Abstract
Long distance races have a physiological impact on runners. Up to now, studies analyzing these physiological repercussions have been mainly focused on muscle and cardiac damage, as well as on its recovery. Therefore, a limited number of studies have been done to explore acute kidney failure and recovery after performing extreme exercises. Here, we monitored renal function in 76 marathon finishers (14 females) from the day before participating in a marathon until 192 h after crossing the finish line (FL). Renal function was evaluated by measuring serum creatinine (sCr) and the glomerular filtration rate (GFR). We randomly grouped our cohort into three intervention groups to compare three different strategies for marathon recovery: total rest (REST), continuous running at their ventilatory threshold 1 (VT1) intensity (RUN), and elliptical workout at their VT1 intensity (ELLIPTICAL). Interventions in the RUN and ELLIPTICAL groups were performed at 48, 96, and 144 h after marathon running. Seven blood samples (at the day before the marathon, at the FL, and at 24, 48, 96, 144, and 192 h post-marathon) and three urine samples (at the day before the marathon, at the finish line, and at 48 h post-marathon) were collected per participant. Both heart rate monitors and triaxial accelerometers were used to control the intensity effort during both the marathon race and the recovery period. Contrary to our expectations, the use of elliptical machines for marathon recovery delays renal function recovery. Specifically, the ELLIPTICAL group showed a significantly lower ∆GFR compared to both the RUN group (p = 4.5 × 10−4) and the REST group (p = 0.003). Hence, we encourage runners to carry out an active recovery based on light-intensity continuous running from 48 h after finishing the marathon. In addition, full resting seems to be a better strategy than performing elliptical workouts.
Highlights
Given the increase of marathon running popularity, the physiological alterations caused by performing such a demanding effort have increased the interest of the scientific community (Scheer, 2019; Rojas-Valverde et al, 2021b; Scheer et al, 2021)
Runnewrs were not dehydrated at the finish line (USG < 1.02 g/ml; Casa et al, 2000; Kavouras, 2002) and percentage of body loss was estimated around 3% (Noakes et al, 2005; Hoffman et al, 2017 in all groups; Supplementary Table S1)
No significant differences in marathon performance were observed across acute kidney injury (AKI) grades (Kruskal Wallis test, p = 0.262)
Summary
Given the increase of marathon running popularity, the physiological alterations caused by performing such a demanding effort have increased the interest of the scientific community (Scheer, 2019; Rojas-Valverde et al, 2021b; Scheer et al, 2021). Running a long-distance race demands a vigorous physical effort, which has been shown to generate transient elevation of biomarkers associated with pathological conditions such as muscle damage, inflammation, heart damage, and renal failure (Briviba et al, 2005; Khodaee et al, 2015; Belli et al, 2018; Knechtle and Nikolaidis, 2018; Nikolaidis et al, 2018; Bernat-Adell et al, 2019, 2020; Martínez-Navarro et al, 2020a,c; Scheer et al, 2021). In the last few years, several studies have focused on studying acute kidney injury (AKI) after performing a physically demanding exercise (Lipman et al, 2014; Traiperm et al, 2016; Mansour et al, 2017; González et al, 2019; Rojas-Valverde et al, 2019; Poussel et al, 2020; Khodaee et al, 2021). Contrary to other acute pathological alterations, renal function has been shown to be normalized 24 h after running a long-distance race. There is a need for monitoring renal function more than 48 h after performing a strenuous exercise
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