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

Cardiovascular Diseases, Vital Organ Fibrosis, and Chronic Inflammation Associated with High-Intensity and/or High-Volume Exercise Training: Double-Edged Sword Effects of Vigorous Physical Activity in Elderly People and/or in Middle-Age Cancer-Therapy-Treated Patients

Cardiotoxicity, cardiovascular diseases (CVDs), hypertension, hepatotoxicity, and respiratory problems occurring several months to several years post-chemotherapy and/or radiotherapy are increasingly documented by scientists and clinicians. Anthracyclines, for example, were discovered in the late 1960s to be dose-dependently linked to induced cardiotoxicity, which frequently resulted in cardiomyopathy and heart failure. Most of those changes have also been associated with aging. While it is well known that exercise can slow down cellular aging processes, lessen the effects of chemotherapy, improve the effectiveness of cancer treatments, and prevent health problems in the general population, it remains unclear how exercise volume or intensity may affect the overall benefits of physical activity on health. For instance, higher rates of sudden cardiac arrest or coronary artery calcification have been found in marathon and ultra-marathon runners. Several additional pathological consequences have also been reported recently on many organs of those athletes. This review reports the most recent evidence suggesting that excessive intensity and/or volume may have deleterious effects on health. These findings are in clear contrast with the popular belief that all forms of physical activity can generally reduce the pathological changes associated with aging or cancer therapies. In conclusion, high-intensity training (HIT) and/or high-volume training (HVT) should not be recommended for middle-age and elderly people who have had cancer therapies or not in order to avoid an exacerbation of the consequences of aging or long-term cancer treatment effects on vital organ structures and functions.

Female performance in skyrunning: biological and psychosocial aspects

BACKGROUND

Skyrunning is a running sport performed in a mountain environment, characterized by reaching an altitude of at least 2000 meters above sea level, where symptoms of acute mountain sickness can appear. This sport has recently gained significant popularity, with an increasing number of participants. The purpose of this study was to analyze female performances in the different subdisciplines of skyrunning.

METHODS

The study considered official results of 173 races of the Italian Skyrunning Federation held in 2021 and 2022. Female and male biological sexes, as well as age and race time of 13,850 participants who crossed the finish line were analyzed.

RESULTS

Female athletes represented 16% of finishers and showed a preference for competitions of medium distances (skyrace and skytrail). They were younger and more self-selected among the most talented in terms of performance compared to males (P<0.001). Males showed significantly faster race times than females in all the competitions (P<0.05). Race times of female winners were on average 123-144% higher than those of male counterparts. In both sexes, winners were predominantly young; female winners were more represented among the older age-groups in skyrace and vertical kilometer (P<0.05).

CONCLUSIONS

Regardless of biological differences affecting female sporting performances, gender inequalities are still widely present despite the progress made in every sport. Since gender equality in sports cannot be separated from gender equality in the sociocultural sphere, it is necessary to invest economically and take proactive measures to achieve real equity, both in the macro-social and sports contexts.

The fastest 24-hour ultramarathoners are from Eastern Europe

Ultramarathon running is of increasing popularity, where the time-limited 24-hour run is one of the most popular events. Although we have a high scientific knowledge about different topics for this specific race format, we do not know where the best 24-hour runners originate from and where the fastest races are held. The purpose of the present study was to investigate the origin of these runners and the fastest race locations. A machine learning model based on the XG Boost algorithm was built to predict running speed based on the athlete´s age, gender, country of origin and the country where the race takes place. Model explainability tools were used to investigate how each independent variable would influence the predicted running speed. A sample of 171,358 race records from 63,514 unique runners from 73 countries participating in 24-hour races held in 57 countries between 1807 and 2022 was analyzed. Most of the athletes originated from the USA, France, Germany, Great Britain, Italy, Japan, Russia, Australia, Austria, and Canada. Tunisian athletes achieved the fastest average running speed, followed by runners from Russia, Latvia, Lithuania, Island, Croatia, Slovenia, and Israel. Regarding the country of the event, the ranking looks quite similar to the participation by the athlete, suggesting a high correlation between the country of origin and the country of the event. The fastest 24-hour races are recorded in Israel, Romania, Korea, the Netherlands, Russia, and Taiwan. On average, men were 0.4 km/h faster than women, and the fastest runners belonged to age groups 35-39, 40-44, and 45-49 years. In summary, the 24-hour race format is spread over the world, and the fastest athletes mainly originate from Eastern Europe, while the fastest races were organized in European and Asian countries.

Does Age Influence Gastrointestinal Status Responses to Exertional-heat Stress?

This meta-data exploration aimed to determine the impact of exertional-heat stress (EHS) on gastrointestinal status of masters age and young adult endurance athletes. Sixteen MASTERS (mean: 44y) and twenty-one YOUNG (26y) recreational endurance athletes completed 2 h of running at 60% ˙V O2max in 35˚C ambient conditions. Blood samples were collected pre-, immediately and 1 h post-EHS, and analyzed for markers of exercise-induced gastrointestinal syndrome (EIGS). Thermo-physiological measures and gastrointestinal symptoms (GIS) were recorded every 10-20 min during EHS. Peak Δ pre- to post-EHS did not substantially differ (p>0.05) between MASTERS and YOUNG for intestinal epithelial injury [I-FABP: 1652pg/ml vs. 1524pg/ml, respectively], bacterial endotoxic translocation [sCD14: -0.09µg/mL vs. 0.84µg/mL, respectively], lipopolysaccharide-binding protein [LBP: 0.26µg/mL vs. 1.76µg/mL, respectively], and systemic inflammatory response profile (SIR-Profile: 92.0arb.unit vs. 154arb.unit, respectively). A significantly higher peak Δ pre- to post-EHS in endogenous endotoxin anti-body IgM (p=0.042), and pro-inflammatory cytokine IL-1β (p=0.038), was observed in YOUNG compared to MASTERS. No difference was observed between incidence (81% and 80%, respectively) and severity (summative accumulation: 21 and 30, respectively) of reported GIS during EHS between MASTERS and YOUNG. Pathophysiology of EIGS in response to EHS does not substantially differ with age progression, since masters and younger adult endurance athletes responded comparably.

Differences in training characteristics of recreational endurance runners by race distance - results from the NURMI Study (Step 2)

Background

Although runner's profiles were previously investigated, information on the training frequency and training distance for short (5 km, 10 km) and long-distance (>21 km) running is absent. The present study aimed to investigate the associations between training routines and exercise habits of recreational endurance runners considering self-reported preferred race distance [10 km, half-marathon (HM), and marathon/ultra-marathon (M/UM)] subgroups.

Methods

This is a cross-sectional study, sampling 154 recreational runners of both sexes. A web survey was used for data collection regarding age, sex, preferred distance (10-km, HM, M/UM), training routines, exercise habits, and periodized training routines. The Chi-square test (Cramer's V) and Kruskal-Wallis test (Eta-Squared η2) with effect sizes were used for comparisons between race distances.

Results

Significant differences were shown for anthropometric, training, and periodization characteristics. Highly significant differences were found between subgroups for the number of sessions, running kilometers, and training hours at all periods and within all four preparation conditions. M/UM runners were training more frequently, for longer durations, and ran greater distances each week.

Conclusion

This finding supports the notion that training habits and periodization characteristics are different for different race distances (10-km, half marathon, marathon, and ultramarathon).

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.

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.

The frequency and performance trends of European countries in the U18 and U20 rankings for 1500 m and 3000 m between 2009-2020

We purpose to determine the nationality of the European middle-distance athletes under 18 years (U18) and under 20 years (U20) during the last decade, to verify the participation trend for each country, and to assess whether the place of competition can be associated with the athletes ranking position. The sample comprised 902 European male runners, ranked among the best finishers from 2009 to 2020. The athletes were divided into two categories (nU18 ​= ​266; and nU20 ​= ​636) of two distances (n1 500 ​m ​= ​397; n3 000 ​m ​= ​505). The Mantel test was used for participation trend and the Chi-square test (χ2) was used to verify differences between the ranking position and the place of competition. For both distances, the highest number of athletes were from Spain (n = 127), followed by Turkey (n = 62) and Great Britain (n = 50). No significant trends were shown for most of the countries, in both distances. A positive trend was shown for Slovenia (i.e., 3000 ​m) over the years. A non-significant association was verified between the countries and the ranking position, as non-significant differences were proved for the place of competition. This information may be useful to guide athlete development programs in each country.

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.

Participation and performance trends in short-, medium, and long-distance duathlon

Participation and performance trends of male and female athletes have been thoroughly analyzed in various endurance sports. Knowing these trends can help coaches and athletes prepare for competitions and may influence their training strategy and career planning. However, duathlon events-consisted of two splits of running (Run1 and Run2) interspersed by a split of cycling (Bike)-have not been thoroughly studied, unlike other endurance sports. The present study aimed to compare participation and performance trends in duathletes who competed in duathlon races hosted by World Triathlon or affiliated National Federations between 1990 and 2021. A total of 25,130 results of age group finishers who competed in run-bike-run duathlon races of varying distances were analyzed with different general linear models. Races were divided into three distances: short-distance (up to 5.5 km run, 21 km bike, 5 km run), medium-distance (5-10 km run, 30-42 km bike, 7-11 km run) and long-distance (at least 14 km run, 60 km bike, 25 km run). On average, women represented 45.6% of all finishers in short-distance, 39.6% in medium-distance and 24.9% in long-distance duathlon races. Throughout the years, men were consistently faster than women in all three race legs (Run 1, Bike, and Run 2) in all three distances across all age groups, and women could not reduce the performance gap. Concerning the age of peak performance, duathletes of the age group 30-34 finished most often in the top three in short- and medium-distance duathlons, whereas male duathletes of the age group 25-29 and female duathletes of the age group 30-34 finished most often in the top three in long-distance duathlons. Women participated less, especially in longer distances, and were constantly slower than men. Duathletes of the age group 30-34 finished most often in the top three. Future studies should analyze participation and performance trends in further subgroups (e.g., elite athletes) and pacing behaviours.

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.

Could Repeated Cardio-Renal Injury Trigger Late Cardiovascular Sequelae in Extreme Endurance Athletes?

Regular exercise confers multifaceted and well-established health benefits. Yet, transient and asymptomatic increases in markers of cardio-renal injury are commonly observed in ultra-endurance athletes during and after competition. This has raised concerns that chronic recurring insults could cause long-term cardiac and/or renal damage. Indeed, extreme endurance exercise (EEE) over decades has sometimes been linked with untoward cardiac effects, but a causal relation with acute injury markers has not yet been established. Here, we summarize the current knowledge on markers of cardiac and/or renal injury in EEE athletes, outline the possible interplay between cardiac and kidney damage, and explore the roles of various factors in the development of potential exercise-related cardiac damage, including underlying diseases, medication, sex, training, competition, regeneration, mitochondrial dysfunction, oxidative stress, and inflammation. In conclusion, despite the undisputed health benefits of regular exercise, we speculate, based on the intimate link between heart and kidney diseases, that in rare cases excessive endurance sport may induce adverse cardio-renal interactions that under specific, hitherto undefined conditions could result in persistent cardiac damage. We highlight future research priorities and provide decision support for athletes and clinical consultants who are seeking safe strategies for participation in EEE training and competition.