Pre Competition Health Screening

The World Triathlon 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. (World Triathlon Competition Rule 2.4 Health)

PPE Documents

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

From 2018, all athletes competing in World Triathlon 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 World Triathlon competitions, must complete the medical questionnaire and undergo a medical examination each year, and, in addition, must undergo a resting ECG every two years. During the COVID 19 outbreak we suggest performing the ECG every year. For all other triathlete age groups this screening is strongly recommended. World Triathlon’s guidelines for “Return to play” after COVID-19 infection can be found here.

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 World Triathlon 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.