Abstract
The physiological demands of marathon and ultra-marathon running are substantial, affecting multiple body systems. There have been several reviews on the physiological contraindications of participation; nevertheless, the respiratory implications have received relatively little attention. This paper provides an up-to-date review of the literature pertaining to acute pulmonary and respiratory muscle responses to marathon and ultra-marathon running. Pulmonary function was most commonly assessed using spirometry, with infrequent use of techniques including single-breath rebreathe and whole-body plethysmography. All studies observed statistically significant post-race reductions in one-or-more metrics of pulmonary function, with or without evidence of airway obstruction. Nevertheless, an independent analysis revealed that post-race values rarely fell below the lower-limit of normal and are unlikely, therefore, to be clinically significant. This highlights the virtue of healthy baseline parameters prior to competition and, although speculative, there may be more potent clinical manifestations in individuals with below-average baseline function, or those with pre-existing respiratory disorders (e.g., asthma). Respiratory muscle fatigue was most commonly assessed indirectly using maximal static mouth-pressure manoeuvres, and respiratory muscle endurance via maximum voluntary ventilation (MVV12). Objective nerve-stimulation data from one study, and others documenting the time-course of recovery, implicate peripheral neuromuscular factors as the mechanism underpinning such fatigue. Evidence of respiratory muscle fatigue was more prevalent following marathon compared to ultra-marathon, and might be a factor of work rate, and thus exercise ventilation, which is tempered during longer races. Potential implications of respiratory muscle fatigue on health and marathon/ultra-marathon performance have been discussed, and include a diminished postural stability that may increase the risk of injury when running on challenging terrain, and possible respiratory muscle fatigue-induced effects on locomotor limb blood flow. This review provides novel insights that might influence marathon/ultra-marathon preparation strategies, as well as inform medical best-practice of personnel supporting such events.
Highlights
The marathon footrace (42.2 km) was once considered among the greatest feats of human endurance [1] and, as a result, marathon running has been used widely as a model to investigate the limits of physiological function
The following inclusion criteria were applied to the original abstracts retrieved using the above search-terms: (1) the study made a novel contribution to the literature on marathon or ultra-marathon rather than ultra-endurance exercise in general; (2) the study explored aspects of pulmonary function and/or respiratory muscle function and/or respiratory muscle fatigue within the context of marathon or ultramarathon running; (3) the study made comparable pre- and post-race assessments of one-or-more aspects of pulmonary and/or respiratory muscle function; and (4) the article was available in English
This physiological test assesses the competency with which an individual inspires or expires volumes of air as a function of time by requiring the subject to perform a series of forced vital capacity (FVC) manoeuvres into a mouthpiece; it is a valuable tool for screening general respiratory health [24]
Summary
The marathon footrace (42.2 km) was once considered among the greatest feats of human endurance [1] and, as a result, marathon running has been used widely as a model to investigate the limits of physiological function. The last few decades have seen an increased popularity of the ultra-marathon; defined as any footrace that exceeds the traditional marathon [2] and that typically lasts for > 6 h [3]. Most ultra-marathons take place over distances ranging from 50 to 160 km in a single stage, and up to 3100 km in multi-stage
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