Swim, bike and run: promoting physical activity in General Practice through triathlon

By Greg Irving GP Clinical Lecturer in General Practice, University of Cambridge and Mary Hardwick Chair of British Triathlon

Whilst there has rightly been much attention given to activities such as running to improve physical activity through General Practice, triathlon should not be overlooked as an evidence based approach. Whilst running shows no reduction in all-cause mortality or cardiovascular mortality, cycling is associated with a reduction in all-cause mortality and swimming a reduction in cardiovascular mortality [1]. Triathletes benefit from a cross training effect and there are fewer injuries in those who incorporate the low impact sports of swimming and cycling into their training compared to those who run alone [2,3].

The benefits of swimming, cycling and running on mental health are well recognised [4], there are numerous reports of individuals using triathlon to overcome mental health problems. Ironman champion Lionel Sanders famously used triathlon to overcome his depression [5]. Others have used it to escape a life of crime – in his book ‘Redemption’ John McAvoy described triathlon as his salvation in his journey from a life behind bars to leading triathlete [6].

In 2018 ~215,000 people competed in at least one triathlon in England [7]. British Triathlon run an accessible low cost  ‘Go Tri’ for those interested in taking part in their first event, many of which are supported by local triathlon clubs [8]. Beyond this sprint through to Iron distance races are available. Triathletes compete in age groups. A wonderful example of an ‘age grouper’ is Edwina Brocklesby – Britain’s oldest female Ironman finisher at the age of 72. In her book ‘Iron gran’ she describes how she used triathlon to limit social isolation and overcome the death of her husband [9].

Duathlons (run, bike, run) aquathlons (swim, run) and  aqua-bike (swim, bike) events are alternatives to triathlons. Tandem bicycles, adapted bicycles, hand-cycles and wheelchairs can be used. Rick Hoyt (cerebral palsy) amazingly participated in the 1989 Ironman World Championships with his father using a boat, specially adapted bike and wheelchair [10]. An ‘In Water Triathlon’ is also possible for those with disability or injury [11].

So next time you wish to promote physical activity to a patient – think of triathlon an accessible evidence based approach.

Image credits: British Triathlon


Greg Irving is a Clinical Lecturer in General Practice at the University of Cambridge and triathlete racing at the Ironman World Championships in 2020. Email. gregirving@doctors.org.uk

Mary Hardwick is Chair of the Board of British Triathlon Federation. She is based in Rutland, UK and also runs a small rural Community Interest Company, Inspire2tri, with a passion to inspire sporting and fitness achievements at all levels of ability within the local community. Mary’s interests span physical activity, public health and rehabilitation. Email: MaryHardwick@britishtriathlon.org

Conflicts of interest

Greg Irving: None to declare.

Mary Hardwick runs a private not-for-profit business (Inspire2tri) https://inspire2tri.com


  1. Oja P, Kelly P et al. Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80 306 British adults: Br J Sports Med. 2017;51(10):812-817
  2. Millet G. Modelling the transfer of training effects on performance in elite triathletes. Int J Sports Med. 2002.
  3. Endurance injuries. https://www.peakendurancesport.com/endurance-injuries-and-health/ [last accessed 19.11.19]
  4. Choi K, Zheutlin A et al. Physical activity offsets genetic risk for incident depression assessed via electronic health records in a biobank cohort study. Depress Anxiety. 2019. doi: 10.1002/da.22967.
  5. Lionel Sanders. https://www.lsanderstri.com [last accessed 19.11.19]
  6. John McAvoy. http://therealmcavoy.com [last accessed 19.11.19]
  7. British Triathlon. https://www.britishtriathlon.org/media/statistics [last accessed 19.11.19]
  8. Go Tri. https://www.gotri.org
  9. Edwina Brocklesby. https://www.ageofnoretirement.org/stories/edwinabrocklesbyirongran [last accessed 19.11.19]
  10. Team Hoyt. http://www.teamhoyt.com [last accessed 19.11.19]
  11. Inspire2tri. https://inspire2tri.com/fitness/in-water-triathlon-2 [last accessed 19.11.19]

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