Air quality, respiratory health and performance in athletes. A summary of the IOC consensus subgroup narrative review on ‘Acute respiratory illness in athletes’

With the WHO stating that nearly 99% of the global population is exposed to air pollution levels that increase the risk of chronic diseases, the question of exercising in polluted environments is relevant to the health of athletes. Major sporting events held under conditions of poor air quality (AQ) have highlighted the lack of answers to concerns raised by organisers and athletes about the associated health risks. This evidence-based narrative review compiles current knowledge and identifies gaps regarding the relationship between AQ and sport. It is a summary of a more comprehensive report prepared for the International Olympic Committee (IOC) Medical and Scientific Commission. This article discusses the various sources of air pollutants encountered during exercise, summarises current AQ guidelines and provides insights into AQ conditions during the Paris 2024 Olympic and Paralympic Games (OPG) as well as in Los Angeles over the past four summers, in preparation for the 2028 OPG. It also summarises the effects of air pollution on the respiratory health and performance of athletes, while proposing mitigation strategies, with a particular emphasis on AQ education.