Personality of marathon runners: a narrative review of recent findings.

Participation in marathons has dramatically increased over the last few years. Marathon running has many proven beneficial effects, especially on cardiovascular health and fitness. Most research has focused on physiologic and pathophysiologic adaptations in connection with endurance exercise. Nevertheless, marathon running also has a major impact on psychological aspects and positively influences mental health, which has only recently attracted research interest. The present narrative review aimed to review the personality traits of marathon runners with an emphasis on recent literature. Marathon runners show a distinct personality and highly characteristic personality traits needed to successfully finish such a demanding race, i.e., a strong sense of vigor, self-sufficiency, and intelligence as well as low scores in anger, fatigue, tension, and depression. Furthermore, personality differences are detectable between runners of different sexes, ages, and performance level groups. This has significant clinical implications for athletes, coaches and competition organizers, as these groups show different patterns of personality traits. Future studies should focus on changes in cognition and mood states pre-, during, and post-endurance events, as well as during training periods. Large-scale studies comparing personality differences by sex, age, and performance are also important for better clinical guidance. See also the graphical abstract(Fig. 1).

Analysis of over 1 million race records shows runners from East African countries as the fastest in 50-km ultra-marathons.

The 50-km ultra-marathon is a popular race distance, slightly longer than the classic marathon distance. However, little is known about the country of affiliation and age of the fastest 50-km ultra-marathon runners and where the fastest races are typically held. Therefore, this study aimed to investigate a large dataset of race records for the 50-km distance race to identify the country of affiliation and the age of the fastest runners as well as the locations of the fastest races. A total of 1,398,845 50-km race records (men, n = 1,026,546; women, n = 372,299) were analyzed using both descriptive statistics and advanced regression techniques. This study revealed significant trends in the performance of 50-km ultra-marathoners. The fastest 50-km runners came from African countries, while the fastest races were found to occur in Europe and the Middle East. Runners from Ethiopia, Lesotho, Malawi, and Kenya were the fastest in this race distance. The fastest 50-km racecourses, providing ideal conditions for faster race times, are in Europe (Luxembourg, Belarus, and Lithuania) and the Middle East (Qatar and Jordan). Surprisingly, the fastest ultra-marathoners in the 50-km distance were found to fall into the age group of 20-24 years, challenging the conventional belief that peak ultra-marathon performance comes in older age groups. These findings contribute to a better understanding of the performance models in 50-km ultra-marathons and can serve as valuable insights for runners, coaches, and race organizers in optimizing training strategies and racecourse selection.

Mental Health in Ultra-Endurance Runners: A Systematic Review.

BACKGROUND: Among ultra-endurance runners (UER), the mental, behavioral, and physical demands of training/competition can result in maladaptive outcomes. Mental health issues are common in athletes and can impact psychology, physical health, and performance. OBJECTIVE: To synthesize information regarding the incidence/prevalence and factors associated with mental health issues among UER. METHODS: Systematic searches were performed in PubMed, SPORTDiscus, Scopus, Cochrane databases, CINAHL, Web of Science, and Medline Ovid using key terms related to UER (e.g., trail running, road running) and psychological issues (e.g., exercise addiction, depression). Inclusion criteria included original articles published in peer-reviewed journals in English, using qualitative or quantitative approaches. We considered papers reporting incidence/prevalence and associated factors with mental health outcomes in UER of both sexes, all ages, and levels of competition (e.g., elite, nonprofessional runners). The Joanna Briggs Institute Analytical Cross-Sectional Studies critical appraisal tool was used for quality assessment. RESULTS: A total of 282 studies were identified, and 11 studies were included in the final selection. A total of 3670 UER were included in the studies. The prevalence of mental health issues among UER ranged between 32.0% and 62.5% for eating disorders, from 11.5% to 18.2% for exercise addiction, 18.6% for depressive symptoms, and 24.5% for sleep disturbance. Exercise addiction was not related to weekly volume, but a strong relationship with exercise in an unstructured space, age, and body mass index was shown. CONCLUSION: Mental health issues among UER are common, especially eating disorders, exercise addiction, sleep disturbances, and depressive symptoms. Further high-quality studies are needed to examine underlying factors and find preventative strategies to protect UER. REGISTRATION: The protocol of this systematic review was registered at the PROSPERO-CRD42022338743.

Pacing Variation in Multistage Ultramarathons: Internet-Based Cross-Sectional Study.

BACKGROUND: Ultramarathon running is the most popular ultraendurance competition in terms of the number of races and runners competing annually worldwide; however, no study has compared pacing and performance over a long period. OBJECTIVE: This study analyzes the pacing of successful finishers and nonfinishers in multistage ultramarathons worldwide. METHODS: A total of 4079 athletes (men=3288; women=791) competing in 99 multistage ultramarathon events from 1983 to 2021 were analyzed, including the number of participants, age, gender, rank, and running speed of successful finishers. RESULTS: The results showed a significant increase in the number of events (n=338) and a significant increase in the number of finishers and nonfinishers (n=5575) in the ultramarathons worldwide during this period. The general linear models (GLMs) of pacing variation showed nonsignificant effects for gender (F1,36.2=2.5; P=.127; ηp2=0.063) and age group (F10,10=0.6; P=.798; ηp2=0.367), but it showed a significant interaction (gender × age) effect (F10,2689=2.3; P=.008; ηp2=0.009). Post hoc analyses showed that men have a higher pacing variation than women in the under 30 years (U30), U35, U45, and U50 groups. Additionally, the fastest women's age group (U35) had the lowest pacing variation. The GLM of pacing variation by gender and event distance showed significant effects for both gender (F1,3=18.5; P<.001; ηp2=0.007) and distance (F2,3=20.1; P<.001; ηp2=0.015). Post hoc analyses showed a growing pacing variation with increasing race distance for both men and women. In addition, men had a higher variation in long events. Furthermore, there was a significant main effect for both genders (F1,3=33.7; P<.001; ηp2=0.012) and rank (F1,3=136.6; P<.001; ηp2=0.048) on performance, with men being faster than women. Pacing varied greatly due to gender (F1,3=4.0; P=.047; ηp2=0.001), with a lower (ie, more even) pacing variation for male athletes in the top 3 finishers. Male nonfinishers showed a higher performance than female nonfinishers (F1,1340=25.6; P<.001), and no difference was identified for pacing variation (F1,789=1.5; P=.228) based on gender. In addition, a weak but significant correlation (r=-0.130; P<.001) was identified between the average running speed and pacing variation for both female and male nonfinishers. CONCLUSIONS: In summary, multistage ultramarathon competitions showed an increasing number of competitors and a higher performance challenge. Men have a higher pacing (ie, less even) variation than women, especially observed in longer events. A higher pacing variation was associated with lower performance for men, women, and nonfinishers.

Elderly female ultra-marathoners reduced the gap to male ultra-marathoners in Swiss running races.

Recent studies showed that female runners reduced the performance gap to male runners in endurance running with increasing age and race distance. However, the investigated samples were generally small. To investigate this further, the present study examined sex differences by age across various race distances (5, 10 km, half-marathon, marathon, and ultra-marathon) using a large dataset of over 1,100,000 race records from Switzerland over two decades (1999-2019). The study explored performance and participation disparities between male and female runners by employing diverse methods, such as descriptive statistics, histograms, scatter and line plots, correlations, and a predictive machine learning model. The results showed that female runners were more prevalent in shorter races (5, 10 km, half-marathon) and outnumbered male runners in 5 km races. However, as the race distance increased, the male-to-female ratio declined. Notably, the performance gap between sexes reduced with age until 70 years, after which it varied depending on the race distance. Among participants over 75 years old, ultra-marathon running exhibited the smallest sex difference in performance. Elderly female ultra-marathoners (75 years and older) displayed a performance difference of less than 4% compared to male ultra-marathoners, which may be attributed to the presence of highly selected outstanding female performers.

InTrack project - Theoretical framework, design, and methods: A study protocol.

Sports performance is the result of a complex interaction between individual and environmental factors. The purpose of this paper is to explain the methods used in the InTrack Project, a cross-sectional and cross-cultural project developed to investigate the variance in the performance of runners from different countries and to understand whether the differences in the performance can be explained by micro-level (athletes characteristics and proximal environment), meso-level (the distal environment that plays a relevant role on the relationships established at micro-level), and the macro-level (environmental features that shape countries characteristics). The sample will be comprised of runners, of both sexes, from four countries. Data collection will be performed in two steps: i) Individual information and ii) Country-level information. At the individual level, data will be obtained from an online survey. At the country level, characteristics data will be obtained from the secondary data available (demographic, social, and economic variables). Statistical procedures expected to be used include multilevel analysis, latent class analysis, addictive and multiplicative interaction in regression models. This wealth of information is of relevance to fill gaps regarding the existence of variables to connect different levels of information, and to provide scientific support about environmental characteristics important to predict runners' performance within and between countries.

The Relative Importance of Training and Social Support for Runners' Performance: A Cross-Sectional Study.

BACKGROUND: Running participation/performance is a complex system. Understanding the variables associated with these behaviors may help to increase population physical activity and improve performance. This study aimed to investigate social and training variables important for running performance using a network approach. METHODS: This cross-sectional study sampled 1151 non-professional Brazilian runners of both sexes (women, 38.2%; men, 61.7%). A questionnaire was available for eligible participants using an online platform, and information regarding training (volume and running pace) and social variables (participation in a running event, participation in a running group, influence on running, runners in the family, and childhood sport) related to runners' performance was obtained. The Chi-square test and network model were estimated by sex. RESULTS: Training characteristics tend to be clustered. For both sexes, the training volume node presented the highest expected influence in the network (1.69 for women and 2.16 for men). Centrality indicators of social variables show that sports childhood participation and the presence of runners in the family were the most important nodes of network connection for women and men, respectively. CONCLUSION: Based on these findings, it was concluded that sports participation during childhood and the practice of running by other family members were important factors to connect variables in the network. These findings have practical applications for health policymakers, highlighting the need to develop educational programs to increase sports participation during childhood and within families.

A macro to micro analysis to understand performance in 100-mile ultra-marathons worldwide.

The purposes of this study were (i) to describe differences in participation in 100-mile ultra-marathons by continent; (ii) to investigate differences in performance between continents; and (iii) to identify the fastest runners by continent and country. Data from 148,169 athletes (119,408 men), aged 18-81 years, and finishers in a 100-miles ultra-marathon during 1870-2020 were investigated. Information about age, gender, origin, performance level (top three, top 10, top 100) was obtained. Kruskal-Wallis tests and linear regressions were performed. Athletes were mostly from America and Europe. A macro-analysis showed that the fastest men runners were from Africa, while the fastest women runners were from Europe and Africa. Women from Sweden, Hungary and Russia presented the best performances in the top three, top 10 and top 100. Men from Brazil, Russia and Lithuania were the fastest. The lowest performance and participation were observed for runners from Asia. In summary, in 100-miles ultra-marathon running, the majority of athletes were from America, but for both sexes and performance levels, the fastest runners were from Africa. On a country level, the fastest women were from Sweden, Hungary and Russia, while the fastest men were from Brazil, Russia and Lithuania.

An analysis of the São Silvestre race between 2007-2021: An increase in participation but a decrease in performance.

This study aimed to investigate the trends of finishers in the São Silvestre race in Brazil, taking into account sex, age, and performance levels. A total of 31 â€‹775 runners (women, n â€‹= â€‹13 â€‹847; men, n â€‹= â€‹17 â€‹928), aged (45.2 â€‹± â€‹16.8) years, finishers in the São Silvestre race between 2007 and 2021, were considered in the present analysis. Data (event year, date of birth, sex, and race times) were downloaded from the official race website. The man-Whitney U test, Spearman correlation, and robust regression model were computed. Participation increased over time for both sexes. Regarding age groups, "31-40 years" (women) and "> 60 years" (men) were those with the highest number of finishers. We found a decrease in performance across the years (ߠ​= â€‹2.45; p â€‹< â€‹0.005), as well as significant differences in race times for both sexes (U â€‹= â€‹42.844; p â€‹< â€‹0.001), with men presenting better performances than women. Over time, it was observed an increase in the performance gap between the sexes, but in general, the performance decreased (ߠ​= â€‹1.76; p â€‹< â€‹0.001). Stakeholders should consider improving the strategies to improve women and young people's participation in running events.

Relationship between running performance and weather in elite marathoners competing in the New York City Marathon.

It is well known that weather and pacing have an influence on elite marathon performance. However, there is limited knowledge about the effect of weather on running speed in elite marathoners. The aim of the present cross-sectional study was to investigate potential associations between running speed and weather variables in elite runners competing in the 'New York City Marathon' between 1999 and 2019. Data from all official female and male finishers with name, sex, age, calendar year, split times at 5 km, 10 km, 15 km, 20 km, 25 km, 30 km, 35 km, 40 km and finish and hourly values for temperature (°Celsius), barometric pressure (hPa), humidity (%) and sunshine duration (min) between 09:00 a.m. and 04:00 p.m. were obtained from official websites. A total of 560,731 marathon runners' records were available for analysis (342,799 men and 217,932 women). Pearson and Spearman correlation analyses were performed between the average running speed and the weather variables (temperature, pressure, humidity and sunshine). Ordinary Least Squares (OLS) regressions were also performed. The runner´s records were classified into four performance groups (all runners, top 100, top 10 and top 3) for comparison. Differences in running speed between the four performance groups were statistically significant (p < 0.05) for both men and women. Pearson (linear) correlation indicated a weak and positive association with humidity in the top 10 (r = 0.16) and top 3 (r = 0.13) performance groups that the running speed of the elite runners was positively correlated with humidity. Regarding sunshine duration, there was a weak and positive correlation with the running speed of the elite groups (r = 0.16 in the top 10 and r = 0.2 in the top 3). Spearman correlation (non-linear) identified a weak but negative correlation coefficient with temperature in all runners' groups. Also, non-linear positive correlation coefficients with humidity and sunshine can be observed in the Spearman matrixes. A Multivariate Ordinary Least Squares (OLS) regression analysis showed no predictive power of weather factors. For elite runners competing in the 'New York City Marathon' between 1999 and 2019, the main findings were that elite runners became faster with increasing humidity and sunshine duration while overall runners became slower with increasing temperature, increasing humidity and sunshine duration. Weather factors affected running speed and results but did not provide a significant predictive influence on performance.

The Influence of Environmental Conditions on Pacing in Age Group Marathoners Competing in the "New York City Marathon".

Background: The two aspects of the influence of environmental conditions on marathon running performance and pacing during a marathon have been separately and widely investigated. The influence of environmental conditions on the pacing of age group marathoners has, however, not been considered yet. Objective: The aim of the present study was to investigate the association between environmental conditions (i.e., temperature, barometric pressure, humidity, precipitation, sunshine, and cloud cover), gender and pacing of age group marathoners in the "New York City Marathon". Methodology: Between 1999 and 2019, a total of 830,255 finishes (526,500 males and 303,755 females) were recorded. Time-adjusted averages of weather conditions for temperature, barometric pressure, humidity, and sunshine duration during the race were correlated with running speed in 5 km-intervals for age group runners in 10 years-intervals. Results: The running speed decreased with increasing temperatures in athletes of age groups 20-59 with a pronounced negative effect for men aged 30-64 years and women aged 40-64 years. Higher levels of humidity were associated with faster running speeds for both sexes. Sunshine duration and barometric pressure showed no association with running speed. Conclusion: In summary, temperature and humidity affect pacing in age group marathoners differently. Specifically, increasing temperature slowed down runners of both sexes aged between 20 and 59 years, whereas increasing humidity slowed down runners of <20 and >80 years old.

Fear of failure in Brazilian runners.

This study aims to investigate the fear or failure (FoF) in Brazilian runners of both sex, performance levels and age categories, as well as to verify the relationship between FoF and socioeconomic status (SES). Sample size as composed by 916. Age, sex, body height, body weight, SES, and running pace were self-reported. The Multidimensional Questionnaire of FoF was applied in an online platform. Running pace, and SES were categorized and processed through multivariate analysis and Spearman correlations, with the p-value set at 0.05. Female runners with better performance (2.13 ± 0.74) and younger (2.16 ± 0.80), as a well as male runners with worse performance (2.04 ± 0.69) and older (2.04 ± 0.89) presented the highest values of FoF. Among women, SES was negatively associated with FoF (r = -0.144; p = 0.006), while a positive association between running pace and SES was observed among men (r = 0.290; p < 0.001). Non-professional Brazilian runners presented low values of FoF.

The Effects of Sex, Age and Performance Level on Pacing in Ultra-Marathon Runners in the 'Spartathlon'.

BACKGROUND: Pacing has been investigated in different kinds of ultra-marathon races, but not in one of the toughest ultra-marathons in the world, the 'Spartathlon'. OBJECTIVE: The aim of the present study was to analyse the pacing of female and male finishers competing in the 'Spartathlon' in regards to their age and performance groups. METHODS: A total of 2598 runners (2255 men and 343 women) finishing 'Spartathlon' between 2011 and 2019 were analysed. We selected 10 checkpoints with split times corresponding to important race sections. Average running speed was calculated for each participant and the average checkpoint running speed for each of the 10 race checkpoints. Furthermore, to assess the pacing strategy of each runner, the percentage of change in checkpoint speed (CCS) in relation to the average race speed was calculated (for each of 10 checkpoints). Finally, the average change in checkpoint speed (ACCS) was calculated for each participant as a mean of the 10 CCSs. RESULTS: Both women and men slowed down through the first 7 checkpoints but increased running speed towards the end of the race (reverse J-shaped pacing). Men showed a significantly greater CCS in the first and second checkpoint (p < 0.01 and p < 0.05, respectively), whereas women showed a more significant change in CCS in the last checkpoint (p < 0.05). Furthermore, age and sex showed no effect on ACCS, whereas ACCS differed between the performance groups. In particular, the slowest and the fastest runners showed a more minor change in ACCS than the two medium groups of both men and women (p < 0.01). CONCLUSIONS: In summary, successful finishers in 'Spartathlon' showed a reverse J-shaped pacing curve with a decrease in running speed from the start to the 7th checkpoint and an increase in running speed thereafter. This strategy was most probably due to the profile of the race course. Men showed a more significant change in checkpoint speed in the first two checkpoints, whereas women showed a more substantial change in the last checkpoint. Age and sex did not affect average checkpoint speed, whereas this speed was different between the different performance groups. The slowest and the fastest runners showed fewer changes in average checkpoint speed than the two medium groups in men and women.

Cross-Cultural adaptation and validation of the Exercise-Induced Leg Pain questionnaire for Spanish speaking patients.

OBJECTIVES: To cross-culturally adapt and validate a Spanish version of the Exercise-Induced Leg Pain questionnaire. DESIGN: Clinical measurement study. PARTICIPANTS: The validity and reliability of the adapted version were assessed in four groups of 40 patients with exercise-induced leg pain, 40 physically active healthy individuals (control group), 40 athletes with other leg conditions and 40 athletes, military personnel and candidates with no history of injury (risk group). MAIN MEASURE: Exercise-Induced Leg Pain questionnaire. REFERENCE MEASURES: Spanish version of the Short-Form 36 and Schepsis postsurgical classification scale. RESULTS: In patients with exercise-induced leg pain, the mean age was 24.9 (± 6.7) years and the mean score of the questionnaire was 62.8 (± 10.9). The standard error of measurement and minimum detectable change threshold were 1.67 and 4.63 points, respectively. Excellent internal consistency (Cronbach's α = 0.942) and test-retest reliability (intraclass correlation coefficient = 0.995) were found. The exploratory and confirmatory factor analyses indicated that a one-factor solution explained 66.84% of the variance. For construct validity, 87.5% of the previously stated hypotheses were fulfilled between the total score of the questionnaire and Short-Form 36 dimensions. Concurrent validity, assessed by the Schepsis scale, was almost perfect (r = 0.92, p < 0.001). The predictive validity of the questionnaire was demonstrated using the receiving operating curve (area of 0.992; 95% CI: 0.983-1, p < 0.001). CONCLUSION: The Spanish version of the Exercise-Induced Leg Pain questionnaire resulted in a reliable and valid instrument to assess patients with exercise-induced leg pain.

Trends in Participation, Sex Differences and Age of Peak Performance in Time-Limited Ultramarathon Events: A Secular Analysis.

Background and Objectives: Increases in the number of participants in time-limited ultra-marathons have been reported. However, no information is available regarding the trends in participation, performance and age in 12 h and 24 h time-limited events. The aim of the study was to describe the trends in runners' participation, performance and age in 12 h and 24 h ultra-marathons for both sexes and to identify the age of peak performance, taking into account the ranking position and age categories. Materials and Methods: The sample comprised 210,455 runners in time-limited ultra-marathons (female 12 h = 23,706; female 24 h = 28,585; male 12 h = 61,594; male 24 h = 96,570) competing between 1876 and 2020 and aged 18 to 86 years. The age of peak performance was tested according to their ranking position (first−third; fourth−tenth and >tenth position) and taking into account their running speed in different age categories (<30 years; 31−40 years; 41−50 years; 51−60 years; >60 years), using the Kruskal−Wallis test, followed by the Bonferroni adjustment. Results: An increase in the number of participants and a decrease in running speed were observed across the years. For both events, the sex differences in performance decreased over time. The sex differences showed that male runners performed better than female runners, but the lowest differences in recent years were observed in the 24 h ultra-marathons. A positive trend in age across the years was found with an increase in mean age ("before 1989" = 40.33 ± 10.07 years; "1990−1999" = 44.16 ± 10.37 years; "2000−2009" = 45.99 ± 10.33 years; "2010−2020" = 45.62 ± 10.80 years). Male runners in 24 h races were the oldest (46.13 ± 10.83 years), while female runners in 12 h races were the youngest (43.46 ± 10.16 years). Athletes ranked first−third position were the youngest (female 12 h = 41.19 ± 8.87 years; female 24 h = 42.19 ± 8.50 years; male 12 h = 42.03 ± 9.40 years; male 24 h = 43.55 ± 9.03 years). When age categories were considered, the best performance was found for athletes aged between 41 and 50 years (female 12 h 6.48 ± 1.74 km/h; female 24 h 5.64 ± 1.68 km/h; male 12 h 7.19 ± 1.90 km/h; male 24 h 6.03 ± 1.78 km/h). Conclusion: A positive trend in participation in 12 h and 24 h ultra-marathons was shown across the years; however, athletes were becoming slower and older. The fastest athletes were the youngest ones, but when age intervals were considered, the age of peak performance was between 41 and 50 years.

The Sex Difference in 6-h Ultra-Marathon Running-The Worldwide Trends from 1982 to 2020.

Background and Objectives: The 6-h ultra-marathon is the shortest time-limited ultra-marathon race, but little has been investigated regarding this race format. Previously, only the age of peak performance in the context of longer time-limited ultra-marathons was determined. The purpose of this study was to investigate the trends in 6-h ultra-marathon races from 1982 to 2020 for female and male ultra-runners, the participation and performance by countries, the age of peak performance, and the differences in performance regarding countries. Materials and Methods: The sample included 23,203 female ultra-runners, aged 18-83 years, and 87,264 male ultra-runners, aged 18-85 years, who were finishers in a 6-h ultra-marathon held between 1982 and 2020. The age of peak performance was tested using the Kruskal-Wallis test, followed by the Bonferroni Correction. The difference in performance by countries was verified using a linear regression model with the fastest runners from Russia in women, and Tunisia in men, used as reference. Results: Over the years, the men-to-women ratio decreased. The mean age was 43.20 ± 9.30 years for female and 46.09 ± 10.17 years for male runners. Athletes in younger age groups were faster than athletes in older age groups. Most female and male participants originated from Germany. Women from Russia (10.01 ± 1.28 km/h) and men from Tunisia (12.16 ± 1.46 km/h) were the fastest. Conclusions: In summary, in 6-h ultra-marathons held between 1982 and 2020, the participation for both women and men increased, while the men-to-women ratio decreased. The mean age was higher in men compared to women. Most female and male runners originated from Germany, but the fastest women were from Russia, and the fastest men from Tunisia. Future studies need to investigate whether Russian women and Tunisian men are also the best in other distance-limited ultra-marathon races, such as 12-h and 24-h.

Trail running injury risk factors: a living systematic review.

OBJECTIVE: To review and frequently update the available evidence on injury risk factors and epidemiology of injury in trail running. DESIGN: Living systematic review. Updated searches will be done every 6 months for a minimum period of 5 years. DATA SOURCES: Eight electronic databases were searched from inception to 18 March 2021. ELIGIBILITY CRITERIA: Studies that investigated injury risk factors and/or reported the epidemiology of injury in trail running. RESULTS: Nineteen eligible studies were included, of which 10 studies investigated injury risk factors among 2 785 participants. Significant intrinsic factors associated with injury are: more running experience, level A runner and higher total propensity to sports accident questionnaire (PAD-22) score. Previous history of cramping and postrace biomarkers of muscle damage is associated with cramping. Younger age and low skin phototypes are associated with sunburn. Significant extrinsic factors associated with injury are neglecting warm-up, no specialised running plan, training on asphalt, double training sessions per day and physical labour occupations. A slower race finishing time is associated with cramping, while more than 3 hours of training per day, shade as the primary mode of sun protection and being single are associated with sunburn. An injury incidence range 0.7-61.2 injuries/1000 hours of running and prevalence range 1.3% to 90% were reported. The lower limb was the most reported region of injury, specifically involving blisters of the foot/toe. CONCLUSION: Limited studies investigated injury risk factors in trail running. Our review found eight intrinsic and nine extrinsic injury risk factors. This review highlighted areas for future research that may aid in designing injury risk management strategies for safer trail running participation.PROSPERO registration numberCRD42021240832.

Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review.

It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.