Male Marathon Research Articles

Artificial intelligence-enhanced detection of subclinical coronary artery disease in athletes: diagnostic performance and limitations.

This study evaluates the diagnostic performance of artificial intelligence (AI)-based coronary computed tomography angiography (CCTA) for detecting coronary artery disease (CAD) and assessing fractional flow reserve (FFR) in asymptomatic male marathon runners. We prospectively recruited 100 asymptomatic male marathon runners over the age of 45 for CAD screening. CCTA was analyzed using AI models (CorEx and Spimed-AI) on a local server. The models focused on detecting significant CAD (≥ 50% diameter stenosis, CAD-RADS 3, 4, or 5) and distinguishing hemodynamically significant stenosis (FFR ≤ 0.8) from non-significant stenosis (FFR > 0.8). Statistical analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The AI model demonstrated high sensitivity, with 91.2% for any CAD and 100% for significant CAD, and high NPV, with 92.7% for any CAD and 100% for significant CAD. The diagnostic accuracy was 73.4% for any CAD and 90.4% for significant CAD. However, the PPV was lower, particularly for significant CAD (25.0%), indicating a higher incidence of false positives. AI-enhanced CCTA is a valuable non-invasive tool for detecting CAD in asymptomatic, low-risk populations. The AI model exhibited high sensitivity and NPV, particularly for identifying significant stenosis, reinforcing its potential role in screening. However, limitations such as a lower PPV and overestimation of disease indicate that further refinement of AI algorithms is needed to improve specificity. Despite these challenges, AI-based CCTA offers significant promise when integrated with clinical expertise, enhancing diagnostic accuracy and guiding patient management in low-risk groups.

Effects Of Blackcurrant During Running In A Male And Female Marathon Des Sables Athlete

Effects Of Blackcurrant During Running In A Male And Female Marathon Des Sables Athlete

Effects of Altitude Training and Sea-Level Training Programs on the Physiological and Performance of Elite Chinese Male Marathon Runners

Background and Aims: Examining the differences between sea-level training programs and altitude offers important new perspectives on how environmental influences affect physiological adaptations and athletic performance. By being aware of these variations, coaches and athletes can tailor training plans to the unique conditions of altitude, which may improve performance in terms of endurance, oxygen use, and general athletic ability. Thus, this study aimed to investigate the effects of altitude training on physiological adaptation and performance in Chinese elite male marathon runners compared to plains training. By comparing the results of altitude training with those of sea-level training, this study sought to determine whether altitude training has a significant advantage in terms of physiological adaptation and performance enhancement for the Chinese elite male marathoner. In addition, exploring the variability of altitude training responses will help to inform an in-depth understanding of training strategies affecting elite marathoners and help to optimize performance enhancement methods in endurance sports. Methodology: Thirty-two Chinese elite male marathon runners will be recruited and subjected to a randomized controlled trial (RCT) in which they will be assigned to either a high altitude or plains training group. SPSS was used to perform independent samples t-tests and paired samples t-tests on the data of technical indicators. Both groups will receive structured and standardized training for a predetermined period, with the altitude of the high-altitude training set at 2366 m for 8 weeks. Results: (1) In the experimental group, the differences in red blood cells (RBC), maximal heart rate (HRmax), maximal oxygen uptake (VO2max), and full marathon performance before the altitude experiment compared to after the altitude experiment were significant (P=0.001); the differences in maximal anaerobic power and hemoglobin (HB) before the experiment were substantial (P<0.005); and the differences in maximal heart rate (HRmax) between the 28 days of the experiment and the post-experiment were substantial. (HRmax) difference was substantial (P=0.001). (2) The red blood cells (RBC), hemoglobin (HB), and maximal oxygen uptake (VO2max) of the experimental group were significantly higher than those of the control group compared with the control group (P < 0.005) Conclusion: The results of the study showed that eight weeks of altitude training at an altitude of 2,366 meters above sea level could improve the athletes' performance in the marathon and aerobic capacity, and could be used in the training of marathon runners.

Revealing the unrevealed: echocardiography for non-ischemic scar tissue detection.

The detection of myocardial scar tissue profoundly influences athletes care and prognostic categorization. Athletes appear to be at risk of developing fatal arrhythmias when harboring a quiescent cardiac disorder. Early identification of disease in asymptomatic individuals through preparticipation screening is means to prevent these events. We presented a male marathon runner master athlete who came at our Department of Sports Medicine for a preparticipation screening. Baseline 12-lead standard electrocardiogram was normal. A maximal cycle ergometer exercise test revealed exercise-induced premature ventricular contractions (PVCs) with uncommon morphology. Echocardiography revealed an hyperechogenic zone at mid-basal posterior segments of the left ventricle. Twenty-four-hours ECG Holter monitoring, with training session, showed some isolated polymorphic PVCs even during training session. Cardiac magnetic resonance (CMR) confirmed the presence of a non-ischemic left ventricular scar (subepicardial) into the mid-basal segment of the posterior wall. Echocardiography is a first-line, economic, and accessible diagnostic test for athletes and it can be useful, when abnormalities are detected, to indicate further investigations, such as CMR. Although non-ischemic left ventricular scarring is difficult to detect on echocardiography, this event is sometimes possible and require further investigation when observed.

Toe Box Shape of Running Shoes Affects In-Shoe Foot Displacement and Deformation: A Randomized Crossover Study.

Long-distance running is popular but associated with a high risk of injuries, particularly toe-related injuries. Limited research has focused on preventive measures, prompting exploration into the efficacy of raised toe box running shoes. This study aimed to investigate the effect of running shoes with raised toe boxes on preventing toe injuries caused by distance running. A randomized crossover design involved 25 male marathon runners (height: 1.70 ± 0.02 m, weight: 62.6 + 4.5 kg) wearing both raised toe box (extended by 8 mm along the vertical axis and 3 mm along the sagittal axis) and regular toe box running shoes. Ground reaction force (GRF), in-shoe displacement, and degree of toe deformation (based on the distance change between the toe and the metatarsal head) were collected. Wearing raised toe box shoes resulted in a significant reduction in vertical (p = 0.001) and antero-posterior (p = 0.015) ground reaction forces during the loading phase, with a notable increase in vertical ground reaction force during the toe-off phase (p < 0.001). In-shoe displacement showed significant decreased movement in the forefoot medial (p < 0.001) and rearfoot (medial: p < 0.001, lateral: p < 0.001) and significant increased displacement in the midfoot (medial: p = 0.002, lateral: p < 0.001). Impact severity on the hallux significantly decreased (p < 0.001), while impact on the small toes showed no significant reduction (p = 0.067). Raised toe box running shoes offer an effective means of reducing toe injuries caused by long-distance running.

Prediction of half-marathon performance of male recreational marathon runners using nomogram.

Long-distance running is a popular competitive sport. We performed the current research as to develop an easily accessible and applicable model to predict half-marathon performance in male recreational half-marathon runners by nomogram. Male recreational half-marathon runners in Zhejiang Province, China were recruited. A set of literature-based and panel-reviewed questionnaires were used to assess the epidemiological conditions of the recruited runners. Descriptive and binary regression analyses were done for the profiling and identification of predictors related to higher half-marathon performance (completing time ≤ 105min). Participants were assigned to the training set (n = 141) and the testing set (n = 61) randomly. A nomogram was used to visually predict the half-marathon performance, and the receiver operating characteristic (ROC) was used to evaluate the predictive ability of the nomogram. A total of 202 participants (median age: 49 years; higher half-marathon performance: 33.7%) were included. After multivariate analysis, three variables remained as significant predictors: longer monthly running distance [adjusted odds ratio (AOR) = 0.992, 95% confidence interval (CI): 0.988 to 0.996, p < 0.001], faster mean training pace (AOR = 2.151, 95% CI: 1.275 to 3.630, p < 0.001), and better sleep quality [the Pittsburgh Sleep Quality Index (PSQI), AOR = 2.390, 95% CI: 1.164 to 4.907, p = 0.018]. The AUC of the training and testing sets in nomogram were 0.750 and 0.743, respectively. Further ternary and linear regression analyses corroborated the primary findings. This study developed a nomogram with good potential to predict the half-marathon performance of recreational runners. Our results suggest that longer monthly running distance, faster mean training pace and better sleep quality notably contribute to better half-marathon performance.

Effects of CurraNZ, a New Zealand Blackcurrant Extract during 1 Hour of Treadmill Running in Female and Male Marathon des Sables Athletes in Hot Conditions: Two Case Studies.

Four weeks before competition in the 2023 Marathon des Sables, a 6-stage, ~250 km running event in the Sahara Desert, we examined the effects of a 7-day intake of New Zealand blackcurrant extract (210 mg anthocyanins per day) on 1 h treadmill running-induced physiological and metabolic responses in the heat (~34 °C, relative humidity: ~30%) in non-acclimatized amateur female and male athletes (age: 23, 38 yrs, BMI: 24.2, 28.4 kg·m-2, body fat%: 29.2, 18.8%, V˙O2max: 50.1, 52.1 mL·kg-1·min-1). During the 1 h run at 50%V˙O2max (speed female: 7.3, male: 7.5 km·h-1), indirect calorimetry was used, and heart rate was recorded at 15 min intervals with core temperature monitoring (0.05 Hz). The 1 h runs took place 3 h after a light breakfast and 2 h after intake of the final dose of New Zealand blackcurrant extract with water allowed ad libitum during the run. The New Zealand blackcurrant extract had no effects on the female athlete. The respiratory exchange ratio (RER) of the female athlete in the non-supplement control condition was 0.77 ± 0.01, indicating an existing ~77% contribution of fat oxidation to the energy requirements. In the male athlete, during 1 h of running, fat oxidation was higher by 21% (p < 0.01), carbohydrate oxidation was 31% lower (p = 0.05), RER was 0.03 units lower (p = 0.04), and core temperature was 0.4 °C lower (p < 0.01) with no differences for heart rate, minute ventilation, oxygen uptake, and carbon dioxide production for the New Zealand blackcurrant condition compared to the non-supplement control condition. Seven-day intake of New Zealand blackcurrant extract (210 mg anthocyanins per day) provided beneficial physiological and metabolic responses during exertional heat stress by 1 h of indoor (~34 °C) treadmill running in a male Marathon des Sables athlete 4 weeks before competition. Future work is required to address whether New Zealand blackcurrant provides a nutritional ergogenic effect for Marathon des Sables athletes during long-duration running in the heat combined with personalized nutrition.

Exercise-induced Hypertension and Carotid Intima-media Thickness in Male Marathon Runners.

This study aimed to identify the relationship between exercise-induced hypertension and carotid artery intima-media thickness in long-distance runners. Sixty healthy male runners aged 40 to 60 years were assigned to the following three groups based on resting blood pressure and maximal systolic blood pressure during a maximal exercise test: normal blood pressure response, exercise-induced hypertension, and complex hypertension. An exaggerated systolic blood pressure response was defined as a maximal systolic blood pressure+≥+210 mmHg during the maximal exercise test, while carotid intima-media thickness was measured using B-mode ultrasonography. The carotid intima-media thickness mean values were the highest in the complex hypertension group (0.72±0.11 mm), followed by exercise-induced hypertension (0.62±0.12 mm) and normal blood pressure groups (0.55±0.13 mm), with a significant difference between the groups (p+<+0.002). In linear regression analysis, the mean intima-media thickness was independently associated with age (p=0.015) and maximal systolic blood pressure (p=0.046) but not with resting systolic blood pressure. These results suggest that exercise-induced hypertension is associated with carotid intima-media thickness, a surrogate marker of cardiovascular disease, in long-distance runners. Therefore, evaluating the blood pressure response during exercise is important for the early detection of potential cardiovascular disease risks in long-distance runners.

Normal bone marrow signal characteristics in whole-body diffusion-weighted images of amateur marathon runners.

Marathon training can reverse bone marrow conversion; however, little is known about the normal bone marrow whole-body diffusion-weighted imaging (WB-DWI) signal characteristics of amateur marathon runners. If marathon training can cause diffuse hyperintensity of bone marrow on WB-DWI is essential for correctly interpreting the diffusion-weighted (DW) images. This study sought to evaluate the WB-DWI signal characteristics of normal bone marrow in amateur marathon runners. In this prospective cross-sectional study, 30 amateur marathon runners who had trained for over 3 years for regular or half-marathon races and had a running frequency of more than 20 days a month at a distance of more than 100 km per month from the Chengde Marathon Outdoor Sports Association in Hebei, China, and 30 age- and gender-matched, healthy volunteers (the control group) who had no long-term heavy-load sports history were recruited between April 2021 to September 2021. All the subjects underwent WB-DWI (b-value: 0, 800 s/mm2) and lumbar vertebral transverse relaxation time (T2) mapping. The bone marrow WB-DWI signal characteristics were analyzed visually and statistically by chi-square (χ2) tests. The apparent diffusion coefficient (ADC), DWI signal intensity, and T2 values of the bone marrow were quantitatively and statistically analyzed by the independent sample t-test and Mann-Whitney U test. No subjects were excluded from the study. The bone marrow of 30 of the 60 subjects (aged 30-50 years) showed diffuse hyperintensity in the DW images. However, in all 60 subjects, the humeral heads, femoral heads, and great trochanters had low signals. The frequency of diffuse bone marrow DWI hyperintensity was significantly higher in the male amateur marathon runners (50%) than the male controls (5%, P=0.003), but no such significant difference was found between the female amateur marathon runners (100%) and female controls (90%, P>0.99). The DW signal intensity ratios of bone marrow to muscle (SIRBM-muscle) were significantly higher in the male amateur marathon runners than the male controls in the thoracic vertebrae (4.68 vs. 3.57, P=0.021), lumbar vertebrae (4.49 vs. 3.01, P<0.001), sacrum (3.67 vs. 2.62, P=0.002), and hip (3.45 vs. 2.50, P=0.002), but were only significantly higher in the female amateur marathon runners than the female controls in the thoracic vertebrae (7.69 vs. 5.87, P=0.029) and hip (4.76 vs. 3.92, P=0.004). The mean T2 values of the lumbar vertebrae were significantly higher in the male amateur marathon runners than the male controls (116.76 vs. 97.63 ms, P=0.001), but no such significant difference was observed between the female amateur marathon runners and the corresponding controls (118.58 vs. 124.10 ms, P=0.386). Marathon training resulted in diffuse hyperintensity in the bone marrow based on WB-DWI in 50% of the male amateur marathon runners aged 30-50 years. Thus, when WB-DWI is used for bone marrow disease screening, marathon training history should be considered to avoid false-positive diagnoses.

Biomechanical Effects of Dominant or Nondominant Limb on Asymmetry during Running Stance Phase

Purpose. This study explores lower limb joint displacement differences during the stance phase and to examine the effects of limb dominance on asymmetry. A total of 32 healthy male amateur marathon runners were recruited (age: 35.33 ± 6.90 years, height: 174.17 ± 3.34 cm, weight: 63.92 ± 4.53 kg). The experiment employed a Vicon eight‐camera motion capture system synchronized with an AMTI force plate to record the phase from heel strike to toe‐off. The continuous relative phase (CRP) between the dominant and nondominant limbs was assessed using of independent t‐test of SPM1d. Results. The hip–knee joint of the dominant limb had a larger maximum CRP (t = 1.104, p &gt; 0.05, effect size = 0.270), smaller minimum CRP (t = −2.672, p &lt; 0.05, effect size = 0.653), larger values of mean absolute relative phase (MARF) (t = 3.275, p &lt; 0.05, effect size = 0.122), and deviation phase (DP) (t = 7.582, p &lt; 0.001, effect size = 0.717) than that of the nondominant limb. Comparing the dominant limb of the knee–ankle joints with the nondominant, there are smaller maximum CRP (t = −0.422, p &gt; 0.05, effect size = 0.144), smaller DP (t = −7.237, p &lt; 0.001, effect size = 0.754), a larger minimum CRP (t = 7.909, p &lt; 0.001, effect size = 2.704), and larger MARF (t = 0.355, p &gt; 0.05, effect size = 0.801). Furthermore, during the stance phases, there are significant differences in coordination modes between the dominant limb and nondominant limb of intersegmental joints (p &lt; 0.05). Conclusion. Throughout different phases of the stance phase, asymmetry in the sagittal plane of lower limb joint displacement is evident. The dominant limb undergoes significant changes in joint leading phase coordination modes, with notably less in‐phase coordination compared to the nondominant limb. This predisposes muscles to overstretching, thereby increasing the risk of muscle strains, while the nondominant limb compensates for lower muscle strength. Recognizing and addressing such asymmetries is key to optimizing nondominant limb strength and minimizing muscle overstretching in the dominant limb, leading to improved stability and movement efficiency during marathon running. Consequently, when designing exercise programs or physical therapy, it is crucial to consider limb dominance‐related symmetry differences to mitigate the risk of injury resulting from interlimb disparities in motion.

The effect of advanced footwear technology on elite male marathon race speed.

The aim of this study was to explore the ergogenic effect of advanced footwear technology (AFT) upon world-class male marathon running speed. A retrospective analysis of 99 world-class male marathon runners' performances between 2012 and 2021 was undertaken, providing a sample size of 971 performances, split into two footwear groups: AFT (n = 299) and traditional (n = 672). Additionally, details regarding the year of the marathon performance and racecourse were extracted. A mixed model for repeated measures (MMRM) analysis were undertaken identifying athlete (Wald Z = 2.821; p = .005) and course (Wald Z = 4.111; p < 0.001) as significant contributors to the variance in marathon running speed and as such were included as random factors with footwear type set as a fixed factor. World-class male marathon running speeds were significantly faster (p < 0.001) when running in AFT (5.441m.s-1) when compared with traditional shoes (5.386m.s-1) with a mean difference of 0.055m.s-1 (95% CI 0.039-0.071m.s-1), translating to an improvement in marathon speed of 1.0% or a 79s improvement in marathon race time. Our findings demonstrate an improvement in world-class male marathon running speed of 1% when running in AFT, a near identical degree of improvement to the male marathon world record ran in AFT. Whilst a 1% improvement in marathon running times associated with AFT is smaller than previously predicted utilizing laboratory-based models, this still reflects a significant degree of improvement at the elite level.

Perspectives of Health and Eating Behaviors in Marathon and Half-Marathoners

Introduction: Marathon and half-marathon runners are a growing population of athletes who have unique training and nutritional demands that put them at risk for health issues. The purpose of this study was to investigate perspectives regarding sport-related health and factors impacting eating behaviors in adult marathoners and half-marathoners. Methods: The Runners Health Choice Questionnaire was deployed online and distributed via a snowball sampling approach. Participants were adult runners who had completed a marathon or half-marathon in the previous three years and planned to participate in another marathon or half marathon in the next 24 months. Collegiate athletes were excluded. Results: Five hundred male and female marathon and half-marathon runners ages 18-79 completed the survey. The relationship between sex and diet classification was significant (χ2 [1, 500]= 7.2194, p= 0.0072); males were significantly more likely to select an atypical diet when compared to females. Time to prepare meals (83.40%) and training run/race that day (81.00%) had a moderate to high impact on daily meal decisions. If provided new nutrition education, 77.24% of runners reported being very likely or somewhat likely to change their diet. Conclusions: Health and eating behaviors and decisions are complex and impacted by several variables: time, training, and an athlete's age and sex. However, runners have a desire to be healthy and a willingness to change with new nutritional information.

Metabolic Pathway Modeling in Muscle of Male Marathon Mice (DUhTP) and Controls (DUC)-A Possible Role of Lactate Dehydrogenase in Metabolic Flexibility.

In contracting muscles, carbohydrates and fatty acids serve as energy substrates; the predominant utilization depends on the workload. Here, we investigated the contribution of non-mitochondrial and mitochondrial metabolic pathways in response to repeated training in a polygenic, paternally selected marathon mouse model (DUhTP), characterized by exceptional running performance and an unselected control (DUC), with both lines descended from the same genetic background. Both lines underwent three weeks of high-speed treadmill training or were sedentary. Both lines' muscles and plasma were analyzed. Muscle RNA was sequenced, and KEGG pathway analysis was performed. Analyses of muscle revealed no significant selection-related differences in muscle structure. However, in response to physical exercise, glucose and fatty acid oxidation were stimulated, lactate dehydrogenase activity was reduced, and lactate formation was inhibited in the marathon mice compared with trained control mice. The lack of lactate formation in response to exercise appears to be associated with increased lipid mobilization from peripheral adipose tissue in DUhTP mice, suggesting a specific benefit of lactate avoidance. Thus, results from the analysis of muscle metabolism in born marathon mice, shaped by 35 years (140 generations) of phenotype selection for superior running performance, suggest increased metabolic flexibility in male marathon mice toward lipid catabolism regulated by lactate dehydrogenase.

Reduced myocardial strain of interventricular septum among male amateur marathon runners: a cardiac magnetic resonance study

ObjectivesTo analyze the long-term effect of multiple marathons on cardiac structure and function in amateur marathon runners compared with healthy controls. DesignCross-sectional study using male amateur marathon runners (n = 32) and age-matched cohort of male healthy controls (n = 12). MethodsA total of 32 male amateur marathon runners (age 44 ± 7 years) and 12 male healthy controls (age 42 ± 8 years) underwent cardiac magnetic resonance (CMR). The relevant parameters of cardiac structure and function were studied employing feature-tracking strain analysis. ResultsAmateur marathon runners showed lower heart rates, body mass index and body surface area. The left ventricular (LV) mass index, LV end-diastolic volume index and right ventricular end-systolic volume index were significantly higher in amateur marathon runners compared with healthy controls. Furthermore, walls of interventricular septum (IVS) in amateur marathon runners were thicker than healthy controls. There was no significant difference between two groups in the global myocardial strain (MS) in LV. However, the segmental radial and circumferential strains of the LV were lower in amateur marathon runners compared to healthy controls, specifically in the 8th and 9th segments. Finally, we also found as the total running intensity increased, so did global longitudinal strain. ConclusionsWe reported higher wall thickness and lower regional radial and circumferential strain in the IVS region in amateur marathon runners, suggesting that prolonged and high-intensity exercise may cause cardiac remodeling. Further studies are needed to investigate whether this is an adaptive or maladaptive change in amateur marathon runners.

Electrophysiological characterization of a 19-years-old male marathon runner suffering a sudden cardiac death

1 in 50,000 of athletes suffers a cardiac student death (SCD) per year, more of them under 35 years of age. Around 25% of these patients had normal structure, implying that other electrical disorder cause these SCD. Determine the electrophysiological causes of a SCD of a young 19-years-old occurred during a marathon with any heart structural diseases. Pathologic left ventricle (PLV) (n = 1, male, 19-years-old) and control left ventricle (CLV) (n = 1, female, 56-years-old) were perfused and imaged using high resolution optical mapping and Di-4-ANEPPS like a dye. Endocardial and endocardial free wall and his bundle were paced to obtain activation time (AT), repolarization time (RT) and action-potential duration (APD). Purkinje-muscle junctions (PMJs) were determine like activation origins far from the his bundle pacing. Effective refractory period (ERP) was determined using S1S2S3S4 short-coupled pacing. The protocol was repeated after isoplenalie injection [500 nM] like β-adrenergic receptor agonist. His-ventricle activation at high frequency pacing was higher in PLV (143ms) than in control (84ms) and decrease in both at similar levels under ISO (≈60ms). APD gradient increase was observed in PLV near PMJs under ISO (from 3ms/mm to 40ms/mm) and any gradient was observed in the control one. Ectopic episodes were observed in PLV under ISO and 82% of the origins had less that 4 mm of distance with the PMJs. In PLV, the ERP in His-pacing is always lower (320, 260, 250 ms) than endocardial (350, 315, 285 ms) pacing but in CLV, the His-pacing ERP was always higher (320, 260, 240 ms) that endocardial pacing (280, 240, 220 ms). Ventricular fibrillation (VF) was observed in PLV after his bundle pacing at high frequency (more than 330 ms) and any VF was observed in CLV. During this VF, 76% of the focal activities had less than 4 mm of distance with the PMJs. Conduction system (CS) of the PLV shows high sensitivity to high frequency pacing and to presence of ISO. Ectopic episodes and APD gradient near PMJs may show the role of Purkinje network like arrhythmic source. Indeed, the shorter ERP during His-pacing than in the endocardium, give the possibility to produce a macro-re-entry in the conduction system and maintain the arrhythmia with focal activities. CS abnormalities likely played a critical role in arrhythmogenicity and maintenance of VF in this patient during sudden cardiac death.

Prevalence and pattern of focal and potential diffuse myocardial fibrosis in male and female marathon runners using contrast-enhanced cardiac magnetic resonance

ObjectivesThis study analyzed the prevalence and pattern of focal and potential diffuse myocardial fibrosis detected by late gadolinium enhancement (LGE) and extracellular volume (ECV) imaging in male and female marathon runners using cardiac magnetic resonance (CMR).MethodsSeventy-four marathon runners were studied including 55 males (44 ± 8 years) and 19 females (36 ± 7 years) and compared to 36 controls with similar age and sex using contrast-enhanced CMR, exercise testing, and blood samples.ResultsContrast-enhanced CMR revealed focal myocardial fibrosis in 8 of 74 runners (11%). The majority of runners were male (7 of 8, 88%). LGE was typically non-ischemic in 7 of 8 runners (88%) and ischemic in one runner. ECV was higher in remote myocardium without LGE in male runners (25.5 ± 2.3%) compared to male controls (24.0 ± 3.0%, p < 0.05), indicating the potential presence of diffuse myocardial fibrosis. LV mass was higher in LGE + males (86 ± 18 g/m2) compared to LGE- males (73 ± 14 g/m2, p < 0.05). Furthermore, LGE + males had lower weight (69 ± 9 vs 77 ± 9 kg, p < 0.05) and shorter best marathon finishing times (3.2 ± 0.3 h) compared to LGE- males (3.6 ± 0.4 h, p < 0.05) suggesting higher training load in these runners to accomplish the marathon in a short time.ConclusionThe high frequency of non-ischemic myocardial fibrosis in LGE + male runners can be related to increased LV mass in these runners. Furthermore, a higher training load could explain the higher LV mass and could be one additional cofactor in the genesis of myocardial fibrosis in marathon runners.Key Points• A high frequency of myocardial fibrosis was found in marathon runners.• Myocardial fibrosis occurred typically in male runners and was typically non-ischemic.• Higher training load could be one cofactor in the genesis of myocardial fibrosis in marathon runners.

Acute Effects of Marathon Running on Lung Function, Lung Mechanics, and Inflammation

This study investigated the influence of the marathon on lung function, mechanics, and pulmonary inflammation. Twenty-eight male amateur marathon runners (42.1±6.2 years) were evaluated before and immediately after marathon. Pulmonary function and mechanics were assessed using spirometry and impulse oscillometry, respectively, whereas fatigue of the respiratory muscles by manovacuometry and lung inflammation by fractional exhaled nitric oxide (FeNO). Marathon induced a significant reduction in the lung function as compared to baseline values: FVC (4.81±0.72 vs 4.67±0.62, p=0.0095), VC IN (4.81±0.72 vs 4.67±0.62, p=0.009), FEV1 (3.83±0.62 vs 3.72±0.59, p=0.0232), and FEV6 (4.87±0.68 vs 4.57±0.63, p=0.0006), as well as an impairment in the lung mechanics in comparison to baseline values: reduced pulmonary impedance (Z5Hz; 2.96±1.36 vs 2.67±1.11; p=0.0305), reduced resistance of the whole respiratory system (R5Hz; 2.76±1.27 vs 2.5±1.08; p=0.0388) and pulmonary reactance (X5Hz; -1.05±0.55 vs -0.91±0.36; p=0.0101) and of resistance of proximal airways (R5Hz; 1.26±0.73 vs 1.06±0.86; p= 0.0377). In addition, maximal inspiratory (MIP; 94.14±41.88 vs 72.52±25.50; p=0.0023) and expiratory (MEP; 99.31±31.84 vs 91.29±19.94; p=0.0454) pressures, as well as FeNO levels were lower after the marathon than values pre-marathon (p=0.0359). Marathon running causes an acute disturbance in lung function and mechanics and compromises respiratory muscle strength.

Exercise Induced-Cytokines Response in Marathon Runners: Role of ACE I/D and BDKRB2 +9/-9 Polymorphisms.

Renin-angiotensin system (RAS) and kallikrein-kinin system (KKS) have a different site of interaction and modulate vascular tone and inflammatory response as well on exercise adaptation, which is modulated by exercise-induced cytokines. The aim of the study was to evaluate the role of ACE I/D and BDKRB2 +9/−9 polymorphism on exercise-induced cytokine response. Seventy-four male marathon finishers, aged 30 to 55 years, participated in this study. Plasma levels of exercise-induced cytokines were determined 24 h before, immediately after, and 24 h and 72 h after the São Paulo International Marathon. Plasma concentrations of MCP-1, IL-6 and FGF-21 increased after marathon in all genotypes of BDKRB2. IL-10, FSTL and BDNF increased significantly after marathon in the genotypes with the presence of the −9 allele. FSTL and BDNF concentrations were higher in the −9/−9 genotype compared to the +9/+9 genotype before (p = 0.006) and after the race (p = 0.023), respectively. Apelin, IL-15, musclin and myostatin concentrations were significantly reduced after the race only in the presence of −9 allele. Marathon increased plasma concentrations of MCP1, IL-6, BDNF and FGF-21 in all genotypes of ACE I/D polymorphism. Plasma concentrations of IL-8 and MIP-1alpha before the race (p = 0.015 and p = 0.031, respectively), of MIP-1alpha and IL-10 after the race (p = 0.033 and p = 0.047, respectively) and VEGF 72 h after the race (p = 0.018) were lower in II homozygotes compared to runners with the presence of D allele. One day after the race we also observed lower levels of MIP-1alpha in runners with II homozygotes compared to DD homozygotes (p = 0.026). Before the marathon race myostatin concentrations were higher in DD compared to II genotypes (p = 0.009). Myostatin, musclin, IL-15, IL-6 and apelin levels decreased after race in genotypes with the presence of D allele. After the race ACE activity was negatively correlated with MCP1 (r = −56, p < 0.016) and positively correlated with IL-8, IL-10 and MIP1-alpha (r = 0.72, p < 0.0007, r = 0.72, p < 0.0007, r = 0.47, p < 0.048, respectively). The runners with the −9/−9 genotype have greater response in exercise-induced cytokines related to muscle repair and cardioprotection indicating that BDKRB2 participate on exercise adaptations and runners with DD genotype have greater inflammatory response as well as ACE activity was positively correlated with inflammatory mediators. DD homozygotes also had higher myostatin levels which modulates protein homeostasis.

Correlation between Spinal Instability and Ankle Injuries in Amateur Marathon Runners

Background: Marathon running is becoming more popular among middle-aged people who have no prior running experience. Improper or incomplete knowledge increases the risk of injuries in amateur runners. Individuals with spinal instability experience alteration in balance control while walking as well as running which in turn results in asymmetrical bodyweight distribution throughout the lower extremity. This changes the pattern of running leading to injuries of hips, knees, and ankle. Methods: The objective of the study was to correlate spinal instability with ankle injuries in amateur marathon runners. In this study, both male and female amateur marathon runners between the age group of 20 and 45 years with normal body mass index (BMI) were chosen and individuals with the previous surgery as well as degenerative diseases of spine and ankle fractures were ruled out. Spinal instability tests were carried out on amateur marathon runners with symptoms of instability. Subjects were asked questions related to ankle injuries. Outcome measures used were Oswestry Disability Index (ODI) and tests for spinal instability. Results: About 57% of participants were tested positive for the passive lumbar extension test and 42% of participants were tested positive for the prone instability test. There was the presence of ankle pain (68%), ankle swelling (24%), heel pain (60%), blisters (42%), ankle sprain (28%), and strain (26%) in selected participants. There were 68% runners with minimal disability and 32% runners with moderate disability. Conclusion: Amateur marathon runners with spinal instability had the presence of ankle injuries like ankle pain, ankle swelling, heel pain, blisters, ankle sprain, and strain. Based on the test performed and interpretation of the ODI and after correlating spinal instability with ankle injuries, we concluded that spinal instability increases the risk of ankle injuries in amateur marathon runners.

Energy supply and influencing factors of mountain marathon runners from Baiyin marathon accident in China

High temperature impacts the performance of marathon athletes, and hypothermia harms athletes. Twenty-one runners died, and eight were injured in the China Baiyin marathon on May 22, 2021. It’s a typical human life test. The energy equations are combined with the maximum energy supply of Chinese male athletes to study this accident. We analyze the human body’s route slope, travel speed, and heat dissipation under low temperatures in this marathon. The study shows that the large slope and long-distance of CP2 to CP3 section and the low temperature during the competition are the main reasons for the accident. The method of quantifying the slope and temperature and calculating the percentage of athletes’ physical consumption proposed in this paper can evaluate the route design of field marathons. We suggest that the physical energy consumption ratio of 90%, i.e. 315 cal/min/kg, should be taken as the maximum energy supply for Chinese male marathon runners. Dangerous risk zones for wind speed and temperature on dangerous path sections are also formulated for athletes to make their assessments. This paper’s theories and methods can effectively help design the marathon route and determine the race time.