Revealing the true nature of a parachute mitral valve during an ultra-trail race.

Pre-participation screening and management of congenital cardiac valvulopathy in competitive athletes can be challenging, particularly within the context of ultra-endurance disciplines. A 55-year-old female athlete without a reported history of cardiac disease exhibited clinical signs of cardiogenic pulmonary edema during a 156 km ultra-trail race. The echocardiographic assessment revealed the presence of a parachute mitral valve, with no evidence of mitral stenosis or regurgitation at rest, but it demonstrated severe dynamic mitral stenosis during exercise. In competitive athletes, the detection of rare valvulopathy should prompt a comprehensive cardiac evaluation aimed at assessing the potential for dynamic valvular dysfunction.

Increased risk of acute kidney injury in the first part of an ultra-trail-Implications for abandonment.

Acute kidneys injuries (AKIs) have been described in marathon and trail running. The currently available data allows assessment of before/after comparisons but does not allow an analysis of what happens during the race. A multidisciplinary assessment protocol was performed during the first trail of Clécy (Normandy France) in November 2021. This allowed an initial assay to be carried out, then at the end of each of the 6 loops of 26 km, and finally after 24 h of recovery. The race extends over 156 km in hilly terrain and 6000 m of elevation gain (D+). The level of impairment according to the RIFLE classification was defined for each runner at each assay. Fifty-five runners were at the start, and the per protocol analysis involved 36 runners (27 men and 9 women, 26 finishers). Fifteen (41.7%) of the riders presented at least one result corresponding to a "RIFLE risk" level. After 24 h of rest, only one runner still had a "RIFLE Risk". The distance around the marathon seems to be the moment of greatest risk. For the first time, we find an association between this renal risk and the probability of abandonment. Many runners are vulnerable to kidney damage during long-duration exercise, which is why it's important to limit risk situations, such as the use of potentially toxic drugs or hydration disorders. The consumption of NSAIDs (nonsteroidal anti-inflammatory drugs) before or during an ultra-distance race should therefore be prohibited. Attention should be paid to hydration disorders.

Glycaemic Effects of a 156-km Ultra-trail Race in Athletes: An Observational Field Study.

BACKGROUND: Ultra-trail running races pose appreciable physiological challenges, particularly for glucose metabolism. Previous studies that yielded divergent results only measured glycaemia at isolated times. OBJECTIVES: We aimed to explore the impact of an ultra-endurance race on continuously measured glycaemia and to understand potential physiological mechanisms, as well as the consequences for performance and behavioural alertness. METHODS: Fifty-five athletes (78% men, 43.7 ± 9.6 years) ran a 156-km ultra-trail race (six 26-km laps, total elevation 6000 m). Participants wore a masked continuous glucose monitoring sensor from the day before the race until 10 days post-race. Blood was taken at rest, during refuelling stops after each lap, and after 24-h recovery. Running intensity (% heart rate reserve), performance (lap times), psychological stress, and behavioural alertness were explored. Linear mixed models and logistic regressions were carried out. RESULTS: No higher risk of hypo- or hyperglycaemia was observed during the exercise phases of the race (i.e. excluding stops for scientific measurements and refuelling) compared with resting values. Laps comprising a greater proportion of time spent at maximal aerobic intensity were nevertheless associated with more time > 180 mg/dL (P = 0.021). A major risk of hyperglycaemia appeared during the 48-h post-race period compared with pre-race (P < 0.05), with 31.9% of the participants spending time with values > 180 mg/dL during recovery versus 5.5% during resting. Changes in circulating insulin, cortisol, and free fatty acids followed profiles comparable with those usually observed during traditional aerobic exercise. However, creatine phosphokinase, and to a lesser extent lactate dehydrogenase, increased exponentially during the race (P < 0.001) and remained high at 24-h post-race (P < 0.001; respectively 43.6 and 1.8 times higher vs. resting). Glycaemic metrics did not influence physical performance or behavioural alertness. CONCLUSION: Ultra-endurance athletes were exposed to hyperglycaemia during the 48-h post-race period, possibly linked to muscle damage and inflammation. Strategies to mitigate muscle damage or subsequent inflammation before or after ultra-trail races could limit recovery hyperglycaemia and hence its related adverse health consequences. TRIAL REGISTRATION NUMBER: NCT05538442 2022-09-21 retrospectively registered.

Power Is More Relevant Than Ascensional Speed to Determine Metabolic Demand at Different Gradient Slopes During Running.

ABSTRACT: Hingrand, C, Olivier, N, Combes, A, Bensaid, S, and Daussin, FN. Power is more relevant than ascensional speed to determine metabolic demand at different gradient slopes during running. J Strength Cond Res 37(11): 2298-2301, 2023-Trail running is characterized by successive uphill and downhill running sessions. To prescribe training intensity, an assessment of maximal running capacity is required. This study compared 2 uphill incremental tests using the same ascensional speed increment to identify the influence of the slope gradient on performance. Ten subjects (8 men and 2 women) performed 3 incremental exercises on various slope (1%: IT01, 10%: IT10, and 25%: IT25), and the ascensional speed increment was similar between IT10 and IT25 (100 m·h-1 every minute). Gas exchanges, heart rate, and power were monitored continuously during the tests. Similar V̇o2max levels were observed in the 3 conditions: 68.7 ± 6.2 for IT01, 70.1 ± 7.3 for IT10, and 67.6 ± 7.0 for IT25. A greater maximal ascensional speed was reached in the IT25 (1760 ± 190 vs. 1,330 ± 106 for IT25 and IT10, respectively, p < 0.01). A significant relationship was observed between relative V̇o2 levels and relative power without any effect of slope. Power should be the parameter used for prescribing training intensity compared with ascensional speed in trail.

Ultrasound assessments of organs and blood vessels before and after 40 days isolation in a cavern (deep time experiment 2021).

Introduction: Spaceflight simulation studies like confinement in small volume habitat with limited physical activity have reported even after 60 days an abnormal arterial wall adaptation with increase thickness or stiffness. The purpose of the current study was to determine the effects on blood vessel and organ structure of 40 days of isolation in a huge habitat with intensive physical activity. Method: Data were collected from 14 individuals (7 male) who isolated in a cavern for 40-days while performing normal daily activities without time references. Ultrasound assessments were performed pre- and post-isolation using a teleoperated system with eight different acoustic windows to obtain 19 measurements on 12 different organ/vascular structures which included the common carotid artery, femoral artery, tibial artery, jugular vein, portal vein, bile duct, kidney, pancreas, abdominal aorta, cervical and lumbar vertebral distance, and Achilles tendon. Results: Common carotid artery measures, including the intima media thickness, stiffness index, and the index of reflectivity measured from the radiofrequency signal, were not changed with isolation. Similarly, no differences were found for femoral artery measurements or measurements of any of the other organs/vessels assessed. There were no sex differences for any of the assessments. Discussion: Results from this study indicate a lack of physiological effects of 40-days of isolation in a cavern, contrary to what observed in previous 60 days confinement. This suggests a potential protective effect of sustained physical activity, or reduced environmental stress inside the huge volume of the confined facility.

Analysis of Factors Associated With Continued Cooling of Core Temperature After Prolonged Cold-Water Swimming.

PURPOSE: To assess the factors associated with continued cooling duration of core temperature (Tcore°) after prolonged outdoor cold-water swimming. METHODS: We designed a cohort study among swimmers participating in an outdoor cold-water swim during qualifying for the English Channel Swim. The day before the event, the participants completed a demographic questionnaire, and body composition was measured using bioelectrical impedance analysis (mBCA 525, Seca). The swimming event consisted of laps over a 1000-m course, for up to 6 hours, in water at 12.5 to 13 °C. Tcore° was measured using an ingestible temperature sensor (e-Celsius, BodyCap) during and up to 1 hour after the swim. RESULTS: A total of 14 participants (38 [11] y; N = 14, n = 11 males, n = 8 in swimming costume and n = 6 in wetsuit) were included. Before swimming, Tcore° was 37.54 (0.39) °C. The participants swam for an average of 194.00 (101.94) minutes, and mean Tcore° when exiting the water was 35.21 (1.30) °C. The duration of continued cooling was 25 (17) minutes with a minimum Tcore° of 34.66 (1.26) °C. Higher body mass index (r = .595, P = .032) and fat mass (r = .655, P = .015) were associated with longer continued cooling, independent of wetsuit wear. Also, the rate of Tcore° drop during swimming (-1.22 [1.27] °C/h) was negatively correlated with the rate of Tcore° gain after swimming (+1.65 [1.23] °C/h, r = -.682, P = .007). CONCLUSION: Increased body mass index and fat mass were associated with Tcore° continued cooling duration after prolonged outdoor cold-water swimming at 12.5 to 13 °C. The rate of Tcore° drop during swimming was negatively correlated with the rate of rewarming.

Study of the Kinetics of the Determinants of Performance During a Mountain Ultramarathon: Multidisciplinary Protocol of the First Trail Scientifique de Clécy 2021.

BACKGROUND: The growing interest of the scientific community in trail running has highlighted the acute effects of practice at the time of these races on isolated aspects of physiological and structural systems; biological, physiological, cognitive, and muscular functions; and the psychological state of athletes. However, no integrative study has been conducted under these conditions with so many participants and monitoring of pre-, per-, and postrace variables for up to 10 days over a distance close to 100 miles. OBJECTIVE: The aim of this study was to evaluate the kinetics of the performance parameters during a 156 km trail run and 6000 m of elevation gain in pre-, per-, and postrace conditions. The general hypothesis is based on significant alterations in the psychological, physiological, mechanical, biological, and cognitive parameters. METHODS: The Trail Scientifique de Clécy took place on November 11, 2021. This prospective experimental study provides a comprehensive exploration of the constraints and adaptations of psychophysiological and sociological variables assessed in real race conditions during a trail running of 156 km on hilly ground and 6000 m of elevation gain (D+). The study protocol allowed for repeatability of study measurements under the same experimental conditions during the race, with the race being divided into 6 identical loops of 26 km and 1000 m D+. Measurements were conducted the day before and the morning of the race, at the end of each lap, after a pit stop, and up to 10 days after the race. A total of 55 participants were included, 43 (78%) men and 12 (22%) women, who were experienced in ultra-trail-running events and with no contraindications to the practice of this sport. RESULTS: The launch of the study was authorized on October 26, 2021, under the trial number 21-0166 after a favorable opinion from the Comité de Protection des Personnes Ouest III (21.09.61/SIRIPH 2G 21.01586.000009). Of the 55 runners enrolled, 41 (75%) completed the race and 14 (25%) dropped out for various reasons, including gastric problems, hypothermia, fatigue, and musculoskeletal injuries. All the measurements for each team were completed in full. The race times (ie, excluding the measurements) ranged from 17.8206 hours for the first runner to 35.9225 hours for the last runner. The average time to complete all measurements for each lap was 64 (SD 3) minutes. CONCLUSIONS: The Trail Scientifique de Clécy, by its protocol, allowed for a multidisciplinary approach to the discipline. This approach will allow for the explanation of the studied parameters in relation to each other and observation of the systems of dependence and independence. The initial results are expected in June 2022. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/38027.