Ultra-endurance Events Research Articles

Age and Sex Differences in IRONMAN World Championship Performance.

Gries, KJ and Witto, PE. Age and sex differences in IRONMAN world championship performance. J Strength Cond Res XX(X): 000-000, 2024-There has been an increasing number of masters athletes, particularly women, who have been competing in ultra-endurance events. With this in mind, we sought to determine the influence of age and sex on IRONMAN World Championship performances from 2014 to 2023. The final times of each component (swim, bike, and run) and overall time were collected for places 1st to 10th in each age group (18-69 years). Sex differences in performance were calculated for each age group. Depth of field (time of nth place/first place), a surrogate for participation, was also calculated for each age group and sex. Significance was set at p < 0.05. These data show a ∼12% sex difference in the performance of the swim, bike, run, and final (p < 0.05), which increased to 20% in the 65-69 years age group (p < 0.05). The differences appeared driven by the bike and run. Depth of field was greater in men than in women (p < 0.05), and the sex difference increased with age. Sex differences in performance trended to be related to depth of field (p = 0.08; R2 = 0.32), suggesting a moderate role of participation in performance sex differences. Although speculative, the performance data can give us an insight into the physiology and sociology of these elite athletes and warrants future research.

Lateral Femoral Condyle Stress Fracture in an Ultramarathoner: A Case Report.

A 62-year-old ultramarathon athlete presented to the clinic with right posterolateral knee pain for 3 to 4 weeks and muscle tightness. Magnetic resonance imaging demonstrated a right lateral femoral condyle fracture. The fracture was treated conservatively, with return full Ironman competition 14 months later. Femoral condyle fractures should be suspected in endurance athletes with nonspecific knee pain to prevent further injury. These fractures are rare, and more studies are needed to determine risk factors, risk classification, and optimal treatment protocol. With rising popularity of ultraendurance events, sports medicine physicians must educate patients on injury recognition and mitigation strategies.

Exploring the use of music during ultramarathons using a think-aloud procedure

Introduction: ultrarunning is a rapidly growing sport and is receiving increased attention in scientific literature. Ultrarunning is the act of running ultramarathons, defined as any distance over a marathon (42.2 km). Some ultramarathons are run over a set time e.g., 12 hours. Ultrarunners face many different challenges throughout their races, including injuries and pain, thoughts of quitting, and boredom (Holt et al., 2014, Sport Psych, 28, 22-35). The application of music during sports and exercise has been shown to be a powerful psychological and ergogenic aid, however, there is a dearth of studies exploring how music is applied in ultrarunning. Previous research around ultramarathons has typically used interviews or a range of scales to collect data (Watkins et al., 2022, Psych Sport Ex, 63, 102271). Think-Aloud (TA) procedures have been used in studies involving shorter distance running (Johnson et al., 2023, Int J Sport Ex Psych) but have not yet been applied to ultrarunning. Accordingly, the present study uses a TA approach to capture ultramarathoners’ thoughts and feelings during an event where they listen to music. Method: ten participants completed a two-stage training procedure of TA to conform with established procedures (McGreary et al., 2024, Sport Ex Perf Psych). The TA procedure permits recording of real-time thoughts. The first stage consists of two problems: a multiplication problem, and an anagram-based problem. The second stage involves thinking aloud for a short period while on a training run. Following the training, participants recorded their thoughts at six time points around their event: before the race, after 1 mile, at 30, 60, and 90% into the race, and within five minutes of race completion. Data Analysis: thematic analysis will be undertaken on the transcribed data and will follow standard procedures. Applications: TA has not been applied in ultrarunning previously and its use in the present study can offer evidence to its future feasibility for similar research. Findings of this study will inform the practical application of music around ultramarathon events, with insights offered for athletes and coaches. Moreover, recommendations will be made as to when music could be applied during an event to maximise its effects. These findings will be couched within contemporary conceptual frameworks for applying music in sport and exercise contexts and offer fresh insight into how these models could be expanded to consider ultra-endurance events more fully.

Urinary hydration biomarkers, but not renal blood velocity, are impacted by a 161-km ultra-endurance footrace

PURPOSE: Recent data suggest that dehydration (i.e., increases in urine specific gravity (USG) and osmolality (OSM)) may contribute to increased risk of acute kidney injury (AKI) [1]. AKI may be transiently elevated in a substantial proportion of athletes upon completing ultra-endurance running events (42km) [2], indicating potential kidney strain via reductions in renal perfusion. However, there are limited data on the effects of ultra-endurance running events on renal blood velocity (RBV). Therefore, we sought to investigate the effects of the 2023 161-km Western States Endurance Run (WSER) on hydration biomarkers and RBV. We hypothesized that USG and OSM would be higher and that RBV would be lower post- versus pre-race. METHODS: We included 17 participants (3F/14M, 44±10yrs, 175±7cm, 69±9kg) with urine samples and RBV data in this analysis. We measured USG with a refractometer and OSM with an osmometer. We assessed RBV in the decubitus position using sonography at the renal and segmental arteries (GE Logiq e). Renal vascular conductance, the ease with which blood flows through kidney vasculature, was calculated as RBV/supine central mean blood pressure (SphygmoCor XCEL). Pre-race measures were collected ≤72 hours before WSER and post-race measures were collected ≤1 hour after finishing. Normality was assessed and paired, two-sided t-tests or Wilcoxon paired tests were used to compare pre- vs. post-race measures. Normalized differences were calculated ([pre-post]/pre) to assess associations between variables using Pearson’s correlation. We set α a priori to ≤ 0.05. Results: The WSER elicited an increase in USG (1.010±0.007 vs 1.026±0.011, p=0.002) and urine OSM (420±220 vs 740±305 mOsm/kg, p=0.003). However, RBV was unaffected post-race in the renal (49.3±10.0 vs 44.6±13.4 cm·s−1, p=0.285) and segmental artery (28.9±6.4 vs 27.5±1.6 cm·s−1, p=0.345). There were no differences in vascular conductance in the renal (0.55±0.10 vs 0.53±0.19 cm·s−1/mmHg, p=0.808) or the segmental artery (0.325±0.02 vs 0.325±0.02 cm·s−1/mmHg, p=0.903). No associations were observed between changes in RBV and changes in hydration biomarkers ( ps&gt;0.243). CONCLUSIONS: We observed large elevations in USG and OSM, which may suggest a transient increase in workload within the kidneys, but no change in renal or segmental artery vascular conductance after WSER. Future analyses are needed to investigate whether AKI biomarkers may be elevated after the completion of ultra-endurance events, particularly among higher-risk runners. National Institutes of Health K01HL160772 (JCW), American Heart Association 23CDA1037938 (JCW), Western States Endurance Run Medical Research Program (GJG), NIH-K01HL147998 (ATR), Auburn University Offce of Vice President for Research Support Program (ATR). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Blood Pressure and Central Arterial Stiffness before and after a 161-km Ultra-Endurance Race

BACKGROUND: Competing in ultra-endurance running events (&gt;42.2 km) is a tremendous physiological stressor. Training for and competing in these events may be detrimental to cardiovascular (CV) health. However, previous findings on acute changes in key CV health measures like blood pressure (BP) and central arterial stiffness after a race remain equivocal. Therefore, we aimed to characterize the acute CV response to an ultra-endurance race. We hypothesized that BP would decrease while central arterial stiffness would increase following the race. Methods: We measured supine BP with an automated brachial cuff and carotid-to-femoral pulse wave velocity (cfPWV - index of central arterial stiffness) with applanation tonometry (SphygmoCor XCEL, AtCor Medical) among 41 finishers (9F/32M; Age: 44 ± 10 years; BMI: 22.7 ± 1.8 kg/m2) of the 2023 161-km Western States Endurance Run (WSER). Measures were taken 1–3 days before (pre) and ≤1 hour after race completion (post). We present data as mean ± SD after confirming normality using Shapiro-Wilk tests (α ≥ 0.05). We assessed differences between pre- and post- systolic BP (SBP), mean BP (MBP), diastolic BP (DBP), cfPWV, and cfPWV normalized to MBP using paired, two-tailed t-tests (α &lt; 0.05). The magnitude of the difference between time points was represented as Cohen’s d ( d) effect sizes. Results: After the race, there was a significant decrease in SBP (129 ± 9 vs. 122 ± 10 mmHg, P &lt; 0.001, d = 0.78), MBP (94 ± 7 vs. 89 ± 10 mmHg, P &lt; 0.001, d = 0.58), and DBP (77 ± 7 vs. 74 ± 8, P = 0.02, d = 0.38) but no change in cfPWV (6.4 ± 1.0 vs. 6.2 ± 0.8 m/s, P = 0.10, d = 0.26) or cfPWV normalized to MBP (0.07 ± 0.01 vs. 0.07 ± 0.01 (m/s)/mmHg, P = 0.83, d = 0.00). CONCLUSION: We found that systolic, mean, and diastolic pressure were all lower after the 161-km WSER, but cfPWV did not change. These findings suggest that running a 161-km ultra-marathon race acutely lowers BP but does not affect central arterial stiffness. Further research is needed to understand the effect of chronic ultra-endurance training and competition on cardiovascular health. FUNDING INFORMATION: Western States Endurance Run Medical Research Program (GJG), National Institutes of Health K01HL160772 (JCW), American Heart Association 23CDA1037938 (JCW). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Completing a 4,486 km Multi-stage Ultramarathon Increases Arterial Stiffness and Alters Circulating Factors That Cause Endothelial Cell Dysfunction

Background: Guideline-based levels of aerobic exercise can improve vascular function, in part by decreasing arterial stiffness and oxidative stress, and increasing nitric oxide bioavailability. However, results from single-stage ultramarathons and ultra-endurance feats in modalities such as biking or triathlons suggest that excessive levels of aerobic exercise may impair vascular function. Some athletes will complete multi-day ultra-endurance events. One such example is the TransEurope FootRace (TEFR), a transcontinental ultramarathon in which participants cover 4,486 km in 64 days. However, the impact of this multi-stage ultramarathon on vascular function is unknown. Purpose: Here, we tested the hypotheses that completing the TEFR would increase arterial stiffness measured in vivo and alter circulating factors that increase reactive oxygen species (ROS) production and reduce the activation of endothelial nitric oxide synthase (eNOS) ex vivo. Methods: Data were obtained from 29 men and 1 woman (48±11 years of age) before and within 10 days of completing the TEFR. Arterial stiffness was assessed as carotid-femoral pulse wave velocity measured via MRI. Human aortic endothelial cells (HAECs) in culture were exposed to 10% subject plasma, then stained with florescent probes to detect basal ROS production (CellROX). Protein concentrations of phosphorylated(p)‐eNOS(S1177), a primary activation site of eNOS, were determined in the cultured HAECs via WES. Protein expression was normalized to total protein in the sample. P-eNOS relative to total protein was compared with total eNOS relative to total protein to determine activated eNOS. Results: Completing the TEFR caused a clinically significant 31% increase in carotid-femoral pulse wave velocity (pre-race: 610±37 cm/s, post-race: 800±99 cm/s; p=0.0374). ROS production increased by 40% in HAECs exposed to post-race plasma compared with pre-race plasma (pre-race: 1308±86 AU, post-race: 1836±131 AU; p&lt;0.0001). P-eNOS(S1177) decreased by 71% in HAECs after compared with before the race (pre-race: 0.080±0.038 AU; post-race: 0.023±0.005 AU; p=0.0047), whereas total eNOS was unchanged (pre-race: 1.646±0.328 AU, post-race 1.634±0.6533 AU, p=0.9137), suggesting a marked decrease in eNOS activation after the race. Conclusions: These findings indicate that completing a 64-day, 4,486 km ultramarathon increases arterial stiffness and changes factors in the circulation that increase ROS production and decrease eNOS activation, denoting reduced endothelial cell functioning. Performing this level of prolonged, strenuous physical exercise impairs vascular function in healthy highly trained adults. K01HL153326; SCHU 2514/1-1; SCHU 2514/1-2. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Training Regimen of an Elite Ultramarathon Runner: A Case Study of What Led Up to the 24-Hour World-Record Run.

Ultramarathon running has gained popularity over several decades. Although there has been considerable research on training for other running events, from the 100-m to the marathon at 26.2 miles (42.2km), there is little evidence on best practices for ultramarathons, where distances potentially exceed 100 miles (160.9km). In this case study, we examine the training regimen of an elite ultramarathon runner who broke 8 world records in 2021 and 2022, including the 24-hour run in which he ran 319.6km in September 2022. Training data from December 28, 2020, to September 17, 2022, were collected from the Strava application database (recorded on Coros watch) and analyzed using Microsoft Excel and Tableau. Our subject completed 5 training blocks, with volume per training block averaging 172.1 to 263km/wk. Peak running volume per training block occurred on average 3.2weeks out from races and reached a maximum of 378km/wk. Recovery was emphasized the week following a race, with less running (19km/wk) and more cross-training. Interval-type workouts (1- to 10-km repeats) were completed throughout training blocks. The average pace during the 24-hour world-record run was 4 minutes and 30seconds per kilometer (4:30/km), closely matching the overall average training pace. These findings suggest that training for ultramarathon races should include high-volume running at varied paces and intensity with cross-training to avoid injuries. We hope that this evidence helps athletes understand how to prepare for these ultraendurance events.

Evaluating injuries and illnesses that occurred during the Yukon Quest International sled dog race, 2018-2020.

The purpose of this study was to evaluate medical record data from the 2018-2020 Yukon Quest International Sled Dog race to examine injury patterns and risk factors for dogs competing in multi-day ultra-endurance events. Specifically, we summarized injuries and illnesses that resulted in canine athletes being removed ("dropped") from competition, and in orthopedic injuries diagnosed in both dropped and finished dogs. The records of 989 dogs that started the race were examined, but only records from dogs in teams that went on to finish the race were included, for a total of 711 records. Three hundred and sixty five dogs (51.3%) were noted to have at least one abnormal finding in their veterinary medical record during the race. Orthopedic injuries were most common, and 291 injuries were ultimately diagnosed in 234 dogs (32.9%). Ultimately, 206 dogs (29%) were dropped from competition, for any reason. The most common reasons for dropping dogs were orthopedic injuries (156 dogs; 188 injuries), gastrointestinal illness (22 dogs), and cardiorespiratory disease (7 dogs). Most orthopedic injuries in dropped dogs occurred in the thoracic limb (n = 121 dogs; 151 injuries). Of those, injuries to the shoulder were most common (n = 77), followed by injuries to the carpus (n = 59), and injury to the pelvic limb (n = 32). Carpal injuries were the most prevalent injury diagnosed in dogs that went on to finish the race (71 of 85 injuries). Carpal injuries were the most prevalent injuries overall in 2018 (51%) and 2019 (52%). In 2020, shoulder injuries were most prevalent (27%), suggesting that trail conditions may have differed between years. The majority of dogs with an orthopedic injury ultimately were removed from competition (156 of 234, or 66.6%), but the likelihood of finishing the race with an injury depended on the type of injury sustained; 71 of 130 dogs (54.6%) with a carpal injury went on to finish the race, whereas only 9 of 86 dogs with a shoulder injury (10.5%) went on to finish. The results of this study can assist mushers and veterinarians in preparing for races, and in decision making during endurance sled dog races.

Effects of a Transoceanic Rowing Challenge on Cardiorespiratory Function and Muscle Fitness.

Ultra-endurance sports and exercise events are becoming increasingly popular for older age groups. We aimed to evaluate changes in cardiac function and physical fitness in males aged 50-60 years who completed a 50-day transoceanic rowing challenge. This case account of four self-selected males included electro- and echo-cardiography (ECG, echo), cardiorespiratory and muscular fitness measures recorded nine months prior to and three weeks after a transatlantic team-rowing challenge. No clinically significant changes to myocardial function were found over the course of the study. The training and race created expected functional changes to left ventricular and atrial function; the former associated with training, the latter likely due to dehydration, both resolving towards baseline within three weeks post-event. From race-start to finish all rowers lost 8.4-15.6 kg of body mass. Absolute cardiorespiratory power and muscular strength were lower three weeks post-race compared to pre-race, but cardiorespiratory exercise economy improved in this same period. A structured program of moderate-vigorous aerobic endurance and muscular training for>6 months, followed by 50-days of transoceanic rowing in older males proved not to cause any observable acute or potential long-term risks to cardiovascular health. Pre-event screening, fitness testing, and appropriate training is recommended, especially in older participants where age itself is an increasingly significant risk factor.

A comparative observational study of carbohydrate intake and continuous blood glucose levels in relation to performance in ultramarathon

Ultra-endurance events have gained global participation, whereas the critical factors of competition results remain to be well elucidated. This study used a nutritional approach to evaluate the association of competition results with carbohydrate intake and blood glucose control during a 100-mile ultramarathon. This observational study was conducted in the 2021 LAKE BIWA 100, which covered 100 miles (169 km) and 10,500 m elevation. The course was divided into 9 segments by aid station. According to the competition results, 22 participants (18 men and 4 women) were divided into higher finishers (n = 7), lower finishers (n = 9), and non-finishers (n = 6). The participants self-recorded their overall dietary intake throughout the race. Glucose levels were monitored every 15 min by a flash glucose monitoring system. Running speed in each segment was standardized to the average of the top five finishers for each gender. Among finishers, the carbohydrate intakes were significantly higher in the higher finishers than in the lower finishers during overall segments, especially in the first half of the race (p < 0.05). There was a significant positive correlation between running speed and carbohydrate intake in the lower finishers (rho = 0.700, p = 0.036). Two-way ANOVA analysis revealed that lowering glucose levels in each segment were more frequently observed in the lower finishers compared to the higher finishers (p = 0.012). Compared to the higher finishers, the lower finishers exhibited significantly greater fluctuations (⊿highest-lowest) in glucose levels (p < 0.001). The fluctuations in glucose levels were significantly and negatively correlated with the running speed of the finishers (rho = − 0.612, p = 0.012). Faster runners consume high amounts of carbohydrates and maintain glucose levels during the 100-mile ultramarathon on the trail, especially at the beginning. Lowering and fluctuating glucose levels during the race are associated with lower running speed in endurance athletes.

Cardiac function and autonomic cardiac function during a multi-stage cycling event: a brief report.

Prolonged and repeated exercise performed during an ultra-endurance event can induce general and cardiac fatigue known as exercise-induced cardiac fatigue. Our objective was to find a possible correlation between the cardiac function and the autonomic cardiac function. During a multistage ultra-endurance event, a female well-trained cyclist underwent daily rest echocardiography and heart rate variability measurements to assess the cardiac function and the cardiac autonomic function. The athlete completed 3,345 km at 65% of her maximum heart rate and 39% of her maximum aerobic power. A progressive improvement of the systolic function for both the left ventricle and the right ventricle was observed during the event. Alterations were observed on the cardiac autonomic function with an imbalance between sympathetic and parasympathetic, but there was no sign of a significant correlation between the cardiac function and the autonomic cardiac function and no signs of cardiac fatigue either. Further analysis should be performed on a larger sample to confirm the obtained results.

A Narrative Review on Nutritional Strategies for Ultra-endurance Cyclists: Emphasising Requirements for Brevet de Randonneurs Events in India

Ultra-endurance cycling, particularly in events such as the Brevet de Randonneurs Mondiaux (BRMs), demands exceptional physical exertion and sustained energy management. In India, BRMs events, which span distances of 200 to 1000 kilometres, pose unique challenges for cyclists, necessitating prolonged physical preparation and consistent performance under demanding conditions. Nutrition plays a critical role in optimising energy availability, enhancing recovery and sustaining performance throughout these events. Despite the wealth of information available through social media, there remains a significant gap in scientifically grounded nutritional guidance specifically tailored to ultra-endurance cyclists. The aim of the present narrative review is to highlight the critical nutritional requirements and strategies essential for ultra-endurance cyclists participating in BRMs events. The review emphasises the need for evidence-based dietary practices to support optimal performance and recovery while addressing the current gap in scientific understanding. It also provides practical, research-informed nutritional guidance for athletes involved in these ultraendurance events. Pre-event preparation focuses on carbohydrate loading, hydration and balanced nutrition to maximise glycogen stores and ensure optimal hydration. During the event, continuous carbohydrate intake, electrolyte replenishment and hydration are critical for maintaining energy levels and preventing dehydration. Post-event recovery emphasises protein consumption for muscle repair, glycogen replenishment and rehydration. The findings underscore the importance of tailored nutritional strategies for ultraendurance cyclists to achieve optimal performance and recovery. Despite the abundance of general information available, there is a clear need for more research-based, practical nutritional guidelines specifically for ultra-endurance cycling. Future research should address this gap to provide athletes with evidence-based recommendations that support their unique nutritional needs.

Usage and Trends of Dietary Supplements in Ultra-Long Distance Endurance Events in China

This research investigates the usage and trends of dietary supplements in ultra-long distance endurance events in China. Ultra-endurance events, characterized by their extraordinary physical demands, present unique challenges to participants. Dietary supplements have gained popularity among athletes as a means to enhance performance and support recovery during these grueling events. However, their usage has implications for both performance and health. This study delves into the landscape of dietary supplementation in ultra-endurance events, examining its historical development, common supplement types, and the motivations behind their usage. Trends in supplement usage are analyzed, considering factors like age, gender, and event type. Furthermore, the study explores how cultural and regional factors influence supplement choices. The implications of dietary supplement usage on participants’ health and performance are discussed, highlighting potential risks and benefits. Recommendations for safe and effective supplementation are provided. By shedding light on these aspects, this research contributes to a comprehensive understanding of dietary supplement practices in the context of ultra-long distance endurance events in China.

Total Energy Expenditure and Nutritional Intake in Continuous Multiday Ultramarathon Events.

Continuous multiday ultramarathon competitions are increasingly popular and impose extreme energetic and nutritional demands on competitors. However, few data have been published on energy expenditure during these events. Here, we report doubly labeled water-derived measures of total energy expenditure (in kilocalories per day) and estimated physical activity level (PAL: total energy expenditure/basal metabolic rate) collected from five elite and subelite finishers (four males and one female, age 34.6 ± 4.9years)-and nutritional intake data from the winner-of the Cocodona 250, a ∼402-km race in Arizona, and from a fastest-known-time record (one male, age 30years) on the ∼1,315-km Arizona Trail. PAL during these events exceeded four times basal metabolic rate (Cocodona range: 4.34-6.94; Arizona Trail: 5.63). Combining the results with other doubly labeled water-derived total energy expenditure data from ultraendurance events show a strong inverse relationship between event duration and PAL (r2 = .68, p < .0001). Cocodona race duration was inversely, though not significantly, associated with PAL (r2 = .70, p = .08). Water turnover varied widely between athletes and was not explained by PAL or body mass. The Cocodona race winner met ∼53% of energy demand via dietary intake, 85.6% of which was carbohydrate, while ∼47% of energy demand was met via catabolism of body energy stores. Together, these results illustrate the energetic deficits incurred during competitive continuous multiday ultramarathon efforts and implicate macronutrient absorption and/or storage as key factors in ultramarathon performance.

Insult of Ultraendurance Events on Blood Pressure: A Systematic Review and Meta-Analysis.

The rise of ultraendurance sports in the past two decades warrants evaluation of the impact on the heart and vessels of a growing number of athletes participating. Bloodpressure is a simple, inexpensive method to evaluate one dimension of an athlete's cardiovascular health. No systematic review or meta-analysis to date has chronicled and delineated the effects of ultraendurance races, such as ultramarathons, marathons, half-marathons, and Ironman triathlon events, specifically on heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) measurements in supine and standing positions before and after the event. This meta-analysis reviews the effects of ultraendurance events on positional and calculated hemodynamic values. Data were extracted from 38 studies and analyzed using a random effects model with a total of 1,645 total blood pressure measurements. Of these, 326 values were obtained from astanding position, and 1,319 blood pressures were taken supine. Pre-race andpost-race measurements were evaluated for clinical significance using established standards of hypotensionand orthostasis. HR and calculated BP features, such as PP and MAP, were evaluated. Across all included studies, the mean supine post-race HR increased by 21±8 beats per minute (bpm) compared to pre-race values. The mean standing post-race HR increased by 23±14 bpm when compared with pre-race HR. Overall, there was a mean SBP decrease of 19±9 mmHgand a DBP decrease of 9±5 mmHgpost-race versus pre-race values. MAP variations reflected SBP and DBP changes. The mean supine and standing pre-race blood pressures across studies were systolic (126±7; 124±14) and diastolic (76±6; 75±12), suggesting that some athletes may enter races with existing hypertension. The post-race increasein the mean HR and decline in mean blood pressure across examined studies suggestthat during long-term events, ultramarathon athletes perform with relatively asymptomatic hypotension.

Historical Performance Trends In Winter Ultra-Endurance Events

Historical Performance Trends In Winter Ultra-Endurance Events

Clustering classification of cyclists according to the acute fatigue outcomes produced by an ultra-endurance event

Clustering classification of cyclists according to the acute fatigue outcomes produced by an ultra-endurance event

Medical Encounters and Treatment Outcomes in Ironman-Distance Triathlon.

This study aimed to examine the injury and illness characteristics, treatments, and outcomes at elite ultraendurance triathlon events. We quantified participant demographics, injury types, treatments, and disposition for medical encounters at 27 Ironman-distance triathlon championships from 1989 to 2019. We then calculated the likelihood of concurrent medical complaints in each encounter. We analyzed 10,533 medical encounters among 49,530 race participants for a cumulative incidence of 221.9/1000 participants (95% confidence interval [CI] = 217.7-226.2). Younger (<35 yr; 259.3/1000, 95% CI = 251.6-267.2) and older athletes (70+ yr; 254.0/1000, 95% CI = 217.8-294.4) presented to the medical tent at higher rates than middle-age adults (36-69 yr; 180.1/1000, 95% CI = 175.4-185.0). Female athletes also presented at higher rates when compared with males (243.9/1000, 95% CI = 234.9-253.2 vs 198.0/1000, 95% CI = 193.4-202.6). The most common complaints were dehydration (438.7/1000, 95% CI = 426.2-451.6) and nausea (400.4/1000, 95% CI = 388.4-412.6). Intravenous fluid was the most common treatment (483/1000; 95% CI = 469.8-496.4). Of the athletes who received medical care, 116.7/1000 (95% CI = 110.1-123.4) did not finish the race, and 17.1/1000 (95% CI = 14.7-19.8) required hospital transport. Athletes rarely presented with an isolated medical condition unless their injury was dermatologic or musculoskeletal in nature. Ultraendurance triathlon events have high rates of medical encounters among female athletes, as well as both younger and older age categories. Gastrointestinal and exertional-related symptoms are among the most common complaints. Intravenous infusions were the most common treatment after basic medical care. Most athletes entering the medical tent finished the race, and a small percentage were dispatched to the hospital. A more thorough understanding of common medical occurrences, including concurrent presentations and treatments, will allow for improved care and optimal race management.

Clinical presentation of exercise-associated hyponatremia in male and female IRONMAN® triathletes over three decades.

Exercise-associated hyponatremia (EAH) is common in ultra-endurance events and severe cases are more common in females. The purpose of this paper is to compare the clinical presentation of EAH between male and female triathletes in ultra-endurance competitions. Medical records with sodium concentrations (n = 3138) from the IRONMAN® World Championships over the timeframe of 1989-2019 were reviewed for both male (n = 2253) and female (n = 885) competitors. Logistic regression was used to explore the relationships between sex, sodium concentration, and various clinical presentations. When comparing male and female triathletes, clinical variables found to have a different relationship with sodium concentration include altered mental status (inversely related in males and not related in females), abdominal pain, muscle cramps, hypotension, and tachycardia (directly related in males and not related in females), and vomiting and hypokalemia (not related in males and inversely related in females). Overall, males lost significantly more weight than females, and notably, approximately half of all athletes were dehydrated and lost weight. Altered mental status, vomiting, abdominal pain, muscle cramps, hypotension, tachycardia, and hyperkalemia appear to present differently between sexes when comparing hyponatremic to eunatremic athletes. Although overhydration is the most common etiology of hypervolemic hyponatremia, hypovolemic hyponatremia comprises a significant amount of hyponatremic triathletes. Further understanding of how EAH presents helps athletes and medical professionals identify it early and prevent life-threatening complications.

Total Energy Expenditure and ad Libitum Fluid/Nutrient Intake During a 24-Hour Mountain-Bike Event: A Case Study.

This case study aimed to measure the TEE, cycling metrics, and ad libitum nutrient/fluid intake during a 24-hour cross-country mountain-bike race. A trained male cyclist (41y, 74.1kg, 172.4cm) received an oral dose of doubly labeled water prior to the 24-hour event for the calculations of TEE and water turnover. Nude body weight and urine samples were collected prerace, during the race, and postrace. Total nutrient intake and total fluid intake in addition to cycling metrics (speed, power output, cadence, and heart rate) were continuously recorded during the event. The rider completed 383km coupled with a vertical gain of 7737m during the 24-hour event. Average speed, power, and heart rate were 16.3 (2)km·h-1, 122 (29)W, and 134 (18)beats·min-1, respectively. TEE and total nutrient intake were 41 and 23.5MJ, respectively. Total carbohydrate intake was 1192g with an average hourly intake of 58 (22)g·h-1. Total body weight was 75.3 and 72.3kg prerace and postrace, respectively, with a measured ad libitum total fluid intake of 13.3L and a water turnover of 17.2L. These data provide novel insights for measures of TEE, total energy intake, and total fluid intake during an ultraendurance cross-country mountain-biking event and provide a foundation for future race/training needs.