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There are limited data on the negative effects of exercise in athletes with acute infective illness. The aim of this study was to determine whether a recently diagnosed prerace acute illness in runners affects the ability to finish a race.Runners were prospectively evaluated in the 3 days before the race for acute infective illness and then received participation advice using clinical criteria based on systemic or localised symptoms/signs. We compared the did-not-start and the did-not-finish frequencies of ill runners (Ill=172: localised=58.7%; systemic=41.3%) with that of a control group of runners (Con=53 734).Runners with a systemic illness were 10.4% more likely not to start compared with controls (29.6% vs 19.2%) (p=0.0073). The risk difference of not starting the race in runners who were advised not to run the race compared with controls was 37.3% (56.5% vs 19.2%, p<0.0001). Compared with controls, runners with illness had a significantly (p<0.05) greater risk (any illness (5.2% vs 1.6%), systemic illness (8.0% vs 1.6%), illness <24 hours before the race (11.1% vs 1.6%)) and relative risk (prevalence risk ratio) (any illness=3.4, systemic illness=4.9, systemic illness <24 hours before the race=7.0) of not finishing the race.Runners with prerace acute systemic illness, and particularly those diagnosed <24 hours before race day, are less likely to finish the race, indicating a reduction in race performance.