The impact of triathlon training and racing on athletes’ general health.

Veronica Vleck1, Gregoire P Millet2, and Francisco Bessone Alves1

1 CIPER. FMH-UL. Portugal.

2 ISSUL, UNIL, Lausanne. Switzerland.

Corresponding author’s email address:

Table S2. Injury occurrence in triathlon (updated from Vleck V. Triathlon. In: Caine DJ, Harmer P, Schiff M, editors. Epidemiology of injury in Olympic sports. International Olympic Committee Encyclopaedia of Sports Medicine Series. West Sussex: Wiley-Blackwell. 2009; 294-320, [202], with permission)a

Reference / Study Design / Injury Definition / Subjects / Format / Ability level / Study duration / Returns (%) / Percentage of group affected by injury
All / Traumatic/ Acute / Overuse / Temp/ fluid related injury
Levy [204- 205] / R / TR, TR, Dr, Med / 31 M / Not clear / Triathlon club members’ i.e. unclear / 1 year / Unclear / 90.3 / - / - / -
Ireland and Micheli [206] / R / Unclear / 117 M, 51 F / 1 of 2 short and 1 IM event / 29% novice, 58% average, 22% expert / Unclear / Unclear / 64 / - / - / -
Murphy [207] / Descriptive / Unclear / Not clear / IM (possibly same as Massimino et al. [211]) / Mixed / Unclear / Unclear / 90.3 / - / - / -
O’Toole et al. [208] / R / Unclear / 35 M, 11 F / IM (Hawaii 1984) / AG - elite / Race medical report + 1 year retrospective / 4.6 / M 76, F 73 (1 year) / M 22, F 18 (1 year) / M 78C ,F 82 (1 year) / Not clear
Massimino et al. [209] b / R / Med / 58 M, 23 F / IM (Hawaii 1985) / Intermediate / Unclear / 8 / - / (22) 15 / 85 / 53.5 dehydration, 1 hypothermia, 1 hyperthermia
Williams et al. [210] / R / TR / ‘felt really uncomfortable in training and racing’ / 251 M, 81 F / 134 OD, 83 L, 115 S / AG-elite / Unclear / 59.3 / 50.6 / - / - / -
Collins et al. [211]c / R / TR, TR, Dr, Med, Non-T / 198 M, 59 F / Short / 38.9% beginners, 49.4 % intermediate, 11.7% elite / 1 year and 1 race. / 45 / - / Excluded / 49 / -
O’Toole et al. [203] / R / Athlete’s judgement. Given list of common overuse injuries / 75 M, 20 F / IM / AG – elite (15% pro.) / 1 year / 9.2 / 91 / - / 91 / -
Jackson [212] / Case study / Clinical case study. / 1 M / Mixed / AG / 8 weeks / - / - / - / 100 / -
Migliorini [213] / R, Descr / OU. Clinical Diagnosis. / 21 M, 3 F / OD (2 IM) / Elite- International Squad / 3 years / N/A / Not clear / - / - / -
Korkia et al. [214] / Pros / TR 1d, Race, Daily function. T/OU. / 124 M, 31 F / 9% M and 0.6% F long, 65.2 % M and 5.1% F short. Not all could be classified. / AG - elite / 8 weeks / 21.0 / 37 P
47 R
5.4/1000 h training, 17.4/1000h comp / 22 / 41% of Pros cases / -
Wilk et al. [215] / R / Tri, S, B or R specific overuse or traumatic injury. / 41 M, 31 F / Not clear / AG / 1 year / 48.0 / 75 (75% Tr, 27.8% comp) / 33.3 / 78.9 / -
Manninen and Kallinen [216]d / R / Unclear (mainly lower back pain). / 70 M, 22 F / 57% IM / ½IM, 43% Sprint and OD / 1 elite / 1 year / 55.0 / 72 MS / Nor differentiated between / - / -
Cipriani, Swartz & Hodgson [217] / R / Unclear (TR, Med?). Worst injuries. / 44 M, 8 F / Unclear (probably mixed) / Mainly intermediate / Ever? / 44 / 83 in tr / Unclear but ‘mostly due to overtraining’ and running / - / -
Vleck and Garbutt [14]e / R / TR, TR, Dr, Med. / 12 / OD / Elite / 5 years / 71.0 / 41.2 / - / 75.0 / -
17 / Sub-elite / 78 / 37.5 / 75.0
87 / AG / 66 / 56.3 / 56.3
Clements, Yates and Curran [218] / R (‘in race’) / Knee injury. TR, TR2d. Clinical diagnosis in n=18 / 46 M, 12 F / Not stated / 7 novice, 17 Club, 26 AG, 7 elite / 3 years / - / 34 / - / 27.8 / -
Fawkner et al. [219] / Pros / TR, TR1d, Dr, Med. / 27 F, 29 M / At least OD / Unclear / 18 weeks / Unclear / 39 / - / - / -
Wilk et al. [220] / Case study / Clinical / 1 M / Middle distance / AG / Case study / N/A / - / - / 100 / -
Hiller et al. [39] / R / Unclear / 1968 M, 470 F / OD / - / Ever / N/A’ / No overall incidence / - / - / -
Richter et al. [42] / Observ / Clinical / 0 M, 1 F / IM / Unclear / Case study / 1 / - / - / - / Hyponat
Burns et al. [221] g / R/Pros / TR, TR 1d, Dr, Med., OU/T / 91 M, 40 F (128 for pros) / Competitors, Australian domestic series. / Novice to elite / 6 months pros, 10 weeks comp / Unclear / 50.4 six months PS, 37.5 comp / 32 / 68 PS, 2.5/1000 hrs, 78 comp 4.6/1000 hrs / -
Egermann et al. [222] / R / TR/ Race / 588 M, 68 F / IM Europe 2000 / <10, 10-12 and >12 hrs / Since start? / 35 / 74.8, 0.71±1.11/1000 hrs
81.3 % tr, 18.7% comp / - / - / -
Vleck [12] / R / TR, TR, Dr, Med. / 7 M / OD / Elite / 5 years / 48.1-91.7 / 29-50 / - / - / -
11 M / OD / Sub-elite
7 M / IM / AG
Pros / OD / Elite / 7 months / 22-84 / - / - / - / -
Sharwood et al. [223] / Observ / Clinical / 293 / IM (2001) / Mixed / Race / All? 12 clinical diagnosis / - / - / - / 2 hyponatraemic
579 / IM (2002)
Shaw et al. [224] / R / TR, TR, Dr, Soc/Ec. / 190 M, 68 F / 62% competitive, 28% national, 12% international, 30% state and 42% local level / 3 seasons and recall for 1 / 55 / 55 / 62 / - / - / -
Burns, Keenan and Redmond [225] / R/Pros / TR, TR 1d, Dr, Med / 44 M, 8 F / As Burns et al. [221] (same study) / Novice to elite / 6 months pros, 10 weeks comp / Unclear / 50.4 PS
37.5 comp / Unclear / 34 PS, 29 comp / -
Villavicencio et al. [226] / R / Acute event leading to TR³ 1d, Dr, Med (low back/neck pain only) / 31 M, 56 F / Unclear / 6.9% elite, 74.7% intermediate, 18.4% novice / Lifetime / 87/about 4000 (2.2%) but denominator unclear / 31-67.8 / 67.8 lower back of which 81.4% sports injury. 48.3 neck pain of which 61.9% sports injury. Neck pain: 66.7 acute, 11.9 sub-acute, 21.4 chronic. Lower back pain: 62.7 acute, 13.6 sub-acute, 23.7 chronic / 31-67.8 / -
Gosling et al. [238] / Observ race / Presenting for medical assistance (race data). / 213 /10173 starters / Race Series (i.e. 6 ‘fun’, 5 S, 1 OD race, each 1 month apart) / Mixed / 2.71/1000 race hours / 2.3% starters or 20.1 presentations/1000 h comp / - / 1.5? (5 fractures/322 injuries) / 10.2% strain / 0.93 heat stroke
Gosling et al. [32] / Observ / Heat casualty, presenting for medical aid / 1844 Event 1 / Each event fun and sprint / Mixed / 2 races / Not clear / 2.8 event 1 injuries. 1.9 event 2 / - / - / 0.8 Event 1
0 Event 2
2000 Event 2
Ellapen et al. [228] / R / TR/ Race 1d, Tri tr/C, Mus / 31/143 / - / 12 / Unclear / Unclear / 12 months / 30.06 / 90.69 / 94.36
Vleck [12]a / R / TR, TR, Dr, Med. / 12 F
18 F / OD
IM / Elite / 5 years / 75%
95% / - / 43.1 / 72.2 / -
Junge et al. [229] / R / Dr, new / 109 / OD / Elite (Olympic Games) / 16 days / - / - / 9.2% of which >40% of injuries due to overuse / - / -
Rimmer and Coniglione [230] / Pros / Dr, Clinical, C / 162 / IM / - / - / - / 37.7 / - / - / 25.9
133 / ½IM / Non-elite / 1 race / - / 10.8 / - / - / 4.2
Galera, Gleizes-Cervera S, Pillard S [231] / R / Tr, C / 309 / Both L and short / Mixed / 1 year / 49.4% / 52.4 / - / - / -
Andersen et al. [94] / Pros / Oslo Sports Trauma Research Centre overuse injury form / 143 M, 31 F / IM / 40% M and 36% F were IM novices / 26 weeks / 63.5% / 56% (CI 51-61), / Average weekly injury rate: 0.97/1000 h tr, 1.02/1000 h comp. Forty one injuries- % of group affected unknown / Substantial OU 20 (CI 18-21). 87% at some point / -
Zwingenberger et al. [232] / R / TR/ Race / 169 M, 43 F / Sprint, OD, ½IM, IM / Amateur / 1 year for both / 20.2% / Not clear / - / - / -
Pros / 40 M, 9 F / 4.67% / R 9.24/1000 h comp, 0.69/1000 h tr, average 0.92/1000 h. Pros 18.45/1000 h comp, 1.39/1000 h tr, average 1.91/1000 h. For sprint, OD, médium and long tri respectively, R 4.06, 6.50, 10.02 and 20.56/1000 h comp and 1.23, 0.53, 0.50 and 0.32/1000 h tr. Average 1.30, 0.68, 0.82 and 0.88/1000 h respectively. / - / - / -

- (dash) = no information, ¯ TR (downward arrow) = decreased training, CI = confidence interval, comp = competition related, Clinical = clinical examination, Descr = descriptive, Dr = seeking of medical aid, hyponat = hyonatremia,½ IM = half Ironman distance (i.e. 1.9 km swim, 90 km cycle, 21 km run), IM = Ironman distance (i.e. 3.8 km swim, 180 cycle, 42.2 km run), L = Long distance (i.e. 18 km swim, 120 km cycle, 30 km run), Med = taking of medication, MD = middle distance (i.e. 2.5 km swim, 80 km cycle, 20 run), Mus = musculoskeletal, N/A = not applicable, Non-T = non traumatic, Observ =.observational, OD = Olympic distance (i.e. 1.5 km swim, 40 km cycle, 10 km run), OU = overuse, Pros = prospective, PS = pre-season, R = retrospective, S = Sprint, Soc/ EC = social or economic cost, T = traumatic, Tr = training related, TR = cessation of training, TR/ Race = cessation of training or racing, ³ 1d for at least 1 day

a Various case study data not included, bIn addition, 1.0, 3.9, 6.3, 10.3, 8.2, and 10.2% of starters received post-race IV fluids in 1981 through to 1986, c Rates estimated retrospectively and unlikely to be strictly comparable because of differing recall periods, d Non significant tendency (p=0.052) for females to exhibit more low back pain than males, e Same methods of retrospective data collection and analysis used in both papers

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