Ultra-obligatory running among ultramarathon runners

Prevalence, severity, and predictors of self-reported depression in ultra-distance runners: An online survey based on 265 athletes

BACKGROUND

Literature suggests a high prevalence of mental health disorders among athletes practicing elite and extreme sports. One of the most commonly encountered disorders in this group of individuals is depression.

OBJECTIVE

The aim of this study was to examine the prevalence, severity, and risk factors of symptoms of self-reported depression among ultra-distance runners.

METHODS

Data was collected using an online survey (February to April 2023) and included 265 (age 48.35 ± 10.52 years) adult ultra-runners. The Beck Depression Inventory-II (BDI-II) was used to measure self-reported depression. Additional variables comprised basic sociodemographic information and information regarding training, ultramarathon experience, and previous injury. Descriptive and interferential statistics were performed using JASP Version 0.16.4.

RESULTS

We found that 21.9 % (n = 58) of ultra-runners suffered from self-reported depression (i.e., BDI-II score ≥ 14) with an average BDI-II score of 22.7 ± 7.1 (moderately severe symptoms). Female ultra-runners had a higher prevalence (30.8 %) of self-reported depression than males (16.2 %, p = .001). Logistic regression revealed that ultra-runners without previous sports injury (p = .01) and those of increasing age (p = .003) had a significantly lower risk of self-reported depression. Similarly, linear regression showed the absence of injury (p < .001) and increasing age (p = .02) resulted in significantly lower BDI-II scores. Training volume in distance and hours per week as well as ultra-running experience did not show any significant association.

CONCLUSIONS

Affecting more than one-fifth of our collective, depressive symptoms appear to be highly prevalent among ultra-runners. Our findings underline the importance of screening for clinical depression, especially among injured athletes. However, the previously assumed peculiarities of the sport in the area of high training volume do not appear to be a significant factor.

COVID-19 Infection in Ultramarathon Runners: Findings of the Ultrarunners Longitudinal TRAcking Study

OBJECTIVE

Ultramarathon runners are a unique patient population who have been shown to have a lower rate of severe chronic medical conditions. This study aimed to determine the effect that COVID-19 infection has had on this population and their running behavior.

DESIGN

The Ultrarunners Longitudinal TRAcking (ULTRA) Study is a large longitudinal study of ultramarathon runners. Questions on health status, running behavior, and COVID-19 infection were included in the most recent survey.

SETTING

Community survey.

PARTICIPANTS

Seven hundred thirty-four ultramarathon runners participated in the study.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Personal, exercise, and COVID-19 infection history.

RESULTS

52.7% of study participants reported having been symptomatic from a COVID-19 infection, with 6.7% testing positive multiple times. Participants required a total of 4 days of hospitalization. The most common symptoms included fever (73.6%), fatigue (68.5%), sore throat (68.2%), runny nose (67.7%), and cough (67.4%). Cardiovascular symptoms, which are of particular interest in the running population, included shortness of breath (46.3%), tachycardia (44.7%), chest pain (36.2%), and wheezing (33.3%). A total of 50 subjects (6.8%) reported long COVID (symptoms lasting more than 12 weeks).

CONCLUSIONS

Severe COVID-19 infection has been rare in this population of ultramarathon runners, although symptomatic infection that affects running is common. To support the well-being of this group of highly active athletes, clinicians should appreciate that cardiovascular symptoms are common and the long-term significance of these symptoms in runners is unknown.

LEVEL OF EVIDENCE

Level 2 prospective study.

Personality of marathon runners: a narrative review of recent findings

Participation in marathons has dramatically increased over the last few years. Marathon running has many proven beneficial effects, especially on cardiovascular health and fitness. Most research has focused on physiologic and pathophysiologic adaptations in connection with endurance exercise. Nevertheless, marathon running also has a major impact on psychological aspects and positively influences mental health, which has only recently attracted research interest. The present narrative review aimed to review the personality traits of marathon runners with an emphasis on recent literature. Marathon runners show a distinct personality and highly characteristic personality traits needed to successfully finish such a demanding race, i.e., a strong sense of vigor, self-sufficiency, and intelligence as well as low scores in anger, fatigue, tension, and depression. Furthermore, personality differences are detectable between runners of different sexes, ages, and performance level groups. This has significant clinical implications for athletes, coaches and competition organizers, as these groups show different patterns of personality traits. Future studies should focus on changes in cognition and mood states pre-, during, and post-endurance events, as well as during training periods. Large-scale studies comparing personality differences by sex, age, and performance are also important for better clinical guidance. See also the graphical abstract(Fig. 1).

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.

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.

Ultra culture-ultra reality: a content analysis of YouTube depictions of ultra endurance sport and comparisons to scientific literature

Introduction

Interest in ultra endurance sport (UES) is increasing, with relevant events growing in popularity. However, these activities may encompass more complex characteristics and demands that do not correspond to scientifically validated correlations between physical activity and improved health. It is unknown whether high volume training for UES can have adverse implications, although certain sociocultural aspects of western society, such as an emphasis on autonomy and self-directed success, may encourage participation as a representation of personal achievement. As media depictions of UES can be highly influential, we aimed to explore prominent messages to better comprehend the values and aspirations of established and aspiring ultra endurance athletes (UEA).

Methods

Using qualitative, conventional content analysis techniques, we evaluated n = 15 popular YouTube videos on various UES to synthesize the most common themes. A YouTube search was conducted, and videos were selected based on sport and relevance. Subsequently, videos were analyzed and coded to discern the most frequently repeated themes.

Results

Five recurring themes were identified: discussion of the mental aspects of UES participation; the adoption of folk-tale storytelling; dietary habits of UEA; a focus on pain and suffering; the use of words associated with mental illness as a colloquial descriptor of UES/UEA.

Discussion

YouTube depictions of UES participation appear to accentuate suffering and co-occurring phenomena as attractive qualities. These resonate with sociocultural ideologies in western contexts, which emphasize fitness and personal success, but appear inconsistent with evidence around potentially adverse health-related implications of UES.

Conclusion

Discrepancies between popular portrayals of UES and scientific evidence suggest a need for greater community education and information sharing about sport-specific risk factors for physical and mental health conditions and appropriate training protocols. Further research is also required to better define the relationship between motivations for UES participation and overall health using interdisciplinary approaches.

The Foot and Ankle in Ultramarathon Runners: Results of the Ultrarunners Longitudinal TRAcking (ULTRA) Study

Background

The foot and ankle play a critical role in ultramarathon running. Because foot and ankle injuries are the most common location of injury in this group, proper care is essential for prevention. In this sport, small issues can become big problems over such long distances, and understanding the preventative measures taken by ultramarathon runners may provide insight for other athletes looking to avoid similar problems. The purpose of this study was to examine the routine and preventative care of the foot and ankle, as well as injury rates, in this group of high-risk athletes.

Methods

The Ultrarunners Longitudinal TRAcking (ULTRA) Study is the largest known prospective longitudinal study of ultramarathon runners. In this portion of the study, participants reported general health status, running behavior and performance, as well as foot and ankle care, injuries, stretching frequency, and shoewear.

Results

A total of 734 ultramarathon runners participated in the study. This group ran a median of 40.2 km per week. Overall, 71.2% of active ultramarathon runners reported a foot or ankle injury in the previous 12 months. The most common injuries reported were plantar fasciitis (36.3%), Achilles tendinitis (24.0%), nonspecific foot pain (14.0%), and stress fractures (13.4%). Sit and reach flexibility test showed that 63.7% of runners could not reach past their toes. There were no significant correlations for sit and reach flexibility or stretching frequency with injury rate.

Conclusion

The high prevalence of foot and ankle injuries in ultramarathon runners does not appear to be influenced by arch type, foot strike pattern, orthotic usage, stretching behavior, or actual flexibility. A high percentage of the study runners used comfort as a shoe selection method, independent of alignment or foot strike pattern. These findings guide the clinician in shared decision making with runners about routine care, including injury prevention and shoe selection.

Level of Evidence

Level II, prospective study.

Differences in Training and Health Characteristics Between Trail Ultrarunners and Shorter Distance Runners

INTRODUCTION

The primary aim of the study was to compare select training and health characteristics between ultramarathon and shorter distance runners participating in a trail race series.

METHODS

A questionnaire was sent to all participants who signed up for a trail race series, including distances of 10 km, half marathon, 50 km, 80.5 km (50 mi), and 100 km. There were 59 participants (27 ultramarathoners and 32 half marathon/10-km runners) who completed the questionnaire. We compared the training and health characteristics between groups using t tests and Fisher exact tests.

RESULTS

There were no significant differences in reported history of stress fracture (15% vs 9%; P=0.70) or sleep quality scores (4.4 vs 5.5; P=0.15) between the ultramarathon and half marathon/10-km groups. Over half of both groups reported trying to change body weight to improve performance, without significant differences between groups (65% vs 53%; P=0.42). A significantly greater proportion of the ultramarathoners reported an episode of binge eating in the 4 wk preceding the race (38% vs 3%; P=0.001).

CONCLUSIONS

Despite differences in training volume, we did not find different injury, sleep, and nutrition data between the ultramarathoners and half marathon/10-km runners, with the exception of more ultramarathoners reporting binging behaviors in the 4 wk leading up to the race. Screening for eating disorder behaviors should be considered in distance runners, particularly ultrarunners.

24 Hours on the Run-Does Boredom Matter for Ultra-Endurance Athletes' Crises?

Sport and exercise can be boring. In the general population, thinking of sports as boring has been linked to exercising less. However, less is known about the role of boredom in people who participate in ultra-endurance competitions: Do these athletes also associate their sports with boredom, and does boredom pose a self-regulatory challenge that predicts if they encounter a crisis during an ultra-endurance competition? Here, we investigate these questions with a sample of N = 113 (n = 34 female) competitors of a 24 h hour running competition, aged M = 37.6 ± 13.8 years. In this study, n = 23 very extreme athletes competed as single starters or in a relay team of 2, and n = 84 less extreme athletes competed in relay teams of 4 or 6. Before the run, athletes completed self-report measures on sport-specific trait boredom, as well as the degree to which they expected boredom, pain, effort, and willpower to constitute self-regulatory challenges they would have to cope with. After the run, athletes reported the degree to which they actually had to deal with these self-regulatory challenges and if they had faced an action crisis during the competition. Analyses revealed that very extreme athletes displayed a significantly lower sport-specific trait boredom than less extreme athletes (p = 0.024, d=-0.48). With respect to self-regulatory challenges, willpower, pain, and effort were expected and reported at a much higher rate than boredom. However, only boredom was as a significant predictor of experiencing a crisis during the competition (odds ratio = 12.5, p = 0.02). Our results show that boredom also matters for highly active athletes. The fact that the experience of boredom-and not more prototypical competition-induced challenges, such as pain or effort-were linked to having an action crisis highlights the relevance of incorporating boredom into the preparation for a race and to the performance management during competition.

Blisters and Calluses from Rowing: Prevalence, Perceptions and Pain Tolerance

Background and Objectives: Rowing is a sport that involves constant gripping, pulling/pushing, and rotational movements of the hands, in a cyclic periodic manner with every stroke, with hundreds of strokes being taken within a short period of time. Dermatological issues on rowers’ hands (fingers and palms) in the form of blisters and calluses are common knowledge within the community, but their prevalence and the rower’s perceptions and pain tolerance to them has never been systematically evaluated. This work addresses these lacunae. Materials and Methods: Analysis of data collected from a survey on a sample of competitive (117) and noncompetitive rowers (28) who row on-water (total 145). Results: It was found that approximately 69% of rowers participating in this study have calluses on their hands for most of their time (considered by them as not painful). The incidence of blisters was found to be lower (but perceived as more painful). Their incidence was found to be fairly independent of the frequency and intensity of training, but they seem to affect most rowers equally at the beginning of season or during a change of position (nonconditioned hands). Blisters and calluses were reported to be mainly located on the proximal phalanges and metacarpo-phalangeal joint area of both hands, i.e., on the lower parts of the fingers and the upper inner palms. Conclusions: Rowers demonstrated a sense of acceptance of these dermatological issues, even a sense of pride in what they represent. The incidence of blisters becoming infected was estimated to be so low that most rowers would not have encountered such serious, albeit rare, consequences.

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.

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.

Exercise Is Medicine? The Cardiorespiratory Implications of Ultra-marathon

Regular physical activity decreases the risk of cardiovascular disease, type II diabetes, obesity, certain cancers, and all-cause mortality. Nevertheless, there is mounting evidence that extreme exercise behaviors may be detrimental to human health. This review collates several decades of literature on the physiology and pathophysiology of ultra-marathon running, with emphasis on the cardiorespiratory implications. Herein, we discuss the prevalence and clinical significance of postrace decreases in lung function and diffusing capacity, respiratory muscle fatigue, pulmonary edema, biomarkers of cardiac injury, left/right ventricular dysfunction, and chronic myocardial remodeling. The aim of this article is to inform risk stratification for ultra-marathon and to edify best practice for personnel overseeing the events (i.e., race directors and medics).

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.

Current Trends in Ultramarathon Running

Exercise is universally recognized for its health benefits and distance running has long been a popular form of exercise and sport. Ultramarathons, defined as races longer than a marathon, have become increasingly popular in recent years. The diverse ultramarathon distances and courses provide additional challenges in race performance and medical coverage for these events. As the sport grows in popularity, more literature has become available regarding ultramarathon-specific illnesses and injuries, nutrition guidelines, psychology, physiologic changes, and equipment. This review focuses on recent findings and trends in ultramarathon running.

The Impact of Modern Ultramarathons on Shaping the Social Identity of Runners. The Case Study of Karkonosze Winter Ultramarathon

Despite the growing interest in extreme sports around the world, researchers have rarely investigated the complex factors that have led to a developed commitment to extreme sports in recent years. Precisely, the social identity of ultramarathoners remains a research niche. The aim of the article is to analyze the impact of a sports event on shaping social identity of ultramarathon runners on the example of Karkonosze Winter Ultramarathon (held in Poland). The qualitative method used in the article—interviews with runners—made it possible to examine the factors that create social identity, among which the motives for participation, sports subculture, and the authenticity of the experience play a key role. The first part of the article describes the theoretical aspects of social identity in sport. The second, empirical part presents the research results supplemented by the statements of the contestants. In this case, the subject of analysis is the motives for participation in a winter ultramarathon and their characteristics. Lastly, the article analyzes the subculture of ultramarathoners and the experience of contestants’ authenticity. The investigated winter ultramarathon created the perfect space for creation, deepening and celebrating the social identity of ultramarathoners assessed as a value in itself. The article enriches the present knowledge about the motivation of ultramarathoners because, unlike the results of quantitative research, it presents in-depth responses of runners who were not always concerned by existing research questionnaires.

Participant Opinions and Expectations about Medical Services at Ultramarathons: Findings from the Ultrarunners Longitudinal TRAcking (ULTRA) Study

Background

This work explores the opinions and expectations of ultramarathon runners about medical services and their perceived quality during ultramarathons.

Methods

Focused questions related to medical services at ultramarathons were included in the 2018 survey of Ultrarunners Longitudinal TRAcking (ULTRA) Study enrollees.

Results

Among the 1,156 respondents, 83.2% agreed that ultramarathons should provide at least a minimum level of medical support with basic first aid and emergency transport services rated as the most important medical services, and individuals with basic first aid training rated as the most important medical providers at ultramarathons. Participant safety was felt to largely be the responsibility of each runner as well as the race and/or medical director. Among 832 respondents having completed an ultramarathon in 2016-2018, their impression of medical services at 4,853 ultramarathons was generally favorable. Of the four percent of times in which medical support was needed, it met expectations 74% of the time. Of the total of 240 different medical issues for which medical support was needed, blister management was the most common, accounting for 26.7% of issues.

Conclusions

Even though medical services receive minimal utilization during ultramarathons, ultramarathon runners largely believe that these events should provide at least a minimum level of medical support. Ultramarathon runners place a high onus for safety during ultramarathons on themselves, but they also place a high level of responsibility on race and medical directors, so it is prudent for the race and medical directors to consider this information and avoid a mismatch between runner expectations and the medical services actually provided.

Running effects on cognition and plasticity (ReCaP): study protocol of a longitudinal examination of multimodal adaptations of marathon running

Regular moderate physical activity (PA) has been linked to beneficial adaptations in various somatic diseases (e.g. cancer, endocrinological disorders) and a reduction in all-cause mortality from several cardiovascular and neuropsychiatric diseases. This study was designed to investigate acute and prolonged exercise-induced cardio- and neurophysiological responses in endurance runners competing in the Munich Marathon. ReCaP (Running effects on Cognition and Plasticity) is a multimodal and longitudinal experimental study. This study included 100 participants (20-60 years). Six laboratory visits were included during the 3-month period before and the 3-month period after the Munich marathon. The multimodal assessment included laboratory measurements, cardiac and cranial imaging (MRI scans, ultrasound/echocardiography) and neurophysiological methods (EEG and TMS/tDCS), and vessel-analysis (e.g. retinal vessels and wave-reflection analyses) and neurocognitive measurements. The ReCaP study was designed to examine novel exercise-induced cardio- and neurophysiological responses to marathon running at the behavioral, functional and morphological levels. This study will expand our understanding of exercise-induced adaptations and will lead to more individually tailored therapeutic options.

Belief in the need for sodium supplementation during ultramarathons remains strong: findings from the Ultrarunners Longitudinal TRAcking (ULTRA) study

In the past, ultramarathon runners have commonly believed that consuming sodium supplements, as capsules or tablets, will prevent exercise-associated hyponatremia (EAH), dehydration, muscle cramping, and nausea, but accumulating evidence indicates that sodium supplementation during ultramarathons is not necessary and may be potentially dangerous. In this work, beliefs about whether sodium supplements should be made available at ultramarathons were assessed during 2018 among 1152 participants of the Ultrarunners Longitudinal TRAcking (ULTRA) study, of which 85.2% had completed an ultramarathon during 2014-2018. Two-thirds (66.4%) of study participants indicated that sodium supplements should be made available at ultramarathons, supported by beliefs that they prevent EAH (65.5%) and muscle cramping (59.1%). Of those indicating that sodium supplements should not be made available, 85.0% indicated it is because runners can provide their own, 27.9% indicated it is because they are not necessary, and 12.1% indicated they could increase thirst drive and cause overhydration. In general, there was a tendency for those who were older, less active in running ultramarathons in recent years, and with a longer history of ultramarathon running to be less likely to know that sodium supplements do not help prevent EAH, muscle cramping, and nausea. Novelty Ultramarathon runners continue to have misunderstandings about the need for sodium supplementation during ultramarathons. Few ultramarathon runners recognize that supplementing sodium intake beyond that in food and drink is generally not necessary during ultramarathons or that it could result in overhydration. Continued educational efforts are warranted to help ensure safe participation in the sport.

Force-velocity characteristics and maximal anaerobic power in male recreational marathon runners

The aim of the present study was to examine the relationship of force-velocity (F-v) characteristics with age and race time in marathon runners. One hundred thirty-five male marathon runners (age 44.2 ± 8.8 years, height 176 ± 6 cm, body mass 24.7 ± 2.6 kg.m^-2 and personal record 4:02 ± 0:45 h:min), separated into eight age groups (<30, 30-35, ., 55-60, >60 years), performed an F-v test on a cycle ergometer consisted of four 7s sprints. The older age groups had the lowest scores in maximal pedalling velocity (v₀; p < 0.001, η_p² = 0.244), relative (rPmax; p = 0.001, η_p² = 0.176) and absolute maximal power (Pmax; p = 0.009, η_p² = 0.135), whereas no difference in maximal force (F₀; p = 0.558, η_p² = 0.044) was shown. Race time correlated moderately with F₀ (r = 0.31, p < 0.001) and Pmax (r = 0.30, p = 0.001). The small magnitude of age-related differences in anaerobic power among most age groups indicated that humans without muscle strength/power training might maintain anaerobic power indices till their sixties.

The "New York City Marathon": participation and performance trends of 1.2M runners during half-century

The aim of the present study was to examine trends in participation, performance, age and nationality during a ~ 50-years period in the largest dataset ever studied in the "New York City Marathon". We analysed 1,174,331 finishers (women, n= 349,145, age 39.7 ± 8.7 years; men, n= 825,186, 41.7 ± 9.2 years). The overall participation increased across calendar years for all nationalities, and this increase was more pronounced in women, which resulted in a decreasing men-to-women ratio. Men were faster and older than women. Ethiopians and Kenyans were the fastest and youngest in women and men, respectively. Japanese were the slowest and Germans were the oldest in both sexes. Race time increased across years. Coaches and fitness trainers should be aware of these trends and should emphasize the development of training programs for older and slower runners.

Motivation in ultra-marathon runners

Background

In ultra-marathon running the proper motivation of the athlete is one of the milestones, not only during the races, but also during the practice sessions, which are long and very exhausting.

Purpose

The aim of this study was to examine the relationship of sport experience (expressed as number of finishes in ultra-marathons) with motivation characteristics of ultra-marathon runners.

Subjects and methods

The Motivation of Marathoners Scale examined the motivation of ultra-marathon runners compared to endurance runners of shorter distances (control group). Participants were 1,539 Polish runners, 382 women (24.7%) and 1,157 men (75.3%). Ultra-marathoners (N=425; 26.7%) finished at least one ultra-marathon, whereas the control group consisted of runners of shorter distances (N=1,114, 72.3%).

Results

Ultra-marathoners had higher scores in affiliation (3.55±1.60 vs 3.34±1.62, P<0.05), life meaning (4.20±1.40 vs 4.03±1.44, P<0.05) and lower in the areas of weight concern (4.33±1.68 vs 4.64±1.65, P<0.01), personal goal achievement (5.09±1.25 vs 4.64±1.65, P<0.001) and self-esteem (4.44±1.36 vs 4.68±1.38, P<0.01), than runners in the control group. The number of completed ultra-marathons was negatively related to the personal goal achievement, competition and recognition scale. The level of training experience was negatively correlated with the personal goal achievement scale in all participants, and with the self-esteem scale in the control group. In summary, ultra-marathoners had different motivations compared to runners of shorter race distance.

Conclusions

These findings should be considered by sport psychologists and other professionals to develop performance-tailored interventions for ultra-marathoners.

The effect of sex, age and performance level on pacing of Ironman triathletes

The aim of the present study was to examine the effect of sex, age and performance level on pacing of Ironman triathletes. Split times (i.e. swimming, cycling, and running) and overall race times of 343,345 athletes competing between 2002 and 2015 in 253 different Ironman triathlon races were analyzed. Participants were classified into nine performance groups according to their overall race time. Times in swimming, cycling, running and transition were expressed as percentage of the overall race time. Women spent relatively less time (%) in swimming, running and transition time, and more time (%) in cycling than men (p < 0.001). The fastest performance group was relatively faster in running (34.8 ± 1.4 versus 40.3 ± 3.0%, η²= 0.098) and transition time (0.9 ± 0.3 versus 2.2 ± 0.6%, η²= 0.178), and relatively slower in swimming (10.2 ± 0.8 versus 9.8 ± 1.5%, η²= 0.018) and cycling (54.1 ± 1.4 versus 47.8 ± 2.8%, η²= 0.138) than the slowest performance group (p < 0.001). The younger age groups were relatively faster in swimming, running and transition time, but relatively slower in cycling. In summary, the fastest Ironman triathletes were the relatively fastest in running and transition times. Thus, race tactics in an Ironman triathlon should focus on saving energy during swimming and cycling for the running split.

Considerations for ultra-endurance activities: part 1- nutrition

Ultra-endurance activities (≥ 4h) present unique challenges that, beyond fatigue, may be exacerbated by sub-optimal nutrition during periods of increased requirements and compromised gastrointestinal function. The causes of fatigue during ultra-endurance exercise are multi-factorial. However, mechanisms can potentially include central or peripheral fatigue, thermal stress, dehydration, and/or endogenous glycogen store depletion; of which optimising nutrition and hydration can partially attenuate. If exercise duration is long enough (e.g. ≥ 10h) and exercise intensity low enough (e.g. 45-60% of maximal oxygen uptake), it is bio-energetically plausible that ketogenic adaptation may enhance ultra-endurance performance, but this requires scientific substantiation. Conversely, the scientific literature has consistently demonstrated that daily dietary carbohydrates (3-12g/kg/day) and carbohydrate intake (30-110g/h) during ultra-endurance events can enhance performance at individually tolerable intake rates. Considering gastrointestinal symptoms are common in ultra-endurance activities, effective dietary prevention and management strategies may provide functional, histological, systemic, and symptomatic benefits. Taken together, a well-practiced and individualized fuelling approach is required to optimize performance in ultra-endurance events.

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.