Acute changes to biomarkers as a consequence of prolonged strenuous running

Arterial function in response to a 50 km ultramarathon in recreational athletes

This study was performed to determine whether prolonged endurance running results in acute endothelial dysfunction and wave-reflection, as endothelial dysfunction and arterial stiffness are cardiovascular risk factors. Vascular function (conduit artery/macrovascular and resistance artery/microvascular) was assessed in 11 experienced runners (8 males, 3 females) before, during and after a 50 km ultramarathon. Blood pressure (BP), heart rate (HR), wave reflection, augmentation index (AIx) and AIx corrected for HR (AIx75) were taken at all time points-Baseline (BL), following 10, 20, 30 and 40 km, 1 h post-completion (1HP) and 24 h post-completion (24HP). Flow-mediated dilatation (FMD) and inflammatory biomarkers were examined at BL, 1HP and 24HP. Reactive hyperaemia area under the curve (AUC) and shear rate AUC to peak dilatation were lower (∼75%) at 1HP compared with BL (P < 0.001 for both) and reactive hyperaemia was higher at 24HP (∼27%) compared with BL (P = 0.018). Compared to BL, both mean central systolic BP and mean central diastolic BP were 7% and 10% higher, respectively, following 10 km and 6% and 9% higher, respectively, following 20 km, and then decreased by 5% and 8%, respectively, at 24HP (P < 0.05 for all). AIx (%) decreased following 20 km and following 40 km compared with BL (P < 0.05 for both) but increased following 40 km when corrected for HR (AIx75) compared with BL (P = 0.02). Forward wave amplitude significantly increased at 10 km (15%) compared with BL (P = 0.049), whereas backward wave reflection and reflected magnitude were similar at all time points. FMD and baseline diameter remained similar. These data indicate preservation of macrovascular (endothelial) function, but not microvascular function resulting from the 50 km ultramarathon.

Effects of Passive or Active Recovery Regimes Applied During Long-Term Interval Training on Physical Fitness in Healthy Trained and Untrained Individuals: A Systematic Review

BACKGROUND

Intermittent exercise programs characterized through intensive exercise bouts alternated with passive or active recovery (i.e., interval training), have been proven to enhance measures of cardiorespiratory fitness. However, it is unresolved which recovery type (active or passive) applied during interval training results in larger performance improvements.

OBJECTIVES

This systematic review aimed to summarize recent evidence on the effects of passive or active recovery following long-term interval exercise training on measures of physical fitness and physiological adaptations in healthy trained and untrained individuals. The study protocol was registered in the Open Science Framework (OSF) platform ( https://doi.org/10.17605/OSF.IO/9BUEY ).

METHODS

We searched nine databases including the grey literature (Academic Search Elite, CINAHL, ERIC, Open Access Theses and Dissertations, Open Dissertations, PsycINFO, PubMed/MEDLINE, Scopus, and SPORTDiscus) from inception until February 2023. Key terms as high-intensity interval training, recovery mode, passive or active recover were used. A systematic review rather than a meta-analysis was performed, as a large number of outcome parameters would have produced substantial heterogeneity.

RESULTS

After screening titles, abstracts, and full texts, 24 studies were eligible for inclusion in our final analysis. Thirteen studies examined the effects of interval training interspersed with passive recovery regimes on physical fitness and physiological responses in trained (6 studies) and untrained (7 studies) individuals. Eleven out of 13 studies reported significant improvements in physical fitness (e.g., maximal aerobic velocity (MAV), Yo-Yo running test, jump performance) and physiological parameters (e.g., maximal oxygen uptake [VO2max], lactate threshold, blood pressure) in trained (effect sizes from single studies: 0.13 < Cohen's d < 3.27, small to very large) and untrained individuals (effect sizes: 0.17 < d < 4.19, small to very large) despite the type of interval training or exercise dosage (frequency, intensity, time, type). Two studies were identified that examined the effects of passive recovery applied during interval training in young female basketball (15.1 ± 1.1 years) and male soccer players (14.2 ± 0.5 years). Both studies showed positive effects of passive recovery on VO2max, countermovement jump performance, and the Yo-Yo running test. Eleven studies examined the effects of interval training interspersed with active recovery methods on physical fitness and physiological parameters in trained (6 studies) and untrained individuals (5 studies). Despite the type of interval training or exercise dosage, nine out of eleven studies reported significant increases in measures of physical fitness (e.g., MAV) and physiological parameters (e.g., VO2max, blood pressures) in trained (effect sizes from single studies: 0.13 < d < 1.29, small to very large) and untrained individuals (effect sizes: 0.19 < d < 3.29, small to very large). There was no study available that examined the effects of active recovery on physical fitness and physiological responses in youth.

CONCLUSIONS

The results of this systematic review show that interval training interspersed with active or passive recovery regimes have the potential to improve measures of physical fitness and physiology outcomes in trained and untrained adults and trained youth. That is, the applied recovery type seems not to affect the outcomes. Nonetheless, more research is needed on the effects of recovery type on measures of physical fitness and physiological adaptations in youth.

Ubiquinol Short-Term Supplementation Prior to Strenuous Exercise Improves Physical Performance and Diminishes Muscle Damage

The benefits of physical exercise on health are diminished when it is non-planned, strenuous, or vigorous, which causes an increase in oxygen consumption and production of free radicals, particularly serious at the muscular level. Ubiquinol could help achieve an antioxidant, anti-inflammatory, and ergogenic effect. The aim of this study is to evaluate whether a supplementation of ubiquinol during a short period could have a positive effect on muscle aggression, physical performance, and fatigue perception in non-elite athletes after high intensity circuit weight training. One hundred healthy and well-trained men, (firemen of the Fire Department of Granada) were enrolled in a placebo-controlled, double-blinded, and randomized study, and separated into two groups: the placebo group (PG, n = 50); and the ubiquinol group (UG, n = 50), supplemented with an oral dose. Before and after the intervention, data related to the number of repetitions, muscle strength, and perceived exertion, as well as blood samples were collected. An increase was observed in the UG regarding average load and repetitions, revealing an improvement in muscle performance. Ubiquinol supplementation also reduced muscle damage markers, showing a protective effect on muscle fibers. Therefore, this study provides evidence that ubiquinol supplementation improves muscle performance and prevents muscle damage after strenuous exercise in a population of well-trained individuals who are not elite athletes.

Can Skin Temperature Be Altered After Different Magnitudes of Eccentric Exercise-Induced Muscle Damage?

Purpose: This study aimed to assess skin temperature (Tsk) changes after different magnitudes of exercise-induced muscle damage (EIMD) of the elbow flexor muscles and investigate whether Tsk is related to indirect markers of EIMD. Methods: Thirty healthy active men were randomly allocated to the mild (MiDG) (n = 15) or moderate (MoDG) (n = 15) muscle damage group. Muscle damage in elbow flexor muscles was induced by 10 (for MiDG) or 30 (for MoDG) maximal eccentric isokinetic contractions at 60 degrees/s. Tsk, maximal voluntary isometric contraction (MVIC), delayed-onset muscle soreness (DOMS), plasma creatine kinase (CK) activity, range of motion (ROM), and pressure pain threshold (PPT) were measured before and up to 72 hr after EIMD. Results: Tsk increased only immediately after EIMD (p < .05; f = 1.44) in the MoDG (4.2%) and MiDG (4.6%), returning to near baseline values 30 min after EIMD and remaining so thereafter. In addition, there was no intergroup difference (p > .05) at any of the times analyzed, or correlation between Tsk and most indirect markers of EIMD. Conclusions: In conclusion, Tsk should not be considered an indirect marker of mild or moderate muscle damage in active men, since alterations in this variable last less than 30 min after damaging exercise and showed no correlation with most indirect markers of EIMD.

Effects of medium- and long-distance running on cardiac damage markers in amateur runners: a systematic review, meta-analysis, and metaregression

BACKGROUND

To finish an endurance race, athletes perform a vigorous effort that induces the release of cardiac damage markers. There are several factors that can affect the total number of these markers, so the aim of this review was to analyze the effect of endurance running races on cardiac damage markers and to identify the factors that modify the levels of segregation of these cardiac damage markers.

METHODS

A systematic search of PubMed, Web of Science, and the Cochrane Library databases was performed. This analysis included studies where the acute effects of running races on cardiac damage markers (troponin I and troponin T) were analyzed, assessing the levels of these markers before and after the races.

RESULTS

The effects of running races on troponin I (mean difference = 0.0381 ng/mL) and troponin T (mean difference = 0.0256 ng/mL) levels were significant. The ages (R² = 14.4%, p = 0.033) and body mass indexes (R² = 14.5%, p = 0.045) of the athletes had a significant interaction with troponin I. In addition, gender, mean speed, time to finish the race, and type of race can affect the level of cardiac damage markers.

CONCLUSION

Endurance running races induce the release of cardiac-damage markers that remain elevated for at least 24 h after the races. In addition, young male athletes with high body mass indexes who perform races combining long duration and moderate intensity (i.e., marathons) release the highest levels of cardiac damage markers. Physicians should take into consideration these results in the diagnosis and treatment of patients admitted to the hospital days after finishing endurance running races.

Altered GDF15 and FGF21 Levels in Response to Strenuous Exercise: A Study in Marathon Runners

Background

Recreational marathon runners face strong physiological challenges. Assessment of potential biomarkers for the biological responses of runners will help to discriminate individual race responsiveness and their physiological consequences. This study sought to analyze the changes in the plasma levels of GDF15 and FGF21, novel endocrine factors related to metabolic stress, in runners following the strenuous exercise of a marathon race.

Methods

Blood samples were obtained from eighteen male runners (mean ±SD, age: 41.7 ±5.0 years, BMI: 23.6 ± 1.8) 48 h before, immediately after, and 48 h after a marathon race, and from age-matched sedentary individuals. The level of GDF15, FGF21, and 38 additional biochemical and hematological parameters were determined.

Results

The basal levels of GDF15 and FGF21 did not differ between runners before the race and sedentary individuals. Significant increases in the mean levels of GDF15 (4.2-fold) and FGF21 (20-fold) were found in runners immediately after the race. The magnitudes of these increases differed markedly among individuals and did not correlate with each other. The GDF15 and FGF21 levels had returned to the basal level 48 h post-race. The post-race value of GDF15 (but not FGF21) correlated positively with increased total white cell count (r = 0.50, P = 0.01) and neutrophilia (r = 0.10, P = 0.01).

Conclusion

GDF15 and FGF21 are transiently increased in runners following a marathon race. The induction of GDF15 levels is associated with alterations in circulating immune cells levels.

The effect of long-term ultra-endurance exercise and SOD2 genotype on telomere shortening with age

Habitual ultra-endurance exercise seems to promote telomere length maintenance, especially at older ages. In addition, the beneficial effect of ultra-endurance training on biological aging is higher in ultra-trail runners who have been engaged to ultra-endurance training during many years. Finally, and for the first time, this study shows that the SOD2 rs4880 polymorphism has a significant impact on telomere length, as well as on acute inflammatory response to a 107-km trail race.

A Primer on Running for the Orthopaedic Surgeon

Long-distance running has become increasingly popular during the past decades. Many running patients pose questions to their orthopaedic surgeons regarding risks, benefits, and running techniques. This article identifies 11 running-related questions that patients may ask and provides information to help answer those questions. This review discusses data on the health benefits of running, common running injuries, the relationship between running and osteoarthritis, recommendations regarding running after orthopaedic surgery, running shoes, and other questions that may arise when treating the running athlete.

Effect of a Marathon on Skin Temperature Response After a Cold-Stress Test and Its Relationship With Perceptive, Performance, and Oxidative-Stress Biomarkers

CONTEXT

Although skin-temperature assessment has received much attention in recent years as a possible internal-load measurement, scientific evidence is scarce.

PURPOSE

To analyze baseline skin temperature and its rewarming through means of a cold-stress test before and after performing a marathon and to study the association between skin temperature and internal/external-load measurements.

METHODS

A total of 16 runners were measured 48 and 24 h before and 24 and 48 h after completing a marathon. The measurements on each day of testing included urine biomarkers of oxidative stress, pain and fatigue perception, skin temperature (at baseline and after a cold-stress test), and jump performance.

RESULTS

Reduced jump performance (P < .01 and effect size [ES] = 0.5) and higher fatigue and pain perception were observed 24 h after the marathon (P < .01 and ES > 0.8). Although no differences in baseline skin temperature were observed between the 4 measuring days, posterior legs presented lower constant (P < .01 and ES = 1.4) and higher slope (P = .04 and ES = 1.1) parameters in the algorithmic equations fitted for skin-temperature recovery after the cold-stress test 24 h after the marathon than on the day before the marathon. Regressions showed that skin-temperature parameters could be predicted by the ratio of ortho-tyrosine isomer to phenylalanine (oxidative stress biomarker) and body fat composition, among others.

CONCLUSIONS

Although baseline skin temperature was not altered 24 or 48 h after a marathon, the application of cold stress after the marathon would appear to be a good method for providing information on vasoconstriction and a runner's state of stress.

Effects of 120 g/h of Carbohydrates Intake during a Mountain Marathon on Exercise-Induced Muscle Damage in Elite Runners

Background-exercise-induced muscle damage (EIMD) and internal exercise load are increased after competing in ultraendurance events such as mountain marathons. Adequate carbohydrate (CHO) intake during exercise optimizes athletic performance and could limit EIMD, reduce internal exercise load and, thus, improve recovery. Therefore, the aim of this study was to research into and compare the effects of high CHO intake (120 g/h) in terms of CHO intake recommendation (90 g/h) and regular CHO intake performed by ultraendurance athletes (60 g/h) during a mountain marathon, on exercise load and EIMD markers (creatine kinase (CK), lactate dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT), urea and creatinine). Materials and Methods-a randomized trial was carried out on 20 male elite runners who had previously undertaken nutritional and gut training, and who consumed different CHO dosages according to experimental (EXP-120 g/h), control (CON-90 g/h) and low CHO intake (LOW-60 g/h) groups during a ~4000 m cumulative slope mountain marathon. EIMD markers were analyzed before the race and 24 h afterwards. Internal exercise load was calculated based on rate of perceived exertion (RPE) during and after the marathon event. Results-internal exercise load during the mountain marathon was significantly lower (p = 0.019; η²p = 0.471) in EXP (3805 ± 281 AU) compared to LOW (4688 ± 705 AU) and CON (4692 ± 716 AU). Moreover, results revealed that the EXP group evidenced significantly lower CK (p = 0.019; η²p = 0.373), LDH (p < 0.001; η²p = 0.615) and GOT (p = 0.003; η²p = 0.500) values 24 h after the mountain marathon race compared to LOW and CON. Along these lines, EIMD and exercise load evidenced a close correlation (R = 0.742; p < 0.001). Conclusion: High CHO intake (120 g/h) during a mountain marathon could limit the EIMD observed by CK, LDH and GOT and internal exercise load compared to CHO ingestion of 60 and 90 g/h.

Regulation of Circulatory Muscle-specific MicroRNA during 8 km Run

Acute prolonged endurance running has been shown to alter muscle-specific circulating microRNA (miRNA) levels. Here, eighteen participants completed an 8 km run. We assessed the levels of hsa-miR-1-3p, -133a-3p, -133b, and -206 and their correlation with conventional biomarkers following exercise. Compared to before exercise (Pre), 8 km run significantly increased the lactate level immediately after exercise (0 h). Myoglobin (Mb) level increased at 0 h while creatine kinase (CK) level increased 24 h after exercise (24 h). The levels of creatine kinase MB isoenzyme (CK-MB) and cardiac troponin I (cTnI) were all elevated at 24 h and within the normal physiological range; The levels of hsa-miR-1-3p, -133a-3p, -133b significantly increased at 0 h but only hsa-miR-133a-3p still elevated at 24 h. Only hsa-miR-206 level decreased at 24 h; Additionally, the changes of hsa-miR-1-3p and hsa-miR-133a-3p were correlated with Mb at 24 h. These findings suggest that muscle-specific miRNA elevation in plasma is likely physiological and that these miRNA may be used as potential biomarkers for load monitoring in individuals.

LDH isoenzyme 5 is an index of early onset muscle soreness during prolonged running

BACKGROUND

Muscle soreness is also induced during prolonged running such as a full marathon, and muscle soreness and increased damage markers are detected immediately after such a running. We named this muscle soreness, early onset muscle soreness (EOMS). Additionally, lactate dehydrogenase (LDH) level which has some isoenzyme is increased immediately after prolonged exercise. However, it is unclear that EOMS is related to muscle damage markers on prolonged running. This study aimed to determine at which point EOMS, and muscle damage markers are related to EOMS during prolonged running.

METHODS

We studied 11 male subjects who habitually perform aerobic exercise. They ran 30 km at 90% of ventilatory threshold intensity. Every 10 km, we estimated perceived muscle soreness, and sampled blood to measure muscle and liver damage, inflammation, and oxidative stress (d-ROM and BAP) markers.

RESULTS

Muscle soreness score lower limbs were significantly appeared at 20 km compared to that at 0 km. Serum lactate dehydrogenase (LDH) level increased at 30 km compared to that at 0 km. LDH isoenzymes 3, 4, and 5, and neutrophils significantly increased at 30 km compared to those at 0 km. Serum LDH isoenzyme 5 and change in aspartate aminotransferase significantly increased at 20 km. In addition, there was a significant correlation between the thigh NRS and amount of serum LDH isoenzyme 5 from 0 km to 20 km. d-ROM and BAP increased at 10 km compared to those at 0 km.

CONCLUSIONS

EOMS started to occur at 20 km during a 30 km running task. Our data suggest that LDH isoenzyme 5 is a marker of occurrence in EOMS during prolonged running.

Long distance training associated to HIIT protocol does not induce changes in blood biochemical markers in adult marathoners

ABSTRACT Objective: to verify blood markers during a 12-week training protocol and after Sao Paulo Marathon. Methods: Blood samples of 9 male marathoners were collected before (C1) and after (C2) 12-week training protocol, before (C3) and after (C4) marathon. Muscle and liver damage markers (creatine kinase [CK-MM], aspartate aminotransferase [AST], alanine aminotransferase [ALT]), oxidative stress levels (thiobarbituric acid reactive substances [TBARS]) and serum iron concentration were measured. Results: changes were identified comparing moment C4 to other moments for CK-MM and iron. For AST, ALT, and TBARS no differences were identified. Conclusion: strenuous exercises might elicit changes on blood markers, needing follow up strategies to avoid impairments to athletes’ performance and health.

Effects of one week different intensity endurance exercise on cardiorespiratory and cardiometabolic markers in junior young athletes

Background

Endurance training in varied intensity zones are more likely to show different adaptive responses. However, it is still unclear the intensity level of endurance exercise in junior young athletes that may promote increased markers for cardiorespiratory and cardiometabolic response. Therefore, we aimed to investigate the effect of 1 week different intensity endurance training on markers of cardiorespiratory and cardiometabolic response in young athletes.

Methods

Thirty apparently healthy male young athletes averaging 19.4±1.3 years of age were recruited and randomly assigned to two different intensity endurance training groups. The first group trained at 60% to 70% maximum heart rate (HRmax) for 45 min per session and the second group trained at 70% to 80% HRmax for 30 min per session for a period of 1 week three sessions per week. A pre-training and post-training, marker of cardiorespiratory and cardiometabolic response was assessed for both groups.

Results

Both intensity training had no significant effect on markers of cardiorespiratory response within and between training groups (p>0.05). Whereas, cardiometabolic markers lactate dehydrogenase (p=0.001), cardiac troponin I (p=0.001) and creatine kinase myocardial band (p=0.001) significantly increased at the end of 1 week within the group in both training groups (p≤0. 05). In the comparative analysis between groups, there was no significant difference in markers of cardiometabolic response (p>0.05).

Conclusion

1 week 60% to 70% HRmax and 70% to 80% HRmax intensity zones induces similar acute effects on markers for cardiometabolic and cardiorespiratory responses between groups and significant elevations of cardiometabolic markers within the groups in moderately trained young athletes.

Physiological and Pathophysiological Responses to Ultramarathon Running in Non-elite Runners

Ultramarathon running represents a major physical challenge even for elite athletes. Runners wellbeing may be challenged by fluid and electrolyte disturbances, hemolysis and skeletal muscle damage, decline in hepatic function and kidney injury. We hypothesized that these effects may even be exacerbated in non-elite runners. Physiological, hematological and biochemical parameters of ten males (26–45 years, weekly training time 8.5 h), participating in a mountain ultramarathon (67 km; approximately 4,500 m of total ascent), were determined before (PRE), immediately after finishing the ultramarathon (POST), and 24 h after the individual finish (REC). Race times of the 8 finishers (2 drop-outs due to hot ambient temperature) varied between 10.4 and 16.1 h, which almost represents the range of the entire starter field (8.82 h–17.47 h). The following changes in mean values of selected markers for skeletal muscle damage and kidney injury were observed from PRE to POST: creatine kinase (CK) + 1289%, lactate dehydrogenase (LDH) + 87%, serum creatinine (CR) + 72%, blood urea nitrogen (BUN) + 96%, and estimated glomerular filtration rate (eGFR) – 45%. Values of CK + 1447%, LDH + 56%, and BUN + 71% remained elevated at REC. White blood cells were increased (+ 137%) only POST. In conclusion, CK and LDH levels and leucocytosis may be considered to be relatively harmless “side-effects” of prolonged running in this group of male subjects with rather moderate ultramarathon experience and training status. However, acute kidney injury may become clinically relevant in this population under the certain conditions, which should be considered by responsible race managers and medical advisors.

Time-Course Responses of Muscle-Specific MicroRNAs Following Acute Uphill or Downhill Exercise in Sprague-Dawley Rats

Objective: The physiological characteristics and acute responses underpinning uphill running differ from those of downhill running and remain less understood. This study aimed to evaluate time-course changes of muscle-specific microRNA (miRNA) responses in striated muscle or circulation in response to uphill and downhill running. Methods: Male Sprague-Dawley rats (n = 84) were randomly assigned to a sedentary group (n = 12) and an exercise group (n = 72). The exercise group performed 90 min of uphill or downhill running. The striated muscle (quadriceps, gastrocnemius, soleus, and cardiac muscle) or circulation (plasma, exosome, exosome-free) levels of six muscle-specific miRNAs (miR-1, miR-133a, miR-133b, miR-206, miR-208a, and miR-499) were assessed at rest, immediately following exercise, and during recovery (1 h and 48 h). Results: Our results show that miR-1 and miR-133a levels are both decreased in quadriceps following downhill running (p < 0.05) while there is no change after uphill running (p > 0.05). In gastrocnemius, both uphill and downhill running decreased miR-1 level immediately after exercise and returned to baseline during recovery (p < 0.05): interestingly, only miR-499 significantly increased following uphill running (p > 0.05). Of the cell-free miRNAs in circulation, only the miR-133b levels in plasma were not affected following uphill running (p > 0.05); the other miRNA levels significantly increased immediately after exercise (p < 0.05), decreased at 1 h and significantly increased at 48 h after exercise (p < 0.05). All selected miRNA levels in exosomes were not affected following uphill running (p > 0.05), while all selected miRNA levels significantly increased during early recovery after downhill running (p > 0.05). In addition, only the miR-133a level in the exosome-free condition showed significant changes following uphill running (p < 0.05), while miR-1, miR-133a, and miR-499 levels showed significant changes after downhill running (p < 0.05). Conclusion: The results indicate that miRNA undergoes dynamic changes in tissue may play an important role in regulating different stress/adaptation following uphill and downhill running. It is likely that changed miRNA levels in plasma may act as a new biomarker for monitoring whole muscular stress during recovery.

Physiology and Pathophysiology in Ultra-Marathon Running

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

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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.

Variation of Traditional Biomarkers of Liver Injury After an Ultramarathon at Altitude

Background:

Significant elevations of traditional biomarkers of liver injury can occur as a result of running an ultramarathon.

Hypothesis:

Traditional serum biomarker levels of liver injury will significantly increase as the result of participating in this 161-km race at altitude.

Study Design:

Prospective cross-sectional study.

Level of Evidence:

Level 3.

Methods:

A total of 64 (before) and 83 (after) volunteer runners participated in a prospective observational field-based study at the Leadville 100 ultramarathon race. Changes in serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), creatine kinase (CK), and bilirubin levels were measured.

Results:

Of 669 athletes who started the race, 352 successfully completed the race within the 30-hour cutoff (53%). Of 36 runners who had pre- and postrace blood samples taken, the mean ALT, AST, and bilirubin levels were increased from 23 ± 10 U/L, 23 ± 5 U/L, and 0.60 ± 0.29 mg/dL to 117 ± 106 U/L, 485 ± 500 U/L, and 1.60 ± 0.61 mg/dL, respectively (all P < 0.001). There was no change in the mean ALP level (P = 0.11). There were no significant correlations between postrace ALT, AST, ALP, lactate dehydrogenase (LDH), and bilirubin levels and athletes’ age, sex, body mass index, or finishing time. Significant positive linear correlations between AST, ALT, and LDH with CK were seen. Athletes in this study did not seek medical attention after the race based on an electronic survey (92% response rate).

Conclusion:

Significant elevations of traditional biomarkers of liver injury occurred as a result of running an ultramarathon at altitude. These correlated with CK, a marker of muscle injury.

Clinical Relevance:

When reviewing laboratory studies of traditional biomarkers of liver injury in athletes after an ultramarathon, significant elevations may be seen from baseline but are likely to be of no clinical consequence.

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Zusammenfassung. In den vergangenen Jahrzehnten hat sich die Zahl der Ultraläufer vervielfacht, und viele Studien haben den Einfluss auf den Bewegungsapparat untersucht. Wir stellen die Erkenntnisse zu Schäden zusammen, die ein Ultramarathon an Gelenken und Muskeln verursachen kann. Die häufigsten Verletzungen bzw. Überlastungsschäden betreffen die untere Extremität, wobei Sprunggelenk und Knie am häufigsten betroffen sind. Bei sehr langen Läufen kommt es zu einer Anpassung mit Verdickung von Sehnen und Knorpel. Ein Ultramarathon kann zu einem ausgeprägten Muskelschaden führen, mit einem Anstieg von myozellulären Metaboliten wie Myoglobin, Laktat-Dehydrogenase und Creatinkinase.

Effects of an Elastic Hamstring Assistance Device During Downhill Running

The purpose of this study was to determine the appropriateness of using an elastic hamstring assistance device to reduce perceived levels of soreness, increase isometric strength, increase passive range of motion, and decrease biomarkers of muscle damage after eccentric exercise, specifically, downhill running This study was conducted in a university exercise physiology laboratory placing sixteen apparently healthy males (X = 21.6 ± 2.5 years) into two groups using a pre-test/post-test design. Pre-intervention measures taken included participants' body height, body mass, body fat, capillary blood samples, VO2max, isometric hamstring strength at 45 and 90 degrees of flexion and passive hamstring range of motion. Post-intervention measures included blood biomarkers, passive range of motion, the perceived level of soreness and isometric strength. An analysis of normality of data was initially conducted followed by multivariate analysis of variance (MANOVA) of hamstring strength at 45 and 90 degrees of flexion, blood myoglobin and passive range of motion of the hamstrings. Statistically significant changes were noted in subject-perceived muscle soreness and isometric strength at 90 degrees at the 24-hour post-exercise trial measure between the two groups. Results would suggest the findings could be explained by the decrease in muscle soreness from utilizing the device during the exercise trial. Further research should be conducted to address sample size issues and to determine if the results are comparable on different surfaces.

Effect of Maximal Versus Supra-Maximal Exhausting Race on Lipid Peroxidation, Antioxidant Activity and Muscle-Damage Biomarkers in Long-Distance and Middle-Distance Runners

Background

Exhausting physical exercise increases lipid peroxidation and causes important muscle damages. The human body tries to mitigate these adverse effects by mobilizing its antioxidant defenses.

Objectives

This study aims to investigate the effect of a maximal versus supra-maximal race sustained until exhaustion on lipid peroxidation, antioxidant activity and muscle-damage biomarkers in trained (i.e. long-distance and middle-distance runners) and sedentary subjects.

Materials and Methods

The study has been carried out on 8 middle-distance runners (MDR), 9 long-distance runners (LDR), and 8 sedentary subjects (SS). Each subject has undergone two exhaustive running tests, the first one is an incremental event (VAMEVAL test), the second one is a constant supra-maximal intensity test (limited-time test). Blood samples were collected at rest and immediately after each test.

Results

A significant increase in malondialdehyde (MDA) concentrations was observed in SS and MDR after the VAMEVAL test and in LDR after the Limited-Time test. A significant difference was also observed between LDR and the other two groups after the VAMEVAL test, and between LDR and MDR after the Limited-Time test. Significant modifications, notably, in myoglobin, CK, LDH, IL-6, TNF-α, and TAS were likewise noted but depending on the race-type and the sportive specialty.

Conclusions

Maximal and supra-maximal races induce a significant increase in lipid peroxidation and cause non-negligible inflammation and muscle damage. These effects were relatively related to the physical exercise type and the sportive specialty.

Energy metabolism, liver and kidney function in adolescent marathon runners

BACKGROUND

To study parameters of energy metabolism, liver and kidney function in adolescent runners completing a standard 42·2-km marathon run.

DESIGN

Observational field study.

MATERIALS AND METHODS

Fifty adolescents (30 healthy males and 20 healthy females) aged between 13 and 17 years participated in the study. All participants underwent routine medical screening. Blood samples were taken before, at the end and 24 h after a competitive marathon to investigate parameters of metabolism, liver and kidney function.

RESULTS

Forty-seven runners completed the race with a mean finishing time of 4 h 57 min 24 s (range: 3 h 17 min 09 s to 6 h 14 min 01 s). None of the participants experienced an adverse medical event during or postmarathon. Findings indicate predominant lipid oxidation during and postmarathon, signs of minor hepatic injury and only transiently reduced kidney function caused by marathon running in adolescents.

CONCLUSION

The observed findings are very similar to those reported in healthy adults. There is no evidence of liver or kidney injury in adolescent runners participating in a standard marathon run.

[(Very) high Creatinkinase concentration after exertional whole-body electromyostimulation application: health risks and longitudinal adaptations]

Due to its individualization, time-efficiency and effectiveness Whole-body-Electromyo-stimulation (WB-EMS) becomes increasingly popular. However, recently (very) high Creatin-kinase concentration were reported, at least after initial WB-EMS-application. Thus, the aim of the study was to determine (1) WB-EMS induced increases of CK-concentration, (2) their impact on corresponding health parameters and (3) training-induced changes of CK-levels.Twenty-six healthy, sportive volunteers without previous experience with WB-EMS were included. Initial high intense WB-EMS application (bipolar, 85 Hz; 350 ms; intermittent, 20 min) led to an increase of the CK-level by the 117fold (28.545 ± 33.611 IU/l) of baseline. CK-peaks were detected after 72-96 h. Despite this pronounced "exertional rhabdomyolysis", we did not determine rhabdomyolysis-induced complications (e.g. acute renal failure, hyperkalemia, hypocalcaemia). After 10 weeks of WB-EMS (1 session/week) CK-reaction to intensive WB-EMS-Application was significantly blunted (906 ± 500 IE/l) and averaged in the area of conventional resistance exercise.In summary, intensity of WB-EMS should be carefully increased during the initial sessions.

The increase in hydric volume is associated to contractile impairment in the calf after the world's most extreme mountain ultra-marathon

Background

Studies have recently focused on the effect of running a mountain ultra-marathon (MUM) and their results show muscular inflammation, damage and force loss. However, the link between peripheral oedema and muscle force loss is not really established. We tested the hypothesis that, after a MUM, lower leg muscles’ swelling could be associated with muscle force loss. The knee extensor (KE) and the plantar flexor (PF) muscles’ contractile function was measured by supramaximal electrical stimulations, potentiated low- and high-frequency doublets (PS10 and PS100) of the KE and the PF were measured by transcutaneous electrical nerve stimulation and bioimpedance was used to assess body composition in the runners (n = 11) before (Pre) and after (Post) the MUM and compared with the controls (n = 8).

Results

The maximal voluntary contraction of the KE and the PF significantly decreased by 20 % Post-MUM in the runners. Hydration of the non-fat mass (NF-Hyd) and extracellular water volume (Ve) were increased by 12 % Post-MUM (p < 0.001) in the runners. Calf circumference (+2 %, p < 0.05) was also increased. Significant relationships were found for percentage increases in Ve and NF-Hyd with percentage decrease in PS10 of the PF (r = −0.68 and r = −0.70, p < 0.05) and with percentage increase of calf circumference (r = 0.72 and r = 0.73, p < 0.05) in the runners.

Conclusions

The present study suggests that increases in circumference and in hydric volume are associated to contractile impairment in the calf in ultra-marathon runners.

Effects of Physical (In)activity on Platelet Function

As platelet activation is closely related to the liberation of growth factors and inflammatory mediators, platelets play a central role in the development of CVD. Virtually all cardiovascular risk factors favor platelet hyperreactivity and, accordingly, also physical (in)activity affects platelet function. Within this paper, we will summarize and discuss the current knowledge on the impact of acute and habitual exercise on platelet function. Although there are apparent discrepancies regarding the reported effects of acute, strenuous exercise on platelet activation, a deeper analysis of the available literature reveals that the applied exercise intensity and the subjects' cardiorespiratory fitness represent critical determinants for the observed effects. Consideration of these factors leads to the summary that (i) acute, strenuous exercise can lead to platelet activation, (ii) regular physical activity and/or physical fitness diminish or prevent platelet activation in response to acute exercise, and (iii) habitual physical activity and/or physical fitness also favorably modulate platelet function at physical rest. Notably, these effects of exercise on platelet function show obvious similarities to the well-recognized relation between exercise and the risk for cardiovascular events where vigorous exercise transiently increases the risk for myocardial infarction and a physically active lifestyle dramatically reduces cardiovascular mortality.

Alterations in redox homeostasis in the elite endurance athlete

BACKGROUND

The production of reactive oxygen (ROS) and nitrogen species (RNS) is a fundamental feature of mammalian physiology, cellular respiration and cell signalling, and essential for muscle function and training adaptation. Aerobic and anaerobic exercise results in alterations in redox homeostasis (ARH) in untrained, trained and well trained athletes. Low to moderate doses of ROS and RNS play a role in muscle adaptation to endurance training, but an overwhelming increase in RNS and ROS may lead to increased cell apoptosis and immunosuppression, fatigued states and underperformance.

OBJECTIVES

The objectives of this systematic review are: (a) to test the hypotheses that ARH occur in elite endurance athletes; following an acute exercise bout, in an endurance race or competition; across a micro-, meso- or macro-training cycle; following a training taper; before, during and after altitude training; in females with amenorrhoea versus eumenorrhoea; and in non-functional over-reaching (NFOR) and overtraining states (OTS); (b) to report any relationship between ARH and training load and ARH and performance; and (c) to apply critical difference values for measures of oxidative stress/ARH to address whether there is any evidence of ARH being of physiological significance (not just statistical) and thus relevant to health and performance in the elite athlete.

METHODS

Electronic databases, Embase, MEDLINE, and SPORTDiscus were searched for relevant articles. Only studies that were observational articles of cross-sectional or longitudinal design, and included elite athletes competing at national or international level in endurance sports were included. Studies had to include biomarkers of ARH; oxidative damage, antioxidant enzymes, antioxidant capacity, and antioxidant vitamins and nutrients in urine, serum, plasma, whole blood, red blood cells (RBCs) and white blood cells (WBCs). A total of 3,057 articles were identified from the electronic searches. Twenty-eight articles met the inclusion criteria and were included in the review.

RESULTS

ARH occurs in elite endurance athletes, after acute exercise, a competition or race, across training phases, and with natural or simulated altitude. A reduction in ARH occurs across the season in elite athletes, with marked variation around intensified training phases, between individuals, and the greatest disturbances (of physiological significance) occurring with live-high-train-low techniques, and in athletes competing. A relationship with ARH and performance and illness exists in elite athletes. There was considerable heterogeneity across the studies for the biomarkers and assays used; the sport; the blood sampling time points; and the phase in the annual training cycle and thus baseline athlete fitness. In addition, there was a consistent lack of reporting of the analytical variability of the assays used to assess ARH.

CONCLUSIONS

The reported biochemical changes around ARH in elite athletes suggest that it may be of value to monitor biomarkers of ARH at rest, pre- and post-simulated performance tests, and before and after training micro- and meso-cycles, and altitude camps, to identify individual tolerance to training loads, potentially allowing the prevention of non-functionally over-reached states and optimisation of the individual training taper and training programme.

Alteração de biomarcadores de lesão miocárdica em atletas após a Maratona Internacional de São Paulo

INTRODUÇÃO: Apesar de a prática regular de exercício físico reduzir o risco de doença cardiovascular, estudos recentes têm documentado elevações em biomarcadores relacionados com danos cardíacos após exercícios prolongados em indivíduos aparentemente saudáveis. OBJETIVO: Investigar as alterações nos níveis de brain natriuretic peptide (BNP) e troponina T cardíaca (cTnT) em atletas amadores após uma maratona, assim como verificar as possíveis relações entre as alterações, antes e depois da prova, apresentada pelos dois biomarcadores e variáveis do teste cardiopulmonar. MÉTODOS: Estudamos 38 atletas do sexo masculino (40,9 ± 6,29 anos) antes e depois da Maratona Internacional de São Paulo, SP, Brasil. Foram realizadas coletas de sangue na veia antecubital para mensurar os biomarcadores cardíacos, cTnT e BNP 24h antes, imediatamente após e 24h após a maratona. Foi realizado teste cardiopulmonar máximo nas três semanas que antecederam a prova. RESULTADOS: Os valores de BNP e cTnT aumentaram imediatamente após a maratona (p<0,001) quando comparados com os valores basais. No terceiro momento (24h) os valores de troponina tiveram uma redução significativa caracterizando um retorno aos valores basais. Não encontramos correlação entre idade e variáveis referentes a intensidade da maratona, porém encontramos correlação dos biomarcadores com o tempo de conclusão da maratona. CONCLUSÃO: Diferentes causas de liberação podem ser assumidas para cTnT e BNP e, neste caso, parecem não refletir dano miocárdico devido ao comportamento da curva destes marcadores, além de não haver relação entre a liberação dos dois biomarcadores.

Physical activity - an important preanalytical variable

The concentration of several biochemical and hematological biomarkers is strongly influenced by a number of preanalytical variables. Several lines of evidence attest that short, middle, and long-term exercise, as well as the relative intensity of physical effort (from mild to strenuous), may influence a broad array of laboratory variables. The amount of extracellular release and clearance from blood of most of these biomarkers is markedly influenced by the biological characteristics of the molecule(s), level of training, type, intensity and duration of exercise, and time of recovery after training. It is hence noteworthy that test results that fall outside the conventional reference ranges in athletes not only may reflect the presence of a given disease, but may frequently mirror an adaptation to regular training or changes that have occurred during and/or following strenuous exercise, and which should be clearly acknowledged to prevent misinterpretation of laboratory data. The aim of this narrative review is to provide an update about the most significant changes of some biochemical and hematological biomarkers in response to physical exercise, for appropriate interpretation of these changes in the context of physically active subjects.