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Kelly CPMG. Is There Evidence for the Development of Sex-Specific Guidelines for Ultramarathon Coaches and Athletes? A Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:6. [PMID: 36695958 PMCID: PMC9877268 DOI: 10.1186/s40798-022-00533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is evidence of sex differences in the physiology of endurance exercise, yet most of the advice and guidelines on training, racing, nutrition, and recovery for ultramarathons are based on research that has largely excluded female athletes. The objective was therefore to review the current knowledge of sex differences in ultramarathon runners and determine if sufficient evidence exists for providing separate guidelines for males and females. METHODS This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases were searched for studies investigating differences in elite and recreational male and female ultramarathon runners. Studies were included if they compared males and females and looked at outcomes relating to the performance or health of ultramarathon runners. The quality of the included studies was determined using the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. RESULTS The search strategy identified 45 studies that met the inclusion criteria. Most studies were observational in design, with only three papers based on randomised controlled trials. The overall quality of the evidence was low. Sex differences in the predictors of ultramarathon performance; physiological responses to training, racing, and recovery; chronic and acute health issues; and pacing strategies were found. There were areas with contradictory findings, and very few studies examined specific interventions. CONCLUSION The results from this review suggest that the development of sex-specific guidelines for ultramarathon coaches and athletes could have a significant effect on the performance and health of female runners. At present, there is insufficient high-quality evidence on which to formulate these guidelines, and further research is required.
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Affiliation(s)
- Claudia P M G Kelly
- College of Medicine and Health, The University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
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Tidmas V, Brazier J, Bottoms L, Muniz D, Desai T, Hawkins J, Sridharan S, Farrington K. Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16887. [PMID: 36554767 PMCID: PMC9779673 DOI: 10.3390/ijerph192416887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Increasingly popular, ultra-endurance participation exposes athletes to extremely high levels of functional and structural damage. Ultra-endurance athletes commonly develop acute kidney injury (AKI) and other pathologies harmful to kidney health. There is strong evidence that non-steroidal anti-inflammatory drugs, common amongst ultra-athletes, is linked to increased risk and severity of AKI and potentially ischaemic renal injury, i.e., acute tubular necrosis. Ultra-endurance participation also increases the risk of exertional rhabdomyolysis, exercise-associated hyponatremia, and gastrointestinal symptoms, interlinked pathologies all with potential to increase the risk of AKI. Hydration and fuelling both also play a role with the development of multiple pathologies and ultimately AKI, highlighting the need for individualised nutritional and hydration plans to promote athlete health. Faster athletes, supplementing nitrates, and being female also increase the risk of developing AKI in this setting. Serum creatinine criteria do not provide the best indicator for AKI for ultra-athletes therefore further investigations are needed to assess the practicality and accuracy of new renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL). The potential of recurring episodes of AKI provide need for further research to assess the longitudinal renal health impact of ultra-participation to provide appropriate advice to athletes, coaches, medical staff, and event organisers.
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Affiliation(s)
- Victoria Tidmas
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Jon Brazier
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Lindsay Bottoms
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Daniel Muniz
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Terun Desai
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Janine Hawkins
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Sivakumar Sridharan
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
- Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK
| | - Ken Farrington
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
- Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK
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The effect of interval and continuous work on markers of acute kidney injury in a hot environment. Eur J Appl Physiol 2022; 122:2437-2450. [PMID: 35999474 DOI: 10.1007/s00421-022-05030-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/15/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine the effect of high-intensity interval work (HIIW) and moderate-intensity continuous work (MICW) on markers of acute kidney injury (AKI) and kidney function in a hot environment. METHODS Nine males completed 2 h of work (2 × 60 min with 10 min passive rest) in a hot environment (40 °C and 15% relative humidity) as either HIIW [2 min at 80% peak oxygen consumption (VO2peak) and 3 min at 30% VO2peak] or MICW (matched for total work of HIIW). Blood and urine samples were collected immediately before (Pre), after (Post), 1 h (1 h Post), and 24 h after (24 h Post) the trials. Urine flow rate (UFR), creatinine clearance, insulin-like growth factor binding protein 7 (IGFBP7), urinary neutrophil gelatinase-associated lipocalin (uNGAL), and urinary kidney injury marker 1 (uKIM-1) were measured to assess kidney function and injury. RESULTS Log IGFBP7 (p < 0.01), log uNGAL (p < 0.01), and log uKIM-1 (p = 0.01) all displayed a main effect for time after both HIIW and MICW. IGFBP7 (p = 0.01) and uKIM-1 (p < 0.01), corrected for Uosm, were higher after HIIW compared to MICW at Post, while IGFBP7 was also higher 1 h Post after HIIW compared to MICW (p = 0.02). UFR significantly decreasing from Pre to Post (p < 0.01) and 1 h Post (p < 0.01), but no main effect for condition (p = 0.53). CONCLUSION Both HIIW and MICW in a hot environment caused an increase in biomarkers of kidney injury (IGFBP7, KIM-1, and NGAL), but HIIW may have a greater impact on biomarkers related to AKI.
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Burtscher J, Vanderriele PE, Legrand M, Predel HG, Niebauer J, O’Keefe JH, Millet GP, Burtscher M. Could Repeated Cardio-Renal Injury Trigger Late Cardiovascular Sequelae in Extreme Endurance Athletes? Sports Med 2022; 52:2821-2836. [DOI: 10.1007/s40279-022-01734-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 12/17/2022]
Abstract
AbstractRegular exercise confers multifaceted and well-established health benefits. Yet, transient and asymptomatic increases in markers of cardio-renal injury are commonly observed in ultra-endurance athletes during and after competition. This has raised concerns that chronic recurring insults could cause long-term cardiac and/or renal damage. Indeed, extreme endurance exercise (EEE) over decades has sometimes been linked with untoward cardiac effects, but a causal relation with acute injury markers has not yet been established. Here, we summarize the current knowledge on markers of cardiac and/or renal injury in EEE athletes, outline the possible interplay between cardiac and kidney damage, and explore the roles of various factors in the development of potential exercise-related cardiac damage, including underlying diseases, medication, sex, training, competition, regeneration, mitochondrial dysfunction, oxidative stress, and inflammation. In conclusion, despite the undisputed health benefits of regular exercise, we speculate, based on the intimate link between heart and kidney diseases, that in rare cases excessive endurance sport may induce adverse cardio-renal interactions that under specific, hitherto undefined conditions could result in persistent cardiac damage. We highlight future research priorities and provide decision support for athletes and clinical consultants who are seeking safe strategies for participation in EEE training and competition.
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Lecina M, Castellar-Otín C, López-Laval I, Carrasco Páez L, Pradas F. Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050569. [PMID: 35629986 PMCID: PMC9146822 DOI: 10.3390/medicina58050569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Miguel Lecina
- Faculty of Health and Sports Sciences, University of Zaragoza, 22002 Huesca, Spain;
| | - Carlos Castellar-Otín
- ENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, Spain;
- Correspondence:
| | - Isaac López-Laval
- Department of Physiatry and Nursery, Section of Physical Education and Sports, Faculty of Health Sciences and Sport, University of Zaragoza, 22002 Huesca, Spain;
| | - Luis Carrasco Páez
- Department of Physical Education and Sport, University of Seville, 41013 Seville, Spain;
| | - Francisco Pradas
- ENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, Spain;
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Loureiro ACC, Nocrato GF, Correia ALL, de Matos RS, Filho JCCN, Daher EDF, Pinto FHM, de Oliveira AC, Ceccatto VM, Fortunato RS, de Carvalho DP. Serum and Urinary Neutrophil Gelatinase-Associated Lipocalin Are Not Associated With Serum Redox Parameters in Amateur Athletes After an Ultramarathon. Front Physiol 2022; 13:811514. [PMID: 35370771 PMCID: PMC8970054 DOI: 10.3389/fphys.2022.811514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the relationship between oxidative stress and NGAL levels in blood and urine of amateur athletes after participating in a 100 km ultramarathon. Methodology The sample was composed of seven athletes, submitted to anthropometric assessment, cardiopulmonary exercise test, collection of urine and blood, measurement of body weight. The rate of perceived exertion (RPE), competition duration, heart rate (HR), energy expenditure and oxygen consumption (V'O2") were also measured during the event. The energy consumption during the race was verified at its end. The analyses were based on the means (M) and respective standard deviations (SD), with statistical significance set at 5% (p < 0.05). Paired t-test was used for comparison between the periods before and after the competition, and Pearson's correlation coefficient was used to measure the linear correlation between quantitative variables. Results Body mass index (BMI) of the sample was 25.75 kg/m2 ± 3.20, body fat percentage 18.54% ± 4.35% and V'O2"max 48.87% ± 4.78. Glucose, cortisol, and neutrophil gelatinase-associated lipocalin (NGAL) (p < 0.01) as well as glutathione peroxidase (GPx) active were higher after the race when compared to basal values. Moreover, lactate, creatinine, microalbuminuria, and glomerular filtration rate (GFR) (p < 0.001) were also higher after the race. After the competition, there was a significant correlation only between serum NGAL and creatinine, which was classified as strong and positive (r: 0.77; p < 0.05). There was a significant reduction (p < 0.05) of body weight after the event (72.40 kg ± 9.78) compared to before it (73.98 kg ± 10.25). In addition, we found an increase of RPE (p < 0.001) after the race. The competition lasted 820.60 min (±117.00), with a 127.85 bpm (±12.02) HR, a 2209.72 kcal ± 951.97 energy consumption, 7837.16 kcal ± 195.71 energy expenditure, and 28.78 ml/kg/min-1 (±4.66) relative V'O2"max. Conclusion The lack of correlation between oxidative stress biomarkers and serum and urine NGAL suggests that NGAL is more sensitive to inflammatory processes than to ROS levels.
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Affiliation(s)
| | | | | | - Robson Salviano de Matos
- Department of Clinical Medicine at the Federal University of Ceará, Ceará Federal University, Fortaleza, Brazil
| | | | | | | | | | | | - Rodrigo Soares Fortunato
- Carlos Chagas Filho Biophysics Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Denise Pires de Carvalho
- Carlos Chagas Filho Biophysics Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
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Lipman GS, Burns P, Phillips C, Jensen J, Little C, Jurkiewicz C, Jarrett B, Walker A, Mansfield N, Krabak BJ. Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running. Clin J Sport Med 2021; 31:e327-e334. [PMID: 32097177 DOI: 10.1097/jsm.0000000000000832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/19/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners. DESIGN Prospective observational study. SETTING The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts. PARTICIPANTS All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire. INTERVENTION Weight change and finish line serum sodium levels were gathered. MAIN OUTCOME MEASURES Incidence of exercise-associated hyponatremia (EAH; <135 mmol·L-1) and hypernatremia (>145 mmol·L-1) by sodium ingestion and climate. RESULTS Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), -4.7 kg (± 9.8)] than EAH [4 (14%), -1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races. CONCLUSIONS This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.
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Affiliation(s)
- Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Patrick Burns
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Caleb Phillips
- Department of Computational Science, University of Colorado, Boulder, Colorado
| | - Jacob Jensen
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Colin Little
- Department of Emergency Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Carrie Jurkiewicz
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Bryan Jarrett
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Anne Walker
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Nicky Mansfield
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Brian J Krabak
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
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Lecina M, López I, Castellar C, Pradas F. Extreme Ultra-Trail Race Induces Muscular Damage, Risk for Acute Kidney Injury and Hyponatremia: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111323. [PMID: 34769840 PMCID: PMC8582916 DOI: 10.3390/ijerph182111323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
A case study involving a healthy trained male athlete who completed a 786 km multi-stage ultra-trail race. Several markers were analyzed in blood and urine samples: creatinine (SCR) for kidney damage, sodium ([Na+]) for hyponatremia, creatine kinase (CK) for exertional rhabdomyolysis, as well as other hematological values. Samples were taken before and after the race and during the recovery period (days 2 and 9 after the race). Results showed: SCR = 1.13 mg/dl, [Na+] =139 mmol/l and CK = 1.099 UI/l. Criteria for the determination of acute kidney damage were not met, and [Na+] concentration was above 135 mEq/L, indicating the absence of hyponatremia. Exertional rhabdomyolysis was suffered by the athlete (baseline CK increased fivefold), though this situation was reverted after 9 days of recovery. Ultra-trail races cause biochemical changes in athletes, which should be known about by healthcare professionals.
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Affiliation(s)
- Miguel Lecina
- Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain; (M.L.); (I.L.)
| | - Isaac López
- Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain; (M.L.); (I.L.)
| | - Carlos Castellar
- ENFYRED Research Group, University of Zaragoza, 22001 Huesca, Spain;
- Correspondence:
| | - Francisco Pradas
- ENFYRED Research Group, University of Zaragoza, 22001 Huesca, Spain;
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Rojas-Valverde D, Martínez-Guardado I, Sánchez-Ureña B, Timón R, Scheer V, Pino-Ortega J, Olcina G. Outpatient Assessment of Mechanical Load, Heat Strain and Dehydration as Causes of Transitional Acute Kidney Injury in Endurance Trail Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910217. [PMID: 34639516 PMCID: PMC8508486 DOI: 10.3390/ijerph181910217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022]
Abstract
Background: This study aimed to globally assess heat strain, dehydration, and mechanical load as acute kidney injury (AKI) indicators in amateur endurance trail athletes during a 35.3 km run. Methods: Thirty amateur experienced trail runners completed an endurance trail run (total positive ascend 1815 m). The following assessments were performed at four measurement time points (pre-, during, immediately post [-post0h], and after 24 h of the finish of the run [-post24h]): serum test (creatinine, blood ureic nitrogen, albumin, creatine kinase, blood ureic nitrogen: creatinine ratio, creatinine clearance, and glomerular filtration rate), mechanical load (impacts and Player Load), heat strain and dehydration (hematocrit, urine solids, body weight and urine specific gravity), pain and exertion perception (rate of perceived exertion, lumbar and bipodal, and one-leg squat pain), and urinalysis (pH, protein, glucose, erythrocytes, and urine specific gravity). Results: There were pre vs. post0h changes in all serum biomarkers (F = 5.4–34.45, p < 0.01). The change in these biomarkers correlated with an increase in mechanical load indicators (r = 0.47–59, p < 0.05). A total of 40% and 23.4% of participants presented proteinuria and hematuria, respectively. Pain and perceived exertion increased significantly due to effort made during the endurance trail running (F = 4.2–176.4, p < 0.01). Conclusions: Endurance trail running may lead to an increase in blood and urine indicators of transitional AKI. The difference in blood and urine markers was significantly related to the mechanical load during running, suggesting potential kidney overload and cumulative mechanical load.
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Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 86-3000, Costa Rica
- Clínica de Lesiones Deportivas (Rehab & Readapt), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional de Costa Rica, Heredia 86-3000, Costa Rica
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain; (R.T.); (G.O.)
- Correspondence: (D.R.-V.); (I.M.-G.); Tel.: +506-88250219 (D.R.-V.)
| | - Ismael Martínez-Guardado
- Faculty of Life and Natural Sciences, University of Nebrija, 28015 Madrid, Spain
- Correspondence: (D.R.-V.); (I.M.-G.); Tel.: +506-88250219 (D.R.-V.)
| | - Braulio Sánchez-Ureña
- Programa de Ciencias del Ejercicio y la Salud, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia 86-3000, Costa Rica;
| | - Rafael Timón
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain; (R.T.); (G.O.)
| | - Volker Scheer
- Ultra Sports Science Foundation, 69310 Pierre-Bénite, France;
| | - José Pino-Ortega
- Biovetmed & Sportsci Research Group, University of Murcia, 30720 San Javier, Spain;
| | - Guillermo Olcina
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain; (R.T.); (G.O.)
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Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review. Sports Med 2021; 52:725-740. [PMID: 34542868 PMCID: PMC8450723 DOI: 10.1007/s40279-021-01561-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/14/2022]
Abstract
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.
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Le Goff C, Kaux JF, Dulgheru R, Seidel L, Pincemail J, Cavalier E, Melon P. The impact of an ultra-trail on the dynamic of cardiac, inflammatory, renal and oxidative stress biological markers correlated with electrocardiogram and echocardiogram. Acta Cardiol 2021; 76:739-747. [PMID: 32539581 DOI: 10.1080/00015385.2020.1778871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The aim of this study was to describe the effects of a 64.2 km ultra-trail on the biomarkers of muscle damage, inflammation and oxidative stress, and compare the results observed with an ECG and an echocardiogram, both performed before and after the race.Thirty-three ultra-trail volunteers (45.8 ± 8.7 years old) were enrolled in our study. Three blood tests were drawn from each runner, one just before (TPRE), one just after (TPOST) and the last 3 h after the end of the race (TPOST3h).All the markers increased. The maximum concentrations observed were at TPOST3h and were significant (p < 0.001) for creatine kinase, creatine kinase isoform MB, high-sensitivity C-reactive protein, uric acid and for the ratio of reduced glutathione to oxidised glutathione. However, in the case of myoglobin, high-sensitive troponin T, N-terminal pro-brain natriuretic peptide, oxidised glutathione, myeloperoxidase, cystatin C and creatinine, the most significant increases were at TPOST (p < 0.001). Modifications were observed in the medical imaging using echocardiography such as reduction of left ventricule end-sytolic and diastolic volumes and left ventricular global longitudinal strain. ECG showed electrical criteria for left ventricular hypertrophy and incomplete right bundle branch block after the race.Endurance races cause significant physiological stress to the body that can be measured by the increase of different biomarkers. From a laboratory perspective, it is important to take into account the possible exercise performed previous to the testing to avoid a misinterpretation of the results. From a training perspective, due to these increases in biomarkers, it is recommended that runners wait at least 72 h after an ultra-trail before subsequent training. In addition a transient impairment of ventricular function due to dehydration were observed.
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Affiliation(s)
- C. Le Goff
- Clinical Chemistry Department, University and University Hospital of Liège, Liège, Belgium
| | - J-F. Kaux
- Physical Medicine and Sports Traumatology Department, SportS2, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborating Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
| | - R. Dulgheru
- Department of Cardiology, University and University Hospital of Liège, Liège, Belgium
| | - L. Seidel
- Biostatistic Department, University Hosptial of Liège, Liège, Belgium
| | | | - E. Cavalier
- Clinical Chemistry Department, University and University Hospital of Liège, Liège, Belgium
| | - P. Melon
- Department of Cardiology, University and University Hospital of Liège, Liège, Belgium
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12
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Khodaee M, Irion B, Spittler J, Saeedi A, Hoffman MD. Characteristics of runners meeting acute kidney injury criteria following a 161‐km ultramarathon. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine & Orthopedics University of Colorado School of Medicine Denver USA
| | - Bjørn Irion
- Western Orthopedics and Sports Medicine Grand Junction CO USA
| | - Jack Spittler
- Department of Family Medicine & Orthopedics University of Colorado School of Medicine Denver USA
| | - Anahita Saeedi
- Department of Biostatistics School of Public Health & Health Sciences University of Massachusetts Amherst MA USA
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13
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Poussel M, Touzé C, Allado E, Frimat L, Hily O, Thilly N, Rousseau H, Vauthier JC, Chenuel B. Ultramarathon and Renal Function: Does Exercise-Induced Acute Kidney Injury Really Exist in Common Conditions? Front Sports Act Living 2020; 1:71. [PMID: 33344994 PMCID: PMC7739841 DOI: 10.3389/fspor.2019.00071] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/19/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Increasing ultramarathons participation, investigation into strenuous exercise and kidney function has to be clarified. Study Design: Prospective observational study. Methods and Protocol: The study used data collected among ultra-marathon runners completing the 2017 edition of the 120 km “Infernal trail” race. Samples were collected within 2 h pre-race (start) and immediately post-race (finish). Measurements of serum creatinine (sCr), cystatin C (Cys), creatine kinase, and urine albumin were completed. Acute Kidney Injury (AKI) as defined by the RIFLE criteria. “Risk” of injury was defined as increased serum Creatinine (sCr) × 1.5 or Glomerular Filtration Rate (GFR) decrease >25%. Injury was defined as 2 × sCr or GFR decrease >50%. These two categories of AKI were combined to calculate total incidence at the finish line. GFR was estimated by two methods, using measure of sCr and using measure of cystatin C. Urinary biomarkers [neutrophil gelatinase-associated lipocalin (NGAL)] were also used to define AKI. Outcome results before and after the race were compared by using McNemar test for qualitative data and Wilcoxon signed-rank test for quantitative data, in modified intent-to-treat and per-protocol analyses. Results: A sample of 24 included finishers, with no use of non-steroidal anti-inflammatory drugs (NSAIDs) was studied. Depending the methodology used to calculate GFR, the prevalence of AKI was observed from 0 to 12.5%. Urinary biomarkers of kidney damage were increased following the race but with no significant decrease in GFR. Discussion/Conclusion: Our study showed a very low prevalence of AKI and no evidence that ultra-endurance running can cause important kidney damage in properly hydrated subjects with no use of NSAIDs. Whether the increase in urinary biomarkers of kidney damage following the race reflects structural kidney injury or a simple metabolic adaptation to strenuous exercise needs to be clarified.
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Affiliation(s)
- Mathias Poussel
- Center of Sports Medicine and Adapted Physical Activity, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Charlie Touzé
- Department of General Practice, Maison de Santé des Trois Monts, Dommartin-les-Remiremont, France
| | - Edem Allado
- Center of Sports Medicine and Adapted Physical Activity, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Luc Frimat
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Oriane Hily
- Center of Sports Medicine and Adapted Physical Activity, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Nathalie Thilly
- Department of Methodology, Promotion and Investigation in Clinical Research, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Hélène Rousseau
- Department of Methodology, Promotion and Investigation in Clinical Research, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Jean-Charles Vauthier
- Department of General Practice, Maison de Santé des Trois Monts, Dommartin-les-Remiremont, France
| | - Bruno Chenuel
- Center of Sports Medicine and Adapted Physical Activity, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
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14
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Semen KO, van der Doelen RHA, van der Lugt M, van Dam DGHA, Reimer J, Stassen FRM, Janssen L, Janssen PKC, Janssen MJW, Bast A, le Noble JLML. Non-steroidal anti-inflammatory drugs increase urinary neutrophil gelatinase-associated lipocalin in recreational runners. Scand J Med Sci Sports 2020; 30:1888-1895. [PMID: 32585737 PMCID: PMC7540343 DOI: 10.1111/sms.13755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/18/2019] [Accepted: 06/16/2020] [Indexed: 12/22/2022]
Abstract
Objectives To study the effects of running with/without the use of pain killers on urinary neutrophil gelatinase‐associated lipocalin (uNGAL) and other parameters of kidney function in recreational runners. Methods Participants of the 10‐ and 21.1‐km Weir Venloop race were enrolled and their urine samples collected before and after the run. Urine dipstick and other conventional tests used to assess kidney function were performed. The presence of ibuprofen, diclofenac, naproxen, and/or paracetamol was assessed by LC‐MS/MS. uNGAL was measured with a two‐step chemiluminescent immunoassay. Results NSAIDs/analgesics were detected in urine of 5 (14.4%) 10‐km runners and 13 (28.9%) 21.1‐km runners. Only half‐marathon participants showed significant increases in uNGAL (pre: 11.7 [7.1‐34.3] ng/mL; post: 33.4 [17.4‐50.4] ng/mL; P = .0038). There was a significant effect of NSAID/analgesic use on uNGAL increase (F2, 76 = 4.210, P = .004). Post hoc tests revealed that uNGAL increased significantly in runners who tested positive for ibuprofen/naproxen compared to runners who did not use any medications (P = .045) or those who tested positive for paracetamol (P = .033). Running distance had a significant influence on the increase in uNGAL (F1, 53 = 4.741, P < .05), specific gravity (F1, 60 = 9.231, P < .01), urinary creatinine (F1, 61 = 10.574, P < .01), albumin (F1, 59 = 4.888, P < .05), and development of hematuria (χ2(4) = 18.44, P = .001). Conclusions Running distance and use of ibuprofen/naproxen were identified as risk factors for uNGAL increase in recreational runners.
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Affiliation(s)
| | - Rick H A van der Doelen
- Department of Clinical Chemistry, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
| | - Monique van der Lugt
- Emergency Department, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
| | - Davy G H A van Dam
- Department of Internal Medicine, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
| | | | - Frank R M Stassen
- Department of Medical Microbiology, NUTRIM - School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Loes Janssen
- Department of Epidemiology, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
| | - Paddy K C Janssen
- Department of Clinical Pharmacy, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcel J W Janssen
- Department of Clinical Chemistry, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
| | - Aalt Bast
- Campus Venlo, Maastricht University, Venlo, The Netherlands.,Department of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands
| | - Jos L M L le Noble
- Department of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands.,Department of Intensive Care, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
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15
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Semen KO, Weseler AR, Janssen MJW, Drittij-Reijnders MJ, le Noble JLML, Bast A. Effects of Monomeric and Oligomeric Flavanols on Kidney Function, Inflammation and Oxidative Stress in Runners: A Randomized Double-Blind Pilot Study. Nutrients 2020; 12:E1634. [PMID: 32492913 PMCID: PMC7353060 DOI: 10.3390/nu12061634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs are frequently used by athletes in order to prevent musculoskeletal pain and improve performance. In combination with strenuous exercise, they can contribute to a reduction of renal blood flow and promote development of kidney damage. We aimed to investigate whether monomeric and oligomeric flavanols (MOF) could reduce the severity of kidney injuries associated with the intake of 400-mg ibuprofen followed by the completion of a half-marathon in recreational athletes. In this double-blind, randomized study, the original MOF blend of extracts from grape seeds (Vitis vinifera L.) and pine bark (Pinus pinaster L.) or placebo were taken for 14 days preceding the ibuprofen/half-marathon. Urine samples were collected before and after the ibuprofen/half-marathon, and biomarkers of kidney injury, inflammation and oxidative stress were assessed. Intake of MOF significantly reduced the incidence of post-race hematuria (p = 0.0004) and lowered concentrations of interleukin (IL)-6 in the urine (p = 0.032). Urinary neutrophil-associated lipocalin, creatine, albumin, IL-8 and malondialdehyde tended to decrease. The supplementation with MOF in recreational runners appears to safely preserve kidney function, reduce inflammation and promote antioxidant defense during strenuous exercise and intake of a single dose of ibuprofen.
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Affiliation(s)
- Khrystyna O. Semen
- Campus Venlo, Faculty of Science and Engineering, Maastricht University, 5911 BV Venlo, The Netherlands;
| | - Antje R. Weseler
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.R.W.); (M.-J.D.-R.); (J.L.M.L.l.N.)
| | - Marcel J. W. Janssen
- Department of Clinical Chemistry and Haematology, VieCuri Medical Center Noord Limburg, 5912 BL Venlo, The Netherlands;
| | - Marie-José Drittij-Reijnders
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.R.W.); (M.-J.D.-R.); (J.L.M.L.l.N.)
| | - Jos L. M. L. le Noble
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.R.W.); (M.-J.D.-R.); (J.L.M.L.l.N.)
- Department of Intensive Care, VieCuri Medical Center Noord Limburg, 5912 BL Venlo, The Netherlands
| | - Aalt Bast
- Campus Venlo, Faculty of Science and Engineering, Maastricht University, 5911 BV Venlo, The Netherlands;
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.R.W.); (M.-J.D.-R.); (J.L.M.L.l.N.)
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16
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Nescolarde L, Roca E, Bogónez-Franco P, Hernández-Hermoso J, Bayes-Genis A, Ara J. Relationship Between Bioimpedance Vector Displacement and Renal Function After a Marathon in Non-elite Runners. Front Physiol 2020; 11:352. [PMID: 32435201 PMCID: PMC7218173 DOI: 10.3389/fphys.2020.00352] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/26/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose: This study investigates the relationship between whole-body bioimpedance vector displacement, using bioelectrical impedance vector analysis (BIVA), and renal function through serum biomarkers [creatinine, urea, sodium, C-reactive protein (CRP), and creatine kinase] and urine biomarkers after a marathon. Methods: Bioimpedance measurements were taken among 19 non-elite runners at 24 h pre-race, immediately post-race, and at 48 h post-race. The bioimpedance measurements were analyzed by BIVA using the Hotelling’s T2 test. The runners were divided according to a cutoff of serum creatinine level immediately post-race in G1 (<1.2 mg/dl of serum creatinine level) and G2 (≥1.2 mg/dl of serum creatinine level). The increase of the serum creatinine levels in 83% of G2 runners was related to acute kidney injury (AKI) stage 1. Results: Neither G1 nor G2 showed a creatinine clearance rate (CCr) lower than 60 ml/min. G2 showed a significant increase in CRP values at 48 h post-race vs baseline compared to G1 (P < 0.05), with over 5 mg/L (6.8–15.2) in 92% of the runners, and in CK values with over 215 U/L (282–1,882) at 48 h post-race in 100% of the runners. By BIVA, the 95% confidence ellipses of G2 showed shorter bioimpedance vectors than G1, with a noticeable minor Xc/H (P < 0.01), indicating an expansion on extracellular water and inflammation. The runners with 48 h post-race Xc/H values ≤30.5 Ω, with a decrease from −3 to −12% with respect to the Xc/H value at 24 h pre-race, indicated AKI stage 1 with 85.7% sensitivity and 91.7% specificity, with a direct correlation between AKI stage 1 with greater CRP values at 48 h post-race and bioimpedance vector displacement, but not with CK values at 48 h post-race. Conclusion: Through this data collection, it was evidenced that a transient reduction in renal function is more related to inflammatory factors than muscle damage. The BIVA method along with serum biomarkers could be used to follow up the kidney function in runners.
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Affiliation(s)
- Lexa Nescolarde
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Emma Roca
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Paco Bogónez-Franco
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - José Hernández-Hermoso
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Department of Surgery, Faculty of Medicine, Universitat Autònoma de Barcelona, Campus UAB, Barcelona, Spain
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Jordi Ara
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
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17
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Abstract
We present a case of severe, acute kidney injury, rhabdomyolysis and dehydration in a 49-year-old, competitive trail runner, after a 110-km trail race in mountainous terrain. Six days after the event, he presented to the hospital with fatigue, weight gain and oedema. Biochemically the diagnosis of severe, acute kidney injury was made, with increased serum creatinine levels of 13.4 mg/dL (normal range 0.67-1.17 mg/dL). He remained hospitalised for two weeks, and improved with conservative measures, without the need for renal replacement therapy. Likely risk factors included ingestion of non-steroidal anti-inflammatory drugs prior to the event, dehydration and prolonged running in mountainous environment at moderate altitude. Renal function largely returned to baseline levels four months after initial presentation. This case highlights that severe kidney injury can occur, even days after ultra-running events, especially in the presence of associated risk factors. If repeated cases of acute kidney injury can trigger chronic kidney injury is currently unclear and further research in this area is warranted. In the meantime, efforts should be made to educate athletes, coaches and health care professionals about the dangers of acute kidney injury and associated risk factors.
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Affiliation(s)
- Volker Scheer
- Sports Medicine, Ultra Sports Science Foundation, Pierre-Benite, FRA
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18
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Alschuler KN, Krabak BJ, Kratz AL, Jensen MP, Pomeranz D, Burns P, Bautz J, Nordeen C, Irwin C, Lipman GS. Pain Is Inevitable But Suffering Is Optional: Relationship of Pain Coping Strategies to Performance in Multistage Ultramarathon Runners. Wilderness Environ Med 2020; 31:23-30. [PMID: 32044211 DOI: 10.1016/j.wem.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/25/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Ultramarathon runners commonly endure musculoskeletal pain during endurance events. However, the effect of pain coping skills on performance has not been examined. METHODS A prospective observational study during three 250 km (155 mi), 6 stage ultramarathons was conducted. Finish line surveys were completed after each of the four 40 km (25 mi) and one 80 km (50 mi) stages of racing. Variables gathered included pain intensity, pain coping strategy use, pain interference, finishing position (quintile), and successful race completion. RESULTS A total of 204 participants (age 41.4±10.3 y; 73% male) reported average pain intensity of 3.9 (±2.0 SD) and worst pain intensity of 5.3 (±2.3) on a 0 to 10 scale. They used greater adaptive pain coping strategies (3.0±1.3) relative to maladaptive strategies (1.3±1.1). Worst pain and pain interference increased over each stage of the race for all runners (P<0.001), with worst pain being significantly different by finishing status (P=0.02). Although all runners endured increased pain and interference, the nonfinishers (28 [14%]) had significantly greater differences in changes in pain intensity (P<0.01) and pain interference (P<0.001). Maladaptive pain coping strategies were more common in nonfinishers; with each 1-point increase (0-6 scale), there was a 3 times increase in odds of not finishing the race. CONCLUSIONS Although increased pain intensity and pain interference was found in all multistage ultramarathon runners, successful event completion was significantly associated with less maladaptive pain coping. Training in coping with pain may be a beneficial part of ultramarathon preparation.
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Affiliation(s)
- Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Neurology, University of Washington, Seattle, WA.
| | - Brian J Krabak
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Patrick Burns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Joshua Bautz
- Department of Emergency Medicine, Naval Medical Center Camp Lejeune, Camp Lejeune, NC
| | - Claire Nordeen
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Crystal Irwin
- LA County - University Southern California Emergency Medicine Residency, Keck School of Medicine, Los Angeles, CA
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
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19
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Little CE, Lipman GS, Migliaccio D, Young DS, Krabak BJ. Accuracy of Estimated Creatinine in Multistage Ultramarathon Runners. Wilderness Environ Med 2019; 30:129-133. [PMID: 30872022 DOI: 10.1016/j.wem.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Ultramarathon running is increasing in popularity worldwide, as is the growing body of research on these athletes. Multiple studies have examined acute kidney injury through estimated baseline creatinine (Cr) and glomerular filtration rate (GFR). Values are estimated through an age-based formula of GFR and the modification of diet in renal disease (MDRD) equation. However, the accuracy of this practice in a cohort of healthy athletes is unknown. METHODS A prospective analysis of the first 40-km (25-mi) stage of 6-stage 250-km (155-mi) multistage ultramarathons in the Sahara, Namibia, Atacama, and Gobi Deserts. Runners had prerace measured baseline Cr compared to estimated values through age-based estimated GFR and back calculation of Cr through the MDRD equation. RESULTS Forty-eight participants (27% female, age 39±10 y) had Cr values analyzed. The mean measured Cr was 0.99±0.17, which was 11% higher than an estimated Cr of 0.88±0.14 (P<0.01). Estimated age-based GFR was 95.9±5.8 mL⋅min-1 compared to GFR based on measured Cr and MDRD of 86.1±14.6 (P<0.001). CONCLUSIONS Estimated values of GFR and Cr by standard age-based values and MDRD equation were significantly inaccurate, which would overinflate the incidence of acute kidney injury. Future studies should devise a new model for estimation of baseline Cr that is validated in this population.
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Affiliation(s)
- Colin E Little
- University of Utah Division of Emergency Medicine, Salt Lake City, UT.
| | | | - Daniel Migliaccio
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David S Young
- Department of Emergency Medicine, University of Colorado, Denver, CO
| | - Brian J Krabak
- Department of Sports Medicine, University of Washington, Seattle, WA
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20
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Hoffman MD. Predicted Risk for Exacerbation of Exercise-Associated Hyponatremia from Indiscriminate Postrace Intravenous Hydration of Ultramarathon Runners. J Emerg Med 2018; 56:177-184. [PMID: 30545731 DOI: 10.1016/j.jemermed.2018.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Asymptomatic or mildly symptomatic exercise-associated hyponatremia (EAH) can be exacerbated by aggressive hydration. OBJECTIVE This work predicts the percentage of athletes at risk for exacerbation of EAH from indiscriminate hydration after an ultramarathon. METHODS Postrace serum sodium, creatinine, creatine kinase (CK), and urea nitrogen concentrations were determined for 161-km ultramarathon participants. Body mass was measured prior to and immediately after the race. Incidents when serum CK was > 20,000 U/L or creatinine ≥ 1.5 times estimated baseline were considered to be "at risk for receiving I.V. hydration" if presenting to a hospital. Those with EAH without body mass loss during the race were considered "overhydrated" and "at risk for EAH exacerbation." RESULTS Among 627 finishers, 16 (2.6%) were at risk for EAH exacerbation. Considering 421 observations at risk for receiving I.V. hydration, 16 (47.1%) of the 34 observations with EAH were at risk for EAH exacerbation. Among those at risk for receiving I.V. hydration and with EAH, serum urea nitrogen and creatine concentration as a multiple of estimated baseline were lower (p < 0.05) for those at risk for EAH exacerbation, compared with those without overhydration, but there were no clinically useful laboratory findings to distinguish these two groups due to considerable overlap of values. CONCLUSIONS Whether in the field or hospital setting, I.V. hydration of an athlete after an ultramarathon carries a notable risk for exacerbating EAH, so clinicians should use caution when hydrating athletes after endurance events.
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Affiliation(s)
- Martin D Hoffman
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, California; University of California Davis Medical Center, Sacramento, California; Ultra Sports Science Foundation, El Dorado Hills, California
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21
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Belli T, Macedo DV, de Araújo GG, Dos Reis IGM, Scariot PPM, Lazarim FL, Nunes LAS, Brenzikofer R, Gobatto CA. Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury. Front Physiol 2018; 9:1368. [PMID: 30349484 PMCID: PMC6186806 DOI: 10.3389/fphys.2018.01368] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: This study aimed to investigate changes in muscle damage during the course of a 217-km mountain ultramarathon (MUM). In an integrative perspective, inflammatory response and renal function were also studied. Methods: Six male ultra-runners were tested four times: pre-race, at 84 km, at 177 km, and immediately after the race. Blood samples were analyzed for serum muscle enzymes, acute-phase protein, cortisol, and renal function biomarkers. Results: Serum creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) increased significantly throughout the race (P < 0.001, P < 0.001; P = 0.002, respectively), and effect size (ES) denoted a large magnitude of muscle damage. These enzymes increased from pre-race (132 ± 18, 371 ± 66, and 28 ± 3 U/L, respectively) to 84 km (30, 1.8, and 3.9-fold, respectively); further increased from 84 to 177 km (4.6, 2.9, and 6.1-fold, respectively), followed by a stable phase until the finish line. Regarding the inflammatory response, significant differences were found for C-reactive protein (CRP) (P < 0.001) and cortisol (P < 0.001). CRP increased from pre-race (0.9 ± 0.3 mg/L) to 177 km (243-fold), cortisol increased from pre-race (257 ± 30 mmol/L) to the 84 km (2.9-fold), and both remained augmented until the finish line. Significant changes were observed for creatinine (P = 0.03), urea (P = 0.001), and glomerular filtration rate (GFR) (P < 0.001), and ES confirmed a moderate magnitude of changes in renal function biomarkers. Creatinine and urea increased, and GFR decreased from pre-race (1.00 ± 0.03 mg/dL, 33 ± 6 mg/dL, and 89 ± 5 ml/min/1.73 m2, respectively) to 84 km (1.3, 3.5, and 0.7-fold, respectively), followed by a plateau phase until the finish line. Conclusion: This study shows evidence that muscle damage biomarkers presented early peak levels and they were followed by a plateau phase during the last segment of a 217-km MUM. The acute-phase response had a similar change of muscle damage. In addition, our data showed that our volunteers meet the risk criteria for acute kidney injury from 84 km until they finished the race, without demonstrating any clinical symptomatology.
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Affiliation(s)
- Taisa Belli
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | - Denise Vaz Macedo
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - Gustavo Gomes de Araújo
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | | | - Pedro Paulo Menezes Scariot
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | - Fernanda Lorenzi Lazarim
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - Lázaro Alessandro Soares Nunes
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - René Brenzikofer
- Laboratory of Instrumentation for Biomechanics (LIB), Faculty of Physical Education, University of Campinas, Campinas, Brazil
| | - Claudio Alexandre Gobatto
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
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22
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Knechtle B, Nikolaidis PT. Physiology and Pathophysiology in Ultra-Marathon Running. Front Physiol 2018; 9:634. [PMID: 29910741 PMCID: PMC5992463 DOI: 10.3389/fphys.2018.00634] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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23
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Abstract
Zusammenfassung. Wir stellen die wichtigsten Erkenntnisse zu Organschädigungen durch einen Ultramarathon zusammen. Nach einem Ultramarathon können kardiale Biomarker wie CK, CK-MB, kardiales Troponin I (cTnI) und N-terminales pro-Brain Natriuretic Peptide (NT-pro BNP) erhöht sein. Bis 80 % und mehr der Finisher klagen über Verdauungsprobleme, die einer der Hauptgründe sind, einen Ultramarathon nicht zu finishen. Bis zu 90 % der Läufer, die einen Ultramarathon aufgeben, klagen über Übelkeit. Nach einem Ultramarathon steigen die Leberwerte oft an, schwerwiegende Konsequenzen bleiben meist aus. Risikofaktoren für eine Einschränkung der Nierenfunktion sind eine ausgeprägte Muskelschädigung mit Rhabdomyolyse, Dehydratation, Hypotonie, Hyperurikämie, Hyponatriämie, geringe Wettkampferfahrung sowie die Einnahme von NSARs. Ultraläufer leiden nach einem Ultramarathon oft an Infekten der oberen Atemwege.
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Affiliation(s)
- Beat Knechtle
- 1 Medbase St. Gallen
- 2 Institut für Hausarztmedizin, Universität Zürich
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24
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Impact of Hot Environment on Fluid and Electrolyte Imbalance, Renal Damage, Hemolysis, and Immune Activation Postmarathon. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:9824192. [PMID: 29430287 PMCID: PMC5753004 DOI: 10.1155/2017/9824192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/09/2017] [Accepted: 10/26/2017] [Indexed: 01/24/2023]
Abstract
Previous studies have demonstrated the physiological changes induced by exercise exposure in hot environments. We investigated the hematological and oxidative changes and tissue damage induced by marathon race in different thermal conditions. Twenty-six male runners completed the São Paulo International Marathon both in hot environment (HE) and in temperate environment (TE). Blood and urine samples were collected 1 day before, immediately after, 1 day after, and 3 days after the marathon to analyze the hematological parameters, electrolytes, markers of tissue damage, and oxidative status. In both environments, the marathon race promotes fluid and electrolyte imbalance, hemolysis, oxidative stress, immune activation, and tissue damage. The marathon runner's performance was approximately 13.5% lower in HE compared to TE; however, in HE, our results demonstrated more pronounced fluid and electrolyte imbalance, renal damage, hemolysis, and immune activation. Moreover, oxidative stress induced by marathon in HE is presumed to be related to protein/purine oxidation instead of other oxidative sources. Fluid and electrolyte imbalance and protein/purine oxidation may be important factors responsible for hemolysis, renal damage, immune activation, and impaired performance after long-term exercise in HE. Nonetheless, we suggested that the impairment on performance in HE was not associated to the muscle damage and lipoperoxidation.
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25
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Krabak BJ, Lipman GS, Waite BL, Rundell SD. Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons. Wilderness Environ Med 2017; 28:291-298. [PMID: 28781178 DOI: 10.1016/j.wem.2017.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/29/2017] [Accepted: 05/25/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. METHODS This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. RESULTS The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. CONCLUSIONS The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.
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Affiliation(s)
- Brian J Krabak
- Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA (Dr Krabak).
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Dr Lipman)
| | - Brandee L Waite
- Department of Physical Medicine and Rehabilitation, University of California, Davis Sports Medicine, Sacramento, CA (Dr Waite)
| | - Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA (Dr Rundell)
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