course and Competition Safety, "E": Equipment and Emergency Preparedness, and "S": Support and Specialized Needs-as a guide for organizing inclusive endurance events. This framework facilitates comprehensive planning for venue access, course layout, adaptive equipment, emergency readiness, and inclusion of support personnel and service animals, thereby promoting safer and more inclusive sporting environments for AWI.