Abstract
It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.
Highlights
Ultra-endurance running (UER) can be defined either by running distance or running time, including multi-day or multi-stage events [1]
Researchers have inquired into the long-term effects of prolonged and strenuous exercise, as UER is one of the most physiologically demanding sports that can potentially lead to long-term health-related issues [12, 13]
Thereafter, we present a synopsis of some of the most influential studies examining the possible association between UER and clinical health problems
Summary
Ultra-endurance running (UER) can be defined either by running distance (races that exceed the marathon distance of 42.195 km) or running time (exceeding 6 h), including multi-day or multi-stage events [1]. Participation in UER decreased significantly in 2020 due to the worldwide coronavirus disease 2019 (COVID-19) pandemic [4]. Research in UER has focused predominantly on acute injuries and medical problems, as well as physiological, biochemical, nutritional, performance, and training-related aspects [5,6,7,8,9,10,11]. Researchers have inquired into the long-term effects of prolonged and strenuous exercise, as UER is one of the most physiologically demanding sports that can potentially lead to long-term health-related issues [12, 13]
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