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Prevalence of illness, poor mental health and sleep quality and low energy availability prior to the 2016 Summer Olympic Games
  1. Michael Drew1,2,3,
  2. Nicole Vlahovich1,4,
  3. David Hughes1,
  4. Renee Appaneal1,
  5. Louise M Burke1,5,
  6. Bronwen Lundy1,5,
  7. Margot Rogers1,
  8. Mary Toomey6,7,
  9. David Watts6,
  10. Gregory Lovell1,
  11. Stephan Praet1,
  12. Shona L Halson1,
  13. Candice Colbey8,
  14. Silvia Manzanero1,
  15. Marijke Welvaert1,3,
  16. Nicholas P West8,
  17. David B Pyne1,3,
  18. Gordon Waddington1,3
  1. 1 Department of Physiotherapy, Australian Institute of Sport, Canberra, Australia
  2. 2 Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
  3. 3 University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, ACT, Australia
  4. 4 Sport and Exercise Science Group, Bond University, Gold Coast, Queensland, Australia
  5. 5 Mary MacKillop Institute for Health Research, Australian Catholic University, Canberra, Australia
  6. 6 Queensland Academy of Sport, Brisbane, Australia
  7. 7 Department of Physiotherapy, Griffith University, Brisbane, Australia
  8. 8 School of Medical Science and Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
  1. Correspondence to Dr Michael Drew, Australian Institute of Sport, Leverrier Cr, Bruce ACT 2614, Australia; mick.drew{at}


Objective Establish the prevalence of illness symptoms, poor sleep quality, poor mental health symptoms, low energy availability and stress-recovery state in an Olympic cohort late in the 3 months prior to the Summer Olympic Games.

Methods Olympic athletes (n=317) from 11 sports were invited to complete questionnaires administered 3 months before the Rio 2016 Olympic Games. These questionnaires included the Depression, Anxiety and Stress Questionnaire, Perceived Stress Scale, Dispositional Resilience Scale, Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy Availability in Females Questionnaire (LEAF-Q), Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and custom-made questionnaires on probiotic usage and travel. Multiple illness (case) definitions were applied. ORs and attributable fractions in the population were used. Factor analyses were used to explore the relationships between variables.

Results The response rate was of 42% (male, n=47, age 25.8±4.1 years; female, n=85, age 24.3±3.9 years). Low energy availability was associated with sustaining an illness in the previous month (upper respiratory, OR=3.8, 95% CI 1.2 to 12). The main factor relating to illness pertained to a combination of anxiety and stress-recovery states (as measured by the REST-Q-52 item). All participants reported at least one episode of illness in the last month (100% prevalence).

Conclusions All participants reported at least one illness symptom in the previous month. Low energy availability was a leading variable associated with illness in Olympic-class athletes. The estimates duration of symptoms ranged from 2 to 7 days. Factor analyses show the interdependence of various health domains and support multidisciplinary care.

  • prevention
  • risk factor
  • athlete

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  • Handling editor Karim M Khan

  • Twitter @_mickdrew

  • Contributors All authors contributed to the design of the study. MD, NV and NPW were responsible for the data collection with input by all remaining researchers. MD and MW were responsible for the data analysis and reporting. All authors provided input to the drafting and final approval of this manuscript.

  • Funding This work was supported by the Australian Institute of Sport HighPerformance Research Fund (Stay Healthy Project, 2015), the Queensland Academy of Sport Centre of Excellencefor Applied Sport Science Research (Grant number CoE056), and Griffith University (Internal Grant). Theauthors also acknowledge the in-kind contributions from the University ofCanberra Research Institute for Sport and Exercise.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Australian Institute of Sport Ethics Committee (approval number 20160407).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors are willing to discuss data sharing under collaborative agreements. Please contact the corresponding author.