Participation and performance trends in 100-km ultra-marathons worldwide

Analyzing Competitive Demands in Mountain Running Races: A Running Power-Based Approach

PURPOSE

This study aimed to analyze the competitive demands of mountain running races of varying lengths.

METHODS

Sixty-six male athletes competed in Vertical race (∼3 km and ∼1000 m of total elevation change), Sky race (∼25 km and ∼3000 m of total elevation change), and SkyUltra race (∼80 km and ∼9000 m of total elevation change). Exercise intensity and competition load (TL) were assessed using running power, heart rate, and rating of perceived exertion (RPE).

RESULTS

The highest exercise intensity was observed in Vertical race (3.9 [0.4] W·kg-1, 93.6% [2.8%] HRmax, and 9.5 [0.7] RPE) compared to Sky race (3.5 [0.5] W·kg-1, 89.9% [2.4%] HRmax, and 8.5 [1.2] RPE), and SkyUltra (2.7 [0.6] W·kg-1, 73.4% [1.1%] HRmax, and 8.2 [1.1] RPE). Vertical races had the highest mean maximal power outputs for periods <10 minutes. They also had the highest proportion of time spent >5 W·kg-1 and the most time spent above the respiratory compensation threshold. The majority of time in SkyUltra was spent at low intensity. The highest TLs were observed in these races (6200.5 [708.0] kJ, 842.0 [35.7] AU for TLHR, and 4897.3 [940.7] AU for TLRPE). However, when normalized to competition time, the SkyUltra event showed the lowest values compared with the Vertical and Sky races (∼11 vs ∼14.5 kJ·min-1, ∼1.5 vs ∼2.5 AU·m-1 for TLHR).

CONCLUSION

The results of this study expand knowledge about the effort demands of mountain races and demonstrate how these demands are affected by race duration. Additionally, the study highlights the potential use of running power for quantifying exercise in this sport.

Bone Stress Injury Epidemiology and Risk Factors in Female Off-Road Runners: A Systematic Review

BACKGROUND

Off-road running is a growing sport with little research investigating injury profiles of female participants. Bone stress injuries (BSIs) are a particularly detrimental injury with little known about their incidence and risk factors in female off-road runners.

OBJECTIVE

Collate and review the available evidence reporting epidemiological data and risk factors associated with BSI in female off-road runners.

DESIGN

Systematic literature review, without meta-analyses.

DATA SOURCES

MEDLINE OVID, PubMed, SPORTDiscus, and MEDLINE EBSCO. Searches were finalized in July 2024.

ELIGIBILITY CRITERIA

Studies that reported injury surveillance statistics and/or risk factors associated with BSIs in female off-road runners.

RESULTS

Seventeen eligible studies were included, of which all reported surveillance statistics and 2 reported risk factors associated with BSI among 897 female runners. Owing to the scarcity of data, cross-country runners were included in the population of off-road runners. Most BSIs were high severity and in the lower leg, with an overall incidence ranging from 0 to 34.39 BSIs per 100,000 athlete-exposures and prevalence ranging from 0% to 40.9%. Study characteristics were reported alongside risk of bias, quality, and level of evidence assessment outcomes from varying tools. Eight significant intrinsic risk factors were associated with BSIs in female off-road runners: increasing age, disrupted menstruation, previous BSI, increased female triad risk, and lower calcium, vitamin D, and calorie intake.

DISCUSSION

Limited by the number of studies available reporting data on the specific target population, which highlights the need for performing high-quality prospective studies in the future, this review summarizes the current epidemiological data and risk factors associated with BSIs in female off-road runners.

Effect of Two Hydration Strategies on CapillarySodium Concentrations in Runners Participating in 170-km Trail Race: The 2015 UltraTrail du Mont-Blanc Experience

OBJECTIVE

This study assessed the impact of 2 hydration strategies on capillary sodium concentrations during Ultra-Trail du Mont-Blanc (UTMB) 2015.

DESIGN

Prospective exposed/nonexposed cohort study.

SETTING

Ultra-Trail du Mont Blanc 2015 (170 km).

PARTICIPANTS

Thousand five hundred sixty-three registered runners of UTMB 2015 asked to predefine their hydration strategy as either "drinking to thirst" or any other mode ("not drinking to thirst").

INTERVENTION

One hundred "drinking to thirst" participants were randomly selected and paired (sex and age) with 96 "not drinking to thirst" participants. Participant weight and capillary sodium concentrations were measured before and after the race.

MAIN OUTCOME MEASURES

Variations of capillary sodium concentrations and weight during the trail according to predefine hydration strategy as either "drinking to thirst" or "not drinking to thirst." Adverse events were recorded. P < 0.05 was considered statistically significant.

RESULTS

Among 196 participants, 88 (62 finishers) "drinking to thirst" and 87 (64 finishers) "nondrinking to thirst" participants were analyzed, respectively. There was no difference in the change in capillary sodium concentrations prerace to postrace between the groups (1.5 ± 4.4 vs 1.5 ± 4.7 mEq/L, P = 0.98). The change in participant weight was also not different (P = 0.3877). Hypernatremia or hyponatremia were reported in 19 of 88 (21.6%) and 24 of 87 (27.6%) in "drinking to thirst" and "non-drinking to thirst" participants, respectively (P = 0.20). The incidence of adverse events was not different between the groups.

CONCLUSION

This study observed no impact of hydration strategy on the change in capillary sodium concentrations before and after UTMB 2015.

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.

Influence of changes in foot morphology and temperature on bruised toenail injury risk during running

Despite runners frequently suffering from dermatologic issues during long distance running, there is no compelling evidence quantitatively investigating their underlying injury mechanism. This study aimed to determine the foot morphology and temperature changes during long distance running and reveal the effect of these alterations on the injury risk of bruised toenail by measuring the subjective-perceived hallux comfort and gap length between the hallux and toebox of the shoe. Ten recreational runners participated in the experimental tests before (baseline), immediately after 5 and 10 km of treadmill running (12 km/h), in which the foot morphology was measured by a 3D foot scanner, the foot temperature was detected by an infrared camera, the perceived comfort was recorded by a visual analogue scale, and the gap length in the sagittal plane was captured by a high-speed camera. Ball width became narrower (106.39 ± 6.55 mm) and arch height (12.20 ± 2.34 mm) was reduced greatly after the 10 km run (p < 0.05). Foot temperature increased significantly after 5 and 10 km of running, and the temperature of dorsal hallux (35.12 ± 1.46 °C), dorsal metatarsal (35.92 ± 1.59 °C), and medial plantar metatarsal (37.26 ± 1.34 °C) regions continued to increase greatly from 5 to 10 km of running (p < 0.05). Regarding hallux comfort, the perceived scores significantly reduced after 5 and 10 km of running (2.10 ± 0.99, p < 0.05). In addition, during one running gait cycle, there was a significant increase in gap length at initial contact (39.56 ± 6.45 mm, p < 0.05) for a 10 km run, followed by a notable decrease upon reaching midstance (29.28 ± 6.81 mm, p < 0.05). It is concluded that the reduced ball width and arch height while increased foot temperature during long-distance running would exacerbate foot-shoe interaction, potentially responsible for bruised toenail injuries.

Environmental Preferences and Concerns of Recreational Trail Runners

Trail running is a fast-growing sport, linked to improvements in both physical and psychological well-being. Despite its popularity, the preferences of trail runners are not well known. The objective of this study was to examine the environmental preferences and concerns of trail runners with respect to age and gender. We conducted a cross-sectional survey of recreational trail runners. A total of 548 people responded, of which 50.1% of respondents were women and 44.2% were men. The sample was distributed relatively evenly across age groups, up to 54 years; respondents over 55 represented only 9.4% of the sample. Comparisons of runner characteristics by gender indicated significant differences (p < 0.05) according to age, distance run per week, and number of days run per week. Certain runner preferences also differed significantly by gender, including importance of running around others, the type of trail races they seek, and whether or not they like to seek "vert" or elevation in their runs. Major concerns for both genders while running included lack of cell reception (Men: 33.8%; Women: 50.8%) and getting lost (Men: 26.8%; Women: 35.5%). Comparisons of the results of this study help to strengthen our understanding of trail runners' environmental preferences and concerns and can be used to guide future design and maintenance of trail environments to encourage greater participation in the sport.

Limits of Ultra: Towards an Interdisciplinary Understanding of Ultra-Endurance Running Performance

Ultra-endurance running (UER) poses extreme mental and physical challenges that present many barriers to completion, let alone performance. Despite these challenges, participation in UER events continues to increase. With the relative paucity of research into UER training and racing compared with traditional endurance running distance (e.g., marathon), it follows that there are sizable improvements still to be made in UER if the limitations of the sport are sufficiently understood. The purpose of this review is to summarise our current understanding of the major limitations in UER. We begin with an evolutionary perspective that provides the critical background for understanding how our capacities, abilities and limitations have come to be. Although we show that humans display evolutionary adaptations that may bestow an advantage for covering large distances on a daily basis, these often far exceed the levels of our ancestors, which exposes relative limitations. From that framework, we explore the physiological and psychological systems required for running UER events. In each system, the factors that limit performance are highlighted and some guidance for practitioners and future research are shared. Examined systems include thermoregulation, oxygen delivery and utilisation, running economy and biomechanics, fatigue, the digestive system, nutritional and psychological strategies. We show that minimising the cost of running, damage to lower limb tissue and muscle fatigability may become crucial in UER events. Maintaining a sustainable core body temperature is critical to performance, and an even pacing strategy, strategic heat acclimation and individually calculated hydration all contribute to sustained performance. Gastrointestinal issues affect almost every UER participant and can be due to a variety of factors. We present nutritional strategies for different event lengths and types, such as personalised and evidence-based approaches for varying types of carbohydrate, protein and fat intake in fluid or solid form, and how to avoid flavour fatigue. Psychology plays a vital role in UER performance, and we highlight the need to be able to cope with complex situations, and that specific long and short-term goal setting improves performance. Fatigue in UER is multi-factorial, both physical and mental, and the perceived effort or level of fatigue have a major impact on the ability to continue at a given pace. Understanding the complex interplay of these limitations will help prepare UER competitors for the different scenarios they are likely to face. Therefore, this review takes an interdisciplinary approach to synthesising and illuminating limitations in UER performance to assist practitioners and scientists in making informed decisions in practice and applicable research.

Pacing Variation in Multistage Ultramarathons: Internet-Based Cross-Sectional Study

BACKGROUND

Ultramarathon running is the most popular ultraendurance competition in terms of the number of races and runners competing annually worldwide; however, no study has compared pacing and performance over a long period.

OBJECTIVE

This study analyzes the pacing of successful finishers and nonfinishers in multistage ultramarathons worldwide.

METHODS

A total of 4079 athletes (men=3288; women=791) competing in 99 multistage ultramarathon events from 1983 to 2021 were analyzed, including the number of participants, age, gender, rank, and running speed of successful finishers.

RESULTS

The results showed a significant increase in the number of events (n=338) and a significant increase in the number of finishers and nonfinishers (n=5575) in the ultramarathons worldwide during this period. The general linear models (GLMs) of pacing variation showed nonsignificant effects for gender (F1,36.2=2.5; P=.127; ηp2=0.063) and age group (F10,10=0.6; P=.798; ηp2=0.367), but it showed a significant interaction (gender × age) effect (F10,2689=2.3; P=.008; ηp2=0.009). Post hoc analyses showed that men have a higher pacing variation than women in the under 30 years (U30), U35, U45, and U50 groups. Additionally, the fastest women's age group (U35) had the lowest pacing variation. The GLM of pacing variation by gender and event distance showed significant effects for both gender (F1,3=18.5; P<.001; ηp2=0.007) and distance (F2,3=20.1; P<.001; ηp2=0.015). Post hoc analyses showed a growing pacing variation with increasing race distance for both men and women. In addition, men had a higher variation in long events. Furthermore, there was a significant main effect for both genders (F1,3=33.7; P<.001; ηp2=0.012) and rank (F1,3=136.6; P<.001; ηp2=0.048) on performance, with men being faster than women. Pacing varied greatly due to gender (F1,3=4.0; P=.047; ηp2=0.001), with a lower (ie, more even) pacing variation for male athletes in the top 3 finishers. Male nonfinishers showed a higher performance than female nonfinishers (F1,1340=25.6; P<.001), and no difference was identified for pacing variation (F1,789=1.5; P=.228) based on gender. In addition, a weak but significant correlation (r=-0.130; P<.001) was identified between the average running speed and pacing variation for both female and male nonfinishers.

CONCLUSIONS

In summary, multistage ultramarathon competitions showed an increasing number of competitors and a higher performance challenge. Men have a higher pacing (ie, less even) variation than women, especially observed in longer events. A higher pacing variation was associated with lower performance for men, women, and nonfinishers.

Modelling performance by continents in swimming

Introduction: There is a growing interest in the scientific community about the progression and congruity in the performance of talented participants who complete representing different nations in the most important international events. The prediction of incoming performances is nowadays in demand with the objective of returning in talent investment. Talent identification programs have tried to select and develop sports talent over years. However, to our knowledge, there is a lack of research about success in swimming World Championships (WCs) performance considering continents-country and how successful outcomes are influenced by these variables. Therefore, the primary goal is to analyze the effect of early specialization comparing the performance progression model of the countries gathered by continents. Methods: Participant's data from all Junior and Senior WCs between 2006 and 2017 from International Swimming Federation (FINA). One-way ANOVA, ANCOVA and regression model were used to explain whether the variable category, age, best z-score, experience, and continent influences the performance obtained in Absolute WC. Results: Significant differences (p < 0.01) were found between the average performance obtained by the two different categories (junior: swimmers participating in junior WCs before senior WCs; senior: swimmers participating in senior WCs without previous participation in junior WCs), where swimmers from category junior showed significant better performance's times than seniors, except in America. ANCOVA results showed that generally, the greatest differences where in the earliest ages, with best performance registered in category junior in all the continents. Also, the experience was a significant variable in the general model. Conclusion: Swimmers who had participated in junior category prior absolute obtained better performance's times than those swimmers who participated directly in absolute, in the first participation in senior WC. Thus, early specialization is a key factor to obtain better results in senior WCs for all the continents, except in America.

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.

Assessment of a Treadmill Speed Incline Conversion Chart: A Validation Study

PURPOSE

To investigate the validity of a treadmill speed incline conversion chart using physiological and subjective measures.

METHODS

Two groups of experienced runners (SLOW and FAST: divided based on their easy run pace) ran 6 speed incline combinations for 5 minutes each. Stages were equivalent according to the HillRunner.com chart, and stage order was randomized. Due to limitations of the chart, SLOW (n = 11) ran at inclines up to 4%, while FAST (n = 22) ran at inclines up 10%. Oxygen consumption (VO2), respiratory exchange ratio, heart rate, blood lactate, overall rating of perceived exertion (RPE), and leg RPE were measured for each stage. VO2 was compared against the VO2 predicted by the American College of Sports Medicine (ACSM) equation (ACSM VO2). Repeated-measures analysis of variance was used to detect differences between stages and inclines, and Hedges g was used as a measure of effect size.

RESULTS

Pooled results (0%-4%, N = 33) showed no incline effect on VO2, respiratory exchange ratio, heart rate, blood lactate, or RPE (P > .05; ηp2=.198), validating the chart at these inclines. At or above 6%, meaningful and significant increases occur in VO2 (g > 0.9, P < .05), with increases in heart rate, blood lactate, and leg RPE at higher inclines. ACSM VO2 underestimated oxygen consumption at all inclines up to 8% (P < .05) but not at 10% (45.9 [4.0] vs 46.7 [2.4] mL·kg-1·min-1; P = .186).

CONCLUSION

The HillRunner.com chart is only valid at or below 4%. At higher inclines, supposedly equivalent stages result in increased exercise intensity. ACSM VO2 underestimates VO2 in trained runners at inclines up to 8%.

Prevalence of Female and Male Athlete Triad Risk Factors in Ultramarathon Runners

OBJECTIVE

To identify the prevalence of male and female athlete triad risk factors in ultramarathon runners and explore associations between sex hormones and bone mineral density (BMD).

DESIGN

Multiyear cross-sectional study.

SETTING

One hundred-mile ultramarathon.

PARTICIPANTS

Competing runners were recruited in 2018 and 2019.

ASSESSMENT OF RISK FACTORS

Participants completed a survey assessing eating behaviors, menstrual history, and injury history; dual-energy x-ray absorptiometry for BMD; and laboratory evaluation of sex hormones, vitamin D, and ferritin (2019 cohort only).

MAIN OUTCOME MEASURE

A Triad Cumulative Risk Assessment Score was calculated for each participant.

RESULTS

One hundred twenty-three runners participated (83 males and 40 females, mean age 46.2 and 41.8 years, respectively). 44.5% of men and 62.5% of women had elevated risk for disordered eating. 37.5% of women reported a history of bone stress injury (BSI) and 16.7% had BMD Z scores <-1.0. 20.5% of men had a history of BSI and 30.1% had Z-scores <-1.0. Low body mass index (BMI) (<18.5 kg/m 2 ) was seen in 15% of women and no men. The Triad Cumulative Risk Assessment classified 61.1% of women and 29.2% of men as moderate risk and 5.6% of both men and women as high risk.

CONCLUSIONS

Our study is the first to measure BMD in both male and female ultramarathon runners. Our male population had a higher prevalence of low BMD than the general population; females were more likely to report history of BSI. Risk of disordered eating was elevated among our participants but was not associated with either low BMD or low BMI.

Guinness World Record: Personal Experience and Physiological Responses of a Non-Professional Athlete Successfully Covering 620 Km in 7-Days by Foot Across the United Arab Emirates

Ultra-endurance record-breaking attempts place significant metabolic, cardiovascular, and mechanical stress on the athlete. This research explores the personal experience and physiological responses of a non-professional athlete attempting the Guinness World Record of covering 620 km on foot across the United Arab Emirates in 7-days or less. The participant wore a smartwatch throughout the challenge to collect heart rate, activity, and environmental temperature data. Anthropometric, body composition, and inflammatory, haematological, and endocrine biomarkers measurements were completed pre- and post-event. A pre- and post-event interview was conducted to collect data on training and preparation, and self-reported experiences during the challenge. Despite episodes of diarrhoea, vomiting, and muscle cramps due to hypohydration during the first days of the challenge, the participant successfully completed 619.01 km in six days, 21 hours, and 47 minutes (average pace 10.11 min/km) achieving a new Guinness World Record. Body mass remained unchanged, fat mass decreased, and fat-free mass especially in the legs increased over the seven days, most likely due to water retention. Biomarkers of stress, cell damage, and inflammation increased. Haematological markers related to red blood cells decreased probably due to exercise-induced increases in plasma volume with the participant classified with mild anaemia post-event. This case study reinforces the importance of amateur athletes attempting similar ultra-endurance events adhering to a pre-planned hydration and nutrition strategy to maximise performance and minimise the risk of injury.

Relationship between Exercise Intensity and IL-6 Increase during an 80 km Long-Distance Running Race

Background: IL-6 plasma concentration (IL-6PC) reflects the systemic inflammation related to exercise intensity level. This study aims to describe the IL-6PC kinetics during a long-distance running race. IL-6PC was measured in 20 male runners before (0 km), at each refreshment point (at 21 and 53 km, i.e., k₂₁ and k₅₃, respectively) and at the end of an 80 km long-distance run (k₈₀). Methods: IL-6PC variations (absolute and relative values in each of the three sections (S)) were calculated over S1 (0_k₂₁), S2 (k₂₁_k₅₃) and S3 (k₅₃_k₈₀) and compared with the exercise intensity (duration*race speed) within each section. Results: The mean IL-6PC increased during the run: 2.1 ± 0.6 ng.L⁻¹ at 0 km, 21.0 ± 11.3 ng.L⁻¹ at k₂₁, 38.9 ± 13.0 ng.L⁻¹ at k₅₃ and 49.8 ± 11.9 ng.L⁻¹ at k₈₀. Exercise intensity increased between S1 (24.2 ± 0.5) and S2 (51.9 ± 3.2) (p = 0.04) but not between S2 and S3 (67.4 ± 4.5) (p = 0.69). IL-6PC variation was associated with exercise intensity within S1 (p = 0.03) and S2 (p = 2 × 10⁻³) and showed at least a trend within S3 (p = 0.06). Conclusions: IL-6PC increases that occur during the early stages of a long-distance run are associated with the running intensity, and then IL-6PC remain stable after the reduction in intensity related to the decrease in running speed.

Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review

Background and objectives: Ultra-trail races can cause episodes of acute kidney injury (AKI) and exercise-associated hyponatremia (EAH) in healthy subjects without previous renal pathology. This systematic review aims to review the incidence of these two syndromes together and separately taking into account the length and elevation of the ultra-trail race examined. Materials and Methods: A systematic review was conducted through electronic search in four electronic databases (PubMed, EBSCO, Web of Science and Alcorze). Results: A total of 1127 articles published between January 2006 and December 31, 2021 were included, 28 of which met the inclusion criteria. The studies were categorized according to the length and stages of the race in four categories: medium (42 to 69 km), long (70 to 99 km), extra (>100 km) and multi-stage if they included various stages. A total of 2950 runners (666 females and 2284 males) were extracted from 28 publications. The AKI incidence found was 42.04% (468 cases of 1113), and 195 of 2065 were diagnosed with EAH, accounting for 9.11%. The concurrence of both pathologies together reached 11.84% (27 individuals) from a total of 228 runners with AKI and EAH simultaneously analyzed. Sorted by race category, the AKI+EAH cases were distributed as follows: 18 of 27 in the extra (13.63% and n = 132), 4 in the large (5.79% and n = 69) and 5 in the medium category (18.15% and n = 27). Conclusions: According to these results, extra and medium races showed a similar incidence of AKI+EAH. These findings underline the importance of the duration and intensity of the race and may make them responsible for the etiology of these medical conditions. Due to their variable incidence, EAH and AKI are often underdiagnosed, leading to poorer prognosis, increased condition seriousness and hindered treatment. The results of this review urge participants, coaches and race organizers to take measures to improve the early diagnosis and urgent treatment of possible EAH and AKI cases.

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.

Acute effects of long-distance races on heart rate variability and arterial stiffness: A systematic review and meta-analysis

This study systematically reviewed and quantified the effects of running a long-distance race (LDR) on heart rate variability (HRV) and arterial stiffness (AS). All types of races of a distance equal to or greater than a marathon (≥42.2 km) were included. A total of 2,220 articles were identified, 52 were included in the qualitative analysis, and 48 were meta-analysed. The standardised mean difference pre- and post-race of various time-domain and frequency-domain indices of HRV, mean arterial blood pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP) and carotid-femoral pulse wave velocity (cfPWV) was calculated. Regarding HRV, there was a significant decrease in most of the variables considered as markers of parasympathetic activity, indicating a shift of autonomic balance towards a reduced vagal tone. Regarding vascular variables, there was a significant drop in blood pressure and reduced AS. In conclusion, running an LDR seems to have a considerable acute effect on the autonomic nervous system, haemodynamics, and vascular properties. The observed effects could be categorised within the expected acute responses to long-lasting, strenuous exercise.

Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review

It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.

3.0 T MRI findings of 104 hips of asymptomatic adults: from non-runners to ultra-distance runners

Objectives

To determine and compare the health status of hip joints of individuals undertaking various lengths of long-distance running and of those who are not running.

Methods

Fifty-two asymptomatic volunteers underwent bilateral hip 3.0 Tesla MRI: (1) 8 inactive non-runners; (2) 28 moderately active runners (average half a marathon (21 km)/week) and (3) 16 highly active runners (≥ marathon (42 km)/week). Two musculoskeletal radiologists reported the hip MRI findings using validated scoring systems. Study participants completed a Hip disability and Osteoarthritis Outcome Score (HOOS) questionnaire to indicate their perceived hip function.

Results

The MRI findings show that there were no significant differences among inactive non-runners, moderately active runners and highly active runners in the amount of labral abnormalities (p=0.327), articular cartilage lesions (p=0.270), tendon abnormalities (p=0.141), ligament abnormalities (p=0.519). Bone marrow oedema was significantly more common in moderately active runners than in non-runners and highly active runners (p=0.025), while small subchondral cysts were more common in runners than in non-runners (p=0.017), but these were minor/of small size, asymptomatic and did not indicate specific exercise-related strain. Articular cartilage lesions and bone marrow oedema were not found in highly active runners. HOOS scores indicate no hip symptoms or functional problems among the three groups.

Conclusion

The imaging findings were not significantly different among inactive non-runners, moderately active runners and highly active runners, in most hip structures, suggesting that long-distance running may not add further damage to the hip joints.

Frequency of Injury and Illness in the Final 4 Weeks before a Trail Running Competition

We aimed to (i) determine self-reported injury and illness frequency in trail runners 4 weeks preceding competition; (ii) compare athletes with and without injury/illness by sex, age, body mass index (BMI) and competition distance; (iii) describe mechanism of injury, anatomical region (injury)/organ system (illness) involved, consequences of injury on preparation and self-perception of injury severity; (iv) compare anatomical region (injury) and organ system (illness) by sex. A total of 654 trail runners (age 36.2, IQR 30.6-43.0; 36.9% females) participated in this retrospective cross-sectional study by completing a self-reported questionnaire. Injury and illness frequency rates were 31.3% (n = 205, CI: 27.7-35.0%) and 22.3% (n = 146, CI: 19.1-25.7%), respectively. No significant difference was found between injured vs. non-injured or ill vs. non-ill study participants by sex, age, BMI and competition distance. Regarding injuries, gradual onset (41.6%) and knee (33.2%) were the most indicated mechanism and anatomical region of injury. At least 85.4% of trail runners changed their training following injury and 79% indicated that their injury would affect their competition performance. Regarding illness, the respiratory tract was the most frequent organ system involved (82.9%). Male and female participants reported similar proportions of anatomical regions (injury) and organ systems (illness) affected. These results could help to generate education strategies and appropriate medical support before and during these competitions.

No Trends in the Age of Peak Performance among the Best Half-Marathoners and Marathoners in the World between 1997-2020

Background and Objectives: We examined the possible trend in the age of peak performance in elite endurance athletes according to sex, continent of athletes’ national citizenship, and ranking position. Since performance is a multifactorial trait, this information can be used to guide the long-term training and to plan the strategies related to the selection process of athletes. Materials and methods: Information of 1852 professional athletes, classified as top 20 performance of each year in marathon and half-marathon events between 1997 and 2020 were considered. Analysis of variance was computed to test differences in age between sex, continent, and rank position. Results: A significant difference between groups in the mean age of peak performance was observed (F (3, 1884) = 42,31; p < 0.001). For both sexes, half-marathoners were younger than marathoners (male, 25.6 ± 3.6 years vs. 28.0 ± 3.9 years; female, 27.5 ± 4.4 years vs. 28.4 ± 4.1). Female half-marathoners in 2004 presented the highest mean age (31.1 ± 4.8 years) compared to their peers in the years 1997, 2001, 2018 and 2019; among male half-marathoners, those in 1999 presented the highest mean age when compared to 2011, 2018, and 2019. Differences between the continents of athletes’ national citizenship were observed (F (4, 1884) = 62,85,601; p < 0,001). Asian runners presented the lowest mean age (26.5 ± 3.7 years), while their European peers presented the highest (31.1 ± 3.9 years). No significant interaction between sex and ranking position was verified. Differences were observed between sexes for categories “4th–10th positions” and “11th–20th” (F (1, 1879) = 23,114; p < 0.001). Conclusions: Over the last two decades, no clear trend was observed in the changes in the age of peak performance among endurance athletes of both sexes, but, in general, female half-marathoners tended to be significantly older than their male peers.

Musculoskeletal Injuries in Ultra-Endurance Running: A Scoping Review

Ultra-endurance running (UER) has seen an important increase in participation over the last few decades. Long hours of UER can lead to excessive stress on the body, resulting in musculoskeletal injuries (MSKI). UER is not a uniform sport and events can differ considerably in distance (over 42.195 km), time (e.g., events over 6 h) and multi-day or multi-stage events on various surfaces (e.g., track, on-road, off-road). The aims of this scoping review were therefore: (1) to examine the current evidence of MSKI, providing a synthesis of the most common MSKI by anatomical region and specific diagnosis; (2) categorize MSKI by type of UER activity (competition: time-limited; multi-stage; continuous UER events and training); (3) describe knowledge gaps in the literature and provide advice on potential further research. Our electronic literature search (PubMed, SPORTDiscus, Web of Science) identified a total of 13 studies (9 in competition, and 4 in training). Anatomical site, diagnosis and rate of injuries differ between competition and training as well as between different UER types. MSKI are observed in 18% of multi-stage events (0.7-1.8 injuries/runner and 7.2 injuries/1000 h). Most MSKI involve the lower leg (35.0%), ankle (16.8%), knee (13.1%) and foot (12.6%), with main diagnosis of medial tibial stress syndrome (30.1%) and patella femoral pain syndrome (PFPS; 7.2%). Single, continuous UER events differ between a 1005 km road race with almost all of the injuries due to overuse, with the main anatomical site of the knee (31%), ankle (28%) and lower leg (14%) and main diagnosis of PFPS (15.6%), compared to a 65 km trail race, with 32.8% of MSKI, mainly on the foot [plantar fasciitis (28.6%)], ankle [sprain (28.6%)] and knee. Timed-UER events (injury rate of 2.1 injuries/athlete) observed most injuries on the ankle (36%) and knee (19%), with the main diagnosis of tendinitis of the foot dorsiflexors (30%). Injuries during training most commonly affect, the back (42%), and knee (40%) and bone stress injuries (22%). Main diagnoses include ankle sprain (18%), iliotibial band injury (16%) and Achilles tendinopathy (11%). Future considerations include examining MSKI in different UER events, environments and surfaces, and on larger study populations. Establishing risk factors, examining sex differences and using a standard reporting system of MSKI in UER are also important.

Recommendations on Youth Participation in Ultra-Endurance Running Events: A Consensus Statement

Participation in ultra-endurance running (UER) events continues to grow across ages, including youth athletes. The 50- and 100-km are the most popular distances among youth athletes. Most youth athletes are between 16-18 years; however, some runners younger than 12 years have successfully completed UER events. Parents, athletes, coaches, race directors, and medical professionals often seek advice regarding the safety of youth athletes participating in these events, especially with regard to potential short and long-term health consequences. UER may impact key organ systems during growth and development. We propose a decision-making process, based on current knowledge and the experience of the consensus group that addresses age regulations, medical and psychological well-being, training status and race-specific factors (such as distance, elevation change, remoteness, ambient temperatures, level of medical assistance, and type of provisions provided by the race organizers) to use until evidence of long-term consequences of UER in youth athletes is available. These recommendations are aimed at safe participation in UER events for youth athletes with a proper and individualized assessment.

Vascular Function Is Differentially Altered by Distance after Prolonged Running

PURPOSE

Ultraendurance exercise is steadily growing in popularity; however, the effect of increasingly prolonged durations of exercise on the vascular endothelium is unknown. The aim of this study was to characterize the effect of various ultramarathon running distances on vascular form and function.

METHODS

We evaluated vascular endothelial function via flow-mediated dilation (FMD) in the superficial femoral artery, as well as microvascular function, inflammatory factors, and central artery stiffness, before and after participants completed 25-km (7M:2F), 50-km (11M:10F), 80-km (9M:4F), or 160-km (9M:2F) trail races all run on the same day and course.

RESULTS

Completion required 149 ± 20, 386 ± 111, 704 ± 130, and 1470 ± 235 min, with corresponding average paces of 6.0 ± 0.8, 7.7 ± 2.2, 8.6 ± 1.3, and 9.6 ± 1.3 min·km-1, respectively. At baseline, there were no differences in participant characteristics across race distance groups. Shear rate stimulus trended toward an increase after the race (P = 0.07), but resting postrace artery diameter (P < 0.001) was elevated to a similar extent in all conditions. There was a reduction in FMD after the 50-km race (Δ -1.9% ± 2.2%, P < 0.01), but not the 25-km (Δ +0.3% ± 2.9%, P = 0.8), the 80-km (Δ -1.5% ± 3.2%, P = 0.1), or the 160-km (Δ +0.5% ± 2.5%, P = 0.5) race. Inflammatory markers increased most after 160 km, but arterial stiffness and microvascular function were not differently affected by race distance.

CONCLUSIONS

Although the superficial femoral artery baseline diameter was larger postexercise regardless of race distance, only the 50-km race reduced FMD, whereas a short-duration higher-intensity race (25 km) and longer-duration lower-intensity races (160 km) did not. Therefore, a 50-km ultramarathon may represent the intersection between higher-intensity exercise over a prolonged duration, causing reduced endothelial function not seen in shorter or longer distances.

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.

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.

Elite 100-km road ultramarathon runners: characteristics and musculoskeletal injuries

BACKGROUND

Currently known data about ultramarathon medical issues has been collected from all combinations of ultramarathon race types (road, trail, etc.) and the population in those studies consists of mixed elite and recreational athletes. There are few studies concerning injuries related to musculoskeletal system injuries in ultramarathon runners.

METHODS

The study was conducted on total of 77 elite ultramarathoners based on a questionnaire-based survey. We studied the elite male and female athletes who participated in the 30^th IAU 100-km World Championships held in Croatia, in 2018.

RESULTS

Ultramarathon runners have higher percentage of lower-leg injuries and rehabilitation of those injuries tend to last longer as ultramarathon runners show specific training habits with less days off and hold a permanent, full-time job and often with a higher academic degree. Furthermore, also the mean age is higher.

CONCLUSIONS

Ultramarathoners have a higher percentage of lower-leg injuries than runners who do not run distances beyond a marathon. In addition, rehabilitation tends to last longer. This may well be correlated also to their specific training loads with fewer days off and training whilst holding a permanent full-time job. Often, they also hold a higher academic degree with years spent in the education system which might influence their mindsets on the medical issues they encounter. Also, being older may also have a bearing on injury occurrence and rehabilitation time.

Participation and Performance in the Oldest Ultramarathon-Comrades Marathon 1921-2019

Participation and performance trends have been analyzed for different ultramarathons for limited time periods. This study examined trends in participation and performance in the oldest ultramarathon in the world, the 'Comrades Marathon' (South Africa), during a century (1921-2019). Data from www.ultra-marathon.org on 100 000 unique finishers were analysed using different general linear models. Women represented 4.2% of the total sample (n=4152), and the first women ran this race in 1978. Before the year 1965, the number of participants in the race ranged between 5 and 35 athletes, then started to grow exponentially until mid 90's. An increase in finishers in the 70 s mainly due to an increase in male athletes in age groups 30-39, 40-49 and 50-59 years was observed (p<0.001). A stable running speed for overall women and men but an improvement in performance for the annual top five women and men were shown (p<0.001). Male runners were faster than female runners for all age groups (p<0.001). While overall performance was not improved across years, the annual top five women and men were able to improve their performance over years.

Mental toughness and self-efficacy of elite ultra-marathon runners

Minimal research has examined psychological processes underpinning ultra-marathon runners' performance. This study examined the relationships between mental toughness and self-efficacy with performance in an elite sample of ultra-marathon runners competing in the 2019 Hawaiian Ultra Running Team's Trail 100-mile endurance run (HURT100). The Mental Toughness Questionnaire (SMTQ) and the Endurance Sport Self-Efficacy Scale (ESSES) were completed by 56 elite ultra-marathon runners in the HURT100 (38 males, 18 females; Mage = 38.86 years, SDage = 9.23). Findings revealed mental toughness and self-efficacy are highly related constructs (r(54) = 0.72, p < 0.001). Mental toughness and self-efficacy did not significantly relate to ultra-marathon performance (mental toughness and self-efficacy with Ultra-Trail World Tour (UTWT) rank F(2, 53) = 0.738, p = 0.483; mental toughness and self-efficacy with likelihood would finish the HURT100 χ2 = 0.56, p = 0.756; mental toughness and self-efficacy with HURT100 placing and time F(2, 53) = 1.738, p = 0.186 and F(2, 30) = 2.046, p = 0.147, respectively). However, participants had significantly and meaningfully higher mental toughness (M = 45.42, SD = 4.26, medium and large effect sizes) than athletes from other sports previously published. Our interpretation is that these results taken in conjunction, suggest a threshold of mental toughness that performers require to be of the standard needed to be able to prepare for and compete in elite ultra-marathon events such as the HURT100; once this mental toughness threshold is met, other factors are likely to be more influential in determining elite level ultra-marathon performance.

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.

The Role of Nationality in Ultra-Endurance Sports: The Paradigm of Cross-Country Skiing and Long-Distance Running

Although the variation of performance by nationality in endurance sports such as marathon has been well studied, little information exists so far on the role of nationality on performance in ultra-endurance sports. The aim of the present study was to review the role of nationality on cross-country skiing and ultra-endurance running. Scopus and PubMed were searched using the syntax "nationality AND (ultra-endurance OR ultra-marathon OR cross-country skiing) in 1/4/2020. This search identified 17 articles, whose references were further examined for relevant literature. It was observed that Russian athletes dominated ultra-endurance running and cross-country skiing races. It was shown that these races were in other countries, where it was assumed that only the best Russians competed. Potential explanations could be misuse of performance enhancing substances, historical, climate-geographical and psychophysiological (e.g., combination of genetic and social factors). In summary, recent studies found a dominance of Russian athletes in specific races (i.e., 'Comrades Marathon', 'Vasaloppet', and 'Engadin Ski Marathon') and disciplines (i.e., ultra-marathon running, cross-country skiing) over a period of several decades. Future studies are need to investigate other events and other sport disciplines to confirm this Russian dominance.

A comparison of economy between two different backpack designs for runners

We compared two backpack designs (back/front or back only) in twelve recreational runners (age 22.0 ± 1.7years). An initial incremental exercise test (VO₂max 52.2 ± 4.7 ml kg^-1.min^-1) was conducted, followed by four tests of 20 min duration (running speed 9.8 ± 1.1 km/h) with loads carried of 0, 1 kg, 3 kg, and 6 kg with the two backpack designs in a randomized order. Economy was assessed by energy cost of running (CR), oxygen cost (O₂ cost), heart rate (HR) and rate of perceived exertion (RPE). Repeated measure ANOVA revealed a non-significant main effect for CR, O₂ cost, HR, RPE between systems. Post-hoc comparison of significant time × position interaction showed for CR, F(3,33) = 5.34, p < .01, η_p² = 0.33, and O₂ cost, F(3,33) = 5.15, p < .01, η_p² = 0.32, that carrying weight in the back/front were significantly lower after 20 min (CR: p = .02 and O₂ cost: p = .03). These results suggest, that for longer runs the equal distribution of weight is advantageous.

Participation and Performance Trends in the Oldest 100-km Ultramarathon in the World

Participation and performance trends in ultramarathon running have been investigated for large datasets and long period of times with an increase in participants and an improvement in performance. However, the analysis of ultramarathons across many decades is missing. We analyzed these trends for 96,036 athletes (88,286 men and 7750 women) from 67 countries competing between 1956 and 2019 in ‘100 km Lauf Biel’ in Switzerland, the oldest 100-km ultramarathon in the world. More men than women participated in all years. The number of male participants reached a peak at around 1985 and a decline in participation occurred thereafter. Women started competing in 1962. Men were always faster than women and both women and men reduced their race times over years. After about 1985, both overall women and men and both female and male winners were not able to improve race times. For men, athletes from all age groups below the age of 49 years old reached a peak of participation in the 1980s, and showed a decrease since then. Regarding age groups, the decrease first started in age group 20–29 years, followed by 30–39, 40–49, 50–59, and 60–69 years. For athletes in age groups 70–79 and 80–89 years, no decrease occurred. For women, age group athletes in age groups 40–49, 50–59, and 60–69 years increased their participation, whereas age groups 20–29 and 30–39 peaked in the late 1980s and started to decrease or stabilize, respectively. Switzerland, Germany, and France were the countries with the highest numbers of participants throughout the history of the race. In men, race times increased after about 1990 for most nationalities; only runners from Germany seemed to stabilize their performance. In women, runners from Italy, France, and Austria improved their performance over the years. In summary, the analysis of the oldest 100-km ultramarathon in the world showed a decrease in participation and an impairment in performance in the last 60 years. These changes were due to a decrease in the number of male ultramarathoners in around the 1980s, where mainly the number of age group runners younger than 70 years decreased.

Participation and Performance Analysis in Children and Adolescents Competing in Time-Limited Ultra-Endurance Running Events

Ultra-endurance running is of increasing popularity in the adult population, mainly due to master runners older than 35 years of age. However, youth runners younger than 19 years of age are also competing in ultra-endurance events, and an increase has been observed in distance-limited events, but no data is available on time-limited ultra-endurance events in this age group. This study investigated participation and performance trends in time-limited ultra-endurance races, including multi-day events, in runners younger than 19 years of age. Between the period 1990 and 2018, the most popular events recorded a total of 214 finishes (from 166 unique finishers (UF)) for 6-h events, 247 (212 UF) for 12-h events, and 805 (582 UF) for 24-h events, respectively. The majority of athletes originated from Europe and North America. Only a minority participated in multi-day events. Overall, speed increased with age, but the overall performance speed decreased across calendar years for 6- and 24-h events as participation numbers grew. In summary, in youth ultra-endurance runners, differences were observed regarding participation and performance across the different time-limited events, the age of the athletes and their country of origin

Heat Stress Challenges in Marathon vs. Ultra-Endurance Running

Several studies have investigated the effect of hot and humid ambient conditions on running exercise up to the marathon. However, studies on exercise longer than marathon are sparse. Events exceeding 6 h can be defined as ultra-endurance and have variable characteristics (e.g., distance, elevation profile, technical difficulty, altitude, night running) making hazardous the transposition of the current knowledge obtained in marathon to ultra-endurance running. Thus, the aim of this manuscript was to discuss the potential differences between marathon and ultra-endurance running in terms of heat stress challenges. The high running intensity (especially for the fastest runners), the urban context with high albedo effect materials, and the hot self-generated microclimate in mass-participation events (especially for the average to slow runners) are specific risk factors associated with marathon running in hot environments. Uphill running/walking (sometimes with poles), exotic destination with long-haul travel, desert environment and the necessity to sustain thermoregulatory and sweating responses for several days are risk factors more specific to ultra-endurance running. These differences call for specific research on the effect of hot ambient conditions in ultra-endurance disciplines to create appropriate recommendations.

Too much too early? An analysis of worldwide childhood ultramarathon participation and attrition in adulthood

BACKGROUND

Physical inactivity is associated with chronic disease and premature death, but excessive exercise can also lead to injury. Ultramarathon running is popular among adults but has not been assessed in children. To analyze ultramarathon participation in children and to determine if they continue running ultramarathons into adulthood provide some evidence of associated health risks.

METHODS

Race results databases were used to identify ultramarathon finishers under the age of 19 between 1960-2017. Participation trends across calendar years, age groups and different race distances were analyzed and continued participation into adulthood examined.

RESULTS

A total of 7775 finishes by 5418 individual children were recorded worldwide with an increase in ultramarathon finishers over time (P<0.0001), with the greatest number among older age groups (>16 years) and the 50 and 100 km race distances. Less than 25% of childhood ultramarathon runners continued running ultramarathons into adulthood and approximately 12% continued beyond 20 years.

CONCLUSIONS

Childhood participants has been growing exponentially over the last 20 years. While few of those children continue to complete ultramarathons into adulthood, the finding that some have continued well into adulthood suggests there is no obligate serious adverse physical impairment resulting from childhood ultramarathon participation.

Enactments and the design of trail running equipment: An example of carrying systems

Sports equipment brands have increasingly turned to experience-centered design, meaning the integration of users' activity into the design process. From an enactive perspective, this research investigated two entries of collecting and analyzing interactions between trail runners and their equipment. The paper articulates two studies. Study 1 analyzed traces of enactments on online forums and showed that trail runners reported the issues they enacted while running and reflexively posted the traces of their activity by highlighting the flaws in their carrying systems. Study 2 presents a field test protocol for assessing different carrying systems. The results showed four typical sequences of enactment that characterized the runners' activity. The outcomes of these two studies of runners' enactments while using equipment suggest a method that designers can appropriate to analyze experiential data, which can then be integrated into the conception process.

Women Reduce the Performance Difference to Men with Increasing Age in Ultra-Marathon Running

Age and sex are well-known factors influencing ultra-marathon race performance. The fact that women in older age groups are able to achieve a similar performance as men has been documented in swimming. In ultra-marathon running, knowledge is still limited. The aim of this study was to analyze sex-specific performance in ultra-marathon running according to age and distance. All ultra-marathon races documented in the online database of the German Society for Ultra-Marathon from 1964 to 2017 for 50-mile races (i.e., 231,980 records from 91,665 finishers) and from 1953 to 2017 for 100-mile races (i.e., 107,445 records from 39,870 finishers) were analyzed. In 50-mile races, race times were 11.74 ± 1.95 h for men and 12.31 ± 1.69 h for women. In 100-mile races, race times were 26.6 ± 3.49 h for men and 27.47 ± 3.6 h for women. The sex differences decreased with older age and were smaller in 100-mile (4.41%) than in 50-mile races (9.13%). The overall age of peak performance was 33 years for both distances. In summary, women reduced the performance difference to men with advancing age, the relative difference being smaller in 100-mile compared to 50-mile races. These findings might aid coaches and ultra-marathon runners set long-term training goals considering their sex and age.

Performance and Participation in the 'Vasaloppet' Cross-Country Skiing Race during a Century

This study investigated gender differences in performance and participation and the role of nationality during one century in one of the largest cross-country (XC) skiing events in the world, the 'Vasaloppet' in Sweden. The total number of female and male athletes who finished (n = 562,413) this race between 1922 and 2017 was considered. Most of the finishers were Swedish (81.03% of women and 88.39% of men), followed by Norwegians and Finnish. The overall men-to-women ratio was 17.5. A gender × nationality association was observed for participation (χ2 = 1,823.44, p < 0.001, φ = 0.057), with the men-to-women ratio ranging from 6.7 (USA) to 19.1 (Sweden). For both genders, the participation (%) of Swedish decreased, and that of all other nationalities (except Swiss) increased across years. Regarding the mean race time, men were faster than women by 14.5% (7 h 52 min 17 s versus 9 h 00 min 55 s, respectively). A trivial gender×nationality interaction regarding the race time was observed (p < 0.001, η2 < 0.001), with gender differences ranging from 4.4% (USA) to 22.0% (Iceland). The race time increased across calendar years for both women (r = 0.45, p = 0.006, moderate magnitude) and men (r = 0.25, p = 0.015, small magnitude). On the basis of these findings, we concluded that a relatively small number of women pariticipates in XC skiing. Therefore, the development of public health policies targeting the participation of women in XC skiing should be a concern in the countries with a tradition of this sport.

Pacing During and Physiological Response After a 12-Hour Ultra-Marathon in a 95-Year-Old Male Runner

In recent years, outstanding performances of elderly people up to 100 years have been reported. In this case study, pacing during and recovery after a 12-h ultra-marathon were described for a 95-year old runner. The athlete achieved a total distance of 52.987 km. Pacing followed a parabolic pattern (U-shaped), where the speed decreased till the middle of the race and then increased. However, no end spurt was observed. A large main effect of lap quartile on speed was observed, where the second quartile was slower than the first quartile and forth. The smallest variability was shown in the first quartile and the largest in the second quartile. During recovery, erythrocytes, hemoglobin and hematocrit increased whereas thrombocytes and leucocytes decreased. CRP, GOT, GPT, y-GT, CK, and LDH were increased post-race and decreased to reference range during recovery. Also, creatinine and urea decreased during recovery. Creatinine clearance increased during recovery. Sodium increased during recovery and remained constantly within the reference range. During recovery body fat and visceral fat mass decreased, whereas body water and lean body mass increased. In summary, a 95-year-old man was able to run during 12 h using a U-shaped pacing and achieving a total distance of nearly 53 km. Increased selected hematological and biochemical parameters returned to pre-race values within a recovery phase of 5 days.

Acute long-distance trail running increases serum IL-6, IL-15, and Hsp72 levels

Interleukin-6 (IL-6), IL-15, and heat shock protein 72 (Hsp72) are molecules that have significant metabolic effects on glucose and fat metabolism and a cell's stress response. The aim of this study is to determine serum levels of these molecules in runners after a long-distance trail run. Serum IL-15 levels after such endurance events have not been investigated yet. Blood samples were collected from 37 athletes (11 female, 26 male) before and after a 35-km trail run, with a total climb of 940 m. Serum was obtained from the samples, and IL-6, IL-15, and Hsp72 levels were measured from using the sandwich ELISA method. The athletes completed the race in 308.3 ± 37.4 min on average. After the race, the mean serum IL-6, IL-15, and Hsp72 concentrations increased 13.2-fold, 2.22-fold, and 1.6-fold, respectively (p < 0.001, p < 0.001, and p = 0.039, respectively). This is the first study to demonstrate the increase in serum IL-15 levels following an acute endurance exercise. In addition to IL-15, we report that IL-6 and soluble Hsp72 levels also increased significantly following a 35-km trail run. Since these molecules are involved in regulating glucose and fat metabolism, significant increases of IL-6, IL-15, and soluble Hsp72 may have health benefits that may be associated with long-distance trail runs, which are becoming more popular worldwide.

Russians are the fastest 100-km ultra-marathoners in the world

Objectives

A recent study investigating the top 10 100-km ultra-marathoners by nationality showed that Japanese runners were the fastest worldwide. This selection to top athletes may lead to a selection bias and the aim of this study was to investigate from where the fastest 100-km ultra-marathoners originate by considering all finishers in 100-km ultra-marathons since 1959.

Methods

We analysed data from 150,710 athletes who finished a 100-km ultra-marathon between 1959 and 2016. To get precise estimates and stable density plots we selected only those nationalities with 900 and more finishes resulting in 24 nationalities. Histograms and density plots were performed to study the distribution of race time. Crude mean, standard deviation, median, interquartile range (IQR), mode, skewness and excess of time for each nationality were computed. A linear regression analysis adjusted by sex, age and year was performed to study the race time between the nationalities. Histograms, density and scatter plots showed that some races seemed to have a time limit of 14 hours. From the complete dataset the finishes with more than 14 hours were removed (truncated dataset) and the same descriptive plots and analysis as for the complete dataset were performed again. In addition to the linear regression a truncated regression was performed with the truncated dataset to allow conclusion for the whole sample. To study a potential difference between races at home and races abroad, an interaction term race site home/abroad with nationality was included in the model.

Results

Most of the finishes were achieved by runners from Japan, Germany, Switzerland, France, Italy and USA with more than 260’000 (85%) finishes. Runners from Russia and Hungary were the fastest and runners from Hong Kong and China were the slowest finishers.

Conclusion

In contrast to existing findings investigating the top 10 by nationality, this analysis showed that ultra-marathoners from Russia, not Japan, were the fastest 100-km ultra-marathoners worldwide when considering all races held since 1959.

[Ultramarathon with Type 1 Diabetes]

Ultramarathon with Type 1 Diabetes Abstract. We report the case of a 63-year-old runner with type 1 diabetes mellitus requiring insulin since the age of 21. At the age of 32, he ran his first marathon, and at the age of 34 the first ultramarathon. So far, he has finished more than 90 marathons and ultramarathons. Thanks to an insulin pump and continuous glucose monitoring, he has so far completed 48 24-h-runs with an average distance of 133 km. The analysis of running volume and HbA1c values showed a significant increase in monthly exercise volume, a significant decrease in HbA1c values over the years, and a significant correlation between monthly running kilometers and HbA1c values.

Untargeted Metabolomics Profiling of an 80.5 km Simulated Treadmill Ultramarathon

Metabolomic profiling of nine trained ultramarathon runners completing an 80.5 km self-paced treadmill-based time trial was carried out. Plasma samples were obtained from venous whole blood, collected at rest and on completion of the distance (post-80.5 km). The samples were analyzed by using high-resolution mass spectrometry in combination with both hydrophilic interaction (HILIC) and reversed phase (RP) chromatography. The extracted putatively identified features were modeled using Simca P 14.1 software (Umetrics, Umea, Sweden). A large number of amino acids decreased post-80.5 km and fatty acid metabolism was affected with an increase in the formation of medium-chain unsaturated and partially oxidized fatty acids and conjugates of fatty acids with carnitines. A possible explanation for the complex pattern of medium-chain and oxidized fatty acids formed is that the prolonged exercise provoked the proliferation of peroxisomes. The peroxisomes may provide a readily utilizable form of energy through formation of acetyl carnitine and other acyl carnitines for export to mitochondria in the muscles; and secondly may serve to regulate the levels of oxidized metabolites of long-chain fatty acids. This is the first study to provide evidence of the metabolic profile in response to prolonged ultramarathon running using an untargeted approach. The findings provide an insight to the effects of ultramarathon running on the metabolic specificities and alterations that may demonstrate cardio-protective effects.

Running Performance, Nationality, Sex, and Age in the 10-km, Half-Marathon, Marathon, and the 100-km Ultramarathon IAAF 1999-2015

Nikolaidis PT, Onywera VO, and Knechtle B. Running performance, nationality, sex, and age in the 10-km, half-marathon, marathon, and the 100-km ultramarathon IAAF 1999-2015. J Strength Cond Res 31(8): 2189-2207, 2017-The aim of this study was to examine the performance of the world's best runners in the 10-km, half-marathon, marathon, and 100-km races by age, sex, and nationality during 1999-2015, using data from the International Association of Athletics Federations (IAAF). A total of 38,895 runners (17,136 women and 21,759 men) were evaluated, with 2,594 (1,360 women and 1,234 men) in the 10-km; 11,595 (5,225 women and 6,370 men) in the half-marathon; 23,973 (10,208 women and 13,765 men) in the marathon; and 733 (343 women and 390 men) in 100-km events. Most runners in the 10-km event (women 40%, men 67%) and the half-marathon (women 30%, men 57%) were Kenyans. In the marathon, most female and male runners were Ethiopians (women 17%, men 14%) and Kenyans (women 15%, men 43%), respectively. In the 100-km event, most runners were Japanese (20% women, and 80% men). Women were older than the men in the 10-km (32.0 ± 6.0 vs. 25.3 ± 4.3 years, p < 0.001), half-marathon (27.5 ± 4.7 vs. 25.9 ± 4.1 years, p < 0.001), and marathon events (29.5 ± 5.5 vs. 29.1 ± 4.3 years, p < 0.001), but not in 100-km event (36.6 ± 6.1 vs. 35.9 ± 5.5 years, p = 0.097). Men were faster than the women in the 10-km (28:04 ± 0:17 vs. 32:08 ± 0.31 (minutes:seconds), p < 0.001), half-marathon (1:01:58 ± 0:00:52 vs. 1:11:21 ± 0:01:18 (hours:minutes:seconds), p < 0.001), marathon (2:13:42 ± 0:03:01 vs. 2:35:04 ± 0:05:21 (hours:minutes:seconds), p < 0.001), and 100-km events (6:48:01 ± 0:11:29 vs. 7:53:51 ± 0:16:37 (hours:minutes:seconds), p < 0.001). East Africans were not the fastest compared with athletes originating from other countries where only the Ethiopian men were faster than all other men in the marathon. In summary, (a) in the 10-km, half-marathon and marathon events, most runners were from Kenya and Ethiopia, and from Japan and Russia in the 100-km event; (b) women were older than the men in all distance events except the 100-km event;