Marathon Athletes Research Articles

Regionally accentuated reversible brain grey matter reduction in ultra marathon runners detected by voxel-based morphometry

BackgroundDuring the 4,487 km ultra marathon TransEurope-FootRace 2009 (TEFR09), runners showed catabolism with considerable reduction of body weight as well as reversible brain volume reduction. We hypothesized that ultra marathon athletes might have developed changes to grey matter (GM) brain morphology due to the burden of extreme physical training. Using voxel-based morphometry (VBM) we undertook a cross sectional study and two longitudinal studies.MethodsPrior to the start of the race 13 runners volunteered to participate in this study of planned brain scans before, twice during, and 8 months after the race. A group of matched controls was recruited for comparison. Twelve runners were able to participate in the scan before the start of the race and were taken into account for comparison with control persons. Because of drop-outs during the race, VBM could be performed in 10 runners covering the first 3 time points, and in 7 runners who also had the follow-up scan after 8 months. Volumetric 3D datasets were acquired using an MPRAGE sequence. A level of p < 0.05, family-wise corrected for multiple comparisons was the a priori set statistical threshold to infer significant effects from VBM.ResultsBaseline comparison of TEFR09 participants and controls revealed no significant differences regarding GM brain volume. During the race however, VBM revealed GM volume decreases in regionally distributed brain regions. These included the bilateral posterior temporal and occipitoparietal cortices as well as the anterior cingulate and caudate nucleus. After eight months, GM normalized.ConclusionContrary to our hypothesis, we did not observe significant differences between TEFR09 athletes and controls at baseline. If this missing difference is not due to small sample size, extreme physical training obviously does not chronically alter GM.However, during the race GM volume decreased in brain regions normally associated with visuospatial and language tasks. The reduction of the energy intensive default mode network as a means to conserve energy during catabolism is discussed. The changes were reversible after 8 months.Despite substantial changes to brain composition during the catabolic stress of an ultra marathon, the observed differences seem to be reversible and adaptive.

Venous Thromboembolism and Marathon Athletes

V enous thromboembolism (VTE) is the collective term for deep vein thrombosis and pulmonary embolism, both of which constitute globally significant public health burdens. Because awareness of VTE is key to its prevention,1 efforts to disseminate advisory and educational information among medical professionals and the population at large, with specific resources for at-risk groups, remain crucial. The benefits of moderate and regular exercise for the general adult population are indisputable. However, for the marathon athlete who …

138 Myocardial Fibrosis in Marathon Athletes: A Marker of Occult Coronary Artery Disease

Several studies have correlated elevations in cardiac biomarkers of injury post marathon with transient and reversible right ventricular (RV) systolic dysfunction as assessed by both transthoracic echocardiography (TTE) and cardiac MRI (CMR). Whether or not permanent myocardial injury occurs due to repeated marathon running in the aging population remains controversial. To assess the extent and severity of cardiac dysfunction after the completion of full marathon running in individuals greater than 50 years of age using cardiac biomarkers, TTE, cardiac computed tomography (CCT), and CMR. A total of 25 healthy volunteers (21 males, 55±4 years old) from the 2010 and 2011 Manitoba Full Marathons (26.2 miles) were included in the study. Cardiac biomarkers and TTE were performed one week prior to the marathon, immediately after completing the race and at one-week follow-up. CMR was performed at baseline and within 24 hours of completion of the marathon, followed by CCT within 3 months of the marathon. All participants demonstrated an elevated cTnT post marathon. Right atrial and ventricular volumes increased, while RV systolic function decreased significantly immediately post marathon, returning to baseline values one week later. Of the entire study population, only two individuals demonstrated delayed enhancement of the subendocardium in the anterior wall of the left ventricle, with evidence of stenosis of the left anterior descending artery on CCT (Figure 1). The presence of myocardial fibrosis in marathon athletes is not due to repeated stress from endurance running, but may be a marker of occult coronary artery disease. (Figure 1).

Hemolysis and Rhabdomyolysis after Marathon and Long Distance Running

Introduction: Hemolysis and rhabdomyolysis may result from prolonged physical activity such as long distance running and marathon. Aim: The aim of this study was to assess the extent of cell damages after 42 km and 180 km of running, and to elucidate possible mechanisms of the membrane damage. The aim of this study was also to examine the effect of a simple dietary supplementation of antioxidative substances such as vitamin E, selenium and zinc. Method: A 41-year-old female schoolteacher ran continuously for 24 hours, achieving a total running distance of about 180 km. A group of well trained marathon athletes, 60 men and 10 women with a median age of 36 years, participated in the Beito Marathon in Norway. A smaller group of less trained people, 19 men and 4 women was also followed during the same marathon. Results: The hemolysis associated with marathon involved the apparent release of less than 250 mg hemoglobin per liter into plasma, whereas the 180 km run appeared to induce at least 20 times more hemolysis. The maximum values of released muscle enzymes after 180 km (CK 20.000 U/l), were several orders of magnitude higher than after marathon (CK 416 U/l). Furthermore, the prolonged physical exercise evoked a substantial inflammatory response. Discussion: Mechanical factors alone may cause cell damage, but we hypothesized a contributory role of cellular formation of free oxygen radicals. Moderate doses of vitamin E and selenium given to well trained marathon runners appeared to exert only negligible protective effects, either because the initiating membrane lesion is not directly related to oxidative stress, or because the training itself represented a much stronger antioxidant protection. However, the extensive membrane damages observed in the ultra marathon phase (42 to 182 km) may be accelerated by a collapse of endogenous antioxidants. Thus, although glutathione (GSH) peroxidase appears to operate adequately for several hours of exercise in well trained individuals, it is tempting to presume an ongoing GSH depletion in the 42-to-182 km phase. Conclusion: Systematic training and a balanced diet prior to long distance running and marathon may protect the body from organ disturbances in marathoners and ultra marathoners. Keywords: Cell membrane integrity, exhaustive exercise, free oxygen radicals, GSH peroxidase, glutathione, membrane lesions, oxidative stress, reactive oxygen species, selenium, vitamin E, zinc

Deep Vein Thrombosis in a Young Marathon Athlete

Resident's case problem. A 21-year-old athletic male college student presented to a direct-access physical therapy clinic with complaints of left calf pain 4 days in duration. After initial examination, a working diagnosis of calf strain was formulated. Three days following initial examination, the patient reported 80% improvement in symptoms and was performing activities of daily living pain free. Four weeks later, the patient returned with complaints of reoccurring calf pain. The patient's signs, symptoms, and history at subsequent follow-up no longer presented a consistent clinical picture of calf strain; therefore, a D-dimer assay was ordered to rule out a deep vein thrombosis (DVT). The D-dimer was elevated so the patient was admitted to the hospital and started on low-molecular-weight heparin. A compression ultrasound revealed an extensive left superficial femoral and popliteal DVT in this otherwise healthy athlete. Lower extremity DVT is a serious and potentially fatal disorder. Physical therapists need to be diagnostically vigilant for vascular pathology in all patients with extremity pain and swelling. Employing the best current evidenced-based screening tools to rule out vascular pathology, such as deep and superficial vein pathology, should be the goal of every clinician. The Wells score is one such screening tool that has proven to be beneficial in this area. This case report presents a dilemma in diagnosis and illustrates the importance of revisiting differential diagnoses with each patient encounter. Clinicians must consider the possibility of a DVT with every patient seen with posterior leg pain. Diagnosis, level 4. doi:10.2519/jospt.2011.3823.

Comparative segmental anthropometric evaluation of triathlon and marathon athletes

The objective of the study was to carry through a comparative segmental evaluation of the corporal composition of competitiveathletes in marathons and triathlons to determine differences in their segmental body composition. 17 male individuals hadparticipated in the study (9 marathon and 8 triathlon athletes), and the protocol was approved by the Ethics Committee (Protocol 226/08).We measured weight and stature and carried through a tetrapolar bioimpedance examination (Tanita Ironman BCC 558) for segmentalanalysis of their body composition. As main results, it was observed that although there were no statistical differences in the percentageof fat among triathlon and marathon athletes (15,2 ± 2,6 versus 15,4 ± 1.5%, respectively), there were significant statistical differencesamong the percentages of fat of the right and left arms of marathon athletes, and triathlon athletes presented an equivalent segmentalcomposition in right and left hemibodies. New approaches in relation to the analysis of the body composition are tools for physicaland nutritional monitoring with positive impact in the interventions, with the purpose of making recommendations for monitoringperformance of competitive athletes in the modalities of marathon and athletics, sport that in Brazil is ever more adopted and admired.

Whole blood coagulation and platelet activation in the athlete: A comparison of marathon, triathlon and long distance cycling

IntroductionSerious thrombembolic events occur in otherwise healthy marathon athletes during competition. We tested the hypothesis that during heavy endurance sports coagulation and platelets are activated depending on the type of endurance sport with respect to its running fraction.Materials and Methods68 healthy athletes participating in marathon (MAR, running 42 km, n = 24), triathlon (TRI, swimming 2.5 km + cycling 90 km + running 21 km, n = 22), and long distance cycling (CYC, 151 km, n = 22) were included in the study. Blood samples were taken before and immediately after completion of competition to perform rotational thrombelastometry. We assessed coagulation time (CT), maximum clot firmness (MCF) after intrinsically activation and fibrin polymerization (FIBTEM). Furthermore, platelet aggregation was tested after activation with ADP and thrombin activating peptide 6 (TRAP) by using multiple platelet function analyzer.ResultsComplete data sets were obtained in 58 athletes (MAR: n = 20, TRI: n = 19, CYC: n = 19). CT significantly decreased in all groups (MAR -9.9%, TRI -8.3%, CYC -7.4%) without differences between groups. In parallel, MCF (MAR +7.4%, TRI +6.1%, CYC +8.3%) and fibrin polymerization (MAR +14.7%, TRI +6.1%, CYC +8.3%) were significantly increased in all groups. However, platelets were only activated during MAR and TRI as indicated by increased AUC during TRAP-activation (MAR +15.8%) and increased AUC during ADP-activation in MAR (+50.3%) and TRI (+57.5%).DiscussionWhile coagulation is activated during physical activity irrespective of type we observed significant platelet activation only during marathon and to a lesser extent during triathlon. We speculate that prolonged running may increase platelet activity, possibly, due to mechanical alteration. Thus, particularly prolonged running may increase the risk of thrombembolic incidents in running athletes.

Análise de parâmetros bioquímicos séricos e urinários em atletas de meia maratona

The aim of this study was to analyze biochemical markers as indicators of athletic performance, in light of a clinical context and athletic. Samples of peripheral blood (8 mL) and urine (50 mL) were collected from 20 marathon athletes at rest and 15 minutes after half marathon. Following, examination of blood, urine and serum markers of renal function, muscle damage and lipidic profile was carried out. Statistical analysis of the results showed a significant increase (p < 0.05) in serum activity of the enzymes CK, CK-MM, CK-MB and LDH, serum creatinine and iron, leukocyte count and neutrophils. Furthermore, triglycerides, VLDL, uric acid in serum showed a significant decrease. This study shows that athletes of marathon show changes in biochemical parameters of blood and urine after competing in this modality, which demonstrates the importance of carrying out laboratory tests as diagnosis for silent biochemical disorders.

Relation of Biomarkers and Cardiac Magnetic Resonance Imaging After Marathon Running

Although previous studies including endurance athletes after marathon running have demonstrated biochemical evidence of cardiac injury and have correlated these findings with echocardiographic evidence of cardiac dysfunction, particularly of the right ventricle, a study of marathon athletes incorporating biomarkers, echocardiography, and cardiac magnetic resonance (CMR) imaging has not been performed to date. The aim of this study was to demonstrate the cardiac changes associated with participation in a marathon using serial cardiac biomarkers, echocardiography, and CMR imaging. Fourteen participants (mean age 33 +/- 6 years, 8 men) completed the full marathon. Myoglobin, creatine kinase, and troponin T were elevated in all athletes after the race. There was a strong linear correlation between right ventricular (RV) fractional area change as assessed by echocardiography and the RV ejection fraction as assessed by CMR imaging (r = 0.96) after the marathon. RV function, using echocardiography, transiently decreased from before to after the race (RV fractional area change 43 +/- 4% vs 33 +/- 5%, p <0.05). There were also postrace changes in left ventricular and RV diastolic filling. Although RV systolic changes were transient, left ventricular and RV diastolic abnormalities persisted up to 1 week after the marathon. No evidence of delayed enhancement of the left ventricular myocardium was found on CMR imaging, suggesting that the increase in cardiac biomarkers after the marathon may not have be due to myocardial necrosis. In conclusion, RV systolic dysfunction transiently occurs after a marathon and has been validated for the first time by CMR imaging. The increase in cardiac troponin after marathon running is likely due to the cytosolic release of the biomarker, not to the true breakdown of the myocyte, as confirmed by delayed enhancement CMR imaging.

Whole blood coagulation and platelet activation in the athlete: a comparison of marathon, triathlon and long-distance running

Thromboembolic events have been reported in marathon athletes during competition. We tested the hypothesis that activation of coagulation and platelets depends on the type of endurance sport and running fraction.

Bone Mineral Density and Degenerative Changes of the Lumbar Spine in Former Elite Athletes

The aim of this study was to assess bone mineral density (BMD) and degenerative changes in the lumbar spine in male former elite athletes participating in different track and field disciplines and to determine the influence of body composition and degenerative changes on BMD. One hundred and fifty-nine former male elite athletes (40 throwers, 97 jumpers, 22 endurance athletes) were studied. Anthropometric (age, body mass index [BMI]) and sport-specific data (personal best, intensity, duration, and time since termination of competitive sports career as well as current sporting activity) were collected. Degenerative changes of the lumbar spine in lateral view were evaluated by using the Kellgren and Lawrence Score. Bone mineral density of the lumbar spine was measured in an anterior-posterior view with dual energy X-ray absorptiometry (DEXA, T-score). Throwers had a higher body mass index than jumpers and endurance athletes. Throwers and jumpers had higher BMD (T-LWS) than endurance athletes. Bivariate analysis revealed a negative correlation of BMD (T-score) with age and a positive correlation with BMD and Kellgren score (p<0.05). Even after multiple adjustment for confounders lumbar spine BMD is significantly higher in throwers, pole vaulters, and long- and triple jumpers than in marathon athletes. Different types of mechanical loading caused by sporting activities seem to influence the BMD of the lumbar spine, even if different body constitutions (i.e. BMI) and age, training history, and degenerative changes in the lumbar spine of former throwers, jumpers, and endurance athletes are taken into consideration.

A case report of hypoxia training in Japan&apos;s representative wheelchair marathon athletes for the Athens Paralympics

A case report of hypoxia training in Japan&apos;s representative wheelchair marathon athletes for the Athens Paralympics

Prevention of Deep Vein Thrombosis and Pulmonary Embolism

Venous thromboembolism comprises deep vein thrombosis (DVT) and pulmonary embolism (PE) and strikes more than 1 in 1000 adults per year, causing discomfort, suffering, and occasionally death. DVT is defined as blood clots in the pelvic, leg, or major upper-extremity veins. These clots can break off from the veins, travel through the heart, and lodge in the lung arteries, causing potentially deadly PE. Although about 300 000 new cases are diagnosed yearly in the United States, probably 3 to 4 times as many cases occur without obvious symptoms and are never detected. This illness is often “silent” and can mimic other common conditions such as heart attack, pneumonia, and anxiety. Its aftermath spans a wide spectrum, from inconsequential to fatal. Awareness of DVT and PE is the best way to prevent this condition. Medical professionals have recognized DVT for almost 2 centuries, but until recently, only about half of Americans were informed about the disease. Without knowledge of DVT as a medical problem, the public could not engage healthcare providers to discuss lifestyle changes and more intensive measures that usually succeed in preventing this illness. Historically, many prominent public figures have been afflicted with DVT but received little attention. However, …

Myocardial adaptation in different endurance sports: an echocardiographic study.

Of this study was to investigate three groups of highly trained competitive endurance athletes consisting of marathon runners, triathletes and cyclists for differences in left ventricular adaptation. 25 marathon athletes, 21 triathlon athletes and 38 cyclists underwent a standard echocardiographic and Doppler study. The left ventricular internal diameter in diastole divided by body surface area was significantly larger in cyclists than in marathon runners (31.6+/-3.0 vs. 30.0+/-2.0 mm/ m2, p < 0.05) but did not differ of that of triathletes. Left ventricular mass was significantly different between marathon runners and triathletes (253.6+/-63.7 vs. 322.0+/-62.1 g, p < 0.005) and between marathon runners and cyclists (253.6+/-63.7 vs. 314.2+/-79.2 g, p < 0.005). Systolic wall stress was significantly different between the marathon runners and the triathletes (88.4+/-11.7 vs. 78.9+/-11.0 g/cm2 p < 0.05). Only a minority of the endurance athletes showed concentric remodeling (7%), whereas a majority showed eccentric remodeling (65%) of the left ventricle. The prevalence of eccentric remodeling was more apparent in cyclists. There were some specific differences in left ventricular diastolic function between the three different endurance sports, but no left ventricular diastolic dysfunction could be detected. There is a sport-specific left ventricular adaptation in endurance athletes. The triathlon heart and the heart of a cyclist differ significantly from a marathon heart.

Rhabdomyolysis in Indonesian marathon athlete

Serum and urine myoglobin assessments were conducted on 37 national marathon athletes who participated in the Asian Marathon III &amp; Proklamaton XV. Three athletes showed a myoglobin value of &lt; 50 ug/L and the other 34 athletes showed a myoglobin value of 211-3300 ug/L. Rhabdomyolysis were only found in 2 athletes, thus the prevalence of rhabdomyolysis is 6.1%. A correlation was found between myoglobinemia value and the athlete’s performance. (Med J Indones 2003; 12: 207-14)

Demographic characteristics of elite Ethiopian endurance runners.

The dominance of East-African athletes in distance running remains largely unexplained; proposed reasons include favorable genetic endowment and optimal environmental conditions. To compare the demographics of elite Ethiopian athletes with the general Ethiopian population and assess the validity of reports linking running long distances to school with endurance success. Questionnaires, administered to 114 members (male and female) of the Ethiopian national athletics team and 111 Ethiopian control subjects (C) obtained information on place of birth, language, distance and method of travel to school. Athletes were separated into three groups according to athletic discipline: marathon (M; N = 34); 5,000-10,000 m (5-10 km; N = 42); and other track and field athletes (TF; N = 38). Frequency differences between groups were assessed using contingency chi-square tests. Regional distributions of marathon athletes differed from controls (P < 0.001) and track and field athletes (P = 0.013), but not the 5- to 10-km athletes (P = 0.21). The 5- to 10-km athletes also differed from controls (P < 0.001). Marathon athletes exhibited excess from the regions of Arsi and Shewa (M: 73%; 5-10 km: 43%; TF: 29%; C: 15%). The language distribution of marathon athletes differed from all groups (P < 0.001), with a predominance of languages of Cushitic origin (M: 75%, 5-10 km: 52%, TF: 46%, C: 30%). A higher proportion of marathon athletes ran to school (M: 68%; 5-10 km: 31%; TF: 16%; C: 24%) and traveled greater distances. Elite endurance athletes are of a distinct environmental background in terms of geographical distribution, ethnicity, and also having generally traveled farther to school, often by running. These findings may reflect both environmental and genetic influences on athletic success in Ethiopian endurance athletes.

Cardiology patient pages. Pulmonary embolism and deep vein thrombosis.

The heart pumps oxygenated blood through the aorta to smaller arteries. After the blood supplies nutrients to vital organs, it returns through veins for reoxygenation in the lungs (Figures 1 and 2⇓). Blood clots called deep vein thrombi (DVT) often develop in the deep leg veins. Pulmonary embolism (PE) occurs when clots break off from vein walls and travel through the heart to the pulmonary arteries. The broader term venous thromboembolism (VTE) refers to DVT, PE, or to a combination of both. Figure 1. The arterial (red) and venous systems (blue) are depicted. The left ventricle (LV) ejects oxygenated blood into the aorta, which circulates blood to vital organs. Deoxygenated blood travels through the venous system to the right atrium, right ventricle, and pulmonary artery. Adapted with permission from MediClip, Clinical Cardiopulmonary Images 1997, CCP01026.TIF, Williams & Wilkins, Baltimore, Md. Figure 2. Deoxygenated blood returns to the heart and lungs for reoxygenation. SVC indicates superior vena cava; IVC, inferior vena cava; RA, right atrium; RV, right ventricle; and PA, pulmonary artery. Adapted with permission from MediClip, Clinical Cardiopulmonary Images 1997, CATHRHT.TIF, Williams & Wilkins, Baltimore, Md. VTE poses a public health threat with an estimated incidence in the United States of 250 000 to 2 million cases per year. Predisposition to VTE arises from acquired conditions, inherited disorders, or both. Many of the acquired risk factors can be modified, thus lessening the likelihood of PE or DVT. Long-haul air travel is the most talked-about risk factor for PE. Other acquired risk factors include obesity, …

Wheelchair marathon racing causes striated muscle distress in individuals with spinal cord injury

Objective: To assess the effects of wheelchair marathon racing in individuals with spinal cord injury (SCI) on circulating muscle enzymes and myoglobin. Subjects: Thirty-one men with SCI, including 25 wheelchair marathon athletes and 6 sedentary men. Design: Serum myoglobin (Mb), creatine kinase (CK) activity, and lactate dehydrogenase (LDH) were measured in participants of the 1995 Oita International Wheelchair Marathon Race (42.195km). Blood samples were obtained 24 hours before, immediately after, 24 hours after, and 7 days after the race. Results: Marathon racing resulted in significant increases in serum Mb, total CK activity, and LDH ( p < .01) after the race. The peak Mb and LDH levels occurred immediately after the race; total CK activity peaked 24 hours after the race. Evaluation of cardiac muscle enzymes showed no significant changes in two CK isoenzymes (CK-MM and CK-MB). Conclusions: Propulsion of the wheelchair in a marathon race induced muscle stress in athletes with SCI. Completion of the marathon race did not cause cardiac muscle damage, however. Elevated muscle enzyme levels likely resulted from muscle distress rather than from dehydration.

Reversible ischemic colitis in a high endurance athlete

Ischemic colitis is a rare but serious consequence of long distance running. Herein we report a well documented case of severe ischemic colitis in an elite class marathon athlete in whom an extensive diagnostic evaluation, including magnetic resonance angiography and hypercoagulation profile, was performed. Our results suggest that physiologic shunting due to splanchnic vasoconstriction, intravascular volume depletion due to chronic dehydration, and possibly some element of hypercoaguability due to secondary polycythemia may have been causative factors. The patient’s full recovery, both clinically and endoscopically, with conservative treatment and ability to resume a vigorous training schedule further support a reversible nonocclusive etiology.

Short-term attenuation of natural killer cell cytotoxic activity in wheelchair marathoners with paraplegia

Objective: To investigate homeostasis of the immune system in athletes with spinal cord injuries during and after racing a wheelchair marathon. Design: The study examined changes in the number and function of natural killer (NK) cells in nine male wheelchair marathon athletes (spinal cord injuries between T5 and T12) who completed the 15th Oita International Wheelchair Marathon Race. Blood samples were obtained the day before, immediately after, and 1 day after the race. Blood samples were also obtained from seven age-matched control subjects with spinal cord injuries but who did not exercise regularly. Results: The number of peripheral leukocytes increased ( p < .01) immediately after the race. In contrast, the number of peripheral NK cells and NK cell cytotoxic activity significantly decreased from 310 ± 130μL to 133 ± 61μL and from 42.6% ± 3.0% to 38.2% ± 3.2%, respectively (mean ± SD), immediately after the race. Plasma cortisol levels were increased after the race. However, all parameters returned to control levels within 24 hours. Measurements in control subjects did not change throughout the experiment. Conclusion: These findings suggest that racing a marathon suppressed peripheral NK cell number as well as NK cell cytotoxic activity in wheelchair athletes and that this was probably mediated by increased postrace cortisol levels. Wheelchair marathon athletes are advised to take extra precaution to avoid infection within 24 hours after racing because of the transient suppression of NK cell cytotoxic activity during this period.