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TaggedAPTARAEnd180 S.A. Guevara et al.
Table 4 (Continued)

StudyTaggedAPTARAEnd Number of participants (N), (M/F), Most common illness symptoms Cause of illness (%)TaggedAPTARAEnd Triathlon discipline IDCFTaggedAPTARAEndTaggedAPTARAEndTaggedAPTARAEndTaggedAPTARATbody
age (year), experience, illnesses (n)TaggedAPTARAEnd (%)TaggedAPTARAEnd (%)TaggedAPTARAEnd
Parkkali et al. N = 215; (age range: 1567); sprint/ Stomach pain (71); nausea (77); Environmental: viral infec- SwimmingTaggedAPTARAEnd ASR/CETaggedAPTARAEndTaggedAPTARAEnd
48
(2017) TaggedAPTARAEnd standard; FTEM: F3; n =72TaggedAPTARAEnd diarrhea (59); vomiting (38); tion; swallowing >3
mouthfuls of water (RR =
fever (23)TaggedAPTARAEnd
2); swam in the event
(RR = 8)TaggedAPTARAEnd
Plews et al. N = 2; age: M: 22; F: 20; standard; Fatigue, painTaggedAPTARAEnd Gradual onset, exercise TaggedAPTARAEnd CE/SPTaggedAPTARAEndTaggedAPTARAEnd
(2012) 57,a TaggedAPTARAEnd FTEM: E1; n =1TaggedAPTARAEnd related, metabolic distur-
bance (immuno-suppres-
sion)TaggedAPTARAEnd
30
Scott (2003) TaggedAPTARAEnd N = 1; age: 37:M; standard; FTEM: CollapseTaggedAPTARAEnd Sudden onset; exercise TaggedAPTARAEnd CE
F3; n =1TaggedAPTARAEnd relatedTaggedAPTARAEnd TaggedAPTARAEndTaggedAPTARAEnd
Shapiro et al. N = 1; F; age = 19; sprint; Headache, nausea, emesis Gradual onset, nutritional, TaggedAPTARAEnd CETaggedAPTARAEndTaggedAPTARAEnd
61
(2006) TaggedAPTARAEnd FTEM: F3; n =1TaggedAPTARAEnd (vomiting), malaise (general exercise related; environ-
discomfort)TaggedAPTARAEnd ment (heat)TaggedAPTARAEnd
Steffen et al. N = 64; (32/32); age = 1617; Pain (40); fever (20); dyspnea/ Infection (50); environ- TaggedAPTARAEnd CETaggedAPTARAEndTaggedAPTARAEnd
(2020) 10,a TaggedAPTARAEnd standard; FTEM: E1E2; n =10TaggedAPTARAEnd cough (10); diarrhea/vomiting mental (10); exercise
(10); other (20)TaggedAPTARAEnd induced (10); other (30)TaggedAPTARAEnd
Stephenson N = 7 (6/1) para-triathletes; TaggedAPTARAEnd Exercise related, gradual TaggedAPTARAEnd ASR/SPTaggedAPTARAEndTaggedAPTARAEnd
et al. (2019) 31,a TaggedAPTARAEnd age = 30 § 10; sprint onsetTaggedAPTARAEnd
FTEM: E1; n =22TaggedAPTARAEnd
Sullivan N = 110 (72/38); age: M: 37; F: 38; Abdominal stitches (10); bowel Exercise intensity (24.2); Running 588 symp- ASR/SPTaggedAPTARAEndTaggedAPTARAEnd
49
(1987) TaggedAPTARAEnd FTEM: F3; n = 958 symptomsTaggedAPTARAEnd dysfunction (7); muscle cramps anxiety (8.5); time of day toms, swimming 288
(14); flatulence (8); abdominal (7.8); recent meals (26.6); symptoms, cycling
cramps (6); belching (8); wheeze/ specific foods (14.3);TaggedAPTARAEnd 204 symptomsTaggedAPTARAEnd
cough (6); skin problems (8);
nausea/vomiting (5); gastro-
esophageal reflux (6); headache
(6); urinary incontinence (3);
hematuria (2); loss of vision (2);
bloody bowel movements (1);
interrupted exercise (8)TaggedAPTARAEnd
Van Asperen N = 827 (757/70); age = 33; standard; GI symptoms (54); stomach ache, Swallowing water, environ- SwimmingTaggedAPTARAEnd ASR/CE/SPTaggedAPTARAEndTaggedAPTARAEnd
et al. (1998) 50,a TaggedAPTARAEnd FTEM: F3TaggedAPTARAEnd nausea/vomiting (26), diarrhea, mental, infectionTaggedAPTARAEnd
side aches, gripes, flatulence,
urge to discharge (25); skin
complaints (5); respiratory
complaints (12); eye complaints
(4); ear complaints (2); head-
aches (2)TaggedAPTARAEnd
Worme et al. N = 71 (50/21); age: M: 39 § 1; F: 32 GI symptoms (50): upper GI: Metabolic disturbances and TaggedAPTARAEnd ASRTaggedAPTARAEndTaggedAPTARAEndTaggedAPTARAEnd
52
(1990) TaggedAPTARAEnd § 2; standard; FTEM: F3TaggedAPTARAEnd heartburn, bloating, vomiting, nutritional factorsTaggedAPTARAEnd
abdominal gas, loss of appetite;
lower GI: diarrhea; hematemesis
(<10)TaggedAPTARAEnd
Note: means missing data.TaggedAPTARAEnd
a
Prospective studies.
Abbreviations: ASR = athlete self-report; AVNRT = atrioventricular nodal re-entrant tachycardia; BP = blood pressure; CE = clinical examination; E1 = event 1;
E2 = event 2; ENT = ear, nose, and throat; F = female; FTEM = Foundation, Talent, Elite, Mastery; GI = gastrointestinal; IDCF= Injury Definitions Concept Frame-
work; M = male; RR = relative risk; SP = sports performance.

injuries occurring during the extensive periods of triathlon injuries sustained by triathletes. In addition, the potential for
training as compared to brief competition exposures. The survival bias may influence competition data, with only
injury incidence figures reported in this systematic review healthy athletes being available for competition, which would
should be interpreted with a degree of caution due to inconsis- substantially underestimate injury rates over an entire season.
66
tencies with reporting and injury surveillance methods. TaggedAPTARAEnd In contrast, epidemiological data focusing on long-course
TaggedAPTARAPThe majority of the current short-course triathlon literature triathlon indicate injury incidence rates to be significantly less
focuses on reporting competition injuries; however, during training (0.75.4 per 1000 training hours) compared to
79%83% of injuries in short-course triathletes are reported competition, which could be due to lack of reporting and/or
to occur in the training environment. 21,39,66 The lack of presentation for medical attention outside of competition. 67,68
training-related injuries in the published literature likely Accurate quantification of training load exposure, and there-
results in a substantial under-representation of total number of fore injury incidence rates, 69 can be challenging, especially in