Insights from the first IOC Olympian Health Cohort: injury and illness in Olympians preparing for the Tokyo 2020 Summer and Beijing 2022 Winter Olympic Games.

Objective: To describe the prevalence and nature of Olympic-career related injuries and illnesses, and behaviours during injury/illness, in Olympians in the 4 years prior to their participation at the Tokyo 2020 and Beijing 2022 Olympic Games.

Methods: 315 current Olympians from 70 countries completed a cross-sectional online survey, distributed by direct email through National Olympian Associations and World Olympians Association databases. Questions included Olympic sport exposure, significant training and competition injury and illness history (lasting >2 weeks) and athlete behaviours during injury/illness.

Results: 65% of Olympians were women (35% men), representing 51 sports (37 summer, 14 winter), aged 28.6 years (4.6). Overall, 58.5% (95% CI 52.2% to 64.9%) of summer and 55.6% (95% CI 44.7% to 66.4%) of winter Olympians were injured, with knee injuries most frequent (19.6% summer, 27.8% winter Olympians). Injury rates were similar between males and females. 17.1% (95% CI 12.3% to 21.9%) of summer and 23.5% (95% CI 13.1% to 31.3%) of winter Olympians were ill, with respiratory illness most frequent. Illness rates were (non-significantly) higher for female versus male winter Olympians (adjusted relative risk 2.04 (95% CI 0.73 to 5.76)) but similar between male and female summer Olympians. 78% of Olympians said they put the most pressure on themselves to return from injury/illness quickly. Almost half reported using painkillers during injury, while one-quarter continued full training/competition during injury/illness. Injury and illness prevalence followed similar bimodal and trimodal seasonal patterns for summer and winter Olympians, respectively.

Conclusions: Olympians report a significant history of injury and illness across the 4 years before the Olympic Games. A biopsychosocial approach that supports athletes during injury/illness absences is needed. Concurrent injury/illness prevention strategies should be considered to reduce the burden of both injuries and illnesses at key times in an athlete's season.