Determinants of recovery from a 161-km ultramarathon

Recovery after Running an "Everesting" Mountain Ultramarathon

Blood markers of muscle microdamage and systemic inflammation do not adequately explain the reduced performance observed over a prolonged recovery after running a mountain ultramarathon. This case study aimed to determine whether the reduced performance after the Everesting mountain ultramarathon can be further assessed by considering cardiorespiratory and metabolic alterations determined via repeated incremental and continuous running tests. A single runner (age: 24 years, BM: 70 kg, BMI: 22, Vo2peak: 74 mL∙min-1∙kg-1) was observed over a preparatory period of two months with a one-month recovery period. The Everesting consisted of nine ascents and descents of 9349 vertical metres completed in 18:22 (h:min). During the first phase of the recovery, enhanced peak creatine kinase (800%) and C-reactive protein (44%) levels explained the decreased performance. In contrast, decreased performance during the second, longer phase was associated with a decreased lactate threshold and Vo2 (21% and 17%, respectively), as well as an increased energetic cost of running (15%) and higher endogenous carbohydrate oxidation rates (87%), lactate concentrations (170%) and respiratory muscle fatigue sensations that remained elevated for up to one month. These alterations may represent characteristics that can explain the second phase of the recovery process after Everesting.

The Consequences of Training and Competition to the Musculoskeletal System in Ultramarathon Runners: A Narrative Review

Ultramarathons are becoming increasingly popular every year, leading to more and more publications focusing on athletes of these endurance events. This paper summarizes the current state of knowledge on the effects of ultramarathons on the motor system. Various studies have attempted to answer questions about negative and positive effects on the musculoskeletal system, common injuries, optimal strategies, and regeneration. Considering the increasing number of ultramarathon athletes, the discoveries may have practical applications for a multitude of experts in the field of sports medicine, as well as for the athletes themselves. Acute locomotor system changes in runners as assessed by locomotor biomarkers are reversible and may be asymptomatic or painful. Injuries suffered by runners largely allow them to finish the competition and are usually overlooked. Regeneration, including regular massage and the use of supporting techniques, allows for faster convalescence. This publication is meant to be a source of knowledge for people associated with this discipline.

Inflammation, muscle damage and postrace physical activity following a mountain ultramarathon

BACKGROUND

The study aimed at exploring whether muscle membrane disruption, as a surrogate for muscle damage, and inflammation recovery following a mountain ultramarathon (MUM) was related with race performance and postrace physical activity.

METHODS

Blood samples were obtained from thirty-four athletes (29 men and 5 women) before a 118-km MUM, immediately after and three- and seven-days postrace. Creatine kinase (CK), lactate dehydrogenase (LDH) and C-reactive protein (CRP) were compared between faster (FR) and slower (SR) runners. Physical activity performed during the week following the MUM was objectively analyzed using accelerometers and compared between FR and SR.

RESULTS

CK was significantly higher in FR at 3 days postrace (P<0.012, d=1.17) and LDH was significantly higher in FR at 3- and 7-days postrace (P=0.005, d=1.01; P<0.015, d=1.05 respectively), as compared to SR. No significant differences were identified in postrace physical activity levels between FR and SR. Significant relationships were found between race time and CK and LDH concentrations at 3 days postrace (r<inf>s</inf>=-0.41, P=0.017; r<inf>s</inf>=-0.52, P=0.002 respectively) and 7 days postrace (r<inf>s</inf>=-0.36, P=0.039; r<inf>s</inf>=-0.46. P=0.007 respectively). However, postrace physical activity was not associated with muscle damage and inflammation recovery, except for light intensity and CRP at 3 days postrace (r<inf>s</inf>=-0.40, P=0.025).

CONCLUSIONS

Race time appeared to have a higher influence on muscle damage recovery than the intensity of physical activities performed in the week after running a MUM. Inflammatory activity takes longer to normalize than muscle damage following a MUM, it is not related with race time and lightly related with postrace physical activity.

Proteinuria in a high-altitude 161-km (100-mile) ultramarathon

PURPOSE

Urine dipstick analysis (UDA) is a useful tool in clinical practices. Abnormalities in UDA parameters have been observed as a result of extreme exercise. The exact incidence of UDA abnormalities, particularly proteinuria, as the result of running ultramarathons is unknown. The purpose of this study was to estimate the incidence of proteinuria and to identify the characteristics of those with proteinuria.

METHODS

We conducted a prospective observational study using urine samples from volunteer athletes before and immediately after the Leadville Trail 100 Run in August 2014. There were 33 runners with both pre-race and post-race samples and a total of 70 provided post-race samples. Demographic information was collected as a part of a larger study.

RESULTS

At least one abnormality was demonstrated in 89% of post-race urine samples. Twenty-one (30%) runners had post-race proteinuria (≥1+). Serum creatine kinase concentration (CK) was the only variable that was significantly correlated with the incidence of proteinuria in a multiple logistic regression model.

CONCLUSION

A majority of runners developed abnormalities in their UDA. Proteinuria was common and found to be associated with serum CK concentration.

The week after running a marathon: Effects of running vs elliptical training vs resting on neuromuscular performance and muscle damage recovery

Our aim was to compare the effects of two exercise modalities vs resting on the time course of neuromuscular performance and muscle damage recovery during the week after running a marathon. Sixty-four finishers from a road marathon completed the study (54 men and 10 women; 39 ± 4 years; 3 h 35 min ± 21 min). The day before the race, within 15 min after finishing the marathon and at 24, 48, 96, 144 and 192 h postrace, lactate dehydrogenase and creatine kinase were analysed. Participants also performed a squat jump (SJ) test before and after the marathon and at 48, 96 and 144 h postrace. On their arrival to the finish line, participants were randomized into one of the three intervention groups: running (RUN), elliptical training (ELIP) and resting recovery (REST). RUN and ELIP groups exercised continuously for 40 min at a moderate intensity (95-105% of the HR corresponding to the first ventilatory threshold) at 48, 96 and 144 h after the marathon. Neither 'Intervention' factor nor 'Intervention x Time' interaction effects were revealed for muscle damage blood markers (p > 0.05). On the other hand, RUN group evidenced an enhancement in SJ performance 96 h post-marathon as compared with REST group (108.29 ± 10.64 vs 100.58 ± 9.16%, p = 0.020, d = 0.80). Consequently, return to running at 48 h post-marathon does not seem to have a negative impact on muscle damage recovery up to eight days post-race and it could be recommended in order to speed up neuromuscular recovery.

Effect of mountain ultramarathon distance competition on biochemical variables, respiratory and lower-limb fatigue

The study aimed at assessing the acute physiological effects of running a 65-km vs a 107-km mountain ultramarathon. Nineteen athletes (15 males and 4 females) from the shorter race and forty three athletes (26 males and 17 females) from the longer race were enrolled. Body weight, respiratory and lower limb strength were assessed before and after the race. Blood samples were obtained before, after and 24-h post-race. Body weight loss did not differ between races. A decrease in squat jump height (p<0.01; d = 1.4), forced vital capacity (p<0.01; d = 0.5), forced expiratory volume in 1 s (p<0.01; d = 0.6), peak inspiratory flow (p<0.01; d = 0.6) and maximal inspiratory pressure (p<0.01; d = 0.8) was observed after the longer race; while, after the shorter race only maximal inspiratory pressure declined (p<0.01; d = 0.5). Greater post-race concentrations of creatine kinase (p<0.01; d = 0.9) and C-reactive protein (p<0.01; d = 2.3) were observed following the longer race, while high-sensitivity cardiac troponin was higher after the shorter race (p<0.01; d = 0.3). Sodium decreased post-competition only after the shorter race (p = 0.02; d = 0.6), while creatinine increased only following the longer race (p<0.01; d = 1.5). In both groups, glomerular filtration rate declined at post-race (longer race: p<0.01, d = 2.1; shorter race: p = 0.01, d = 1.4) and returned to baseline values at 24 h post-race. In summary, expiratory and lower-limb fatigue, and muscle damage and inflammatory response were greater following the longer race; while a higher release of cardiac troponins was observed after the shorter race. The alteration and restoration of renal function was similar after either race.

Physiology and Pathophysiology in Ultra-Marathon Running

In this overview, we summarize the findings of the literature with regards to physiology and pathophysiology of ultra-marathon running. The number of ultra-marathon races and the number of official finishers considerably increased in the last decades especially due to the increased number of female and age-group runners. A typical ultra-marathoner is male, married, well-educated, and ~45 years old. Female ultra-marathoners account for ~20% of the total number of finishers. Ultra-marathoners are older and have a larger weekly training volume, but run more slowly during training compared to marathoners. Previous experience (e.g., number of finishes in ultra-marathon races and personal best marathon time) is the most important predictor variable for a successful ultra-marathon performance followed by specific anthropometric (e.g., low body mass index, BMI, and low body fat) and training (e.g., high volume and running speed during training) characteristics. Women are slower than men, but the sex difference in performance decreased in recent years to ~10–20% depending upon the length of the ultra-marathon. The fastest ultra-marathon race times are generally achieved at the age of 35–45 years or older for both women and men, and the age of peak performance increases with increasing race distance or duration. An ultra-marathon leads to an energy deficit resulting in a reduction of both body fat and skeletal muscle mass. An ultra-marathon in combination with other risk factors, such as extreme weather conditions (either heat or cold) or the country where the race is held, can lead to exercise-associated hyponatremia. An ultra-marathon can also lead to changes in biomarkers indicating a pathological process in specific organs or organ systems such as skeletal muscles, heart, liver, kidney, immune and endocrine system. These changes are usually temporary, depending on intensity and duration of the performance, and usually normalize after the race. In longer ultra-marathons, ~50–60% of the participants experience musculoskeletal problems. The most common injuries in ultra-marathoners involve the lower limb, such as the ankle and the knee. An ultra-marathon can lead to an increase in creatine-kinase to values of 100,000–200,000 U/l depending upon the fitness level of the athlete and the length of the race. Furthermore, an ultra-marathon can lead to changes in the heart as shown by changes in cardiac biomarkers, electro- and echocardiography. Ultra-marathoners often suffer from digestive problems and gastrointestinal bleeding after an ultra-marathon is not uncommon. Liver enzymes can also considerably increase during an ultra-marathon. An ultra-marathon often leads to a temporary reduction in renal function. Ultra-marathoners often suffer from upper respiratory infections after an ultra-marathon. Considering the increased number of participants in ultra-marathons, the findings of the present review would have practical applications for a large number of sports scientists and sports medicine practitioners working in this field.

A Placebo-Controlled Trial of Riboflavin for Enhancement of Ultramarathon Recovery

Background

Riboflavin is known to protect tissue from oxidative damage but, to our knowledge, has not been explored as a means to control exercise-related muscle soreness. This study investigated whether acute ingestion of riboflavin reduces muscle pain and soreness during and after completion of a 161-km ultramarathon and improves functional recovery after the event.

Methods

In this double-blind, placebo-controlled trial, participants of the 2016 161-km Western States Endurance Run were assigned to receive a riboflavin or placebo capsule shortly before the race start and when reaching 90 km. Capsules contained either 100 mg of riboflavin or 95 mg of maltodextrin and 5 mg of 10% ß-carotene. Subjects provided muscle pain and soreness ratings before, during, and immediately after the race and for the 10 subsequent days. Subjects also completed 400-m runs at maximum speed on days 3, 5, and 10 after the race.

Results

For the 32 (18 in the riboflavin group, 14 in the placebo group) race finishers completing the study, muscle pain and soreness ratings during and immediately after the race were found to be significantly lower (p = .043) for the riboflavin group. Analysis of the 400-m run times also showed significantly faster (p < .05) times for the riboflavin group than the placebo group at post-race days 3 and 5. Both groups showed that muscle pain and soreness had returned to pre-race levels by 5 days after the race and that 400-m run times had returned to pre-race performance levels by 10 days after the race.

Conclusions

This preliminary work suggests that riboflavin supplementation before and during prolonged running might reduce muscle pain and soreness during and at the completion of the exercise and may enhance early functional recovery after the exercise.