The largest prospective study on illness in rugby union players has revealed that 70% of the players studied in just one season’s Super Rugby Tournament reported illness at some time during the tournament.

Professor Martin Schwellnus, Director of the University of Pretoria’s (UP) Sport, Exercise Medicine and Lifestyle Institute (SEMLI), was the lead researcher in this international collaborative study, which took place between 2010 and 2016. During this time, 1 340 male professional rugby players were assessed.

He explained that a medical illness in this study’s case was regarded as “any non-trauma-related symptom or sign presenting in a player that required medical attention from the team physician on a specific day”.  Examples of illness include respiratory tract infections and gastro-intestinal infections. Player availability is linked to team success, making the maintenance of a team important.

The Super Rugby Tournament is an annual event lasting about 16 weeks, with intense training sessions and weekly matches. On top of this, players travel between countries with time zones varying between two and 11 hours. Prof Schwellnus said international travel across multiple time zones also increases the risk of illness.

A previous SEMLI study showed that international travel across multiple time zones during the 2010 tournament increased the risk of illness two to three times during “away” time periods.

Professor Martin Schwellnus. 

“The reasons for this observed higher incidence of illness was not clear but could be attributed to a number of different factors including: the prolonged and strenuous nature of the competition; exposure to different environmental conditions (temperature, humidity, atmospheric pollution) and variation of diet.” said Prof Schwellnus. Players travelling between continents may also be exposed to different strains of pathogenic organisms.

He said, “Acute illness can increase the risk of serious medical complications and even sudden death during strenuous exercise.” 

The study had a second part to it – it is also the largest one on an illness-prevention programme undertaken in international sport. In an effort to reduce the incidence of acute illness during the Super Rugby Tournament, Prof Schwellnus and his team developed the Team Illness Prevention Strategy (TIPS), which showed positive results among players. 

The TIPS study spanned seven seasons, studying six South African teams playing in the Super Rugby Tournament. It worked closely with team physicians who collected illness data on a daily basis during competition periods.

Since its intervention, TIPS has been associated with a 59% reduction in overall incidence of illness during the Super Rugby Tournament, with a significant reduction in illness of all commonly affected organs. Prior to this intervention, previous studies showed a high overall illness rate during a season of this tournament, with respiratory tract infections and gastro-intestinal infections being the most common. Respiratory tract infections accounted for more than 75% of infective illnesses.

The efficacy and success of the TIPS strategy was in “its pragmatic approach to illness prevention in a demanding (intense and long) rugby tournament that required teams to undertake both domestic and international long-haul travel”, said Prof Schwellnus. Further to the success in reducing illness among players is the co-operation and involvement of team medical staff, management as well as athletes implementing TIPS.

The strategy’s pragmatic approach involves elements that are easy to implement, with pre-screening of players before a tournament and good hygiene practices to reduce infection and illness. Prof Schwellnus said: “Team physicians could consider local antimicrobial spray, probiotics and, in some cases, prophylactic antibiotics to reduce the risk of infection, particularly respiratory tract and gastro-intestinal infections.”

Super Rugby Lions vs Bulls match at Loftus. (Shutterstock)

The pre-screening is standard medical screening performed by the team physicians and is based on guidelines from World Rugby. It includes general medical and injury history and medication/supplement use by the athlete. Prof Schwellnus said the primary components look particularly at players who have an increased risk of illness. “This could include a past history of respiratory infections, allergies, known gastrointestinal illness or known dermatological conditions.”

TIPS discourages players from sharing utensils or water bottles and encourages regular hand washing and the use of personal antiseptic hand gel. Players should also ensure they are getting enough sleep. Furthermore, they should avoid continuous exposure to air-conditioned or polluted environments. “Players could also consider taking a high dose of Vitamin C (>1 000mg/day) during tournaments.” It is essential that symptoms are reported early, so that early isolation of players is implemented at the onset of symptoms.

Because of international travel across multiple time zones, Prof Schwellnus recommended players consider prophylactic local anti-microbial spray, probiotics and antibiotic prophylaxis – medication used to prevent a disease from occurring in specific cases. This is to boost their immune system and reduce the risk of infection, particularly respiratory tract and gastro-intestinal infections.

While a similar study was conducted among the UEFA Champions League Football players over multiple seasons, the TIPS intervention leads to lower incidences of illness among Super Rugby players compared to that reported in the UEFA League.

“The findings from the TIPS intervention therefore have important clinical implications for other travelling sport teams,” said Prof Schwellnus. Although this study was carried out on Super Rugby teams, the researchers see potential application in other sports tournaments such as the Olympic Games and future Rugby World Cups, with the aim of producing illness-free players and athletes.