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Background

The TransEurope FootRace 2009 (TEFR09) was one of the longest transcontinental ultramarathons with an extreme endurance physical load of running nearly 4,500 km in 64 days. The aim of this study was to assess the wide spectrum of adaptive responses in humans regarding the different tissues, organs and functional systems being exposed to such chronic physical endurance load with limited time for regeneration and resulting negative energy balance. A detailed description of the TEFR project and its implemented measuring methods in relation to the hypotheses are presented.

Methods

The most important research tool was a 1.5 Tesla magnetic resonance imaging (MRI) scanner mounted on a mobile unit following the ultra runners from stage to stage each day. Forty-four study volunteers (67% of the participants) were cluster randomized into two groups for MRI measurements (22 subjects each) according to the project protocol with its different research modules: musculoskeletal system, brain and pain perception, cardiovascular system, body composition, and oxidative stress and inflammation. Complementary to the diverse daily mobile MR-measurements on different topics (muscle and joint MRI, T2*-mapping of cartilage, MR-spectroscopy of muscles, functional MRI of the brain, cardiac and vascular cine MRI, whole body MRI) other methods were also used: ice-water pain test, psychometric questionnaires, bioelectrical impedance analysis (BIA), skinfold thickness and limb circumference measurements, daily urine samples, periodic blood samples and electrocardiograms (ECG).

Results

Thirty volunteers (68%) reached the finish line at North Cape. The mean total race speed was 8.35 km/hour. Finishers invested 552 hours in total. The completion rate for planned MRI investigations was more than 95%: 741 MR-examinations with 2,637 MRI sequences (more than 200,000 picture data), 5,720 urine samples, 244 blood samples, 205 ECG, 1,018 BIA, 539 anthropological measurements and 150 psychological questionnaires.

Conclusions

This study demonstrates the feasibility of conducting a trial based centrally on mobile MR-measurements which were performed during ten weeks while crossing an entire continent. This article is the reference for contemporary result reports on the different scientific topics of the TEFR project, which may reveal additional new knowledge on the physiological and pathological processes of the functional systems on the organ, cellular and sub-cellular level at the limits of stress and strain of the human body.

Please see related articles: http://www.biomedcentral.com/1741-7015/10/76 and http://www.biomedcentral.com/1741-7015/10/77

Background

During the extremely challenging 4,487 km ultramarathon TransEurope-FootRace 2009, runners showed considerable reduction of body weight. The effects of this endurance run on brain volume changes but also possible formation of brain edema or new lesions were explored by repeated magnetic resonance imaging (MRI) studies.

Methods

A total of 15 runners signed an informed consent to participate in this study of planned brain scans before, twice during, and about 8 months after the race. Because of dropouts, global gray matter volume analysis could only be performed in ten runners covering three timepoints, and in seven runners who also had a follow-up scan. Scanning was performed on three identical 1.5 T Siemens MAGNETOM Avanto scanners, two of them located at our university. The third MRI scanner with identical sequence parameters was a mobile MRI unit escorting the runners. Volumetric 3D datasets were acquired using a magnetization prepared rapid acquisition gradient echo (MPRAGE) sequence. Additionally, diffusion-weighted (DWI) and fluid attenuated inversion recovery (FLAIR) imaging was performed.

Results

Average global gray matter volume as well as body weight significantly decreased by 6% during the race. After 8 months, gray matter volume returned to baseline as well as body weight. No new brain lesions were detected by DWI or FLAIR imaging.

Conclusions

Physiological brain volume reduction during aging is less than 0.2% per year. Therefore a volume reduction of about 6% during the 2 months of extreme running appears to be substantial. The reconstitution in global volume measures after 8 months shows the process to be reversible. As possible mechanisms we discuss loss of protein, hypercortisolism and hyponatremia to account for both substantiality and reversibility of gray matter volume reductions. Reversible brain volume reduction during an ultramarathon suggests that extreme running might serve as a model to investigate possible mechanisms of transient brain volume changes. However, despite massive metabolic load, we found no new lesions in trained athletes participating in a multistage ultramarathon.

See related commentary http://www.biomedcentral.com/1741-7015/10/171

The study was conducted to evaluate the metabolic responses to a 24 h ultra-endurance race in male runners. Paired venous and capillary blood samples from 14 athletes (mean age 43.0 ± 10.8 years, body weight 64.3 ± 7.2 kg, VO2max 57.8 ± 6.1 ml kg−1 min−1), taken 3 h before the run, after completing the marathon distance (42.195 km), after 12 h, and at the finish of the race, were analyzed for blood morphology, acid–base balance and electrolytes, lipid profile, interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and serum enzyme activities. Mean distance covered during the race was 168.5 ± 23.1 km (range 125.2–218.5 km). Prolonged ultra-endurance exercise triggered immune and inflammatory responses, as evidenced by a twofold increase in total leukocyte count with neutrophils and monocytes as main contributors, nearly 30-fold increase in serum IL-6 and over 20-fold rise in hsCRP. A progressive exponential increase in mean creatine kinase activity up to the level 70-fold higher than the respective pre-race value, a several fold rise in serum activities of aspartate aminotransferase and alanine aminotransferase, and a fairly stable serum γ-glutamyl transferase level, were indicative of muscle, but not of liver damage. With duration of exercise, there was a progressive development of hyperventilation-induced hypocapnic alkalosis, and a marked alteration in substrate utilization towards fat oxidation to maintain blood glucose homeostasis. The results of this study may imply that progressive decline in partial CO2 pressure (hypocapnia) that develops during prolonged exercise may contribute to increased interleukin-6 production.

Context:

The behaviors and beliefs of recreational runners with regard to hydration maintenance are not well elucidated.

Objective:

To examine which beverages runners choose to drink and why, negative performance and health experiences related to dehydration, and methods used to assess hydration status.

Design:

Cross-sectional study.

Setting:

Marathon registration site.

Patients or Other Participants:

Men (n = 146) and women (n = 130) (age = 38.3 ± 11.3 years) registered for the 2010 Little Rock Half-Marathon or Full Marathon.

Intervention(s):

A 23-item questionnaire was administered to runners when they picked up their race timing chips.

Main Outcome Measure(s):

Runners were separated into tertiles (Low, Mod, High) based on z scores derived from training volume, expected performance, and running experience. We used a 100-mm visual analog scale with anchors of 0 (never) and 100 (always). Total sample responses and comparisons between tertile groups for questionnaire items are presented.

Results:

The High group (58±31) reported greater consumption of sport beverages in exercise environments than the Low (42 ± 35 mm) and Mod (39 ± 32 mm) groups (P < .05) and perceived sport beverages to be superior to water in meeting hydration needs (P < .05) and improving performance during runs greater than 1 hour (P < .05). Seventy percent of runners experienced 1 or more incidents in which they believed dehydration resulted in a major performance decrement, and 45% perceived dehydration to have resulted in adverse health effects. Twenty percent of runners reported monitoring their hydration status. Urine color was the method most often reported (7%), whereas only 2% reported measuring changes in body weight.

Conclusions:

Greater attention should be paid to informing runners of valid techniques to monitor hydration status and developing an appropriate individualized hydration strategy.

The association of skinfold thicknesses with race performance has been investigated in runners competing over distances of ≤50 km. This study investigated a potential relation between skinfold thicknesses and race performance in male ultra-marathoners completing >50 km in 24 hours. Variables of anthropometry, training, and previous performance were related to race performance in 63 male ultra-marathoners aged 46.9 (standard deviation [SD] 10.3) years, standing 1.78 (SD 0.07) m in height, and weighing 73.3 (SD 7.6) kg. The runners clocked 146.1 (SD 43.1) km during the 24 hours. In the bivariate analysis, several variables were associated with race performance: body mass (r = −0.25); skinfold thickness at axilla (r = −0.37), subscapula (r = −0.28), abdomen (r = −0.31), and suprailiaca (r = −0.30); the sum of skinfold thicknesses (r = −0.32); percentage body fat (r = −0.32); weekly kilometers run (r = 0.31); personal best time in a marathon (r = −0.58); personal best time in a 100-km ultra-run (r = −0.31); and personal best performance in a 24-hour run (r = 0.46). In the multivariate analysis, no anthropometric or training variable was related to race performance. In conclusion, in contrast to runners up to distances of 50 km, skinfold thicknesses of the lower limbs were not related to race performance in 24-hour ultra-marathoners.

Objectives

Changes in plasma thioredoxin (TRX) concentrations before, during, and after a 130-km endurance race were measured with the aim of elucidating the relationship between exercise and oxidative stress (OS).

Methods

Blood samples were taken from 18 runners participating in a 2-day-long 130-km ultra-marathon during the 2 days of the race and for 1 week thereafter. There were six sampling time points: at baseline, after the goal had been reached on the first and second day of the endurance race, respectively, and on 1, 3, and 5/6 days post-endurance race. The samples were analyzed for plasma TRX concentrations, platelet count, and blood lipid profiles.

Results

Concentrations of plasma TRX increased from 17.9 ± 1.2 ng/mL (mean ± standard error of the mean) at baseline to 57.3 ± 5.0 ng/mL after the first day’s goal had been reached and to 70.1 ± 6.9 ng/mL after the second day's goal had been reached; it then returned to the baseline level 1 day after the race. Platelet counts of 21.3 ± 1.2 × 104 cell/μL at baseline increased to 23.9 ± 1.5 × 104 cells/μL on Day 1 and to 26.1 ± 1.0 × 104 cells/μL on Day 2. On Day 7, the platelet counts had fallen to 22.1 ± 1.2 × 104 cell/μL. There was a significant positive correlation between plasma TRX and platelet count.

Conclusions

These data suggest that plasma TRX is an OS marker during physical exercise. Further studies are needed to determine the appropriate level of exercise for the promotion of health.

Physical activity, likely through induction of neuroplasticity, is a promising intervention to promote brain health. In athletes it is clear that training can and does, by physiological adaptations, extend the frontiers of performance capacity. The limits of our endurance capacity lie deeply in the human brain, determined by various personal factors yet to be explored. The human brain, with its vast neural connections and its potential for seemingly endless behaviors, constitutes one of the final frontiers of medicine. In a recent study published in BMC Medicine, the TransEurope FootRace Project followed 10 ultra-endurance runners over around 4,500 km across Europe and recorded a large data collection of brain imaging scans. This study indicates that the cerebral atrophy amounting to a reduction of approximately 6% throughout the two months of the race is reversed upon follow-up. While this study will contribute to advances in the limits of human performance on the neurophysiological processes in sports scientists, it will also bring important understanding to clinicians about cerebral atrophy in people who are vulnerable to physical and psychological stress long term.

See related research article http://www.biomedcentral.com/1741-7015/10/170

Background

Regular exercise is beneficial for cardiovascular health but a recent meta-analysis indicated a relationship between extensive endurance sport and a higher risk of atrial fibrillation, an independent risk factor for stroke. However, data on the frequency of cardiac arrhythmias or (clinically silent) brain lesions during and after marathon running are missing.

Methods/ Design

In the prospective observational “Berlin Beat of Running” study experienced endurance athletes underwent clinical examination (CE), 3 Tesla brain magnetic resonance imaging (MRI), carotid ultrasound imaging (CUI) and serial blood sampling (BS) within 2-3 days prior (CE, MRI, CUI, BS), directly after (CE, BS) and within 2 days after (CE, MRI, BS) the 38th BMW BERLIN-MARATHON 2011. All participants wore a portable electrocardiogram (ECG)-recorder throughout the 4 to 5 days baseline study period. Participants with pathological MRI findings after the marathon, troponin elevations or detected cardiac arrhythmias will be asked to undergo cardiac MRI to rule out structural abnormalities. A follow-up is scheduled after one year.

Results

Here we report the baseline data of the enrolled 110 athletes aged 36-61 years. Their mean age was 48.8 ± 6.0 years, 24.5% were female, 8.2% had hypertension and 2.7% had hyperlipidaemia. Participants have attended a mean of 7.5 ± 6.6 marathon races within the last 5 years and a mean of 16 ± 36 marathon races in total. Their weekly running distance prior to the 38th BMW BERLIN-MARATHON was 65 ± 17 km. Finally, 108 (98.2%) Berlin Beat-Study participants successfully completed the 38th BMW BERLIN-MARATHON 2011.

Discussion

Findings from the “Berlin Beats of Running” study will help to balance the benefits and risks of extensive endurance sport. ECG-recording during the marathon might contribute to identify athletes at risk for cardiovascular events. MRI results will give new insights into the link between physical stress and brain damage.

Trial registration

clinicaltrials.gov NCT01428778

Objective

To investigate factors associated with menstrual dysfunction, self‐reported bone stress injuries and energy balance in women runners.

Methods

613 runners were randomly sampled during the registration period for an endurance event. Demographic information, including self‐reported height and weight, training and injury history and menstrual history, was collected by questionnaire.

Results

Ultra‐marathon (ULTRA) participants (n = 276) were significantly older (mean (SD) 39 (8.2) vs 34 (10.5) years; p<0.001), lighter (58.2 (6.6) vs 59.6 (8.3) kg; p<0.05) and reported a higher training volume (p<0.001) than half‐marathon (HALF) participants (n = 337). Significantly more ULTRA subjects than HALF subjects reported a previous bone stress injury (21% vs 14%; p<0.05). There was no difference between the groups for menstrual status, but age at menarche was later (p<0.01) in the ULTRA group. Data were combined according to the absence (REG; n = 368/602 (61%)) or presence (IRREG; n = 234/602 (39%)) of a history of menstrual irregularity. Subject morphology was similar between groups, but the IRREG group had a higher self‐reported measure on the self‐loathing subscale (SLSS; p<0.01). The whole group was then classified according to current menstrual status, with 165 women being classified as currently irregular. (OLIGO/AMEN; 11.6%) and 445 women as currently regular (EUMEN; 88.4%). There were no morphological differences between the groups, however the OLIGO/AMEN group had a later age of menarche (p<0.01) than the EUMEN group. Further, women who reported a previous bone stress injury had higher SLSS scores than those who did not (2.91 (0.98) vs 2.68 (0.84); p<0.05).

Conclusions

There may be two independent mechanisms associated with energy balance, which are related to bone stress injuries, but may not necessarily be related to menstrual dysfunction.

OBJECTIVE: To describe the incidence of injuries and other health problems sustained during participation in a marathon. METHODS: A cohort study was undertaken involving the 1993 Auckland Citibank marathon participants. Demographic data and information on injuries and other health problems sustained during, immediately after, and 7 d following the marathon were obtained from a pre-race questionnaire, the medical aid posts, and a post-race questionnaire. RESULTS: Of the 1219 starters, 916 (75.1%) completed both questionnaires. Seventy five individuals (6.2%) sought assistance at the medical aid posts. During or immediately after the marathon, 283 systemic health problems were reported by 218 respondents (23.8%) and 2671 specific health problems were reported by 846 respondents (92.4%). In the 7 d following the marathon, 1905 specific health problems were reported by 723 respondents (79.2%). The majority of the specific health problems were blisters, stiffness, and pain, predominantly involving the lower limbs. CONCLUSIONS: Although a high proportion of participants experienced health problem during the race, very few of these problems were serious. Many of the entrants were still experiencing problems 7 d after the marathon.

OBJECTIVES: To identify risk factors for injuries and other health problems occurring during or immediately after participation in a marathon. METHODS: A prospective cohort study was undertaken of participants in the 1993 Auckland Citibank marathon. Demographic data, information on running experience, training and injuries, and information on other lifestyle factors were obtained from participants before the race using an interviewer-administered questionnaire. Information on injuries and other health problems sustained during or immediately after the marathon were obtained by a self administered questionnaire. Logistic regression analyses were undertaken to identify significant risk factors for health problems. RESULTS: This study, one of only a few controlled epidemiological studies that have been undertaken of running injuries, has identified a number of risk factors for injuries and other health problems sustained in a marathon. Men were at increased risk of hamstring and calf problems, whereas women were at increased risk of hip problems. Participation in a marathon for the first time, participation in other sports, illness in the two weeks before the marathon, current use of medication, and drinking alcohol once a month or more, were associated with increased self reported risks of problems. While increased training seemed to increase the risk of front thigh and hamstring problems, it may decrease the risk of knee problems. There are significant but complex relations between age and risk of injury or health problem. CONCLUSIONS: This study has identified certain high risk subjects and risk factors for injuries and other health problems sustained in a marathon. In particular, subjects who have recently been unwell or are taking medication should weigh up carefully the pros and cons of participating. 




Elevation of creatine kinase (CK) in serum after exertion is a reliable marker of skeletal muscle injury. Limited data exist on CK levels in conditioned athletes after endurance training and competition. Serum CK was measured by a kinetic UV method (normal < 100 U/L) in 15 long distance runners before (pre-race), 24 hours after (post-race) and four weeks following (post-race) the 1979 Boston Marathon. CK levels were elevated throughout the study. Mean values for all runners and for those finishing before and after three hours and 30 minutes are as follows: Post-race CK was significantly elevated among the ten faster as compared to the five slower runners (p = 0.025). Elevations of creatine kinase drawn 24 hours post-marathon are inversely related to finishing times among the runners tested.

Background

An association between fluid intake and changes in volumes of the upper and lower limb has been described in 100-km ultra-marathoners. The purpose of the present study was (i) to investigate the association between fluid intake and a potential development of peripheral oedemas leading to an increase of the feet volume in 100-km ultra-marathoners and (ii) to evaluate a possible association between the changes in plasma sodium concentration ([Na+]) and changes in feet volume.

Methods

In seventy-six 100-km ultra-marathoners, body mass, plasma [Na+], haematocrit and urine specific gravity were determined pre- and post-race. Fluid intake and the changes of volume of the feet were measured where the changes of volume of the feet were estimated using plethysmography.

Results

Body mass decreased by 1.8 kg (2.4%) (p < 0.0001); plasma [Na+] increased by 1.2% (p < 0.0001). Haematocrit decreased (p = 0.0005). The volume of the feet remained unchanged (p > 0.05). Plasma volume and urine specific gravity increased (p < 0.0001). Fluid intake was positively related to the change in the volume of the feet (r = 0.54, p < 0.0001) and negatively to post-race plasma [Na+] (r = -0.28, p = 0.0142). Running speed was negatively related to both fluid intake (r = -0.33, p = 0.0036) and the change in feet volume (r = -0.23, p = 0.0236). The change in the volume of the feet was negatively related to the change in plasma [Na+] (r = -0.26, p = 0.0227). The change in body mass was negatively related to both post-race plasma [Na+] (r = -0.28, p = 0.0129) and running speed (r = -0.34, p = 0.0028).

Conclusions

An increase in feet volume after a 100-km ultra-marathon was due to an increased fluid intake.

Objective

To evaluate the potential effects of a 308-km ultra-marathon on bone and cartilage biomarkers.

Method

Venous blood samples were collected at pre-race, 100 km, 200 km, and 308 km checkpoints. The following markers of cartilage damage and bone metabolism were studied: osteocalcin (OC), osteoprotegerin (OPG), and calcium, phosphorous, and cartilage oligomeric matrix protein (COMP).

Results

Blood samples were taken from 20 male runners at four different checkpoints. Serum COMP was increased by 194.1% (130.7% at 100 km and 160.4% at 200 km). Serum OPG was significantly increased by 158.57% at 100 km and 114.1% at 200 km compared to the pre-race measures. OC was transiently suppressed at 200 km. Serum calcium and phosphorous concentrations decreased compared to the pre-race measures.

Conclusion

This study showed that the 308-km ultra-marathon induced several changes, including transient uncoupling of bone metabolism, increased bone resorption, suppressed bone formation, and bone turnover and had a major impact on cartilage structure.

In the last decades, the participation of elderly trained people in endurance events such as marathon running has dramatically increased. Previous studies suggested that the performance of master runners (> 40 yrs) during marathon running has improved. The aims of the study were : (i) to analyze the changes in participation and performance trends of master marathon runners between 1980 and 2009 and, ii) to compare the gender differences in performance as a function of age across the years. Running times of the best male and female runners between 20 and 79 yrs of age who competed in the New-York City marathon were analyzed. Gender differences in performance times were analysed for the top 10 male and female runners between 20 and 65 yrs of age. The participation of master runners increased during the 1980–2009 period, to a greater extent for females compared to males. During that period, running times of master runners significantly (P<0.01) decreased for males older than 64 yrs and for females older than 44 yrs, respectively. Gender differences in running times decreased over the last 3 decades but remained relatively stable across the ages during the last decade. These data suggest that male (≥ 65 yrs) and female (≥ 45 yrs) master runners have probably not yet reached their limits in marathon performance. The relative stability of gender differences in marathon running times across the different age groups over the last decade also suggests that age-related declines in physiological function do not differ between male and female marathoners.

A survey of 707 participants in the 13th Annual Trail's End Marathon in Seaside, Oregon, showed a high incidence of gastrointestinal disturbances, predominantly of the lower tract, associated with long-distance running. The urge to defecate, both during and immediately after running, occurred in over a third of runners. Bowel movements (35%) and diarrhea (19%) were relatively common after running, and runners occasionally interrupted hard runs or races for bowel movements (18%) or diarrhea (10%). Lower gastrointestinal disturbances were more frequent in women than in men and in younger than in older runners. Awareness of the frequency and nature of gastrointestinal symptoms documented by this survey will assist physicians in evaluating abdominal complaints in runners.

Marathon runners tend to form clusters during competition, possibly as a means of improving their performance. Studies of international competitors in Fukuoka and Tokyo races have shown a density of 0.44 to 0.80 runners.m2 among those maintaining a pace of 4.8-5.6 m.s-1, clustering being most marked among elite performers. Some 95% of clustered runners maintained a minimum distance of 0.5-1.5 m from other competitors; moreover, such competitors avoided occupying an angle of +/- 15 degrees either before or behind other runners. The phenomenon merits closer study by those interested in the bettering of marathon performance.

Two questionnaires were given to the participants of the Danish national marathon championship to obtain information on health, training habits, previous injuries and the medical problems sustained during and after the competition. All 60 participants replied to both questionnaires. The elite runner is training between 90-150 km per week, using one daily training session. He is generally careful about stretching and warming up and down. Forty-three per cent of runners sustained injuries in the last year that prevented them from training, but only 3% needed to stay off work. The most common reasons for not completing the race were exhaustion and injuries to the lower extremities. Sixty-one per cent of the runners who did not drink at all refreshment stations dropped out, whereas only 27% of those who did dropped out. There was no difference in relation to results or medical problems between the group who used a special diet before the run and those who did not. The major medical problems were gastrointestinal disturbances, skin lesions and pain or cramps in the lower extremities. No serious injuries were reported.

To determine the prevalence of various gastrointestinal disturbances related to long-distance running and its effect on weight, diet and everyday digestive problems, we gave a questionnaire to 279 leisure-time marathon runners, comprising 10% of the participants in a local marathon race. Their answers disclosed a prevalence of dietary changes, weight reduction and altered bowel habits (mainly looser stools and/or more frequent defaecation) of 37, 38 and 48% respectively. A quarter reported earlier long lasting gastrointestinal problems, which improved in 41% of the runners after they started regular training. Thirty-four percent experienced gastrointestinal disturbances during or after running, 20% to such an extent that it seriously affected their performance.

The purpose of this longitudinal questionnaire study was to investigate the effects of participation or non participation in a marathon race on future running behaviour. The majority (70 per cent) of the participants who intended to run a future marathon actually did so and only 11 per cent stopped running altogether. Fewer of the pre-race drop-outs (31 per cent) who indicated their intention to run a future marathon actually did so (P less than 0.001) and more of them (24 per cent) stopped running altogether (P less than 0.001) compared with the runners in the finishers' sample. These results suggest that the experience of running in a marathon does not negatively influence future running habits. However, failure to run in a race for which an entry has been made may lead to a reduced involvement in running. The present study also examined the reasons for pre-race drop-out. Injury (36 per cent), lack of training (31 per cent) and illness (12 per cent) were the most frequently given reasons for drop-out. Few differences were found between the pre-race drop-outs and the finishers, but the drop-outs did feel that running was less important (P less than 0.001), reported a greater number of longer term injuries (P less than 0.001) and did significantly less training (P less than 0.001) than the finishers.

Images

Purpose

The objectives of this study were to describe the distribution of all runners' performances in the largest marathons worldwide and to determine which environmental parameters have the maximal impact.

Methods

We analysed the results of six European (Paris, London, Berlin) and American (Boston, Chicago, New York) marathon races from 2001 to 2010 through 1,791,972 participants' performances (all finishers per year and race). Four environmental factors were gathered for each of the 60 races: temperature (°C), humidity (%), dew point (°C), and the atmospheric pressure at sea level (hPA); as well as the concentrations of four atmospheric pollutants: NO2 – SO2 – O3 and PM10 (μg.m−3).

Results

All performances per year and race are normally distributed with distribution parameters (mean and standard deviation) that differ according to environmental factors. Air temperature and performance are significantly correlated through a quadratic model. The optimal temperatures for maximal mean speed of all runners vary depending on the performance level. When temperature increases above these optima, running speed decreases and withdrawal rates increase. Ozone also impacts performance but its effect might be linked to temperature. The other environmental parameters do not have any significant impact.

Conclusions

The large amount of data analyzed and the model developed in this study highlight the major influence of air temperature above all other climatic parameter on human running capacity and adaptation to race conditions.

An experienced marathon runner died suddenly during a competitive race. At necropsy, ventricular hypertrophy but no asymmetrical septal hypertrophy was found. Histological studies showed features of hypertrophic cardiomyopathy. The coronary arteries were normal. We propose that the runner died from myocardial ischaemia, precipitated by marathon running on a background of hypertrophic cardiomyopathy. Excess cardiac work, induced by marathon running in the presence of mild congenital cardiac defects, could have contributed to the development of the cardiomyopathy.

Images

Background

Completing a marathon is one of the most challenging sports activities, yet the source of running fatigue during this event is not completely understood. The aim of this investigation was to determine the cause(s) of running fatigue during a marathon in warm weather.

Methodology/Principal Findings

We recruited 40 amateur runners (34 men and 6 women) for the study. Before the race, body core temperature, body mass, leg muscle power output during a countermovement jump, and blood samples were obtained. During the marathon (27 °C; 27% relative humidity) running fatigue was measured as the pace reduction from the first 5-km to the end of the race. Within 3 min after the marathon, the same pre-exercise variables were obtained.

Results

Marathoners reduced their running pace from 3.5 ± 0.4 m/s after 5-km to 2.9 ± 0.6 m/s at the end of the race (P<0.05), although the running fatigue experienced by the marathoners was uneven. Marathoners with greater running fatigue (> 15% pace reduction) had elevated post-race myoglobin (1318 ± 1411 v 623 ± 391 µg L−1; P<0.05), lactate dehydrogenase (687 ± 151 v 583 ± 117 U L−1; P<0.05), and creatine kinase (564 ± 469 v 363 ± 158 U L−1; P = 0.07) in comparison with marathoners that preserved their running pace reasonably well throughout the race. However, they did not differ in their body mass change (−3.1 ± 1.0 v −3.0 ± 1.0%; P = 0.60) or post-race body temperature (38.7 ± 0.7 v 38.9 ± 0.9 °C; P = 0.35).

Conclusions/Significance

Running pace decline during a marathon was positively related with muscle breakdown blood markers. To elucidate if muscle damage during a marathon is related to mechanistic or metabolic factors requires further investigation.

INTRODUCTION:

There are no available data addressing the potential clinical risks of open-water swimming competitions.

OBJECTIVE:

Address the risks of hypothermia and hypoglycemia during a 10-km open-water swimming competition in order to alert physicians to the potential dangers of this recently-introduced Olympic event.

METHODS:

This was an observational cross-sectional study, conducted during a 10-km open-water event (water temperature 21°C). The highest ranked elite open-water swimmers in Brazil (7 men, 5 women; ages 21±7 years old) were submitted to anthropometrical measurements on the day before competition. All but one athlete took maltodextrine ad libitum during the competition. Core temperature and capillary glycemia data were obtained before and immediately after the race.

RESULTS:

Most athletes (83%) finished the race with mild to moderate hypothermia (core temperature <35°C). The body temperature drop was more pronounced in female athletes (4.2±0.7°C vs. male: 2.7±0.8°C; p=0.040). When data from the athlete who did not take maltodextrine was excluded, capillary glycemia increased among athletes (pre 86.6±8.9 mg/dL; post 105.5±26.9 mg/dL; p=0.014). Time to complete the race was inversely related to pre- competition body temperature in men (r=−0.802; p=0.030), while it was inversely correlated with the change in capillary glycemia in women (r=−0.898; p=0.038).

CONCLUSION:

Hypothermia may occur during open-water swimming events even in elite athletes competing in relatively warm water. Thus, core temperature must be a chief concern of any physician during an open-water swim event. Capillary glycemia may have positive effects on performance. Further studies that include more athletes in a controlled setting are warranted.

Background

Anecdotal evidence suggests ultra-runners may not be consuming sufficient water through foods and fluids to maintenance euhydration, and present sub-optimal sodium intakes, throughout multi-stage ultra-marathon (MSUM) competitions in the heat. Subsequently, the aims were primarily to assess water and sodium intake habits of recreational ultra-runners during a five stage 225 km semi self-sufficient MSUM conducted in a hot ambient environment (Tmax range: 32°C to 40°C); simultaneously to monitor serum sodium concentration, and hydration status using multiple hydration assessment techniques.

Methods

Total daily, pre-stage, during running, and post-stage water and sodium ingestion of ultra-endurance runners (UER, n = 74) and control (CON, n = 12) through foods and fluids were recorded on Stages 1 to 4 by trained dietetic researchers using dietary recall interview technique, and analysed through dietary analysis software. Body mass (BM), hydration status, and serum sodium concentration were determined pre- and post-Stages 1 to 5.

Results

Water (overall mean (SD): total daily 7.7 (1.5) L/day, during running 732 (183) ml/h) and sodium (total daily 3.9 (1.3) g/day, during running 270 (151) mg/L) ingestion did not differ between stages in UER (p < 0.001 vs. CON). Exercise-induced BM loss was 2.4 (1.2)% (p < 0.001). Pre- to post-stage BM gains were observed in 26% of UER along competition. Pre- and post-stage plasma osmolality remained within normal clinical reference range (280 to 303 mOsmol/kg) in the majority of UER (p > 0.05 vs. CON pre-stage). Asymptomatic hyponatraemia (<135 mmol/L) was evident pre- and post-stage in n = 8 UER, corresponding to 42% of sampled participants. Pre- and post-stage urine colour, urine osmolality and urine/plasma osmolality ratio increased (p < 0.001) as competition progressed in UER, with no change in CON. Plasma volume and extra-cellular water increased (p < 0.001) 22.8% and 9.2%, respectively, from pre-Stage 1 to 5 in UER, with no change in CON.

Conclusion

Water intake habits of ultra-runners during MSUM conducted in hot ambient conditions appear to be sufficient to maintain baseline euhydration levels. However, fluid over-consumption behaviours were evident along competition, irrespective of running speed and gender. Normonatraemia was observed in the majority of ultra-runners throughout MSUM, despite sodium ingestion under benchmark recommendations.