Respiratory health of the endurance athlete : prevalence of respiratory related conditions/illnesses in endurance athletes

Master Thesis


Permanent link to this Item
Journal Title
Link to Journal
Journal ISSN
Volume Title

University of Cape Town

Background: Endurance athletes, in particular triathletes and ultra-distance runners, undergo high volumes of intense training in preparation for events. There is recent epidemiological evidence that the respiratory tract is the most common system affected by illness in athletes during tournaments. Respiratory tract symptoms have also been shown to affect endurance athletes particularly in the post- event period. However, the prevalence of respiratory related illnesses including respiratory tract symptoms, asthma, and allergies in the pre-race period has not been well studied in endurance athletes. Objective: The main aims of this dissertation were 1) to review the existing literature focussing on the epidemiology, pathogenesis, possible aetiology and management of respiratory tract symptoms, asthma and allergies in athletes, and 2) to conduct an investigation to determine the pre-event period prevalence (6 weeks and 1 week before an event) and nature of respiratory tract symptoms, asthma and allergies in Ironman triathletes and ultra-distance runners. Methods: In the first part of the dissertation, a review of the literature pertaining to respiratory tract symptoms and illness was undertaken. In the second part of the dissertation, a cross-sectional descriptive study was undertaken in 441 triathletes entering the 2006 and 2007 Ironman Triathlon, and 152 ultra- distance runners in the 2009 Two Oceans Ultra-marathon. In the 1 to 3 days before the race (registration period), participants were requested to complete a validated pre-event medical questionnaire containing sections on demographics, training and previous competition, common medical conditions and detailed sections on respiratory symptoms in the 6 weeks and 1 week period before the race, as well as asthma and allergies experienced. Respiratory symptoms were divided into upper respiratory tract symptoms (URTS), lower respiratory tract symptoms (LRTS) and systemic symptoms (SS). All data obtained regarding these respiratory related illnesses were compared between the triathlete group and the ultra- distance runners. Results: The main findings in the experimental section of the dissertation were that 1) triathletes trained significantly more hours in the 6 weeks and 1 week before an event than ultra-distance runners, 2) the period prevalence (6 weeks before the race) of respiratory tract symptoms was 50% of triathletes and 35% of ultra-distance runners, 3) upper respiratory tract symptoms and particularly nasal symptoms (nasal congestion and rhinorrhoea) were significantly more common in triathletes (21 to 27%) in comparison with ultra-distance runners (12 to 17%), 4) systemic symptoms (especially pyrexia) were significantly more common in ultra-distance runners in the 1 week before an event (9.2 vs. 2.4%), 5) the point prevalence of self-reported asthma was low in both study groups (ultra-distance runners 3.4% and triathletes 8.3%) although symptoms of dry cough, wheezing, shortness of breath and "tight" chest were reported by 25 to 80% of athletes in both study populations, 6) in most cases the diagnosis of asthma was made by means of history taking and a physical examination by a physician, 7) majority of triathletes used beta 2-agonists only as the treatment of choice for asthma symptoms, while ultra-distance runners used combinations of corticosteroids and beta 2-agonist inhalers as first line treatment, 8) allergies were reported by 34% of triathletes and 22.3% of ultra-distance runners, 9) most allergic symptoms in both study groups were confined to the upper respiratory tract with hay fever ranging from 77 to 83% and sinusitis 55 to 64.2%, and 10) the most common medication used for allergies by triathletes and ultra- distance runners, were anti-histamine tablets. Conclusion: There is a high period prevalence of respiratory symptoms in triathletes and ultra-distance runners in the 6 weeks before an endurance event. Triathletes had a significantly higher prevalence of upper respiratory tract symptoms (especially nasal symptoms) in comparison to ultra-distance runners, which might be related to allergies and a higher training volume. There also appears to be a lack in proper diagnostic evaluation of asthma in these endurance athletes with suboptimal and improper treatment of asthma and allergies. Approximately 10% of ultra-distance runners had systemic symptoms in the week before the event, indicating a lack of athlete education on possible risks of exercising with a systemic illness.

Includes bibliographical references (pages 97-102).