The Health Policy at the service of athletes

In implementing the QUARTZ Event Program, the organizers of the 2018 World Trail Championships committed themselves to protecting the health of athletes and to upholding a sport without doping, in line with the values at the heart of trail running. 

The QUARTZ Program aims to protect the health of runners and to contribute to a doping-free sport.  The program, one of the major components of ITRA's Health Policy, is divided into three sub-programs: QUARTZ Elite, QUARTZ Regular and QUARTZ Event.

At the 2018 World Trail Championships, ITRA – in conjunction with Athletes for Transparency (AFT) and the Ultra Sports Science Foundation (USS) – met with the 49 delegations from all over the world. Runners and team managers were given information concerning the importance of regular, competent and transparent health monitoring in the context of high-level trail running. To this end, ITRA gives runners access to a private free online health space on the Sports and Health Online (SHOL) platform. This confidential space is accessible via the ITRA runner account and as much information as possible should be stored there (medical history, medicines prescribed and ongoing treatments, TUEs where applicable, up-to-date lab reports, etc.). By means of all these elements, the biological profile of a runner can be more accurately identified. 

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The Croatian team passing the tests of the health policy.

Following these meetings for raising awareness, the top 10 male and female athletes competing in the 2018 World Trail Championships and the fastest male runner and the fastest female runner from each delegation were asked to provide blood samples in order for their biological profile to be updated.
The work of the QUARTZ Event program at the 2018 World Trail Championships fell into three distinct stages:
  • pre-race: runners entered relevant information in their confidential health space (SHOL platform);
  • one or two days before the race:  selected runners underwent blood tests;
  • post-race:  the tested athletes were able to access their test results (and any related remarks) on their confidential health space (SHOL platform). 
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The Great Britain team listening the briefing about the Health Policy. 

The results for the 102 athletes tested during the 2018 World Trail Championships are as follows:
  • 90 normal profiles (no medical risk identified);
  • 7 atypical profiles (biological values outside the laboratory normal values but with no major health risk before the competition;
  • 5 profiles with one or more potential pathologies (profiles requiring a medical follow-up but presenting no major health risk prior to the competition);
  • 0 abnormal profiles; 
  • 0 "no-start rule" (athletes identified as "atypical" or "with potential pathologies" did not present any serious medical risk before the race).

The actors of the health Policy

Loïc Lescouff is responsible for managing the daily work and the ITRA database. At the 2018 World Trail Championships he was responsible for making information available to the athletes and members of the delegations and for discussing the objectives and activities of the Health Policy with them.

How the team briefing was going on? 

The teams displayed a high level of interest. A short presentation was given and we tried to summarize a large amount of information, the topic being rendered complex by its novelty. Many athletes were expecting anti-doping testing. However, that is not the main aim of the program, which is designed to process the medical data provided by the athletes with the object of safeguarding the health of runners and upholding a healthy sport. The Health Policy is an entirely novel concept and, surprisingly, has no counterparts in other disciplines – which is why so we are devoting so much energy to explaining the policy to all athletes.

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Loïc presenting the Health Policy to the teams. 

As far as the athletes are concerned, there was a variety of reactions when we gave examples of specific instances when the QUARTZ program had detected particularly serious health problems (a dangerous anaemia, a kidney problem, severe dehydration...) in runners immediately before the start of a race. The prevention element of the Health Policy makes it possible to limit as far as possible the grave and often little-known risks to which elite athletes are exposed when they alternate intensive training and very demanding competitions throughout the year, with no respite.

Pierre Sallet, President of the Association "Athletes for Transparency", who was present when blood samples were taken from the athletes, answers our questions. 

What is the point of a Health Policy at this type of event?

The primary objective of the Health Policy is to monitor the health of runners but it is also a very effective tool in the fight against doping. Above all, its role is a preventative one. We ask the athletes for information concerning their general state of health, as well as any medications and treatments they may take. Testing (blood, saliva, urine, ...), at events or as part of a more targeted annual check-up (QUARTZ Elite Program), allow us not only to detect possible pathologies but also to check that what is reported corresponds to what we find ... Atypical profiles can also be individually monitored and if we detect abnormal profiles the information is forwarded to the official anti-doping organisations. Our work is closely related to, and complements, that of the anti-doping organisations. Rather than looking for doping substances as such, our aim is to track biological profiles over the course of several races and see if the evolution of these profiles is cohesive. For example, an athlete who is 2m10 tall has an atypical (above average height) but consistent profile in that he/she remains 2m10 tall all year round. On the other hand, should testing suddenly show the same adult to be only 1m70 tall, we detect a problem that will be investigated more closely and, if appropriate, reported. The program also promotes the education of athletes, helping them avoid unwittingly falling foul of anti-doping regulations when taking drugs for medical purposes without realising that these may be classed as banned substances and be harmful to their health. 

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Pierre exchanging with the teams

How did the athletes perceive this Health Policy during the 2018 World Trail Championships?

For the vast majority of athletes, the value of the policy was clear; others were non-committal and a few did not see the point of the exercise. For the latter group, trail running is a sport that does not need this type of monitoring and in which doping does not exist. However, the sport is a young discipline and standards of conduct should be established from the start, where in the health of athletes is automatically monitored and the athletes are alerted to potential malpractice – of which they are frequently unaware; thus, on the contrary, the questions are legitimate and necessary, helping us towards a clearer overview of such a program. 

A number of athletes queried the rationale of testing only the top (ITRA Performance Index) 10 men and women and the best male and best female runners from each delegation. Why such a selection has been made?

The ideal solution would be to test all the athletes but such an initiative would necessitate far greater organization and would take several days. Setting up a system of this type would require further economic and logistical planning. For this reason, we chose to test the top runners (ITRA PI ranking) in order to ensure that the elite competitors are in good health and to set an ethical example. For the general public and for the external image of the sport, it is important to spread the word as widely as possible that this is a sport practiced by honest athletes. Our aim is to tackle the visible tip of the iceberg, represented by elite runners, who are prolific communicators and role models for all runners. The good habits they acquire will self-evidently influence, and be adopted by, the maximum number of other runners. It is also important to note that the QUARTZ Regular program caters for all runners. They are invited to fill their SHOL confidential health area (at no cost) in order to benefit from closer medical supervision in the event of a consultation and/or any intervention by medical teams during a race. 

pierre sallet_twc_2018

What are the essential features of the Health Policy?

The Health Policy has no precedent in the world of sport; a real change is taking place. The policy is of great significance not only for the athletes but also for the institutions who can utilise the program as a basis for monitoring and safeguarding the health of athletes and of their sport, as well as for guaranteeing a doping-free sport. Equipment manufacturers can ensure that their athletes continue to progress whilst respecting the core values of trail running. All the actors involved in implementing the Health Policy, as well as the athletes and their coaches, the manufacturers of equipment and the institutions, can be proud of their participation in this program, unique in the world of sport. 

Patrick Basset, anaesthetist, Chairman of the ITRA Medical Commission, founder of the Ultra Sports Science Foundation

What is the point of the Health Policy? 

The Health Policy is for all runners, elite and amateur alike. Trail running is a new sport that is still developing and is not yet "professionalised". Very often, the organizers of international races do not have an appropriate medical structure for providing the kind of assistance that is specifically related to ultra-endurance sport. Most runners, meanwhile, are unaware of the serious consequences of sustaining an extreme effort over a long period, as in the case of high-level trail running. The very particular requirements of this discipline, in conjunction with the specificity of the terrain (high altitude, the technical difficulty of routes, remote desert sites...), add a dimension of increased risk. The underlying concept is that of bringing together different but complementary fundamental principles in a joint initiative to promote the education, awareness and protection of runners and the discipline of trail running. 

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Patrick explaining the different parts of the QUARTZ Program

At the same time, it has become evident that the international fight against doping is flawed and that athletes from a number of sports have managed to "slip through the net" or were only found to have taken banned substances several years after winning titles – thus creating a negative image of their sport. 

With regard to trail running, our intention was to create a Health Policy while the sport was still in its infancy by educating athletes to adopt good habits in the interests of their own health and making them aware of the risks to which they are exposed when practising this sport, as well as of the risks, sometimes unknown, related to doping. The scourge of doping must be tackled at its roots and good practice established with respect to the federations, the athletes and the delegations as well as all amateur runners. To achieve this, medical research and preventative measures will have to be very precisely regulated. 

This is why implementation of the Health Policy at the 2018 World Trail Championships was essential. Elite runners must be made aware of the risks to which they are exposed and it must be ensured that they are provided with every possible tool for avoiding or minimising damage to their health. The athletes often travel very long distances to compete. As a consequence of frequent long-distance travel, the risks to their health are likely to be greater than average. It is important to meet with them and warn them of the specific pathologies related to the practice of their sport and to offer appropriate dietary advice, etc. The same athletes then become natural purveyors of good practice. Their influence spreads through the sport and they become role models. Through the medium of their interviews, their victories and their sponsors, they convey the message, transmitting the core values of trail-running. 

The metaphor of Formula 1 motor sport provides a good example. Formula 1 racing is used for testing engines and braking systems that are subsequently deployed in on-road vehicles available to the general public. The same is true of research carried out under the auspices of the Health Policy. Elite runners serve as a test subjects; the results can then be disseminated as broadly as possible. 

patrick basset twc 2018

What characterises the Health Policy?

Prevention is better than cure. What really distinguishes the Health Policy from a more traditional system is freedom of access and transparency.  Everyone is welcome: treating physicians, doctors in attendance at races, all the medical teams... And, whilst it goes without saying that the personal data of athletes is strictly confidential, some athletes decide to make their health space public in the interest of total transparency.  
Such an approach has the advantage of ensuring independence and of eliminating accountability to any particular organisation. The program was born of a meeting of trail running devotees, who came together with the objective of safeguarding the health of runners whilst developing a healthy and natural sport and respecting the values at the heart of trail running. 

An appraisal by Carla Tena, Marketing Manager of Penyagolosa Trails 

It is important to carry out of tests, such as those proposed by ITRA, on a regular basis before big events. The tests incorporated into the Health Policy can detect potential anomalies in runners, thereby protecting their health and enhancing safety - which is very important, not least in order to ensure the success of the event.  For the athletes, this takes only a few minutes and allows ongoing monitoring of their health. 

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