IOC Advanced Team Physician Course 2017, Antalya, Turkey
Medical challenges of travel - risk of illness / infections and injuries
Prof. Martin Schwellnus Professor of Sport and Exercise Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
IOC Research Centre Travel medicine – sports medicine Medical hazards of travel
1. Does international travel increase the risk of injury?
2. Does international travel increase the risk of illness?
3. Are strategies to prevent illness during travel effective?
IOC Research Centre Incidence of illness during the 2010 Super 14 Rugby tournament
For a team physician taking care of a 30 player squad: 1. > 70% of players will report an illness during the 16 week tournament 2. A team physician will see 1 illness every 1.6 days 3. Respiratory, gastrointestinal and dermatological conditions are common 4. Infections are common 5. > 50% of illnesses were reported more than 24 hours after onset of symptoms (NB: preventing spread, early isolation)
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Travelling and the Super 14 Rugby tournament
Super Rugby tournament: •259 elite rugby players from 8 teams •16-week competition period (22 676 player days) •Multiple travelDoes (east- westinternational and west-east) travel increase the incidence of injury and illness in Outcomes: 1. Incidencerugby of injury union(away and playershome) participating in 2. Incidence of illness in 3 time periods: •Baseline: Before travellinga 16-week tournament? •Travel: After travel > 5hrs time zone 11 hours difference •Return – After return to home country
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Is travelling related to an increased risk of injury?
Super 14 Rugby tournament
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Travel and the incidence of time loss injuries during the 2012 Super Rugby tournament (per 1000 playing hours)
No significant differences in injury risk between home and away location
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Travel and the incidence of injuries during the Sevens Rugby World Series
There was no evidence to suggest that players were exposed to a greater risk of injury following extensive air travel and crossing multiple time zones
Fuller, C et al, BJSM 2015; 49; 458-494
IOC Research Centre Is travelling related to an increased risk of illness / infections?
Super 14 Rugby tournament
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Travel and all illness Baseline
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Travel and all illness Travel (> 5 time zones) incidence
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Travel and all illness Return to home country
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Travel and infective illness
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Travel and illness by systems Super 14 rugby tournament
Respiratory tract Gastro-intestinal tract
Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504
IOC Research Centre Air travel and risk of respiratory tract and GIT illness in elite cross-country skiers
37 elite cross-country skiers, 9 years, 7016 person–weeks Variables: training, competition, air travel, altitude, performance level, sex, season
Air travel and competition were major risk factors for acute respiratory tract and gastrointestinal symtoms
Svendsen I, et al, BJSM 2016; 50; 809-815
IOC Research Centre Illness at the London 2012 Paralympic Games and country clusters: Respiratory illness/1000 athlete days
3X 1,3 4,3 2,7 3,9 2X X 3X 3,2 3-6X
4,0 8,2 X
IOC Research Centre Practical clinical advice to reduce illness in the travelling athlete
1. Be aware of the higher risk periods for illness (? It is the destination not the travel) 2. Knowledge of expected illness and types 3. Travelling: • Know the destination (altitude, pollution, allergens, food) • Medical screening of athletes (respiratory illness, allergies, past history of illness, dermatological screening) • Vaccinate / chemoprophylaxis • Hand sanitizers • Avoid handAre shaking these measures • Probiotics 4. Planning of medical support – medical kit, nutrition, fluids 5. Establish contact with medicaleffective? colleagues/services in destination countries 6. Educate athletes • Foods – e.g. bottled water, unpeeled fruits • Report symptoms early (isolation) • Personal hygiene (e.g. hand washing / sanitizers)
IOC Research Centre Thank you for your attention
IOC Research Centre