Health problems in elite Para athletes - A prospective cohort study of 53,739 athlete days

Objectives
Longitudinal data on injury and illnesses in Para athletes is limited. Therefore, the aim was to illustrate the epidemiology of health problems concerning demographic factors and sporting exposure in an elite Para athlete cohort.
Design
Prospective cohort study.
Methods
All German Paralympic squad athletes were invited to participate in this study. Between 2019 and 2021 health problems were monitored via a weekly online questionnaire (Oslo Sports Trauma Research Centre questionnaire on health problems). Additionally, primary sporting activity, training exposure, and subjective training intensity per week were recorded. Epidemiological descriptive statistics, hazard ratios and odds ratios were analysed.
Results
Over an observation period of 124 weeks, 122 Para athletes (48 % females; mean age: 28 years) reported 438 (248 substantial) health problems, equally paired into illnesses and injuries. Females demonstrated a two-fold risk of sustaining a substantial health problem (hazard ratio = 1.8; 95 % confidence interval: 1.2–2.8). A lower risk of sustaining a substantial health problem is associated with more than 5 years of elite training (odds ratio = 0.9; 95 % confidence interval: 0.8–0.9). At any given time, 10.5 % (95 % confidence interval: 9.6–11.5) of the participants reported a substantial health problem and prevalence was elevated during weeks of competition (9.8 %; 95 % confidence interval: 4.2–15.4). During training camps new overuse injuries were mainly reported (41.2 %), whilst acute injuries peaked during competitions (31.8 %). Changes to the normal training intensity were associated with more substantial health problems (odds ratio range = 1.5–4; 95 % confidence interval range = 1.1–4.8).
Conclusions
Monitoring of female athletes, and those with less than five years of experience is substantial. Health problem patterns varied during the season. Education of coaches and medical staff is necessary to safely guide the Para athletes.