Weight changes, medical complications, and performance during an Ironman triathlon

Evolution of the thirst mechanism in Homo: The need and limitations of thirst and hydration

There is a view that the perception of thirst and actual body fluid balance may affect cognitive and exercise performance. The evolutionary evidence suggests that our survival was dependent on our ability to sweat profusely when hunting during the heat of the day (persistence hunting), so if water deficits were not tolerated, consequently the thirst mechanism would limit our persistence hunting capability. This also means that hunting and searching for water was undertaken with some extent of water deficit, and in turn suggests that performance; physical and cognitive, was conducted with a degree of dehydration. Given the current views on the maintenance of body water for performance, there is a need to evaluate the evidence relating to tolerance limits for water deficits with respect to both physical and cognitive performance. This review considers the thirst mechanism and the conditions and selective pressures under which this might have evolved. Consideration will be given to how the thirst mechanism influences our physical and cognitive performance. The review suggests that Homo developed appropriate tolerances for water deficits and thirst perception, with a safety margin that prevented detrimental declines in physical and cognitive performance to the point of inhibiting corrective action. This would have offered a selective advantage, enabling the search for water and functioning adequately during periods of water scarcity.

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

OBJECTIVE

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

DESIGN

Prospective exposed/nonexposed cohort study.

SETTING

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

PARTICIPANTS

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

INTERVENTION

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

New model of sports tourism with sustainable tourism development to increase tourist arrivals in Central Aceh Regency, Indonesia

Introduction

This study explores the development and implementation of a new sports tourism product called "Run H2O Ride" as a strategy for sustainable tourism in Indonesia.

Methods

The research employs a research and development (R&D) methodology, focusing on identifying potential issues, conducting literature reviews, designing the product, validating the design, and undergoing product development. A combination of discussion group forums (FGD) and expert judgment decisions was used to design the new sport tourism model.

Results

The effectiveness of the model was assessed through limited product tests, main product tests, and operational product tests involving respondents from the local community and tourists. The results indicate that the "Run H2O Ride" model has been well-received, with positive feedback on its suitability and effectiveness in attracting tourists and enhancing the local economy.

Discussion

The study concludes by recommending further research to refine the model and emphasizes the importance of local government support and community participation in sustainable tourism development. Theoretical implications highlight the significance of sports tourism events in promoting tourism, while practical implications suggest alternative solutions for increasing tourist visits and improving destination image. Policy recommendations for local governments are proposed to adopt and implement sports tourism events, aligning with long-term development plans for regional tourism growth.

The effects of a multi-day cross-country mountain bike race on myocardial function, stress, inflammation and cardiac biomarkers in amateur master athletes

This study aimed to examine the effects of a multi-day mountain bike race on amateur master athlete cyclists (AMA). AMA (50±5 years) completed 2 stages of a mountain bike race. Six weeks before racing, echocardiography, blood and maximal cardiopulmonary exercise tests (CPET) were performed. One hour after completion of each race stage, echocardiography measurements were taken and blood was sampled for stress, inflammatory and cardiac biomarkers. Main outcomes of the CPET were maximal oxygen consumption (VO2max) 50.7±6.5 ml/kg/min; maximal power 328±45 Watt and ventilatory threshold of 86%VO2max. Participants completed 95.7km with an elevation of 1650m on the first day, and 92.5km with an elevation of 1410m on the second day, with completion times of 357±42 and 390 ±43 minutes, respectively. After racing, increases in Creatine Phosphokinase and C-reactive protein (3-6 fold) (p<0.001), Troponin I (4-fold) (p<0.001) and N-terminal pro-brain natriuretic peptide (NT-Pro BNP) (4-7-fold) (p<0.001) were noted, with a reduction in the myocardial global work index of 17-24% (p<0.001). No correlations were found between Troponin I or NT-Pro BNP and myocardial global work index. Highly aerobically fit AMA participating in demanding endurance events demonstrated elevated stress, inflammatory, muscle damage and cardiac biomarkers. However, these changes did not significantly correlate with altered cardiac function. In addition, consecutive days of demanding prolonged cycling exercise did not have cumulative effects on the measured myocardial parameters.

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update

The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.

Hydration and Performance in Young Triathletes During a Competition in Tropical Climate

PURPOSE

We examined fluid intake, the relation between body mass (BM) loss and performance, and core temperature in young triathletes during a competition in tropical climate.

METHODS

Fluid intake and pre and post BM were measured in 35 adolescent athletes, and core temperature was measured in one female and one male.

RESULTS

Mean urine specific gravity (1.024 [0.007]) indicated that athletes were in suboptimal state of hydration upon waking. Race time was 73.2 (8.0) minutes. BM decreased by 0.6 (0.3) kg (P < .05). Fluid intake (528.5 [221.6] mL) replaced 47% of the fluid loss (1184.9 [256.4] mL) and was higher during run (11.5 [6.6] mL·min-1) compared to bike (7.3 [3.1] mL·min-1), P < .01. Loss in BM was ≥1.0% in 66% and ≥1.5% in 29% of the athletes. Males showed a moderate association between percentage loss in BM and finishing time (r = -.52), higher sweat rates (1.0 [0.3] L·h-1), and faster times (69.4 [7.5] min; P < .05). Core temperature rose to 40.1 °C in the female and 39.6 °C in the male.

CONCLUSION

Young triathletes competing in a hot/humid climate became mildly to moderately dehydrated and hyperthermic even when water and sports drinks were available but did not show symptoms of heat illness.

Exercise-induced hypohydration impairs 3 km treadmill-running performance in temperate conditions

Research assessing exercise-induced hypohydration on running performance in a temperate environment is scarce. Given the weight-bearing nature of running, the negative effects of hypohydration might be offset by the weight-loss associated with a negative fluid balance. Therefore, this study investigated the effect of exercise-induced hypohydration on running performance in temperate conditions. Seventeen intermittent games players (age 22 ± 1 y; VO2peak 52.5 ± 4.1 mL∙kg-1∙min-1) completed preliminary and familiarisation trials, and two experimental trials consisting of 12 blocks of 6 min of running (65% VO2peak; preload) with 1 min passive rest in-between, followed by a 3 km time trial (TT). During the preload, subjects consumed minimal fluid (60 mL) to induce hypohydration (HYP) or water to replace 95% sweat losses (1622 ± 343 mL; EUH). Body mass loss (EUH -0.5 ± 0.3%; HYP -2.2 ± 0.4%; P < 0.001), and other changes indicative of hypohydration, including increased serum osmolality, heart rate, thirst sensation, and decreased plasma volume (P ≤ 0.022), were apparent in HYP by the end of the preload. TT performance was ~6% slower in HYP (EUH 900 ± 87 s; HYP 955 ± 110 s; P < 0.001). Exercise-induced hypohydration of ~2% body mass impaired 3 km running TT performance in a temperate environment.

Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review

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.

Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports

The majority of reviews on sports nutrition issues focus on macronutrients, often omitting or paying less attention to substances such as sodium. Through the literature, it is clear that there are no reviews that focus entirely on the effects of sodium and in particular on endurance sports. Sodium intake, both at high and low doses, has been found to be associated with health and performance issues in athletes. Besides, there have been theories that an electrolyte imbalance, specifically sodium, contributes to the development of muscle cramps (EAMC) and hyponatremia (EAH). For this reason, it is necessary to create this systematic review, in order to report extensively on the role of sodium consumption in the population and more specifically in endurance and ultra-endurance athletes, the relationship between the amount consumed and the occurrence of pathological disorders, the usefulness of simultaneous hydration and whether a disturbance of this substance leads to EAH and EAMC. As a method of data collection, this study focused on exploring literature from 2000–2021. The search was conducted through the research engines PubMed and Scopus. In order to reduce the health and performance effects in endurance athletes, simultaneous emphasis should be placed on both sodium and fluid intake.

Impact of Repeated Acute Exposures to Low and Moderate Exercise-Induced Hypohydration on Physiological and Subjective Responses and Endurance Performance

This study aimed to examine whether repeated exposures to low (2%) and moderate (4%) exercise-induced hypohydration may reverse the potentially deleterious effect of hypohydration on endurance performance. Using a randomized crossover protocol, ten volunteers (23 years, V˙O_2max: 54 mL∙kg^-1∙min^-1) completed two 4-week training blocks interspersed by a 5-week washout period. During one block, participants replaced all fluid losses (EUH) while in the other they were fluid restricted (DEH). Participants completed three exercise sessions per week (walking/running, 55% V˙O_2max, 40 °C): (1) 1 h while fluid restricted or drinking ad libitum, (2) until 2 and (3) 4% of body mass has been lost or replaced. During the first and the fourth week of each training block, participants completed a 12 min time-trial immediately after 2% and 4% body mass loss has been reached. Exercise duration and distance completed (14.1 ± 2.7 vs. 6.9 ± 1.5 km) during the fixed-intensity exercise bouts were greater in the 4 compared to the 2% condition (p < 0.01) with no difference between DEH and EUH. During the first week, heart rate, rectal temperature and perceived exertion were higher (p < 0.05) with DEH than EUH, and training did not change these outcomes. Exercise-induced hypohydration of 2% and 4% body mass impaired time-trial performance in a practical manner both at the start and end of the training block. In conclusion, exercise-induced hypohydration of 2% and 4% body mass impairs 12 min walking/running time-trial, and repeated exposures to these hypohydration levels cannot reverse the impairment in performance.

Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running

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.

Prospective Observational Study of Weight-based Assessment of Sodium Supplements on Ultramarathon Performance (WASSUP)

BACKGROUND

Sodium supplements are ubiquitous in endurance running, but their impact on performance has been subjected to much debate. The objective of the study was to assess the effect of sodium supplementation as a weight-based predictor of race performance in ultramarathon runners.

METHODS

Prospective observational study during an 80 km (50 mi) stage of a 6-stage 250 km (155 mi) ultramarathon in Chile, Patagonia, Namibia, and Mongolia. Finish line hydration status as measured by weight change, point-of-care serum sodium, and questionnaire provided sodium ingestion categories at 33rd percentile and 66th percentile both for weight-adjusted rate and total sodium consumption, then analyzed for significant relationships to race performance, dysnatremia, and hydration.

RESULTS

Two hundred sixty-six participants were enrolled, with 217 (82%) with complete sodium supplement rate data, 174 (80%) with finish line sodium, and 161 (74%) with both pre-race weights and total sodium ingestion allowing weight-based analysis. Sodium intake ranged from 131-533 mg/h/kg (2-7.2 gm), with no statistically significant impact on pace, race time, or quintile rank. These outcomes did not change when sodium intake was analyzed as a continuous variable or by sub-group analysis of the 109 (68%) normonatremic runners. When controlled for weight-adjusted sodium intake, performance was poorly correlated with hydration (r = - 0.152, 95% CI - 0.348-0.057). Dehydrated runners outperformed those overhydrated, with 11% of top 25th percentile finishers dehydrated (versus 2.8% overhydrated), with 3.6 min/km faster pace and time 4.6 h faster finishing time.

CONCLUSIONS

No association was found between sodium supplement intake and ultramarathon performance. Dehydrated runners were found to have the best performance. This reinforces the message to avoid overhydration.

Does Hypohydration Really Impair Endurance Performance? Methodological Considerations for Interpreting Hydration Research

The impact of alterations in hydration status on human physiology and performance responses during exercise is one of the oldest research topics in sport and exercise nutrition. This body of work has mainly focussed on the impact of reduced body water stores (i.e. hypohydration) on these outcomes, on the whole demonstrating that hypohydration impairs endurance performance, likely via detrimental effects on a number of physiological functions. However, an important consideration, that has received little attention, is the methods that have traditionally been used to investigate how hypohydration affects exercise outcomes, as those used may confound the results of many studies. There are two main methodological limitations in much of the published literature that perhaps make the results of studies investigating performance outcomes difficult to interpret. First, subjects involved in studies are generally not blinded to the intervention taking place (i.e. they know what their hydration status is), which may introduce expectancy effects. Second, most of the methods used to induce hypohydration are both uncomfortable and unfamiliar to the subjects, meaning that alterations in performance may be caused by this discomfort, rather than hypohydration per se. This review discusses these methodological considerations and provides an overview of the small body of recent work that has attempted to correct some of these methodological issues. On balance, these recent blinded hydration studies suggest hypohydration equivalent to 2–3% body mass decreases endurance cycling performance in the heat, at least when no/little fluid is ingested.

Ultra-triathlon-Pacing, performance trends, the role of nationality, and sex differences in finishers and non-finishers

Ultra-triathlons are defined as triathlons longer than the traditional Ironman distance and became more popular in the last two decades; however, scarce scientific evidence of these events are available. Therefore, we aimed to investigate the trends of performance, pacing, nationality, sex differences, and rate of non-finishers in ultra-triathlons. Data from 1985 to 2018 were collected including Double Iron, Triple Iron, Quintuple Iron, and Deca Iron ultra-triathlons. Different pacing patterns by event and sex were observed (P < .05); athletes spent less %time in swimming and cycling, and more %time in running as the distance of event was longer; women spent more %time in cycling and less% time in running in Double and Triple. Performance analysis showed a negative trend over time for men and women since 1985. Switzerland, France, and Germany were the fastest nations in ultra-triathlons. The frequency of North Americans competing in Europe was very low (<5%), whereas Europeans often competed in North America (~25%). The rate of non-finishers between sexes was similar in all races with the exception of Deca Iron ultra-triathlon, which was much greater (~20%) for women. Non-finishers had slower race times in swimming and cycling splits than finishers. In conclusion, ultra-triathletes should redistribute their energy among swimming, cycling, and running depending on their sex and distance of race. Performance in ultra-triathlons has been decreasing in men and women over the years, but sex difference in performance remained. Europeans were the fastest ultra-triathletes and compete in Europe and North America. Additionally, non-finishers were slower swimmers and cyclists than finishers.

Changes in Triathletes' Performance and Body Composition During a Specific Training Period for a Half-Ironman Race

The number of recreational athletes completing a Half-Ironman triathlon has increased exponentially in recent years. However, there is a lack of research on how to train for this kind of an event. The purpose of this study was thus to analyse triathletes’ changes in performance and body composition following a triathlon-specific training period. Fourteen male amateur triathletes completed a 7-week period of general training and a 13-week period of specific training for a Half-Ironman triathlon. Anthropometric measures and performance tests were carried out to assess the effects of the specific training program. Results showed that the pre-test value of VO_2max for cycling was inversely correlated not only with the percentage of change in cycling performance, but also with the percentage change in several variables of running performance. In swimming, inverse correlations were observed between the time of the first 800 m test and the time percentage change for this test, but not with the percentage change in the performance of other segments of the race. Moreover, the somatotype component of endomorphy and the fat mass percentage of the first anthropometry were highly correlated with the percentage change in VO_2max in the run segment. These results highlight the importance of providing individualised training, considering that the same training program had a different impact on recreational triathletes belonging to the same group. Amateur athletes with higher initial performance levels probably need a greater amount of training to achieve improved adaptation.

Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review

Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110-115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon-Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).

[Exercise-Associated Hyponatremia in Endurance Performance]

Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.

The ergogenic potency of carbohydrate mouth rinse on endurance running performance of dehydrated athletes

PURPOSE

To examine the effect of carbohydrate (CHO) mouth rinsing on endurance running responses and performance in dehydrated individuals.

METHODS

In a double blind, randomised crossover design, 12 well-trained male runners completed 4 running time to exhaustion (TTE) trials at a speed equivalent to 70% of VO_2peak in a thermoneutral condition. Throughout each run, participants mouth rinsed and expectorated every 15 min either 25 mL of 6% CHO or a placebo (PLA) solution for 10 s. The four TTEs consisted of two trials in the euhydrated (EU-CHO and EU-PLA) and two trials in the dehydrated (DY-CHO and DY-PLA) state. Prior to each TTE run, participants were dehydrated via exercise and allowed a passive rest period during which they were fed and either rehydrated equivalent to their body mass deficit (i.e., EU trials) or ingested only 50 mL of water (DY trials).

RESULTS

CHO mouth rinsing significantly improved TTE performance in the DY compared to the EU trials (78.2 ± 4.3 vs. 76.9 ± 3.8 min, P = 0.02). The arousal level of the runners was significantly higher in the DY compared to the EU trials (P = 0.02). There was no significant difference among trials in heart rate, plasma glucose and lactate, and psychological measures.

CONCLUSIONS

CHO mouth rinsing enhanced running performance significantly more when participants were dehydrated vs. euhydrated due to the greater sensitivity of oral receptors related to thirst and central mediated activation. These results show that level of dehydration alters the effect of brain perception with presence of CHO.

Predicted Risk for Exacerbation of Exercise-Associated Hyponatremia from Indiscriminate Postrace Intravenous Hydration of Ultramarathon Runners

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.

Bioelectrical Impedance Vector Analysis (BIVA) and Body Mass Changes in an Ultra-Endurance Triathlon Event

This study aimed to provide the first description of the whole-body bioimpedance vector of nine non-professional triathletes, and to assess body mass (BM) and vector variations evoked by an ultra-endurance triathlon event. Anthropometric and bioelectrical assessments were performed before (PRE), after (POST), and 48 hours following the race (POST48h). Bioimpedance vector analysis (BIVA) showed triathletes' vectors placed to the left of the major axis and mostly outside the 50% tolerance ellipse of the reference population. Vector migration in POST indicated dehydration, paralleled by a decrease in BM (p = 0.0001). Increased hydration status from POST to POST48h was suggested by a reversed vector migration and increased BM (p = 0.0001). Compared to PRE, POST48h values reflected fluid retention by changes in BIVA, while BM was still lower (p = 0.0001). Racing time was positively related to basal resistance -R/h- (r = 0.68; p = 0.04) and bioimpedance -Z/h- (r = 0.68; p = 0.045). Besides, basal R/h and Z/h were positively related to PRE-to-POST changes of R/h and Z/h (r = 0.80; p = 0.009). PRE-to-POST changes of R/h and Z/h were positively related to racing time (r = 0.80, p = 0.01) and internal workload (r = 0.80, p ≤ 0.02). Notwithstanding the lack of significant correlation between BM and bioelectrical parameters, the vector's behavior was explained from a multifactorial perspective (including BM variations) by using multiple regression analysis. On the other hand, BM changes were not related to racing time, internal workload or energy deficit (ranges: r = - 0.46 to 0.65; p = 0.06 to 0.98). In conclusion, these triathletes exhibit a specific bioelectrical distribution. Furthermore, vector migration was consistent with fluid loss induced by the event. Finally, vector analysis seems to provide additional information about hydration changes 48h after the event in comparison with BM alone.

Considerations for ultra-endurance activities: part 2 - hydration

It is not unusual for those participating in ultra-endurance (> 4 hr) events to develop varying degrees of either hypohydration or hyperhydration. Yet, it is important for ultra-endurance athletes to avoid the performance limiting and potentially fatal consequences of these conditions. During short periods of exercise (< 1 hr), trivial effects on the relationship between body mass change and hydration status result from body mass loss due to oxidation of endogenous fuel stores, and water supporting the intravascular volume being generated from endogenous fuel oxidation and released with glycogen oxidation. However, these effects have meaningful implications during prolonged exercise. In fact, body mass loses well over 2% may be required during some ultra-endurance activities to avoid hyperhydration. Therefore, the typical hydration guidelines to avoid more than 2% body mass loss do not apply in ultra-endurance activities and can potentially result in hyperhydration. Fortunately, achieving the balance of proper hydration during ultra-endurance activities need not be complicated and has been well demonstrated to generally be achieved by simply drinking to thirst and avoiding excessive sodium supplementation with intention of replacing all sodium losses during the exercise.

Management of Suspected Fluid Balance Issues in Participants of Wilderness Endurance Events

Dehydration and exercise-associated hyponatremia (EAH) are both relatively common conditions during wilderness endurance events. Whereas dehydration is treated with fluids, EAH is appropriately managed with fluid restriction and a sodium bolus but can worsen with isotonic or hypotonic fluids. Therefore, caution is recommended in the provision of postevent rehydration in environments where EAH is a potential consideration because accurate field assessment of hydration status can be challenging, and measurement of blood sodium concentration is rarely possible in the wilderness. Dehydration management with oral rehydration is generally adequate and preferred to intravenous rehydration, which should be reserved for athletes with sustained orthostasis or inability to tolerate oral fluid ingestion after some rest. In situations where intravenous hydration is initiated without known blood sodium concentration or hydration status, an intravenous concentrated sodium solution should be available in the event of acute neurological deterioration consistent with the development of EAH encephalopathy.

Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons

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.

Exercise-Associated Hyponatremia: 2017 Update

Exercise-associated hyponatremia (EAH) was initially described in the 1980s in endurance athletes, and work done since then has conclusively identified that overdrinking beyond thirst and non-osmotic arginine vasopressin release are the most common etiologic factors. In recent years, EAH has been described in a broader variety of athletic events and also has been linked to the development of rhabdomyolysis. The potential role of volume and sodium depletion in a subset of athletes has also been described. This review focuses on the most recent literature in the field of EAH and summarizes key new findings in the epidemiology, pathophysiology, treatment, and prevention of this condition.

Injuries and Health Considerations in Ultramarathon Runners

Ultramarathon runners are a relatively small and unique group of distance runners with somewhat different medical issues than other distance runners. This article outlines some of those differences so that clinicians caring for these runners in the clinic or at competitions might be better prepared.

Incidence and Prevalence of Acute Kidney Injury During Multistage Ultramarathons

OBJECTIVE

Determine prevalence, incidence, and risk factors of acute kidney injury (AKI) during multistage ultramarathons.

DESIGN

Prospective observational cohort study.

SETTING

Jordanian Desert 2012; Atacama Desert, Chile 2012 and 2013; and Gobi Desert 2013 RacingThePlanet 250 km, 6-stage, ultramarathons.

PARTICIPANTS

One hundred twenty-eight participants (384 measurements) from the Jordan (25, 19.5%), Gobi (35, 27.3%), 2012 Atacama (24, 18.8%), and 2013 Atacama (44, 34.4%) races.

INTERVENTIONS

Blood samples and weights were gathered and analyzed immediately after stage 1 (40 km), 3 (120 km), and 5 (225 km).

MAIN OUTCOME MEASURES

Changes in serum creatinine (Cr), cumulative incidence, and prevalence of AKI were calculated for each stage with "risk of injury" defined as 1.5 × baseline Cr and "injury" defined as 2 × Cr.

RESULTS

Cumulative incidence of AKI was 41.4%. Stage 1 had 56 (43.8%) with risk of AKI and 24 (18.8%) with injury; in stage 3, 61 (47.7%) were at risk, 41 (32%) had injury; in stage 5, 62 (48.4%) runners were at risk and 36 (28.1%) had injury. Acute kidney injury was significantly associated with females [odds ratio (OR), 4.64; 95% confidence interval (CI), 2.07-10.37; P < 0.001], lower pack weight (OR, 0.71; 95% CI, 0.56-0.91; P < 0.007), and percentage weight loss (OR, 0.87; 95% CI, 0.78-0.97; P < 0.015). Lowest quintile of finishers was less likely to develop AKI (OR, 0.18; 95% CI, 0.04-0.78; P < 0.022).

CONCLUSIONS

Prevalence of AKI was 63%-78% during multistage ultramarathons. Female sex, lower pack weight, and greater weight loss were associated with renal impairment.

The influence of hydration state on thermoregulation during a 161-km ultramarathon

It is advised that individuals should avoid losing >2% of their body mass during exercise in order to prevent hyperthermia. This study sought to assess whether a loss of >2% body mass leads to elevations in core temperature during an ultramarathon. Thirty runners agreed to take part in the study. Body mass and core temperature were measured at the start, at three locations during the race and the finish. Core temperature was not correlated with percent body mass change (p = 0.19) or finish time (p = 0.11). Percent body mass change was directly associated with finish time (r = 0.58, p < 0.01), such that the fastest runners lost the most mass (~3.5-4.0%). It appears that a loss of >3% body mass does not contribute to rises in core temperature. An emphasis on fluid replacement for body mass losses of this magnitude during prolonged exercise is not justified as a preventative measure for heat-related illnesses.

Selected human physiological responses during extreme heat: the Badwater Ultramarathon

The purpose of this article was to examine various physiological responses during an ultramarathon held in extreme heat. Our investigation was conducted at The Badwater Ultramarathon, a nonstop 217-km run across Death Valley, CA, USA. This study recruited 4 male athletes, average age of 43 (±SD) (±7.35), (range) 39-54 years. All 4 subjects successfully completed the race with a mean finish time of 36:20:23 hours (±SD) (±3:08:38) (range) 34:05:25-40:51:46 hours, and a mean running speed of 6.03 km·h(-1) (±SD) (±0.05), (range) 5.3-6.4 km·h(-1). The anthropometric variables measured were (mean, ±SD) mass 79.33 kg (±6.43), height 1.80 m (±0.09), body surface area 1.93 m2 (±0.16), body mass index 24.38 kg·m(-2) (±1.25), fat mass 13.88% (±2.29), and body water 62.08% (±1.56). Selected physiological variables measured were core body temperature, skin temperature, heart rate, breathing rate, and blood pressure. Rate of perceived intensity, rate of thermal sensation, and environmental factors were also monitored. Our study found (mean and ±SD) core body temperature 37.49° C (±0.88); skin temperature 31.13° C (±3.06); heart rate 106.79 b·min(-1) (±5.11); breathing rate 36.55 b·min(-1) (±0.60); blood pressure 128/86 mm Hg (±9.24/4.62); rate of perceived intensity 5.49 (±1.26); rate of thermal sensation 4.69 (±0.37); daytime high temperature of 46.6° C, and a mean temperature of 28.35° C. Our fastest finisher demonstrated a lower overall core body temperature (36.91° C) when compared with the group mean (37.49° C). In contrast to previous findings, our data show that the fastest finisher demonstrates a lower overall core body temperature. We conclude that it may be possible that a time threshold exists whereby success in longer duration events requires an ability to maintain a lower core body temperature vs. tolerating a higher core body temperature.

Effects of G-trainer, cycle ergometry, and stretching on physiological and psychological recovery from endurance exercise

The purpose of this study was to compare the effectiveness of 3 treatment modes (Anti-Gravity Treadmill [G-trainer], stationary cycling [CompuTrainer], and static stretching) on the physiological and psychological recovery after an acute bout of exhaustive exercise. In a crossover design, 12 aerobically trained men (21.3 ± 2.3 years, 72.1 ± 8.1 kg, 178.4 ± 6.3 cm, (Equation is included in full-text article.): 53.7 ± 6.3 ml·kg·min) completed a 29-km stationary cycling time trial. Immediately after the time trial, subjects completed 30 minutes of G-trainer or CompuTrainer (40% (Equation is included in full-text article.)) or static stretching exercises. A significant time effect was detected for plasma lactate (p = 0.010) and serum cortisol (p = 0.039) after exercise. No treatment or treatment by time interaction was identified for lactate or cortisol, respectively. No main effects for time, treatment, or treatment by time interaction were identified for interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α). No differences were observed among treatments in skeletal muscle peak power output, mean power output, time to peak power, and rate to fatigue at 24 hours postexercise bout. Finally, no significant changes in mood status were observed after exercise and between treatment groups. When compared with stationary cycling and static stretching, exercise recovery performed on the G-trainer was unable to reduce systemic markers of stress and inflammation, blood lactate, or improve anaerobic performance and psychological mood states after an exhaustive bout of endurance exercise. Further research is warranted that includes individualized recovery modalities to create balances between the stresses of training and competition.

Wilderness Medical Society practice guidelines for the prevention and treatment of heat-related illness: 2014 update

The Wilderness Medical Society (WMS) convened an expert panel to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures as well as best practice recommendations for both field and hospital-based therapeutic management of heat illness. These recommendations are graded on the basis of the quality of supporting evidence, and balance between the benefits and risks or burdens for each modality. This is an updated version of the original WMS Practice Guidelines for the Prevention and Treatment of Heat-Related Illness published in Wilderness & Environmental Medicine 2013;24(4):351-361.

Body Weight, Serum Sodium Levels, and Renal Function in an Ultra-Distance Mountain Run

OBJECTIVE

To determine body weight and serum [Na] changes in runners completing an 85-km mountain run, particularly with reference to their "in-race" hydration protocols.

DESIGN

Prospective observational cohort study.

SETTING

Cradle Mountain Run, Tasmania, Australia, February 2011.

PARTICIPANTS

Forty-four runners (86% of starters) prospectively enrolled, with 41 runners (80% of starters) eligible for inclusion in final data set.

MAIN OUTCOME MEASURES

Body weight change, serum sodium concentration change, and hydration plan (according to thirst vs preplanned fluid consumption).

RESULTS

There was 1 case of exercise-associated hyponatremia (EAH) [postrace [Na], 132 mmol/L]. This runner was asymptomatic. There was a strongly significant correlation between the change in serum [Na] and body weight change during the race. There was a significant inverse correlation between serum [Na] and volume of fluid consumed. Change of serum [Na] was not correlated with the proportion of water versus electrolyte drink consumed. Runners drinking to thirst consumed significantly lower average fluid volumes and had higher postrace serum [Na] than those complying with a preplanned hydration protocol (142 mmol/L vs 139 mmol/L). More experienced runners tended to drink to thirst.

CONCLUSIONS

There was a 2% incidence of EAH in this study. Serum [Na] change during an 85-km mountain run was inversely correlated with the volume of fluid consumed. The results provide further evidence that EAH is a dilutional hyponatremia caused by excessive consumption of hypotonic fluids. Drinking to thirst represents a safe hydration strategy for runners in a wilderness environment.

CLINICAL RELEVANCE

Drinking to thirst during endurance running events should be promoted as a safe hydration practice.

Hydration and thermoregulation during a half-ironman performed in tropical climate

The aim of this study was to compare the core temperature (TC) and markers of hydration status in athletes performing a half Ironman triathlon race in hot and humid conditions (27.2 ± 0.5°C, relative humidity was 80 ± 2%). Before and immediately after the 2012 Guadeloupe half Ironman triathlon, body mass and urine osmolarity (mean ± SD) were measured in 19 well-trained male triathletes. TC was measured before and after the race, and at each transition during the event, using an ingestible pill telemetry system. Ambient temperature and heart rate (HR) were measured throughout the race. Mean ± SD performance time was 331 ± 36 minutes and HR was 147 ± 16 beats·min(-1). Wet bulb globe temperature (WBGT) averaged 25.4 ± 1.0°C and ocean temperature was 29.5°C. The average TC at the beginning of the race (TC1) was 37.1 ± 0.7°C; it was 37.8 ± 0.9°C after swimming (TC2), 37.8 ± 1.0°C after cycling (TC3), and (TC4) 38.4 ± 0.7°C after running. Body mass significantly declined during the race by 3.7 ± 1.9 kg (4.8 ± 2.4%; p < 0.05), whereas urine osmolarity significantly increased from 491.6 ± 300.6 to 557.9 ± 207.9 mosm·L(-1) (p < 0.05). Changes in body mass were not related to finishing TC or urine osmolarity. Ad libitum fluid intake appears applicable to athletes acclimatized to tropical climate, when performing a half Ironman triathlon in a warm and humid environment. Key pointsAd libitum fluid intake appears applicable to athletes acclimatized to tropical climate when performing a half Ironman triathlon in a warm and humid environment.The final core temperature average was 38.8 ± 0.7ºC after the event in these triathletes and the athletes showed no evidence of heat illness while competing in a warm and humid environment.Core temperature was dependent on both activity and anthropometry.

Energy balance of triathletes during an ultra-endurance event

The nutritional strategy during an ultra-endurance triathlon (UET) is one of the main concerns of athletes competing in such events. The purpose of this study is to provide a proper characterization of the energy and fluid intake during real competition in male triathletes during a complete UET and to estimate the energy expenditure (EE) and the fluid balance through the race.

METHODS

Eleven triathletes performed a UET. All food and drinks ingested during the race were weighed and recorded in order to assess the energy intake (EI) during the race. The EE was estimated from heart rate (HR) recordings during the race, using the individual HR-oxygen uptake (Vo2) regressions developed from three incremental tests on the 50-m swimming pool, cycle ergometer, and running treadmill. Additionally, body mass (BM), total body water (TBW) and intracellular (ICW) and extracellular water (ECW) were assessed before and after the race using a multifrequency bioimpedance device (BIA).

RESULTS

Mean competition time and HR was 755 ± 69 min and 137 ± 6 beats/min, respectively. Mean EI was 3643 ± 1219 kcal and the estimated EE was 11,009 ± 664 kcal. Consequently, athletes showed an energy deficit of 7365 ± 1286 kcal (66.9% ± 11.7%). BM decreased significantly after the race and significant losses of TBW were found. Such losses were more related to a reduction of extracellular fluids than intracellular fluids.

CONCLUSIONS

Our results confirm the high energy demands of UET races, which are not compensated by nutrient and fluid intake, resulting in a large energy deficit.

A variant within the AQP1 3'-untranslated region is associated with running performance, but not weight changes, during an Ironman Triathlon

The objective of this study was to test the association of the rs1049305 (G > C) variant within the 3'-untranslated region of the aquaporin 1 gene, AQP1, with changes in body weight, post-race serum sodium concentration and performance in Ironman triathletes. Five hundred and four male Ironman triathletes were genotyped for the rs1049305 variant within the AQP1 gene. Change in pre- and post-race body weight was calculated for 470 triathletes and used as a proxy for changes in body fluid during the race, as well as to divide triathletes into biologically relevant weight-loss groups (0-3%, 3-5% and >5%). There were no rs1049305 genotype effects on post-race serum sodium concentrations (P = 0.647), pre-race weight (P = 0.610) nor relative weight change during the Ironman Triathlons (P = 0.705). In addition, there were no significant differences in genotype (P = 0.640) nor allele (P = 0.643) distributions between the weight loss groups. However, triathletes who carry a C-allele were found to complete the 42.2-km run stage faster (mean 286, s = 49 min) than triathletes with a GG genotype (mean 296, s = 47 min; P = 0.032). The AQP1 rs1049305 variant is associated with running performance, but not relative body weight change, during the 2000, 2001 and 2006 South African Ironman Triathlons.

The impact of triathlon training and racing on athletes' general health

Although the sport of triathlon provides an opportunity to research the effect of multi-disciplinary exercise on health across the lifespan, much remains to be done. The literature has failed to consistently or adequately report subject age group, sex, ability level, and/or event-distance specialization. The demands of training and racing are relatively unquantified. Multiple definitions and reporting methods for injury and illness have been implemented. In general, risk factors for maladaptation have not been well-described. The data thus far collected indicate that the sport of triathlon is relatively safe for the well-prepared, well-supplied athlete. Most injuries 'causing cessation or reduction of training or seeking of medical aid' are not serious. However, as the extent to which they recur may be high and is undocumented, injury outcome is unclear. The sudden death rate for competition is 1.5 (0.9-2.5) [mostly swim-related] occurrences for every 100,000 participations. The sudden death rate is unknown for training, although stroke risk may be increased, in the long-term, in genetically susceptible athletes. During heavy training and up to 5 days post-competition, host protection against pathogens may also be compromised. The incidence of illness seems low, but its outcome is unclear. More prospective investigation of the immunological, oxidative stress-related and cardiovascular effects of triathlon training and competition is warranted. Training diaries may prove to be a promising method of monitoring negative adaptation and its potential risk factors. More longitudinal, medical-tent-based studies of the aetiology and treatment demands of race-related injury and illness are needed.

Physiopathological, Epidemiological, Clinical and Therapeutic Aspects of Exercise-Associated Hyponatremia

Exercise-associated hyponatremia (EAH) is dilutional hyponatremia, a variant of inappropriate antidiuretic hormone secretion (SIADH), characterized by a plasma concentration of sodium lower than 135 mEq/L. The prevalence of EAH is common in endurance (<6 hours) and ultra-endurance events (>6 hours in duration), in which both athletes and medical providers need to be aware of risk factors, symptom presentation, and management. The development of EAH is a combination of excessive water intake, inadequate suppression of the secretion of the antidiuretic hormone (ADH) (due to non osmotic stimuli), long race duration, and very high or very low ambient temperatures. Additional risk factors include female gender, slower race times, and use of nonsteroidal anti-inflammatory drugs. Signs and symptoms of EAH include nausea, vomiting, confusion, headache and seizures; it may result in severe clinical conditions associated with pulmonary and cerebral edema, respiratory failure and death. A rapid diagnosis and appropriate treatment with a hypertonic saline solution is essential in the severe form to ensure a positive outcome.

Relationship between physiological parameters and performance during a half-ironman triathlon in the heat

Triathlon is a popular outdoor endurance sport performed under a variety of environmental conditions. The aim of this study was to assess physiological variables before and after a half-ironman triathlon in the heat and to analyse their relationship with performance. Thirty-four well-trained triathletes completed a half-ironman triathlon in a mean dry temperature of 29 ± 3ºC. Before and within 1 min after the end of the race, body mass, core temperature, maximal jump height and venous blood samples were obtained. Mean race time was 315 ± 40 min, with swimming (11 ± 1%), cycling (49 ± 2%) and running (40 ± 3%) representing different amounts of the total race time. At the end of the competition, body mass changed by -3.8 ± 1.6% and the change in body mass correlated positively with race time (r = 0.64; P < 0.001). Core temperature increased from 37.5 ± 0.6ºC to 38.8 ± 0.7ºC (P < 0.001) and post-race core temperature correlated negatively with race time (r = -0.47; P = 0.007). Race time correlated positively with the decrease in jump height (r = 0.38; P = 0.043), post-race serum creatine kinase (r = 0.55; P = 0.001) and myoglobin concentrations (r = 0.39; P = 0.022). In a half-ironman triathlon in the heat, greater reductions in body mass and higher post-competition core temperatures were present in faster triathletes. In contrast, slower triathletes presented higher levels of muscle damage and decreased muscle performance.

Analysis of weight change and Borg rating of perceived exertion as measurements of runner health and safety during a 6-day, multistage, remote ultramarathon

OBJECTIVE

To determine the feasibility of using weight change and Borg score as tools for monitoring runner health and safety during a multistage, remote ultramarathon.

DESIGN

Observational cohort study of feasibility on nonblinded event participants.

SETTING

Six-day, multistage, remote ultramarathon in Utah.

PARTICIPANTS

Twenty-seven athletes in the 2012 Desert R.A.T.S. (Race Across the Sand) ultramarathon.

ASSESSMENT OF RISK FACTORS

Participant weight, health conditions that limited race participation, such as fatigue or exhaustion, and Borg score were reviewed.

MAIN OUTCOME MEASURES

Inability to complete a stage of the race (Did Not Finish status) or development of a clinically significant health condition during the race. Potential prognostic risk factors, such as a high Borg score and weight loss, were analyzed.

RESULTS

An overall decrease in weight was observed over the course of the event. Median percent weight changes were losses of 2.96% (day 1), 7.42% (day 2), 2.21% (day 4), and 3.35% (day 6). There was no statistically significant difference in percent weight change between the 14 runners who finished the race and the 13 runners who did not finish the race (U = 73; z = 0.189; P = 0.85). Runners' ability to complete the race was related to the development of adverse health conditions (P = 0.004). Median Borg scores reported were 15 (day 1), 17 (day 2), 13 (day 3), 16 (day 4), and 15 (day 6). Only 2 racers who finished the entire event without adverse events ever gave a Borg score of ≥ 18.

CONCLUSIONS

The feasibility of weight change as a tool for monitoring runner health and safety in this setting is limited, but the Borg rating of perceived exertion warrants further study as a potential field expedient tool for monitoring runner health and safety during a multiday, remote ultramarathon.

Repeated familiarisation with hypohydration attenuates the performance decrement caused by hypohydration during treadmill running

This study examined the effect of repeated familiarisation to hypohydration on hypohydrated exercise performance. After familiarisation with the exercise protocol, 10 recreationally active males completed a euhydrated (EU-pre) and hypohydrated (HYPO-pre) trial, which involved a 45-min steady state run at 75% peak oxygen uptake (45SS) followed by a 5-km time trial (TT). Euhydration and hypohydration were induced by manipulating fluid intake in the 24-h pre-exercise and during the 45SS. Subjects then completed 4 habituation sessions that involved replication of the HYPO-pre trial, except they completed 60 min of running at 75% peak oxygen uptake and no TT. Subjects then replicated the euhydrated (EU-post) and hypohydrated (HYPO-post) trials. Body mass loss pre-TT was 0.2 (0.2)% (EU-pre), 2.4 (0.3)% (HYPO-pre), 0.1 (0.1)% (EU-post), and 2.4 (0.3)% (HYPO-post). TT performance was 5.8 (2.4)% slower during the HYPO-pre trial (1459 (250) s) than during the EU-pre trial (1381 (237) s) (p < 0.01), but only 1.2 (1.6)% slower during the HYPO-post trial (1381 (200) s) than during the EU-post trial (1366 (211) s) (p = 0.064). TT performance was not different between EU-pre and EU-post trials, but was 5.1 (2.3)% faster during the HYPO-post trial than the HYPO-pre trial (p < 0.01). Heart rate was greater during HYPO trials than EU trials (p < 0.001), whilst rating of perceived exertion (RPE) response was similar to TT time and was lower in the HYPO-post trial than the HYPO-pre trial (p < 0.01). In conclusion, hypohydration impaired 5-km running performance in subjects unfamiliar with the hypohydration protocol, but 4 familiarisation sessions designed to habituate subjects with the hypohydration protocol attenuated the performance decrement, seemingly via an attenuation of RPE during hypohydrated exercise.

Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners

PURPOSE

This work combines and reanalyzes 5 yr of exercise-associated hyponatremia (EAH) research at 161-km ultramarathons in northern California with primary purposes to define the relationship between postrace blood sodium concentration ([Na]) and change in body weight; to examine the interactions among EAH incidence, ambient temperature, and hydration state; and to explore the effect of hydration status on performance.

METHODS

Prerace and postrace body weight and finish time data were obtained on 887 finishers, and postrace [Na] was also obtained on a subset of 669 finishers.

RESULTS

EAH incidence was 15.1% overall (range, 4.6%-51.0% by year) and had a significant positive relationship with ambient temperature. Of the runners with EAH, 23.8% were classified as overhydrated (weight change, ≥0), 40.6% were euhydrated (weight change, <0% to -3%), and 35.6% were dehydrated (weight change, <-3%) at the finish. There was a weak significant relationship (r = 0.17, P < 0.0001) between postrace [Na] and change in body weight such that a lower [Na] was more common with increased weight loss. Considering all finishers examined, 18.5% were dehydrated and 34.9% were overhydrated at the finish. There was a weak significant relationship (r = 0.092, P = 0.006) between change in body weight and performance in that faster runners tended to lose more weight. Top finishers varied in body weight change from ∼1% gain to ∼6% loss.

CONCLUSIONS

EAH incidence can be high in 161-km ultramarathons in northern California. In this environment, EAH is more common with dehydration than overhydration and is more common in hotter ambient temperature conditions. Because weight loss >3% does not seem to have an adverse effect on performance, excessive sodium supplementation and aggressive fluid ingestion beyond the dictates of thirst are ill advised.