Polar Thigh and Other Medical Observations During the Longest Solo Unsupported One-Way Polar Ski Expedition in Antarctica.

Antarctic expeditions are exceptional challenges for the human body, and medical issues such as nutritional deficiencies, polar anemia, cold injuries, and even death have been reported. We prospectively investigated medical issues encountered by a 33-year-old female adventurer completing the longest solo unsupported one-way polar ski expedition in Antarctica, covering 1484.53 km in 70 days and 16 h from Hercules Inlet to the Ross Ice Shelf, in temperatures estimated from -12 to -50°C and wind speeds of up to 60 mi/h. The adventurer developed a debilitating overuse musculoskeletal neck injury due to poor environmental conditions (ie, poor visibility, wind, and soft snow) while pulling a heavy sled and continuously holding the neck in a flexed position for checking directions on a mounted compass. The adventurer further developed a cold injury on the left calf (polar thigh) that gradually worsened and became ulcerated and more painful throughout the expedition. Potential risk factors included cold ambient temperatures, exposure to windy conditions, and clothing. After the expedition, this injury was treated with a skin graft. Important changes in body mass were observed (ie, reduction of body mass by 26.7% after the expedition) as well as general fatigue, muscle soreness, and sleep deterioration. This case study contributes to the body of knowledge of medical issues during Antarctic expeditions and provides the first scientific account of an adventurer with polar thigh. Further research into this condition is recommended.

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.

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.

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.

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.

Apparent temperature and heat-related illnesses during international athletic championships: A prospective cohort study.

International outdoor athletics championships are typically hosted during the summer season, frequently in hot and humid climatic conditions. Therefore, we analyzed the association between apparent temperature and heat-related illnesses occurrence during international outdoor athletics championships and compared its incidence rates between athletics disciplines. Heat-related illnesses were selected from illness data prospectively collected at seven international outdoor athletics championships between 2009 and 2018 using a standardized methodology. The Universal Thermal Climate Index (UTCI) was calculated as a measure of the apparent temperature based on weather data for each day of the championships. Heat-related illness numbers and (daily) incidence rates were calculated and analyzed in relation to the daily maximum UTCI temperature and between disciplines. During 50 championships days with UTCI temperatures between 15℃ and 37℃, 132 heat-related illnesses were recorded. Average incidence rate of heat-related illnesses was 11.7 (95%CI 9.7 to 13.7) per 1000 registered athletes. The expected daily incidence rate of heat-related illnesses increased significantly with UTCI temperature (0.12 more illnesses per 1000 registered athletes/°C; 95%CI 0.08-0.16) and was found to double from 25 to 35°C UTCI. Race walkers (RR = 45.5, 95%CI 21.6-96.0) and marathon runners (RR = 47.7, 95%CI 23.0-98.8) had higher heat-related illness rates than athletes competing in short-duration disciplines. Higher UTCI temperatures were associated with more heat-related illnesses, with marathon and race walking athletes having higher risk than athletes competing in short-duration disciplines. Heat-related illness prevention strategies should predominantly focus on marathon and race walking events of outdoor athletics championships when high temperatures are forecast.

The Impact of the COVID-19 Pandemic on Endurance and Ultra-Endurance Running.

Background and objectives: The COVID-19 outbreak has become a major health and economic crisis. The World Health Organization declared it a pandemic in March 2020, and many sporting events were canceled. Materials and Methods: We examined the effects of the COVID-19 pandemic on endurance and ultra-endurance running (UER) and analyzed finishes and events during the COVID-19 pandemic (observation period March 2020-October 2020) to the same time period pre-COVID-19 outbreak (March 2019-October 2019). Results: Endurance finishes decreased during the pandemic (459,029 to 42,656 (male: 277,493 to 25,582; female 181,536 to 17,074; all p < 0.001). Similarly, the numbers of endurance events decreased (213 vs. 61 events; p < 0.001). Average marathon finishing times decreased during the pandemic in men (5:18:03 ± 0:16:34 vs. 4:43:08 ± 0:25:08 h:min:s (p = 0.006)) and women (5:39:32 ± 0:19:29 vs. 5:14:29 ± 0:26:36 h:min:s (p = 0.02)). In UER, finishes decreased significantly (580,289 to 110,055; p < 0.001) as did events (5839 to 1791; p < 0.001). Popular event locations in United States, France, UK, and Germany decreased significantly (p < 0.05). All distance and time-limited UER events saw significant decreases (p < 0.05). Conclusions: The COVID-19 pandemic has had a significant effect on endurance and UER, and it is unlikely that running activities return to pre-pandemic levels any time soon. Mitigation strategies and safety protocols should be established.

Defining Off-road Running: A Position Statement from the Ultra Sports Science Foundation.

Off-road running continues to grow in popularity, with differing event categories existing, and terminologies are often used interchangeably and without precision. Trail running, mountain running, skyrunning, fell running, orienteering, obstacle course racing and cross-country running all take place predominantly in off-road terrain. Ultramarathon running refers to any running event over marathon distance conducted in any terrain and surface. Although some overlap may exist between these running events, mainly through the common denominator of off-road terrain, distinct features need to be recognised. As scientific interest in these activities grows, it becomes important to clarify these terms and develop a universal language for discussing these events. Similarly, off-road running athletes are generally not properly defined within the scientific literature, which makes intra- and inter-study comparisons difficult. The current position statement of the Ultra Sports Science Foundation highlights the different off-road running events and recommends clear reference to distance, surface, elevation change and altitude, type of event (continuous vs. staged), type of support, name and year of the event, governing body, and guidance on terminology. We further recommend to describe off-road running athletes by basic data, physiological determinants, training and competition characteristics in the scientific literature in order to facilitate and guide further research and practice.

Multimodal approach towards understanding the changes in the autonomic nervous system induced by an ultramarathon.

Purpose: Running an ultramarathon can be considered as a multifaceted, intense stressor inducing changes within the autonomic nervous system (ANS). The aim of this study was to examine changes within and across ANS modalities in response to an ultramarathon.Methods: Thirteen runners (44.3 ± 5.9 years) completed a 65 km run. Electrodermal activity (EDA), heart rate (HR), and skin temperature measured at wrist (Temp), were recorded before and after running. Three-minute intervals were analysed. Mean values were compared by t-tests for dependent samples. Joint principal component analysis-canonical correlation analysis (PCA-CCA) and multiset CCA techniques were employed to measure the interactions between either any two or among all modalities.Results: HR (p < 0.01) and EDA (p < 0.01) increased, while Temp decreased (p < 0.01). PCA-CCA revealed one significant component (p < 0.05) for each modality pair in pre and post measures. Component strength increased from pre (mean = 0.73) to post (mean = 0.92) test. Multiset CCA supported the assumption of increasing strength of correlations across modalities.Conclusion: Ultramarathon, an intense physical stressor, increases correlations across modalities pointing towards a reorganization of central ANS control to restore dynamic balance after physical load. This characterization of ANS-states might offer new avenues for training control.

Age-related participation and performance trends of children and adolescents in ultramarathon running.

Participation and performance trends as well as the performance differences among sexes in ultra-endurance running have been well described in the adult population; however, less information on such trends existed in youth ultramarathoners. The aim of the present study was to investigate the age-related participation and performance trends of children and adolescent ultramarathoner runners. Data on runners, younger than 19 years of age, competing from 1960 to 2018 in distance-limited ultramarathons of 50 km, 100 km, 50 miles and 100 miles, were analysed. During this period, the number of ultramarathon participation increased, most notably among boys, most runners originated from Europe, and the 50- and 100-km race distances were the most popular. Overall, male runners were faster than female runners, except in the case of European and Oceanian origin, where girls were faster over the 50-km race. The fastest male runners originated from Africa and the fastest girls from Oceania, and the average running speed has largely decreased for both sexes over calendar years. In summary, this study was the first to report details on participation and performance trends in youth ultramarathoners competing in distance-limited ultramarathons.

VO2max Testing in Trail Runners: Is There a Specific Exercise Test Protocol?

Trail running places specific physiological demands on the human body due to its uphill and downhill running sections. We developed and investigated a more sport-specific trail exercise test protocol (inclination and speed incremental protocol), and compared it to two standard exercise test protocols (horizontal step and ramp protocol) in thirteen highly trained trail runners (age 31±6 years, height 179±6.4 cm, weight 69.2±7.9 kg, BMI 21.6±2.1 kg/m2). The maximum oxygen uptake (VO2max) measured during the trail test (62.5±5.9 ml·kg-1·min-1, [95% CI: 59.0-66.1]) was significantly higher compared to both the step test (60.1±5.3 ml·kg-1·min-1, [95% CI: 56.8-63.3], p=0.024) and the ramp test (59.7±5.5 ml·kg-1·min-1, [95% CI: 56.4-63.0], p=0.028). Time to task failure was significantly shorter in the trail test (557±73 s, [95% CI: 512-601]) compared to both the step test (1378±152 s, [95% CI: 1286-1470], p<0.001) and the ramp test (605±95, [95% CI: 547-662], p<0.001). Other physiological measurements obtained were similar. The trail test was the preferred choice in our group of trail runners. This study supports the implementation of the trail test in practice, and recommends that its validity be evaluated further.

Circulatory endotoxin concentration and cytokine profile in response to exertional-heat stress during a multi-stage ultra-marathon competition.

Exertional-heat stress has the potential to disturb intestinal integrity, leading to enhanced permeability of enteric pathogenic micro-organisms and associated clinical manifestations. The study aimed to determine the circulatory endotoxin concentration and cytokine profile of ultra-endurance runners (UER, n=19) and a control group (CON, n=12) during a five stage 230km ultra-marathon (mean ± SD: 27h38min ± 3h55min) conducted in hot and dry environmental conditions (30ºC to 40ºC and 31% to 40% relative humidity). Body mass and tympanic temperature were measured, and venous blood samples were taken before (pre-stage) and immediately after (post-stage) each stage of the ultra-marathon for the analysis of gram-negative bacterial endotoxin, C-reactive protein, cytokine profile (IL-6, IL-1ß, TNF-α, IFN-γ, IL-10, and IL- 1ra), and plasma osmolality. Gastrointestinal symptoms and perceptive thermal tolerance rating were also monitored throughout competition. Mean exercise-induced body mass loss over the five stages ranged 1.0% to 2.5%. Pre- and poststage plasma osmolality in UER ranged277 to 282mOsmol/kg and 286 to 297 mOsmol/kg, respectively. Pre-stage concentrations of endotoxin (peak: 21% at Stage 5), C-reactive protein (889% at Stage 3), IL-6 (152% at Stage 2), IL-1ß (95% at Stage 5), TNF-α (168% at Stage 5), IFN-γ (102% at Stage 5),IL-10 (1271% at Stage 3), and IL-1ra (106% at Stage 5) increased as the ultra-marathon progressed in UER; while no changes in CON were observed (except for IL-1ß, 71% at Stage 5). Pre- to post-stage increases were observed for endotoxin (peak: 22% at Stage 3), C-reactive protein (25% at Stage 1), IL-6 (238% at Stage 1), IL-1ß (64% at Stage 1), TNF-α (101% at Stage 1), IFN-γ (39% at Stage 1), IL-10 (1100% at Stage 1), and IL-1ra(207% at Stage 1) concentrations in UER. Multi-stage ultra-marathon competition in the heat resulted in a modest circulatory endotoxaemia accompanied by a pronounced pro-inflammatory cytokinaemia by post-Stage 1, both of which were sustained throughout competition at rest (pre-stage) and after stage completion. Compensatory anti-inflammatory responses and other external factors (i.e., training status, cooling strategies, heat acclimatization, nutrition and hydration) may have contributed towards limiting the extent of pro-inflammatory responses in the current scenario.

Psychological aspects of the longest, solo, unsupported one-way polar ski expedition in Antarctica by a female adventurer.

INTRODUCTION: Antarctic expeditions present exceptional physiological and mental challenges. Research data are lacking on psychological aspects of such endeavours. The aim of our study is to provide data on changes in mood, well-being, personality traits and personal experiences during an Antarctica crossing. METHODS: This is a study of a 33-year-old female British Army officer (height 175 cm; weight 75 kg; body mass index 24.49 kg/m2; VO2max 49 mL/kg/min) who completed the longest, solo, unsupported, one-way polar ski expedition. The expedition started at Hercules Inlet and finished at Ross Ice Shelf, lasting 70 days and 16 hours covering 1484.53 km, with temperatures estimating from -12°C to -50°C and wind speeds of up to 60 miles per hour. The adventurer pulled all equipment and nutrition in a pulk (sled), weighing approximately 120 kg. Five psychometric questionnaires were completed pre post and during the expedition, including the International Personality Item Pool - Neuroticism, Extraversion and Openness-60, Brief Assessment of Mood, Positive and Negative Affective Schedule, Profile of Mood States, Wellness questionnaire, as well as an unstructured open questionnaire. RESULTS: Mood generally deteriorated, particularly positive affective mood. Scores for fatigue and muscle soreness increased, with a reduction in sleep times. Personality traits of openness, agreeableness, and conscientiousness remained stable throughout the expedition, with some reduction in extraversion and an increase in neuroticism. Personal accounts give a unique insight into the increasing demands on the mental and physical impact of the expedition. CONCLUSIONS: Meticulous preparation and planning may have led to a successful expedition, including physical preparation, prior on-field experience, and psychological preparedness and resiliance. Some of these strategies may be applicable to a range of settings, including future Antarctic expeditions, expeditions in extreme environments, or missions within a military context.

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.

Water and sodium intake habits and status of ultra-endurance runners during a multi-stage ultra-marathon conducted in a hot ambient environment: an observational field based study.

BACKGROUND: Anecdotal evidence suggests ultra-runners may not be consuming sufficient water through foods and fluids to maintenance euhydration, and present sub-optimal sodium intakes, throughout multi-stage ultra-marathon (MSUM) competitions in the heat. Subsequently, the aims were primarily to assess water and sodium intake habits of recreational ultra-runners during a five stage 225 km semi self-sufficient MSUM conducted in a hot ambient environment (Tmax range: 32°C to 40°C); simultaneously to monitor serum sodium concentration, and hydration status using multiple hydration assessment techniques. METHODS: Total daily, pre-stage, during running, and post-stage water and sodium ingestion of ultra-endurance runners (UER, n = 74) and control (CON, n = 12) through foods and fluids were recorded on Stages 1 to 4 by trained dietetic researchers using dietary recall interview technique, and analysed through dietary analysis software. Body mass (BM), hydration status, and serum sodium concentration were determined pre- and post-Stages 1 to 5. RESULTS: Water (overall mean (SD): total daily 7.7 (1.5) L/day, during running 732 (183) ml/h) and sodium (total daily 3.9 (1.3) g/day, during running 270 (151) mg/L) ingestion did not differ between stages in UER (p < 0.001 vs. CON). Exercise-induced BM loss was 2.4 (1.2)% (p < 0.001). Pre- to post-stage BM gains were observed in 26% of UER along competition. Pre- and post-stage plasma osmolality remained within normal clinical reference range (280 to 303 mOsmol/kg) in the majority of UER (p > 0.05 vs. CON pre-stage). Asymptomatic hyponatraemia (<135 mmol/L) was evident pre- and post-stage in n = 8 UER, corresponding to 42% of sampled participants. Pre- and post-stage urine colour, urine osmolality and urine/plasma osmolality ratio increased (p < 0.001) as competition progressed in UER, with no change in CON. Plasma volume and extra-cellular water increased (p < 0.001) 22.8% and 9.2%, respectively, from pre-Stage 1 to 5 in UER, with no change in CON. CONCLUSION: Water intake habits of ultra-runners during MSUM conducted in hot ambient conditions appear to be sufficient to maintain baseline euhydration levels. However, fluid over-consumption behaviours were evident along competition, irrespective of running speed and gender. Normonatraemia was observed in the majority of ultra-runners throughout MSUM, despite sodium ingestion under benchmark recommendations.

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.

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.