Recommendations on the Appropriate Level of Medical Support at Ultramarathons

Running for Your Life: Metabolic Effects of a 160.9/230 km Non-Stop Ultramarathon Race on Body Composition, Inflammation, Heart Function, and Nutritional Parameters

Moderate endurance exercise leads to an improvement in cardiovascular performance, stress resilience, and blood function. However, the influence of chronic endurance exercise over several hours or days is still largely unclear. We examined the influence of a non-stop 160.9/230 km ultramarathon on body composition, stress/cardiac response, and nutrition parameters. Blood samples were drawn before (pre) and after the race (post) and analyzed for ghrelin, insulin, irisin, glucagon, cortisol, kynurenine, neopterin, and total antioxidant capacity. Additional measurements included heart function by echocardiography, nutrition questionnaires, and body impedance analyses. Of the 28 included ultra-runners (7f/21m), 16 participants dropped out during the race. The remaining 12 finishers (2f/10m) showed depletion of antioxidative capacities and increased inflammation/stress (neopterin/cortisol), while energy metabolism (insulin/glucagon/ghrelin) remained unchanged despite a high negative energy balance. Free fat mass, protein, and mineral content decreased and echocardiography revealed a lower stroke volume, left end diastolic volume, and ejection fraction post race. Optimizing nutrition (high-density protein-rich diet) during the race may attenuate the observed catabolic and inflammatory effects induced by ultramarathon running. As a rapidly growing discipline, new strategies for health prevention and extensive monitoring are needed to optimize the athletes’ performance.

What Is an Extreme Sports Healthcare Provider: An Auto-Ethnographic Study of the Development of an Extreme Sports Medicine Training Program

“I remember when sex was safe and skydiving was dangerous” read a popular bumper sticker during the HIV crisis. Popular perceptions of extreme sport (ES) often include the descriptor ‘dangerous’. Therefore, why is the popularity of ES increasing exponentially with “dedicated TV channels, internet sites, high-rating competitions, and high-profile sponsors drawing more participants”? More importantly, how should health practitioners respond to the influx of ES athletes with novel injuries, enquiries and attitudes. This paper describes the results of a collaborative auto-ethnographic approach to answering “what is an extreme sports medicine health care provider and what are the components of an effective Extreme Sports Medicine (ESM) training program?” The study was conducted following the first ESM university course offered in Australia with the intention of assessing the learning design and reflecting on the development and practice of ES health practitioners. We explicated three overarching themes common to both the ES health practitioner and for the effective training of healthcare providers in the support of ES endeavors and athletes. These themes were individual, task and environmental factors. The impacts of these findings confirm that ESM courses are vital and should be designed specifically to ensure that practitioners are effectively supported to develop the unique skills necessary for practice in real world extreme sports events.

Incidence of exercise-associated hyponatremia during a high-altitude 161-km ultramarathon

[Purpose]

Exercise-associated hyponatremia (EAH) is a well-known condition among endurance athletes at low altitudes. The incidence of EAH during ultramarathons at high altitudes warrants further investigation. This prospective observational study was conducted on the participants of the Leadville Trail 100 run, a 161-km race held at a high altitude (2,800 m-3,840 m).

[Methods]

Venous blood samples were collected before and immediately after the race. The participants completed an electronic survey after the race. Our main outcome measure was the post-race serum sodium ([Na⁺]) level.

[Results]

Of the 672 athletes who started the race, 351 (52%) successfully completed the event within the 30-hour cut-off. Post-race blood samples were collected from 84 runners (66 finishers). Both pre- and post-race blood samples were collected from 37 participants. Twenty percent of the post-race participants had EAH. Only one post-race participant had a [Na⁺] level of <130 mmol/L. All participants with EAH were asymptomatic. One participant had an abnormal pre-race [Na⁺] level (134 mmol/L). Female participants had a significantly higher rate of EAH than male participants (40% vs. 16%; p=0.039). Age, body mass index, weight changes, race completion status, nonsteroidal anti-inflammatory drug use, and urine specific gravity were not associated with the development of EAH. Lower postrace [Na⁺] levels were associated with higher serum creatine kinase values (R²=0.1, p<0.005).

[Conclusion]

High altitude (3,840 m peak) does not appear to enhance the incidence of EAH after an ultramarathon footrace. This suggests that ambient temperature (low temperatures reduce risk), sex (female predilection), endurance running, and overhydration are more prominent risk factors for EAH than high altitude.

An Analysis of Participation and Performance of 2067 100-km Ultra-Marathons Worldwide

This study aimed to analyze the number of successful finishers and the performance of the athletes in 100-km ultra-marathons worldwide. A total of 2067 100-km ultra-marathon races with 369,969 men and 69,668 women competing between 1960 and 2019 were analyzed, including the number of successful finishers, age, sex, and running speed. The results showed a strong increase in the number of running events as well as a strong increase in the number of participants in the 100-km ultra-marathons worldwide. The performance gap disappeared in athletes older than 60 years. Nevertheless, the running speed of athletes over 70 years has improved every decade. In contrast, the performance gap among the top three athletes remains persistent over all decades (F = 83.4, p < 0.001; _pη² = 0.039). The performance gap between the sexes is not significant in the youngest age groups (20–29 years) and the oldest age groups (>90 years) among recreational athletes and among top-three athletes over 70 years. In summary, especially for older athletes, a 100-km ultra-marathon competition shows an increasing number of opponents and a stronger performance challenge. This will certainly be of interest for coaches and athletes in the future, both from a scientific and sporting point of view.