Abstract Introduction Runners from East Africa including Kenya, Ethiopia and Uganda have dominated middle- and long-distance running events, for almost six decades. This narrative review examines and updates current understanding of the factors explaining the dominance of East Africans in distance running from a holistic perspective. Content The dominance of East African distance runners has puzzled researchers, with various factors proposed to explain their unparalleled success. Four key elements emerge: 1) biomechanical and physiological attributes, 2) training characteristics, 3) psychological motivations, and 4) African diet. Runners from East Africa often exhibit ectomorphic somatotypes, characterized by lean body compositions which lead them to an extraordinary biomechanical and metabolic efficiency. Their sociocultural lifestyle, training regimens beginning at a young age with aerobic activities, seem crucial, as well as moderate volume, high-intensity workouts at altitudes ranging from 2,000 to 3,000 m. Psychological factors, including a strong motivation to succeed driven by aspirations for socioeconomic improvement and a rich tradition of running excellence, also contribute significantly. A multifactorial explanation considering these factors, without a clear genetic influence, is nowadays the strongest argument to explain the East African phenomenon. Summary and outlook To unravel the mystery behind the supremacy of East African runners, it is imperative to consider these multifaceted factors. The predominantly rural lifestyle of the East African population underscores the importance of aligning modern lifestyles with the evolutionary past of Homo sapiens, where physical activity was integral to daily life. Further research is required to explain this phenomenon, with a focus on genetics.
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