Objectives Longitudinal data on injury and illnesses in Para athletes is limited. Therefore, the aim was to illustrate the epidemiology of health problems (HP) concerning demographic factors and sporting exposure in an elite Para athlete cohort. Design Prospective cohort study Methods All German Paralympic squad athletes were invited to participate in this study. Between 2019 and 2021 HP were monitored via a weekly online questionnaire (Oslo Sports Trauma Research Centre questionnaire on HP). Additionally, primary sporting activity, training exposure, and subjective training intensity per week were recorded. Epidemiological descriptive statistics, hazard ratios (HR) and odd ratios (OR) were analysed. Results Over an observation period of 124 weeks, 122 Para athletes (48% females; mean age:28 years) reported 438 (248 substantial) HP, equally paired into illnesses and injuries. Females demonstrated a two-fold risk of sustaining a substantial HP (HR = 1.8; 95%CI:1.2-2.8). A lower risk of sustaining a substantial HP is associated with more than 5 years of elite training (OR = 0.9; 95%CI:0.8-0.9). At any given time, 10.5% (95%CI:9.6-11.5) of the participants reported a substantial HP and prevalence was elevated during weeks of competition (9.8%; 95%CI:4.2-15.4). During training camps new overuse injuries were mainly reported (41.2%), while acute injuries peaked during competitions (31.8%). Changes to the normal training intensity were associated with more substantial HP (OR range = 1.5-4; 95%CI range = 1.1-4.8). Conclusions Monitoring of female athletes, and those with less than five years of experience is substantial. HP patterns varied during the season. Education of coaches and medical staff is necessary to safely guide the Para athletes. Practical Implications • Education of Para athletes, coaches and medical staff might be unavoidable to safely guide the Para athletes. • Training and medical personnel should emphasise a health problem "check in" at the start of training camps to potentially prevent overuse injuries. • Subjective intensity rating during training sessions could be used to adapt training intenseness and possibly reduce health problems. • Close monitoring and communication with female and early career Para athletes might reduce the risk of sustaining a health problem.
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