Maximising Triathlon Health and Performance: The State of the Art

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It is with great pleasure that Professor Piacentini and I present this closing Editorial for the Special Issue of Sports on “Maximising Triathlon Health and Performance: The State of the Art”. Thirty-four papers—of which 52% were accepted for publication—were submitted to this Special Issue. At the time of writing in December 2024, the 18 published papers had already been viewed over 106,000 times. Vleck et al.’s publication (Paper (P)3), entitled “Work, Training and Life Stress in ITU World Olympic Distance Age-Group Championship Triathletes”, has been shortlisted for the Sports Paper of the Year 2023 award. Our featured authors (listed below) include many world-renowned experts in the field. Many other subject experts, including the coach of an Olympic medallist, devoted significant time and expertise to this project as reviewers. Notably, several of the submissions (e.g., P16, Hotfiel et al., 2019) resulted from collaborations between researchers and National Federation staff. We are privileged that our contributors chose to publish their research findings, including that of a randomised control trial (P10, Grim et al., 2019), with us. We are happy to have also featured first author papers from several (then) Ph.D. students- the incoming generation of triathlon subject experts. We extend our congratulations to those authors who have since been awarded their doctorates: Dr Claudio Quagliarotti (ITA) [1], Dr Alba Cuba-Dorado (ESP) [2], Dr Joel Walsh (AUS) [3], and Dr Jørgen Melau (NOR) [4]. Dr Thibaut Ledanois (FR) [5], Dr Stuart Evans (AUS) [6], and Dr Christian Weich (GER) [7] also recently obtained their triathlon-related doctorates. João Henrique Falk Neto (CAN), who proved himself an outstanding compère of the Edmonton 2020/2021 ITU Science and Triathlon conference; Héctor Arévalo-Chico (ESP), who both conducted research with and recently accompanied members of the Spanish team to the Paris Olympic Games; and Atsushi Aoyagi (JPN), whose papers we also feature in our Special Issue—are all close to submitting their Ph.D.’s [8,9,10]. We sincerely thank Atsushi Aoyagi for kindly accepting Dr Vleck’s invitation to include his paper on the exercise intensity at which age group triathletes race in Olympic distance triathlons in this Special Issue. In common with many of the other papers in the Special Issue, Aoyagi et al.’s paper is surely destined to become regarded as a classic in the field.

The number- 10- and the submission dates, which are reasonably close to each other, of all the aforementioned doctoral theses is a testament to how scientific research related to our sport has evolved. The first triathlon paper was published just forty years ago. To our knowledge, the first doctorates on triathlons (both of which included National Squad athletes in their subject groups) were awarded to Professor Grégoire Millet (in 1999) [11], followed by myself [12]. Professor Millet was a former French National Olympic distance triathlon champion and a French National Triathlon Squad coach. In 2000, he was British Triathlon’s Performance Director for triathlon’s first Olympic Games. As such, he was an exemplar of what is an increasingly distinguishing feature of those who are involved in triathlon research. The fact that so many of our peers are actively researching and coaching and/or training for/racing triathlon (and sometimes all three at the same time), as Grégoire himself pointed out, is likely to facilitate the successful dissemination of our research findings. Almost all of the individuals whose work is featured in this Special Issue possess these same characteristics. Importantly, we were privileged to have published contributions from several researchers with a fourth, immensely valuable feature. As doctors, paramedics, physiotherapists, and/or surgeons, they have active field-, medical tent-, and/or hospital-based experience of protecting the health and safety of athletes. Dr Jørgen Melau—a paramedic and the safety director of the Norseman Xtreme triathlon, who is now the holder of a Ph.D. on physiological changes induced by cold water swimming [4]—personifies these outstanding individuals. Importantly, our authors also include those who have been (Engelhardt, Vleck) longstanding representatives on the committees or boards of either their respective continental governing bodies or World Triathlon. Thus, all of our contributors were uniquely placed to bring this collation of papers, with its stated aim of acting as a spur to the instigation and expansion of collaborative research projects that have the potential to improve applied practice in the sport, to fruition.

In 2007, Millet and I, together with David Bentley, published an invited commentary [13] on the extent to which a reciprocal relationship existed between the development of the sport of triathlon and the nature of the scientific investigation that was directly related to both it and to endurance sport in general. This Editorial provides us with a timely opportunity to revisit the questions that we first posed in the International Journal of Sports Physiology and Performance (IJSPP) 17 years ago. They fall under three main headings. Has science influenced the knowledge and practices in a given sport? Is sports science part of the development of the sport? Is sports science an important parameter for the emergence of new practices (i.e., training or testing methods and technological development) or coach education, and vice versa?

In Table 1, we provide selected examples of the above issues being addressed in the literature as a whole. We do the same for the three areas for which this Special Issue invited submissions, namely:

• (a)Triathlon health in training and/or competition (health evaluation, event medical care, open water swimming, and heat acclimation) (Papers 7, 9, 13, 16, and 18).
• (b)Training and risk factors for maladaptation (as evidenced by injury, illness, and non-functional overreaching and/or performance stagnation), including how it may change with athlete age, ability level, and event distance specialisation (Papers 3 and 5).
• (c)Optimising training and race preparation- at the cutting edge (preparation for the Olympic Games, what can scientists tell coaches, what can coaches tell scientists, what do athletes want, and how technology can change the game, e.g., as regards research into both the aetiology and the prediction of maladaptation) (Papers 1, 2, 4, 6, 8, 10–12, 14–15, and 17).

Essentially, our reply to the above key questions about whether reciprocity exists between the sport and research related to it is “yes, to some extent, but more work is needed”. We highlight the fact that the event guidelines for open-water swimming have been revised on the basis of research that was commissioned and funded by this sport’s governing body, amongst others. Research that has the potential to directly improve event medical care (e.g., P10, Melau et al., 2019. Late-Presenting Swimming-Induced Pulmonary Edema: A Case Report Series From The Norseman Xtreme Triathlon) is continuously being published. Surprisingly, however (and especially given the opportunities that amateur triathlon’s unique age-group system provides for research into the effects of multi-disciplinary exercise training in ageing populations), few comprehensive studies of either triathlon training or of its long-term effects exist. The latter point is relevant to medical issues (e.g., the incidence of skin cancer; see [40]). It also applies to research into how triathlon participation might offset the effects of ageing and (given that it is a multi-disciplinary sport) might affect those at the other end of the age spectrum, e.g., motor skill development of younger athletes (of less than 8 years of age) [54,55]. There also appears to have been little investigation to date on the extent to which triathlon participation can either positively [56]) or negatively [57] impact mental health, and/or non-communicable disease [51]. It would prove useful if how triathletes actually train were better researched- both for those who take part in the sport and, probably, for sports science in general. We further recommend that more research be carried out into the extent to which current coaching accreditation courses and coaches themselves are both up to date with and implement findings from the triathlon literature. We applaud the sterling work of Professor Romauld Lepers on the decline of performance with age in masters athletes [58,59,60,61]. Lepers’ work to make the practical implications of his findings available to the wider exercising public (Lepers, 2021 [62]) sets an excellent example for us all.

We are privileged that this Special Issue was met with such an enthusiastic, collaborative response from the triathlon community worldwide. We are confident that the papers contained within it should also prove relevant to its component sports, and we extend our grateful thanks to everyone who was involved and continues to support research in our sport. We note that the analysis that I conducted in 2007 for the IJSPP commentary [13] was based on the 278 articles with triathlon or triathlete in the title that were published in PubMed between the first published paper in 1984 and the end of 2006. After four decades of research https://lida.sport-iat.de/dtu-triathlon/ (LIDA)- the database of scientific literature related to triathlon that is based on a collaboration between the Deutschen Triathlon Union (DTU) and the Institute of Applied Training Science Leipzig (IAT), now numbers over 1440 triathlon articles and over 19,000 triathlon related items. This database is freely available. In closing this Editorial, we therefore extend a special thank you to Birgit Franz, who was working on the aforementioned database when I started my triathlon-related Ph.D. over thirty years ago, and still works on it, for her significant contribution to the sport.

Finally, we wish to both acknowledge the work of Professor (Doug) Hiller, M.D., and make a related announcement. Professor Hiller was one of the first three members of the medical committee of the International Triathlon Union (ITU, now World Triathlon) in 1989. He (together with Pamela S. Douglas M.D. and Professor Mary L. O’Toole) was one of the initial leading trio of researchers to publish on triathlon and was involved with drafting the first set of medical guidelines for what would eventually become USA Triathlon. He was inducted into the Hall of Fame of the ITU in August 2019 for his lifetime contributions to this evolving Olympic sport.

The triathlon chapter in the 2010 IOC book on epidemiology of injury and illness in Olympic sports [45] concluded with these words: “It is strongly urged that a collaborative research team of race organizers, technical officials, coaches, athletes, medical support staff, and researchers working at both the grass-roots and the top end of the sport be established, for an adequate database of injury data to be compiled and used to drive continuous improvement in triathlon training and competition practice, as well as education of athletes, coaches, and both technical and medical staff”. Professor Hiller and Professor Christopher Connolly of Washington State University have now set up such a global triathlon safety database (GTSD, www.globaltrisafety.org). The GTSD is both a medical data repository and provides secure data management and analysis for triathlon organizations worldwide. To date, it is supported by the World Triathlon, Ironman Triathlon, and USA Triathlon. In addition to the LIDA database and the recently established Triathlon Research Initiative (www.triathlonresearchinitiative.com), it is likely to prove to be a critically valuable resource for the sport.

We strongly encourage all of our colleagues in the sport to make use of the GTSD and, in so doing, improve the translation of research findings into improvement in applied practice because “Nothing is more important than the health and safety of the athlete.”(Hiller, undated quote). $[eqn]$ Sincerely,Veronica Vleck, Ph.D.Professor Maria Francesca Piacentini, Ph.D.