Sleep, Fatigue, and Recovery Profiles of the Longest Solo Unsupported One-Way Polar Ski Journey Across Antarctica.

PURPOSE: Antarctic expeditions are exceptional physiological challenges. Sleep plays a critical role in athletic performance, recovery, and wellness, with sleep disturbances having a negative impact on health and performance. METHODS: The authors investigated sleep, fatigue, and recovery profiles of the longest solo unsupported one-way polar ski journey across Antarctica. A 33-year-old woman covered 1484.53 km from Hercules Inlet to the South Pole, finishing at the Ross Ice Shelf, in 70 days and 16 hours. Questionnaires on sleep (Pittsburgh Insomnia Rating Scale and Karolinska Sleepiness Scale), fatigue (Subjective Assessment of Fatigue), recovery (Total Quality Recovery), and wellness were completed at different time points (before, during, and after the expedition). RESULTS: Average daily sleep time was between 4 and 5 hours, increasing to 7 hours for the final part of the expedition. Satisfaction of sleep and lack of energy deteriorated as the expedition progressed, alongside signs of clinical insomnia. Fatigue and muscle soreness increased with increasing milage, with extreme levels and very poor recovery toward the end of the expedition. Despite this, the adventurer continued to perform on extremely high levels. Postexpedition scores returned to baseline, demonstrating the incredible adaptation and ability to recovery. The postexpedition interview showed that prior experience of an Antarctic expedition may have prepared the athlete and made her more resilient for this challenge. CONCLUSIONS: The data provide unique insights into Antarctic expeditions and may help us understand the limits of human performance when planning future expeditions of this nature. Female athletes are capable of extreme challenges, breaking established performance boundaries.

Carbohydrate beliefs and practices of ultra-endurance runners in Ireland for gastrointestinal symptom management.

Purpose: This study aimed to investigate the carbohydrate beliefs and practices of ultra-endurance runners in Ireland to gain an understanding of their gastrointestinal symptom (GIS) management strategies. Methodology: An adapted version of a previously developed and validated questionnaire was distributed online to ultra-endurance runners, recognized as those who completed a single bout of exercise lasting 4 or more hours. The questionnaire asked about carbohydrate awareness and sourcing, and dietary practices, particularly in relation to GIS management. Results: A total of n = 68 individuals completed the adapted questionnaire. Of these, n = 1 was excluded due to their reporting of an ulcerative colitis diagnosis. The remaining participants included 46 men and 21 women. Personal previous experience was the main source directing participants' nutrition practices (n = 30), while only 3 participants quoted sourcing information from qualified professionals. Forty-two participants experienced GIS, usually equally around training and competition times. Many participants had not previously implemented any specific dietary or non-dietary strategies to alleviate exercise-induced GIS. Supplementing with nitrates (n = 9) and probiotics (n = 4) were the most common dietary practices to alleviate GIS, while other practices (n = 14) and portion control (n = 13) were the most reported non-dietary practices. Discussion: Similar to previous studies, these findings suggest that GISs are prevalent in the ultra-endurance running community, occurring regardless of whether during training or an event. Similarly, this research highlights the vast range of GISs experienced by this population. However, the absence of both dietary and non-dietary-related practices used for GIS management alludes to a current deficit in the availability of nutrition information specific to this problem. Further research is required to understand the mechanisms behind ultra-endurance-associated GISs and its various management strategies as well as best practices for communicating these to the target audience to reduce individuals' risks of developing long-term, chronic health complications.

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.

Does Ultra-Endurance Passion Make Athletes Happy?

Sport psychology research of ultra-endurance (UE) athletes focused predominantly on their psychological characteristics, traits, and behaviors. However, their happiness and passion, as well as a unified framework for UE hobby phenomenon, were not sufficiently investigated. This study aims to: (1) identify the main contributors to happiness and passion of non-professional UE athletes; and (2) explore the possible relationships between types of sport passion, motivation, and athletic identity. During data collection, 116 non-professional UE athletes (mean age 43.66 years, SD = 8.97, 16.4% female) responded to an online questionnaire. Statistical analyses revealed that obsessive UE passion (p < 0.05) and amotivation (p < 0.05) predicted lower levels of happiness. A higher level of obsessive passion was predicted by extrinsic motivation (p < 0.005), amotivation (p < 0.05), and exclusivity identity (p < 0.001); a lower level was predicted by social identity (p < 0.05) and years in sports (p < 0.05). Weekly training hours and age correlated positively with passion strength, while amotivation was strongly negatively related to training volume. These results indicate that happiness of UE athletes depends on the type of sport passion formed and the quality of the underlying motivation: obsessive passion and amotivation seem to be the main enemies of happiness for UE athletes. This novel finding connecting passion, happiness, and motivation contributes to both a better understanding of the psychology of UE athletes and has practical implications for UE athletes, coaches, athletes' social circles, and sport psychologists. Due to known maladaptive outcomes of obsessive passion, including its negative impact on overall well-being, health, and now also on happiness, its formation in UE athletes needs to be observed and prevented. While the study shows predictors of obsessive passion and high vs. low obsessive passion, future research should investigate how harmonious passion impacts athletes' happiness, motivation, and identity. Likewise, research among the UE entourage would help to better understand the social impact of UE as a serious hobby and the formation of UE lifestyles. We also suggest our Temporal Framework for Progressive UE Engagement and Passion, which was further developed based on the results of this study, to be used and validated by sport psychologists.

Endurance Sporting Events.

Endurance sports encompass a broad range of events from marathons and triathlons to ultramarathons, long-distance cycling, skiing, and swimming. As these events have experienced a surge in popularity, we have a greater need to understand the associated medical risks. This article reviews the history of endurance races, reviews the most critical and common causes of cardiovascular, heat, electrolyte, and musculoskeletal injuries/illnesses, and discusses considerations for medical directors/personnel associated with such events.

Investigating the Effects of Ultraendurance Running on Athletes' Heart Rate and Blood Pressure.

Background While the effects of exercise on the cardiovascular system are well documented, ultra-endurance sports involve distances beyond the scope of traditional marathons and have grown in popularity at a staggering pace in recent years. While short-term high-intensity exercise stimulates sympathetic rises in heart rate (HR) and blood pressure (BP), the depletion of fluid and electrolyte reserves characteristic of ultra-endurance sports may contribute to decreases in overall BP after the race. If decompensation of the autonomic safety net occurs, orthostatic hypotension as a result of fluid loss during an event may cause fatigue, dizziness, syncope, or collapse. Methodology Subjects were recruited by emails sent to race participants and at pre-race meetings, and no participants were excluded from the study. We observed BP and HR changes in subjects before and after ultramarathon activity in both supine and standing positions over multiple races of variant length and terrain from 50 to 240 km from 2013 to 2018. Participants entered races in Florida, with a mean age of 43.8 and an average body mass index (BMI) of 21.2. In addition to pre-race and post-race measurements, positional post-race BPs and HRs were analyzed for orthostatic trends. Results Of those who participated, 140 completed the events and post-race HR and BP measurements were recorded. The mean systolic blood pressure (SBP) increase from pre-race to post-race standing was 21 mmHg, while the mean diastolic blood pressure (DBP) rise was 13 mmHg. While in a supine position, there was a 15 mmHg increase in SBP from pre-race to post-race, along with a 7 mmHg rise in diastolic pressure. Post-race supine to standing average BP change was insignificant. In the supine position, the mean HR increased by 20 beats per minute (bpm) after the race and by 27 bpm while standing. After the race, the average increase in HR supine to standing was 15 bpm. Conclusions The SBP changed much more notably than diastolic pressures likely due to the increase in stroke volume associated with the sympathetic response during exercise. HR values also climbed as a result of exercise stress in the setting of catecholamine release, and the combined influence contributed to increased cardiac output despite water and electrolyte loss during the event. Post-race, no trends of orthostatic hypotension were noted either with HR or BP when rising from a supine position. The significance of the contribution of fluid intake during the race to compensatory mechanisms under neural control requires further study.

Evolutionary Echoes: A Four-Day Fasting and Low-Caloric Intake Study on Autonomic Modulation and Physiological Adaptations in Humans.

This study evaluates the psychophysiological response to a simulated hunter-gatherer endurance task with restricted caloric intake over four days. It assesses changes in body composition, autonomic modulation, and physical and cognitive performance. Participants underwent daily 8 h fasted walks followed by a 150 kcal meal to replicate hunter-gatherer activity and dietary patterns. Measurements of metabolic, respiratory, and subjective well-being, along with heart rate variability (HRV) monitoring, were conducted pre- and post-activity to evaluate the impact of endurance activity under caloric restriction. We found weight loss, decreased body and visceral fat, and reduced skeletal muscle mass and water percentage. High sympathetic activation and stable urinary markers, except for increased proteinuria, indicated stress responses and muscular degradation. Elevated perceived exertion post-exercise with good adaptation to prolonged effort underlines the body's adaptability to ancestral lifestyle conditions, highlighting the connection among endurance, nutrition, and psychophysiological health.

Is There a Role of Beetroot Consumption on the Recovery of Oxidative Status and Muscle Damage in Ultra-Endurance Runners?

(1) Background: Ultra-endurance exercise involves a high physical impact, resulting in muscle damage, inflammatory response and production of free radicals that alter the body's oxidative state. Supplementation with antioxidants, such as beetroot, may improve recovery in ultra-endurance runners. The aim of this study was to determine whether there is a correlation between beetroot intake and recovery of serum oxidative status, inflammatory response and muscle damage parameters after an ultra-endurance race. (2) Methods: An observational and longitudinal study was conducted by means of surveys and blood samples collected from 32 runners during the IX Penyagolosa Trails CSP®® race and the two following days. The variables C-reactive protein (CRP), lactate dehydrogenase (LDH), creatine kinase (CK), the activity of the antioxidant enzymes glutathione peroxidase (GPx) and glutathione reductase (GR) as well as the oxidative damage markers malondialdehyde (MDA), carbonyl groups (CG) and loss of muscle strength using the squat jump (SJ) test were analyzed to discriminate whether beetroot consumption can modulate the recovery of ultra-trail runners. (3) Results: Significant differences were observed between runners who ingested beetroot and those who did not, in terms of oxidative status, specifically in serum GPx activity at 24 and 48 h, muscle damage variables CK and LDH and regarding the SJ test results at the finish line. Therefore, the intake of supplements containing beetroot positively influences the recovery of serum oxidative status and muscle damage after ultra-endurance running.

Exercise-Induced Fluid Retention, Cardiac Volume Overload, and Peripheral Edema in Ultra-Distance Cyclists.

Introduction: Ultracyclists expose themselves to extreme physical challenges. This study aimed to elucidate the effects of ultracycling on electrolyte and fluid balance and investigate the potential occurrence of peripheral edema. Methods: A total of 4 clinical visits were performed before, during, and after a 6-day bicycle ride in 13 ultracyclists (5 female, 8 male) including serial laboratory analyses of blood and urine, bioelectrical impedance, and echocardiography. Throughout the ride, participants continuously tracked fluid intake, measured extremity circumferences daily, and self-tested urinary electrolytes using a point-of-care testing device. Portrait photos were judged by 20 physicians for occurrence of facial and eyelid edema. Results: Participants covered a mean distance of 1205 km and 19,417 vertical meters. From baseline to day 6, body weight remained stable (P = 0.479); however, body composition changed with increasing total body water (TBW) (+1.98 l ± 1.37, P = 0.003) and plasma volume (+18.86 % ± 10.7, P < 0.001). A significant increase in N-terminal pro brain natriuretic peptide (NT-proBNP) (+297.99 ng/l ± 190.42, P < 0.001) until day 6 indicates concomitant cardiac volume overload. Swelling of face and eyelids peaked on day 5 (both P ≤ 0.033). On recovery, changes partly resolved. Although urinary sodium concentration showed a nadir on day 4 (-32.18 mmol/l ± 23.88, P = 0.022), plasma osmolality (+5.69 mmosmol/kg ± 5.88, P = 0.004) and copeptin (+38.28 pg/ml ± 18.90, P < 0.001) increased steadily until day 6. Conclusion: Ultracycling over multiple days induces extracellular volume expansion, peripheral edema, and cardiac volume overload. Renal sodium and water retention is likely contributing to this condition.

Physiological assessment of a 16 day, 4385 km ultra-endurance mountain bike race: A case study.

The Tour Divide (TD) is a 4385 km ultra-endurance bicycle race that follows the continental divide from Canada to Mexico. In this case study, we performed a comprehensive molecular and physiological profile before and after the completion of the TD. Assessments were performed 35 days before the start (Pre-TD) and ∼36 h after the finish (Post-TD). Total energy expenditure was assessed during the first 9 days by doubly labelled water (2 H2 18 O), abdominal and leg tissue volumes via MRI, and graded exercise tests to quantify fitness and substrate preference. Vastus lateralis muscle biopsies were taken to measure mitochondrial function via respirometry, and vascular function was assessed using Doppler ultrasound. The 47-year-old male subject took 16 days 7 h 45 min to complete the route. He rode an average of 16.8 h/day. Neither maximal O2 uptake nor maximal power output changed pre- to post-TD. Measurement of total energy expenditure and dietary recall records suggested maintenance of energy balance, which was supported by the lack of change in body weight. The subject lost both appendicular and trunk fat mass and gained leg lean mass pre- to post-TD. Skeletal muscle mitochondrial and vascular endothelial function decreased pre- to post-TD. Overall, exercise performance was maintained despite reductions in muscle mitochondrial and vascular endothelial function post-TD, suggesting a metabolic reserve in our highly trained athlete.

The Acute Impact of Endurance Exercise on Right Ventricular Structure and Function: A Systematic Review and Meta-analysis.

There have been many studies since the late 1980s investigating the effect of endurance exercise on the left ventricle. More recently, attention has shifted to the right heart, with suggestions that endurance exercise may have a detrimental effect on the right ventricle. This systematic review and meta-analysis summarizes and critiques 26 studies, including 649 athletes, examining the acute impact of endurance exercise on the right ventricle. We also present a subanalysis contrasting ultraendurance with endurance exercise. Finally, we identify areas for future research, such as the influence of sex, ethnicity, and age.

Low Energy Intake Leads to Body Composition and Performance Decrements in a Highly-Trained, Female Athlete: The WANDER (Woman's Activity and Nutrition during an Extensive Hiking Route) Case Study.

OBJECTIVE: This case study's purpose was to quantify energy intake vs energy expenditure during a thru-hiker's trek and assess its relationship to performance and health. METHODS: A highly trained, female thru-hiker (Age (yrs): 62, Ht (cm): 157, Wt (kg): 53.5, BMI (kg/m2): 21.7, %BF: 26.0) embarked on a 4-month journey through the Pacific Crest Trail, USA. The athlete's body composition and 3-day diet record were assessed before (PRE) and after the hike (POST). During the hike, she tracked her diet and performance daily and completed a wellness survey each time she reached a town-check point. Data were analyzed for descriptive (weekly averages, means ± SD) and frequency statistics. RESULTS: She spent 10 wk (∼70 days) on the trail and hiked 1,506.35 km (26.1 ± 3.2 km/day) with an estimated energy expenditure of ∼2334 ± 351 kcal/day. During the hike, she under consumed calories (1285.3 ± 103 kcal) and dietary carbohydrate (169.5 ± 19.5g), fat (49.7 ± 5.8g), protein (41.9 ± 4.8g; 0.8 g/kg), fiber (11.8 ± 2.1g) and sodium (1642.4 ± 298.6 mg) when compared to ultra-endurance nutrition recommendations. She was unable to complete the trail due to fatigue and anthropometric changes. By POST, she had decreased total mass (PRE: 53.5 kg vs POST: 48.4 kg), BMI (PRE 21.6 vs POST: 19.5), fat-free mass (PRE: 39.6 vs POST: 38.8), and body fat (PRE: 26% vs POST: 19.6%) when compared to PRE. CONCLUSION: Trail-related challenges combined with high energy expenditures led to low nutrient intake which contributed to trail-ending injuries and performance decrements. Research aimed at addressing the barriers associated with thru-hike fueling is needed to identify nutritional opportunities to support hikers' performance and reduce injury risks.

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. Blood pressure 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 a standing position, and 1,319 blood pressures were taken supine. Pre-race and post-race measurements were evaluated for clinical significance using established standards of hypotension and 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 mmHg and a DBP decrease of 9±5 mmHg post-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 increase in the mean HR and decline in mean blood pressure across examined studies suggest that during long-term events, ultramarathon athletes perform with relatively asymptomatic hypotension.

Exploring the Nutrition Strategies Employed by Ultra-Endurance Athletes to Alleviate Exercise-Induced Gastrointestinal Symptoms-A Systematic Review.

(1) Background: Participation in ultra-endurance sports, particularly ultra-running, has increased over the previous three decades. These are accompanied by high energetic demands, which may be further exacerbated by extreme environmental conditions. Preparation is long-term, comprising of sufficient exercise management, supportive dietary habits, and nutritional intakes for optimal adaptations. Gastrointestinal symptoms are often cited as causing underperformance and incompletion of events. Though the majority do not pose serious long-term health risks, they may still arise. It has been suggested that the nutritional interventions employed by such athletes prior to, during, and after exercise have the potential to alter symptom incidence, severity, and duration. A summary of such interventions does not yet exist, making it difficult for relevant personnel to develop recommendations that simultaneously improve athletic performance by attenuating gastrointestinal symptoms. The aim of this research is to systematically review the literature investigating the effects of a nutrition intervention on ultra-endurance athletes exercise-induced gastrointestinal symptom incidence, severity, or duration. (2) Methods: A systematic review of the literature was conducted (PubMed, CINAHL, Web of Science, and Sports Discus) in January 2023 to investigate the effects of various nutrition interventions on ultra-endurance athletes' (regardless of irritable bowel syndrome diagnosis) exercise-induced gastrointestinal symptoms. Variations of key words such as "ultra-endurance", "gastrointestinal", and "nutrition" were searched. The risk of bias in each paper was assessed using the ADA quality criteria checklist. (3) Results: Of the seven eligible studies, one was a single field-based case study, while the majority employed a crossover intervention design. A total of n = 105 participants (n = 50 male; n = 55 female) were included in this review. Practicing a diet low in short-chain, poorly absorbed carbohydrates, known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), as well as employing repetitive gut challenges of carbohydrates, remain the most promising of strategies for exercise-induced gastrointestinal symptom management. (4) Conclusion: Avoiding high-FODMAP foods and practicing repetitive gut challenges are promising methods to manage gastrointestinal symptoms. However, sample sizes are often small and lack supportive power calculations.

Comparing the Performance Gap Between Males and Females in the Older Age Groups in IRONMAN® 70.3: An Internet-Based Cross-Sectional Study of More Than 800,000 Race Records.

BACKGROUND: The sex difference in the three split disciplines (swimming, cycling, and running) and overall race times in triathlon races has mainly been investigated for the Olympic distance and IRONMAN® triathlon formats, but not for the half IRONMAN® distance, i.e., the IRONMAN® 70.3. The aim of the present study was to investigate the sex differences in IRONMAN® 70.3 by age group in 5-year intervals for the split disciplines of this race. Data from 823,459 records (625,393 males and 198,066 females) of all age group finishers (in 5-year intervals) competing in all official IRONMAN® 70.3 races held worldwide between 2004 and 2020 were analyzed, and sex differences by age group and split disciplines were evaluated. RESULTS: Males were faster than females in all split disciplines and all age groups. The sex difference was lower in swimming than in cycling and running and less pronounced for triathletes between 20 and 50 years of age. After the age of 60 years, females were able to reduce the sex difference to males in swimming and cycling, but not in running, where the reduction in the sex difference started after the age of 70 years. The lowest sex difference was in the age group 75 + years for swimming and cycling and in the age group 30-34 years for running. Across age groups, the sex difference was U-shaped in swimming and running, with an increase after 18-24 years in swimming and after 40-44 years in running. In contrast, the sex difference decreased continuously with the increasing age for cycling. CONCLUSIONS: In conclusion, the study found that the sex difference in performance decreases with age in the IRONMAN® 70.3 race distance. However, females did not outperform males at older ages. Notably, sex differences were observed across different disciplines, with swimming displaying lower differences compared to cycling and running. These findings underscore the complex interplay between age, sex, and performance in endurance sports, emphasizing the need for additional research to understand the factors influencing these differences.

Psychomotor Performance after 30 h of Sleep Deprivation Combined with Exercise.

Sleep deprivation (SD) usually impairs psychomotor performance, but most experiments are usually focused on sedentary conditions. The purpose of this study was to evaluate the influence of 30 h of complete SD combined with prolonged, moderate exercise (SDE) on human psychomotor performance. Eleven endurance-trained men accustomed to overnight exertion were tested twice: in well-slept and non-fatigued conditions (Control) and immediately after 30 h of SDE. They performed a multiple-choice reaction time test (MCRT) at rest and during each workload of the graded exercise test to volitional exhaustion. At rest, the MCRT was shorter after SDE than in the Control (300 ± 13 ms vs. 339 ± 11 ms, respectively, p < 0.05). During graded exercise, there were no significant differences in MCRT between groups, but the fastest reaction was observed at lower workloads after SDE (158 ± 7 W vs. 187 ± 11 W in Control, p < 0.05). The total number of missed reactions tended to be higher after SDE (8.4 ± 0.7 vs. 6.3 ± 0.8 in Control, p = 0.06). In conclusion, SDE is different from SD alone; however, well-trained men, accustomed to overnight exertion can maintain psychomotor abilities independently of the extent of central fatigue. Exercise can be used to enhance psychomotor performance in sleep-deprived subjects in whom special caution is required in order to avoid overload.

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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Previous studies have used the doubly labeled water method to evaluate the total energy expenditure (TEE) during Ironman, ultramarathon trail runs, and competitive road cycling. However, the technique has not been applied to a 24-hour cross-country mountain-bike event. PURPOSE: 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. METHODS: A trained male cyclist (41 y, 74.1 kg, 172.4 cm) 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. RESULTS: The rider completed 383 km coupled with a vertical gain of 7737 m 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 23.5 MJ, respectively. Total carbohydrate intake was 1192 g with an average hourly intake of 58 (22) g·h-1. Total body weight was 75.3 and 72.3 kg prerace and postrace, respectively, with a measured ad libitum total fluid intake of 13.3 L and a water turnover of 17.2 L. CONCLUSIONS: 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.

Mental Health Disorders in Ultra Endurance Athletes per ICD-11 Classifications: A Review of an Overlooked Community in Sports Psychiatry.

INTRODUCTION: Although research suggests that exercise benefits mental health, psychiatric disorders have been acknowledged in the ultra-endurance-athlete population. At present, the mental-health consequences of high-volume training associated with ultra-endurance sports are not well understood. METHODS: We conducted a narrative review summarizing primary observations about mental disorders per ICD-11 criteria in ultra-endurance athletes using a keyword search in Scopus and PubMed. RESULTS: We identified 25 papers discussing ICD-11-classified psychiatric disorders such as depression, anxiety, eating disorders, attention-deficit/hyperactivity disorder, and schizophrenia in ultra-endurance athletes. DISCUSSION: Although evidence is limited, available papers indicate that there is a sizable incidence of mental-health issues and composite psychopathological vulnerabilities in this community. We contend that ultra-endurance athletes may represent a different, though similar, demographic than elite and/or professional athletes, as they often engage in high-volume training with similarly high motivation. This can have regulatory implications, which we also highlight. CONCLUSION: Mental illness in ultra-endurance athletes is an underrepresented topic in sports medicine, though psychiatric disorders may be especially prevalent in this population. Further inquiry is necessary to inform athletes and healthcare practitioners about the possible mental-health implications associated with participation in ultra-endurance sports.

Personality Traits Associated with the Risk of Exercise Dependence in Ultraendurance Athletes: A Cross-Sectional Study.

Exercise dependence (ED) is common in endurance athletes and can lead to physical and psychological distress with various health effects. We designed a prospective cross-sectional study to investigate the personality traits associated with ED among ultraendurance athletes. A total of 507 participants (41.6 (9.8) years, men: 73.7%) completed (1) a screening questionnaire about sociodemographic data, sporting habits, and healthcare data, (2) the Exercise Dependence Scale-Revised (EDS-R, 21 items scored from 1 (never) to 6 (always), 7 subscales), (3) the Big Five Inventory (BFI), and (4) 2 items of the SCOFF (Sick-Control-One Stone-Fat-Food) questionnaire regarding possible eating disorders. Based on the EDS-R scores, 37 (7.3%) participants were at risk for ED (scores ≥ 5/6 on ≥3 subscales), 366 (72.2%) were nondependent but symptomatic (scores ≥ 3/6 on ≥3 subscales), and 104 (20.5%) were asymptomatic. Participants with ED had a greater training volume and a higher prevalence of possible eating disorders. A higher level of neuroticism was associated with increased EDS-R scores (r = 0.294; p < 0.001), with significantly higher scores in the ED group (F = 14.50, p < 0.001). The association between neuroticism and ED was not moderated by the presence of eating disorders. These findings will help to screen ultraendurance athletes at risk for ED and optimize their care.