Pre Competition Health Screening

The ITU Medical Committee strongly recommends a periodic health evaluation (PHE) for all the triathletes, performed by a sports physician, starting with a Pre Participation Examination (PPE) prior to engaging in competitive sport. (ITU Competition Rule 2.4 Health)

PPE Documents

ITU would like to remind all National Federations and athletes that beginning in 2017, all entered junior triathletes for the ITU international competitions are required to have completed the PPE. 

From 2018, all athletes competing in the ITU competitions in Youth, Junior, U23, Elite and Elite paratriathlon categories must have completed a pre-competition health screening which includes a questionnaire, a physical examination and an ECG following the IOC’s recommended procedure.

Thereafter, all Youth, Junior, U23, Elite and Elite paratriathlon athletes, competing in ITU competitions, must complete the medical questionnaire and undergo a medical examination each year, and, in addition, must undergo a resting ECG every two years. For all other triathlete age groups this screening is strongly recommended.

It is the responsibility of the National Federations to ensure that these pre-competition health screening procedures have been performed. The NFs are required to confirm to ITU with the PPE Certification that all entered athletes have completed the screening. The certificate should be sent to

More than 90% of sudden death in competitive athletes are related to pre-existing cardiovascular problems (SCD). The SCD of an athlete on the field remains the most devastating medical event in sports.

The purpose of this screening is to identify, as accurately as possible, athletes at risk in order to advise them accordingly. According with the European Society of Cardiology (ESC), epidemiology studies on population of thousands of competitive athletes showed a decrease of up to 89% in SCDs with a PPE including a 12 lead rest ECG.

The screening takes place in three steps.

  1. Answer the Medical Questionnaire: this questionnaire is strictly confidential and must given to the responsible team doctor before the medical examination.
  2. Physical Examination: by the doctor following the IOC recommendations published in the “Lausanne Recommendations” about the Sudden Cardiovascular Death in Sport Consensus.
    • Cardiac auscultation:
      • Rate/rhythm
      • Murmur: systolic/diastolic
      • Systolic click
    • Blood Pressure
    • Radial and Femoral Pulses
    • Marfan stigmata
  3. A 12 lead rest electrocardiogram (ECG). Doctor to look for anomalies in rhythm, conduction or repolarisation.

Select cases with a positive personal history, family history of potentially inherited cardiac disease, or positive physical or ECG result will require further evaluation by an age-appropriate cardiac specialist.


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