Marathon Research Articles

Perceptions of Cycleway Risks Before and After Running

Fatigue may influence risk perception for subsequent physical activities. Participants volunteered to fill out a questionnaire, rating the perception of risk of cycleway pictures either before or after running a half or a full marathon race. The after race running group also reported workload, flow state, and stress state measures. We found the runners who responded after the race rated the cycleways as riskier than those who responded before the race. This effect was partially moderated by the length of the race run; runners who ran a full marathon were more likely to rate the cycleways as personally risky. The full marathon runners also reported more physical and mental fatigue than the half-marathon runners, but interestingly, they rated the race as less mentally and physically demanding. Fatigue may impact the perception of physical risks.

The association between marathon running and high-sensitivity cardiac troponin: A systematic review and meta-analysis.

Marathon running is an extreme sport with a distance of about 42 kilometers. Its relationship to high-sensitivity cardiac troponin (hs-cTn) remains controversial. As the gold standard for detecting myocardial injury, the trends of hs-cTn before and after a marathon were investigated and analyzed. A literature search was conducted in PubMed, EMBASE, and Cochrane Library databases by combing the keywords marathon and troponin, and studies regarding high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after marathon running (not for half-marathon and ultra-marathon) were included. "Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group" were used to assess the risk of bias. Statistical analysis was performed using Review Manager, presenting data as mean values and 95% confidence intervals (CIs). Sensitivity analysis and subgroup analysis were performed if there was high heterogeneity among studies based on I2 statistic. A total of 13 studies involving 824 marathoners were included in this systematic review and meta-analysis. Both hs-cTnI (MD 68.79 ng/L, [95% CI 53.22, 84.37], p< 0.001) and hs-cTnT (MD 42.91 ng/L, [95% CI 30.39, 55.43], p< 0.001) were elevated after running a marathon, but the concentration of hs-cTnT returned to baseline after 72 to 96 h post-race (MD 0.11ng/L, [95% CI -1.30, 1.52], p= 0.88). The results of subgroup analysis demonstrated that the 99th percentile upper reference limit of hs-cTnT might be the source of heterogeneity. The concentrations of hs-cTnI and hs-cTnT were increased after marathon running, but the change of hs-cTnT is usually not seen as irreversible myocardial injury.

Functional nutrition for the health of exercising individuals and elite sportspersons.

Elite sportspersons who are involved in high-intensity physical sports indulge in severe training and competition schedules, which exposes them to high levels of inflammatory and oxidative stress, hence it may hamper their health sometimes. Disturbance in the health of sportspersons also induces compromised performances. Functional nutrition is essential for elite sportspersons training for securing both rest and recovery to have proper health and anticipated performance. Apart from serving the energy needs of the sportspersons, the nutrition strategies should provide them with certain metabolic advantages, which provide greater health and immunity, to ensure proper training and competition. The diet of the sportspersons needs to contain appropriate anti-inflammatory and antioxidative nutrients, to ensure to reduction and control of the physiological stress of tissues during high-intensity physical sports, especially during marathon running. Preserving anabolic valence among sportspersons for muscle myokine optimization is an essential aspect of sports nutrition, which secures health and provides excellent performance potential. Preservation and optimization of gut microbiome among sportspersons enhance immune health and performance, through proper gut integrity and enhanced metabolic cascades. As the genes are to be properly expressed for excellent manifestation in protein synthesis and other metabolic signaling, achieving genetic valance through proper nutrition ensures the health of the sportspersons. Functional nutrition seems a very necessary and potent factor in the training and competition aspects of elite sportspersons since nutrition not only provides recovery but also ensures proper health for elite sportspersons.

Identification of pre-race ultrasonographic abnormalities of the Achilles tendon and association with future injuries in runners

ABSTRACT Objective To determine if specific morphological changes in ultrasonographic images of Achilles tendons are associated with the development of pain in distance runners. Methods This study is a blinded, retrospective analysis of 276 Achilles tendon ultrasound images, which were used to determine if specific morphologic findings could positively or negatively predict future Achilles tendon pain development in distance runners. Pre-race ultrasound scans were performed on 138 asymptomatic half- and full marathon runners (276 tendons in total) who were followed for 12 months after their races. Specific patterns of morphologic abnormality were identified (location, size, and appearance of ultrasound abnormality within the tendon). Sonographic findings were blindly assessed by a medical student, a resident, and a physician who has significant sonographic imaging experience. These specific abnormalities were then compared to those who later did or did not develop tendon pain. Results Three findings were found to have significant odds of association with the development of pain: 1) focal deep midsubstance intratendinous hypoechogenicity, 2) focal superficial midsubstance intratendinous hypoechogenicity, and 3) linear hyperechogenicity extending into middle of tendon from calcaneus. Conclusion These results suggest that the aforementioned specific morphologic abnormalities in the Achilles tendon may be associated with the future development of pain symptoms in distance runners in this cohort. Looking for these specific abnormalities may increase the specificity of identifying precursors to Achilles tendon pain development.

Exploring Women’s Marathon Participation in the United States, 1980-2019

Over 45 percent of participants in U.S. marathon events identify as women (World’s Largest, n.d.), a noteworthy development considering women comprised just 11% of participants in 1980 (Ryder, 2013). Most U.S. women competing in marathon events also identify as white and middle class, indicating significant racial and socio-economic divisions in this growth in participation. The rise in U.S. women’s marathoning is linked to historical changes in the late twentieth century, particularly the passage of Title IX, movements for social justice and women’s liberation, and the commercialization and marketization of running events. How does the increase in women’s participation relate to performance rates in organized marathon events? To better understand the historical and sociocultural factors associated with U.S. women’s engagement in marathoning, this article examines the performance statistics and demographics of the top U.S. women marathon runners from 1980 to 2019 in three major marathon events in the country: New York City, Boston, and Chicago. Results demonstrate the age of high performing female marathon runners has increased significantly during the period, while race time has decreased significantly, and top performers have been largely white. These findings are discussed and contextualized with respect to historical and sociocultural factors surrounding the growth in U.S. women’s marathon participation.

Gender differences in footwear characteristics between half and full marathons in China: a cross-sectional survey

There are concerns about the risk of injuries caused by marathons in China. Since male and female runners have different injury risks, gender differences in running shoe functionality should be further complemented. A supervised questionnaire survey of 626 marathon runners was collected. The questionnaire was categorized into four sections: (1) participant profile, (2) importance of shoe properties, (3) functional evaluation of shoe properties and (4) importance ranking of shoe properties. The Mann–Whitney U test, Fisher’s exact test of cross tabulation and Chi-square test, and two-way ANOVA were used to analyze the results of this survey. The significance level was set at P < 0.05. The full marathon participants were older than the half marathon participants. There was no gender difference in the importance of shoe features to elite runners. In addition, women are more concerned about upper elasticity and have higher requirements for running shoes than men. Women were more focused on injury prevention, while men were more focused on running performance. Heel cushioning was identified by all participants as the most important running shoe feature. There were no gender differences between elite players’ demand for running shoes, but significant gender differences were found between genders at other running levels.

Does Running Increase the Risk of Hip and Knee Arthritis? A Survey of 3804 Marathon Runners.

Long-distance running is a popular form of cardiovascular exercise with many well-described health benefits, from improving heart health to the management of obesity, diabetes, and mental illness. The impact of long-distance running on joint health in recreational runners, however, remains inconclusive. The prevalence of osteoarthritis in runners is not associated with an athlete's running-related history, including the number of marathons completed, cumulative years of running, average weekly mileage, and average running pace. Prospective cohort study. Level 3. A survey was distributed to all participants registered for the 2019 or 2021 Chicago marathon (n = 37,917). Surveys collected runner demographics and assessed for hip/knee pain, osteoarthritis, family history, surgical history, and running-related history. Running history included the number of marathons run, number of years running, average running pace, and average weekly mileage. The overall prevalence of osteoarthritis was identified, and a multivariable logistic regression model was used to identify variables associated with the presence of hip and/or knee osteoarthritis. Surveys were completed by 3804 participants (response rate of 10.0%). The mean age was 43.9 years (range, 18-83 years) and participants had completed on average 9.5 marathons (median, 5 marathons; range, 1-664 marathons). The prevalence of hip and/or knee arthritis was 7.3%. A history of hip/knee injuries or surgery, advancing age, family history, and body mass index (BMI) were risk factors for arthritis. Cumulative number of years running, number of marathons completed, weekly mileage, and mean running pace were not significant predictors for arthritis. The majority (94.2%) of runners planned to run another marathon, despite 24.2% of all participants being told by a physician to do otherwise. From this largest surveyed group of marathon runners, the most significant risk factors for developing hip or knee arthritis were age, BMI, previous injury or surgery, and family history. There was no identified association between cumulative running history and the risk for arthritis.

Wind tunnel evaluation of novel drafting formations for an elite marathon runner

Drafting is a strategy in marathon running races that reduces the drag force acting on a designated runner. Drafting involves a formation of athletes, called pacers, running in front of (and sometimes behind) the designated runner. The present experiments evaluated complex formations involving up to seven pacers with the aim of enhancing the performances of an elite marathoner. Wind tunnel measurements with 1/10 scale articulated runner manikins were carried out. First, simple formations with one or two pacers were examined and the results were compared with previous investigations. Second, the runner formations of the Nike Breaking2 and INEOS 1:59 Challenge events whose goal was to break the 2 h marathon barrier were studied. The main finding was the identification of three complex formations of six and seven pacers that allow a drag-force reduction of about 60% with respect to a solo runner and an estimated time saving of 262 s. These results point to how it may be possible to run the fastest marathon ever.

Effects of running a marathon on sclerostin and parathyroid hormone concentration in males aged over 50.

The aim of our study was to verify whether running a marathon (32nd Wroclaw Marathon) was associated with changes in sclerostin and intact PTH (iPTH) concentration in middle-aged males. We enrolled 33 males who completed the marathon race. Blood samples were taken 60 minutes before (V1), immediately after (V2), and 7 days after the run (V3). The mean serum sclerostin concentration was 42.4 ± 10.8 pmol/L at V1, increased to 62.9 ± 12.6 pmol/L at V2 (t= -11.206; p < 0.001) and returned to baseline in V3 (t = 8.344; p < 0.001, V3 vs. V2). A similar trend was recorded for iPTH (t= -7.440; p < 0.001, for V2 vs. V1; t = 6.229; p < 0.001, for V3 vs. V2), at V3, iPTH levels remained significantly higher than V1 (t= -2.759; p = 0.010). The results of our study suggest that, in middle-aged males, running a marathon affects skeletal metabolism by activating two counteracting mechanisms, although temporarily overlapping: first, by a sudden inhibition of bone formation, through induction sclerostin expression and, secondly, by a long-lasting induction of PTH, which also guarantees the maintenance of adequate circulating levels of calcium. The net effect would be the maintenance of adequately high levels of circulating calcium to be used for neuromuscular activity and muscle contraction.

Assessment of Blood Glucose Responses in a Female National-Level Marathon Runner Using Continuous Glucose Monitoring during a Real-World Marathon Race

Background: The effects of the use of continuous glucose monitoring (CGM) in elite endurance athletes are unclear. This case study reported the blood glucose (BG) levels of a female national-level marathon runner during a real-world marathon race. Methods: Heart rate and BG levels were monitored throughout the race. Results: The runner completed the race in 2:46 h:min, which was an improvement from her previous personal record by just under one min. Her BG levels were stable from approximately 5–40 km of the race at a mean concentration of 7.13 mmol/L, with a standard deviation of 0.20 mmol/L and a coefficient of variation of 2.8%. Increases in BG levels and heart rate were observed 6 min after the race and during the 40–42.195 km section, respectively. Conclusions: The runner broke her own record and exhibited stable BG levels throughout the race, with the highest BG value detected immediately after the race. Considering that quantity, content, and timing of pre-race meals and supplementation during the race can affect BG levels, future studies should assess additional detailed parameters in more detail and monitor multiple races with the same elite endurance athletes to acquire more definitive evidence on CGM usefulness among elite endurance athletes.

A Pilot Study Using Entropy for Optimizing Self-Pacing during a Marathon.

A new group of marathon participants with minimal prior experience encounters the phenomenon known as "hitting the wall," characterized by a notable decline in velocity accompanied by the heightened perception of fatigue (rate of perceived exertion, RPE). Previous research has suggested that successfully completing a marathon requires self-pacing according to RPE rather than attempting to maintain a constant speed or heart rate. However, it remains unclear how runners can self-pace their races based on the signals received from their physiological and mechanical running parameters. This study aims to investigate the relationship between the amount of information conveyed in a message or signal, RPE, and performance. It is hypothesized that a reduction in physiological or mechanical information (quantified by Shannon Entropy) affects performance. The entropy of heart rate, speed, and stride length was calculated for each kilometer of the race. The results showed that stride length had the highest entropy among the variables, and a reduction in its entropy to less than 50% of its maximum value (H = 3.3) was strongly associated with the distance (between 22 and 40) at which participants reported "hard exertion" (as indicated by an RPE of 15) and their performance (p < 0.001). These findings suggest that integrating stride length's Entropy feedback into new cardioGPS watches could improve marathon runners' performance.

Analysis of sudden cardiac death in competitive athletes, possibilities for reducing cases

Sudden cardiac death in athletes is rare (0.5 to 1 per 100000 athlete years), but sudden cardiac death in known athletes causes general shock. Our research aim was to collect and study as many sudden cardiac death cases as possible, judge the role of stress and look for ways to reduce fatal tragedies. From registers and newspaper articles found on the Internet, we collected 360 (including 14 women) athletes' sudden cardiac death cases where the sport, age and place of death (during training/competition/after) could be determined. From these, a single database has been prepared in order of the year of death. The cases were grouped and analyzed by sports. Based on our results and literature data, we made recommendations to reduce fatalities. There were more sudden cardiac deaths in competitions than in trainings (239 vs. 99), but tragedies also happened during warm-ups and chess without physical exertion, furthermore, there was no sudden cardiac death in the stakeless training of marathon/half marathon/triathlon athletes; all these prove the role of stress, so we recommend a psychological conversation before a high-stakes race. There were also a lot of sudden cardiac deaths (79/360) during team sports trainings, so we recommend reanimation readiness there as well. After training/competition, sudden cardiac death happened mainly in sports requiring high static effort, where post-competition monitoring is also recommended. Those who died in training were younger than those who died during the race (p<0.01), so young people should be monitored more closely for medical and (under)fitness. Marathon runners and triathletes were older than team athletes (p<0.005) and only died in competition, so for them a basic examination and an ECG within 1 month before competition are recommended. Conclusions drawn from literature data: sports medicine examination should be standardized and documented in an accessible way; since resuscitation started earlier and professionally is more effective, all competitors should receive reanimation training. Orv Hetil. 2023; 164(29): 1155-1163.

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.

Determining the effect and magnitude of advanced footwear technology on female distance running performance

There is limited work, to date, in which the potential performance-enhancing effects of Advanced Footwear Technology (AFT) in the female elite athlete has been considered. This study aimed to retrospectively explore publicly available race data for a marathon, half-marathon, and 10-km elite events to analyse the effect of AFT, along with athlete and event characteristics, to determine the effect on female running performance. Race performance times for the top 20 female athletes within the world were extracted from 1990 to 2020 (n = 1722), along with athlete and event characteristics from 2010 to 2020 (n = 660). Data for race shoes were available for 655 of the 660 performances. The changes in grouped mean performance times over the years that AFT had been adopted were compared with the grouped mean of the corresponding number of years immediately prior show marathon, half-marathon, and 10-km performance times were 1.7, 1.72, and 1.75% (p < 0.001, pη2 > 0.220) faster during the AFT period. Repeated performance analysis comparing the improvement in race times between the control group and athletes who adopted AFT showed athletes who adopted AFT improved significantly more over the marathon (2.64%, p < 0.001) and half-marathon (1.67%, p < 0.002). Advanced Footwear Technology correlated (r > 0.50) with improvements in the marathon and half-marathon, but not the 10-km. Based on multiple regression modelling, it can be suggested that wearing AFT improves marathon race time by 78 s (0.93%), and half-marathon race time by 28 s (0.71%). Based on these results, we observe a small but meaningful performance-enhancing effect of AFT within elite female athletes.

Restarting Athens Marathon During COVID-19 Uncertainty

The COVID-19 outbreak had a disastrous effect in the event industry. This has also heavily affected sport events with substantial disruptions, postponements, and even cancellations. The study focuses on Athens Marathon participants, and examines their perspectives concerning their willingness to support the restart of the event. The research was held in November 2021, during the restart of Athens Marathon at Kalimarmaro stadium in Athens, Greece. Drawing from a sample of 400 race runners in all three Athens Marathon races (5 km, 10 km, 42 km), the research examines the chaordic systems of participants' decision-making through the employment of fuzzy-set Qualitative Comparative Analysis. The findings have generated three sufficient pathways (event loyalty, COVID-19 effect, brand protection) that are able to lead to the participants' willingness to support the restart of Athens Marathon. The contribution of the study lies in both theoretical and methodological domains, while it also provides several managerial implications.

Transformational escapes: Accessing consumer transformation through extraordinary experiences

AbstractPrevious research implies that the transformational potential of extraordinary experiences arises from the engagement with the experiential context, although we still do not know how this process happens and to what extent it changes consumers. In this article, we explore the processes by which consumers transform themselves through extraordinary experiences and the characteristics of such a transformation. Based on a three‐year ethnography in the context of marathon running, we identified the three processes that engender consumer transformation: the physical transformation process, the mental transformation process, and the discursive transformation process. These processes are sheltered by the transformational escape, defined as the consumption setting that integrates structural and antistructural features through the engagement of consumers' routine with the extraordinary experience, enabling consumer transformation. We extend current theorizations by revealing the dynamics that elongate extraordinary experience duration, enable the dynamic between routine and extraordinary experience, and enlarge the reach of consumer transformation.

Consideration on size, velocity and path of droplets emitted during running.

People began to wear face masks during physical activities due to spread of COVID-19. There are no previous studies about the need for wearing masks while running. Assuming a citizen runner who runs full marathon in 4 hours, we verified the path and the amount of droplet dispersal, setting a humanoid mannequin with a mask in simulated running environment (Experiment 1). We also had six adults exercise in the same environment to examine droplet behaviors when not wearing a face mask (Experiment 2). Average droplet size was determined, and repeated measures ANOVA was carried out to examine statistical significance. To evaluate observed droplet behaviors, theoretical solutions of the downfall motion of large droplets were then derived, taking air resistance into consideration. Experiment 1: wearing a face mask caused more droplets to adhere to the face; Experiment 2: droplets were emitted in conversation, coughing or sneezing, and they fell within social distancing. Average droplet size was not sensitive to the wind velocity. It could vary with a significant difference for time and wind velocity. Observed velocity and path of droplet can be expressed by the theoretical solutions. Velocity and path of large droplets can be expressed by the theoretical solution of particles in downfall motion under air resistance. We therefore conclude that wearing a mask while running gives adverse effects in preventing infection. Possibility of droplet transmission while running is considered low even when not wearing a face mask, as long as social distancing is ensured.

Patellofemoral Pain Syndrome Is Associated With Chronic Disease and Allergies in 60 997 Distance Runner Race Entrants: SAFER XXX Study.

Patellofemoral pain syndrome (PFPS) is a common running-related injury. Independent risk factors associated with PFPS have not been described in a large cohort of distance runners. Descriptive, cross-sectional study. 21.1 and 56 km Two Oceans Marathon races (2012-2015). 60 997 race entrants. Participants completed a compulsory prerace medical screening questionnaire (history of PFPS in the past 12 months, n = 362; no injury history, n = 60 635). Selected risk factors associated with a history of PFPS were explored using univariate & multivariate analyses: demographics, training/running variables, history of chronic diseases (composite chronic disease score), and any allergy. Prevalence ratios (PRs, 95% confidence intervals). Risk factors associated with PFPS (univariate analysis) were increased years of recreational running (PR = 1.09; P = 0.0107), older age (>50 years), and chronic diseases (PR > 2): gastrointestinal disease (PR = 5.06; P < 0.0001), cardiovascular disease (CVD) (PR = 3.28; P < 0.0001), nervous system/psychiatric disease (PR = 3.04; P < 0.0001), cancer (PR = 2.83; P = 0.0005), risk factors for CVD (PR = 2.42; P < 0.0001), symptoms of CVD (PR = 2.38; P = 0.0397), and respiratory disease (PR = 2.00; P < 0.0001). Independent risk factors (multivariate analysis) associated with PFPS (adjusted for age, sex, and race distance) were a higher chronic disease composite score (PR = 2.68 increased risk for every 2 additional chronic diseases; P < 0.0001) and a history of allergies (PR = 2.33; P < 0.0001). Novel independent risk factors associated with PFPS in distance runners are a history of multiple chronic diseases and a history of allergies. Identification of chronic diseases and allergies should be considered as part of the clinical assessment of a runner presenting with a history of PFPS.

Evaluation of the electrocardiogram RV5 /V6 criteria in the diagnosis of left ventricular hypertrophy in marathon runners.

To assess the value of electrocardiogram (ECG) RV5/V6 criteria for diagnosing left ventricular hypertrophy (LVH) in marathons. A total of 112 marathon runners who met the requirements for "Class A1" events certified by the Chinese Athletics Association in Changzhou City were selected, and their general clinical information was collected. ECG examinations were performed using a Fukuda FX7402 Cardimax Comprehensive Electrocardiograph Automatic Analyser, whereas routine cardiac ultrasound examinations were performed using a Philips EPIQ 7C echocardiography system. Real-time 3-dimensional echocardiography (RT-3DE) was performed to acquire 3-dimensional images of the left ventricle and to calculate the left ventricular mass index (LVMI). According to the LVMI criteria of the American Society of Echocardiography for the diagnosis of LVH, the participants were divided into an LVMI normal group (n=96) and an LVH group (n=16). The correlation between the ECG RV5/V6 criteria and LVH in marathon runners was analysed using multiple linear regression stratified by sex and compared with the Cornell (SV3+RaVL), modified Cornell (SD+RaVL), Sokolow-Lyon (SV1+RV5/V6), Peguero-Lo Presti (SD+SV4), SV1, SV3, SV4, and SD criteria. In marathon runners, the ECG parameters SV3+RaVL, SD+RaVL, SV1+RV5/V6, SD+SV4, SV3, SD, and RV5/V6 were able to identify LVH (all p<.05). When stratified by sex, linear regression analysis revealed that a significantly higher number of ECG RV5/V6 criteria were evident in the LVH group than in the LVMI normal group (p<.05), both with no adjustment and after initial adjustment (including age and body mass index), as well as after full adjustment (including age, body mass index, interventricular septal thickness, left ventricular end-diastolic diameter, left ventricular posterior wall thickness, and history of hypertension). Additionally, curve fitting showed that the ECG RV5/V6 values increased with increasing LVMI in marathon runners, exhibiting a nearly linear positive correlation. In conclusions, the ECG RV5/V6 criteria were correlated with LVH in marathon runners.

Skin Cancer Risk, Sun-Protection Knowledge and Behavior in Athletes—A Narrative Review

Outdoor sports are associated with increased exposure to ultraviolet radiation, which may result in sunburn, solar damage, and skin cancers. Water and winter sports create additional adverse conditions, such as washing away sunscreen by water and reflection of UV rays by the water and snow. Sweating-increased skin photosensitivity and activity-induced immunosuppression are associated with a greater risk of developing skin cancers. In this review, we focus on a group of athletes and sports participants and analyze 62 articles concerning sun exposure during outdoor sports, the risk of developing skin cancer, and knowledge and behavior regarding photoprotection methods. Various practices have been linked to an increased risk of developing basal cell carcinoma (BCC), squamous cell carcinoma (SCC), malignant melanoma (MM), or UV-induced skin damage. Water sports and mountaineering increase the risk of BCC. Surfing and swimming are risk factors for SCC. Melanoma is more common in swimmers, surfers, and marathon runners. Photoprotection behaviors can reduce potential skin damage and skin cancers. Athletes’ knowledge about the risk of malignant lesions was satisfactory, but despite the risks, outdoor sports participants seem not to protect themselves from the sun adequately.