Abstract: Drawing on a literature review and bibliometric analysis, and based on an examination of the overall progress of research on large language models (LLMs) in health communication, this article proposes a framework of triple positioning and a stratified approach to LLMs in sports health communication. It reviews the evolution and thematic characteristics of relevant studies from 2014 to 2024 and points out several major limitations in existing research, including an overemphasis on technical instrumentalism in research paradigms, a concentration on the individual level in terms of analytical focus, and the dominance of medical and computer-science perspectives alongside insufficient interdisciplinary integration. It further proposes a triadic role framework in which LLMs function as tools, participants, and infrastructure in sports health communication, and analyzes the possible ways in which they may reshape practices in this field. Building on this triadic framework, the article discusses directions for sports health communication research at the individual, group, and societal levels, with a view to providing a reference for theoretical development and interdisciplinary innovation in sports health communication in the age of artificial intelligence.