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Kaarup S, Hansen HP, Lindhard K. A question to the physician from a patient on hemodialysis: Would it be safe to run a marathon? A case report. Hemodial Int 2023; 27:E5-E8. [PMID: 36328770 DOI: 10.1111/hdi.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
A patient on maintenance hemodialysis asked his physician if it would be safe for him to run a marathon. For healthy persons, studies show that it is relatively safe. Very few data are available on patients on hemodialysis performing out of center endurance exercise. To address this question, we conducted a clinical study to investigate the electrolyte derangements during different running distances. Our main concern was development of hyperkalemia. We present a case of an anuric hemodialysis patient, who ran eight different runs with a maximum distance of 32.2 km. Blood was analyzed before and after the runs. We did not find severe hyperkalemia at any point. According to this study, we found no signs of increased risk.
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Affiliation(s)
- Sophie Kaarup
- Department of Nephrology, Herlev Hospital, Herlev, Denmark
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2
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Exercise-Associated Hyponatremia in Marathon Runners. J Clin Med 2022; 11:jcm11226775. [PMID: 36431252 PMCID: PMC9699060 DOI: 10.3390/jcm11226775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Exercise-associated hyponatremia (EAH) was first described as water intoxication by Noakes et al. in 1985 and has become an important topic linked to several pathological conditions. However, despite progressive research, neurological disorders and even deaths due to hyponatremic encephalopathy continue to occur. Therefore, and due to the growing popularity of exercise-associated hyponatremia, this topic is of great importance for marathon runners and all professionals involved in runners' training (e.g., coaches, medical staff, nutritionists, and trainers). The present narrative review sought to evaluate the prevalence of EAH among marathon runners and to identify associated etiological and risk factors. Furthermore, the aim was to derive preventive and therapeutic action plans for marathon runners based on current evidence. The search was conducted on PubMed, Scopus and Google Scholar using a predefined search algorithm by aggregating multiple terms (marathon run; exercise; sport; EAH; electrolyte disorder; fluid balance; dehydration; sodium concentration; hyponatremia). By this criterion, 135 articles were considered for the present study. Our results revealed that a complex interaction of different factors could cause EAH, which can be differentiated into event-related (high temperatures) and person-related (female sex) risk factors. There is variation in the reported prevalence of EAH, and two major studies indicated an incidence ranging from 7 to 15% for symptomatic and asymptomatic EAH. Athletes and coaches must be aware of EAH and its related problems and take appropriate measures for both training and competition. Coaches need to educate their athletes about the early symptoms of EAH to intervene at the earliest possible stage. In addition, individual hydration strategies need to be developed for the daily training routine, ideally in regard to sweat rate and salt losses via sweat. Future studies need to investigate the correlation between the risk factors of EAH and specific subgroups of marathon runners.
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Lindinger MI, Cairns SP. Regulation of muscle potassium: exercise performance, fatigue and health implications. Eur J Appl Physiol 2021; 121:721-748. [PMID: 33392745 DOI: 10.1007/s00421-020-04546-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/29/2020] [Indexed: 12/30/2022]
Abstract
This review integrates from the single muscle fibre to exercising human the current understanding of the role of skeletal muscle for whole-body potassium (K+) regulation, and specifically the regulation of skeletal muscle [K+]. We describe the K+ transport proteins in skeletal muscle and how they contribute to, or modulate, K+ disturbances during exercise. Muscle and plasma K+ balance are markedly altered during and after high-intensity dynamic exercise (including sports), static contractions and ischaemia, which have implications for skeletal and cardiac muscle contractile performance. Moderate elevations of plasma and interstitial [K+] during exercise have beneficial effects on multiple physiological systems. Severe reductions of the trans-sarcolemmal K+ gradient likely contributes to muscle and whole-body fatigue, i.e. impaired exercise performance. Chronic or acute changes of arterial plasma [K+] (hyperkalaemia or hypokalaemia) have dangerous health implications for cardiac function. The current mechanisms to explain how raised extracellular [K+] impairs cardiac and skeletal muscle function are discussed, along with the latest cell physiology research explaining how calcium, β-adrenergic agonists, insulin or glucose act as clinical treatments for hyperkalaemia to protect the heart and skeletal muscle in vivo. Finally, whether these agents can also modulate K+-induced muscle fatigue are evaluated.
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Affiliation(s)
- Michael I Lindinger
- Research and Development, The Nutraceutical Alliance, Burlington, ON, L7N 2Z9, Canada
| | - Simeon P Cairns
- SPRINZ, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 1020, New Zealand.
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 1020, New Zealand.
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Association between collapse and serum creatinine and electrolyte concentrations in marathon runners: a 9-year retrospective study. Eur J Emerg Med 2021; 28:34-42. [PMID: 32976313 DOI: 10.1097/mej.0000000000000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Abnormal biochemical measurements have previously been described in runners following marathons. The incidence of plasma sodium levels outside the normal range has been reported as 31%, and the incidence of raised creatinine at 30%. This study describes the changes seen in electrolytes and creatinine in collapsed (2010-2019 events) and noncollapsed (during the 2019 event) runners during a UK marathon. METHODS Point-of-care sodium, potassium, urea and creatinine estimates were obtained from any collapsed runner treated by the medical team during the Brighton Marathons, as part of their clinical care, and laboratory measurements from control subjects. RESULTS Results from 224 collapsed runners were available. Serum creatinine was greater than the normal range in 68.9%. About 6% of sodium results were below, and 3% above the normal range, with the lowest 132 mmol/l. Seventeen percent of potassium readings were above the normal range; the maximum result was 8.4 mmol/l, but 97% were below 6.0 mmol/l. In the control group, mean creatinine was significantly raised in both the collapse and control groups, with 55.4% meeting the criteria for acute kidney injury, but had resolved to baseline after 24 h. Sodium concentration but not the potassium was significantly raised after the race compared with baseline, but only 15% were outside the normal range. CONCLUSION In this study, incidence of a raised creatinine was higher than previously reported. However, the significance of such a rise remains unclear with a similar rise seen in collapsed and noncollapsed runners, and resolution noted within 24 h. Abnormal sodium concentrations were observed infrequently, and severely abnormal results were not seen, potentially reflecting current advice to drink enough fluid to quench thirst.
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Rosenbloom CJ, Morley FL, Ahmed I, Cox AR. Oral non-steroidal anti-inflammatory drug use in recreational runners participating in Parkrun UK: Prevalence of use and awareness of risk. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:561-568. [DOI: 10.1111/ijpp.12646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022]
Abstract
Abstract
Objective
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in endurance running and by elite athletes. We examined the pattern of use of NSAIDs, the purpose of use and knowledge of the adverse effects of NSAID use in a population of recreational runners at Parkrun UK.
Methods
An online observational non-interventional cross-sectional survey of Parkrun UK participants being over the age of 18, on Parkrun UK’s mailing list, and residing in the UK.
Key Findings
Runners (n = 806) had a high use of NSAIDs in the past 12 months (87.8%). The average age of respondents was 48.39 years. There was a significant association between those taking an oral NSAID in the last twelve months and those with a sporting injury (χ2 = 10.89, df = 1, n = 797, P = 0.001). Ibuprofen was the most commonly used NSAID (81.1%). A third of runners had experienced an adverse drug reaction associated with NSAIDs, usually gastrointestinal. Half of runners used NSAIDs with no advice, and patient information leaflets were the most common source for those that had advice. Ninety-four per cent of runners would like more information on the harms and benefits of NSAIDs.
Conclusions
Some recreational runners have a high use of NSAIDs, which is chronic in nature and a potential health risk. Recreational runners want more information on the harms and benefits of NSAIDs. Race event organizers should provide evidence-based advice on the use of NSAIDs.
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Affiliation(s)
- Craig James Rosenbloom
- Centre for Sports and Exercise Medicine, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Faye L Morley
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Imran Ahmed
- School of Pharmacy, University of Birmingham, Birmingham, UK
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Semen KO, Weseler AR, Janssen MJW, Drittij-Reijnders MJ, le Noble JLML, Bast A. Effects of Monomeric and Oligomeric Flavanols on Kidney Function, Inflammation and Oxidative Stress in Runners: A Randomized Double-Blind Pilot Study. Nutrients 2020; 12:E1634. [PMID: 32492913 PMCID: PMC7353060 DOI: 10.3390/nu12061634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs are frequently used by athletes in order to prevent musculoskeletal pain and improve performance. In combination with strenuous exercise, they can contribute to a reduction of renal blood flow and promote development of kidney damage. We aimed to investigate whether monomeric and oligomeric flavanols (MOF) could reduce the severity of kidney injuries associated with the intake of 400-mg ibuprofen followed by the completion of a half-marathon in recreational athletes. In this double-blind, randomized study, the original MOF blend of extracts from grape seeds (Vitis vinifera L.) and pine bark (Pinus pinaster L.) or placebo were taken for 14 days preceding the ibuprofen/half-marathon. Urine samples were collected before and after the ibuprofen/half-marathon, and biomarkers of kidney injury, inflammation and oxidative stress were assessed. Intake of MOF significantly reduced the incidence of post-race hematuria (p = 0.0004) and lowered concentrations of interleukin (IL)-6 in the urine (p = 0.032). Urinary neutrophil-associated lipocalin, creatine, albumin, IL-8 and malondialdehyde tended to decrease. The supplementation with MOF in recreational runners appears to safely preserve kidney function, reduce inflammation and promote antioxidant defense during strenuous exercise and intake of a single dose of ibuprofen.
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Affiliation(s)
- Khrystyna O. Semen
- Campus Venlo, Faculty of Science and Engineering, Maastricht University, 5911 BV Venlo, The Netherlands;
| | - Antje R. Weseler
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.R.W.); (M.-J.D.-R.); (J.L.M.L.l.N.)
| | - Marcel J. W. Janssen
- Department of Clinical Chemistry and Haematology, VieCuri Medical Center Noord Limburg, 5912 BL Venlo, The Netherlands;
| | - Marie-José Drittij-Reijnders
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.R.W.); (M.-J.D.-R.); (J.L.M.L.l.N.)
| | - Jos L. M. L. le Noble
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.R.W.); (M.-J.D.-R.); (J.L.M.L.l.N.)
- Department of Intensive Care, VieCuri Medical Center Noord Limburg, 5912 BL Venlo, The Netherlands
| | - Aalt Bast
- Campus Venlo, Faculty of Science and Engineering, Maastricht University, 5911 BV Venlo, The Netherlands;
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.R.W.); (M.-J.D.-R.); (J.L.M.L.l.N.)
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7
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Martin TG, Pata RW, Jou D, Narowska G, Myrick K, Malloy KA, Lafalce AM, Feinn R. The influence of non-modifiable and modifiable factors on cardiac biomarkers after marathon running. J Sports Med Phys Fitness 2019; 59:1771-1778. [PMID: 30722651 DOI: 10.23736/s0022-4707.19.09247-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study investigated the influence of modifiable (training) and non-modifiable factors (age and gender) on cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) levels post-marathon. METHODS Thirteen female and nine male recreational runners participated in the 2015 Hartford Marathon. A venous blood draw was taken from each subject at 24 hours pre-race, immediately post-race and 24 hours post-race. RESULTS Weekly mileage and weekly long runs were recorded for a 12-week period prior to the marathon. No association was found between age and BNP (P=0.11, P=0.50) or cTnI (P=0.69, P=0.28) for either post-race time points. No association was found between gender and cTnI for either post-race time points (P=0.09, P=0.57). However, BNP elevation, at 24 hours post-race was more pronounced in females than males (P=0.047). For cTnI levels immediately post-race, a negative association was found for average weekly mileage (P=0.006), while a positive association was found for the number of long runs exceeding 20 miles (P=0.05). No association between training and BNP were found. CONCLUSIONS These results suggest that female runners may experience greater cardiac stress than males. In addition, runners with greater weekly training mileage experienced less cardiac stress post-race, while runners who ran too many 20+ mile long runs, experienced more cardiac stress post-marathon.
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Affiliation(s)
- Thomas G Martin
- Department of Biomedical Sciences, Quinnipiac University, Hamden, CT, USA -
| | - Rachel W Pata
- Department of Physical Therapy, Quinnipiac University, Hamden, CT, USA
| | - David Jou
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA
| | - Gabriela Narowska
- Department of Biomedical Sciences, Quinnipiac University, Hamden, CT, USA
| | - Karen Myrick
- School of Nursing, Quinnipiac University, Hamden, CT, USA
| | - Kelly A Malloy
- Department of Physical Therapy, Quinnipiac University, Hamden, CT, USA
| | - Amanda M Lafalce
- Department of Physical Therapy, Quinnipiac University, Hamden, CT, USA
| | - Richard Feinn
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA
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8
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Martinez-Cano JP, Cortes-Castillo V, Martinez-Villa J, Ramos JC, Uribe JP. Dysnatremia among runners in a half marathon performed under warm and humid conditions. BMJ Open Sport Exerc Med 2018; 4:e000351. [PMID: 29955376 PMCID: PMC6018873 DOI: 10.1136/bmjsem-2018-000351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/30/2018] [Accepted: 05/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Dysnatremia has been associated with sports activity, especially long-distance running and endurance sports. High fluid intake is associated with hyponatremia. This study aims to evaluate dysnatremia and risk factors in half-marathon runners under warm and humid environmental conditions. Methods A cross-sectional study was performed among randomly selected runners in the 2017 Cali half marathon. Runners on diuretic therapy or with a known history of kidney disease were excluded. Participants went through a 2-day assessment. Previous medical history, training history, body mass index and running history were determined in the first assessment. Symptoms of dysnatremia and level of fluid consumption during the race were registered during the second assessment and post-run blood sampling for serum [Na+] was also undertaken. Results 130 runners were included in the study. The complete 2-day assessment was performed on 81 participants (62%) that were included in the final analysis. No cases of hyponatremia were found; instead, there were six cases of asymptomatic hypernatremia (7.4%). This hypernatremia had a statistically significant association with lower frequency (p=0.01) and volume of fluid intake during the race (water: p=0.02, Gatorade: p=0.04). Conclusion Hyponatremia has been associated with high fluid intake in races performed under cool weather, such as the Boston Marathon during spring. In contrast, hypernatremia was found in a half marathon in warm and humid weather, which was associated with lower volume and frequency of fluid intake, suggesting that under warm and humid conditions, a median fluid intake of 900 mL during the race could prevent this event.
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Affiliation(s)
| | | | | | | | - Juan Pablo Uribe
- Center for Clinical Investigations, Fundación Valle del Lili, Cali, Colombia
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9
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Hodgson LE, Walter E, Venn RM, Galloway R, Pitsiladis Y, Sardat F, Forni LG. Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review. BMJ Open Sport Exerc Med 2017; 3:e000093. [PMID: 29259804 PMCID: PMC5731225 DOI: 10.1136/bmjsem-2015-000093] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/23/2016] [Accepted: 03/26/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION A growing body of evidence suggests even small rises in serum creatinine (SCr) are of considerable clinical relevance. Given that participants in endurance events are exposed to potential (repeated) renal insults, a systematic review was undertaken to collate current evidence for acute kidney injury (AKI), complicating such events. METHODS A systematic review of studies and case reports meeting inclusion criteria on Medline and EMBASE (inception to October 2015). Included: studies with markers of renal function before and after endurance or ultraendurance events; case reports of severe AKI. Two reviewers assessed risk of bias using the Newcastle-Ottawa scale. RESULTS Eleven case report publications (n=27 individuals) of severe AKI, were retrieved, with risk factors including systemic illness or nephrotoxic medications usually identified. From 30 studies of endurance and ultraendurance events, mean rise in SCr was 29 (±12.3) µmol/L after marathon or ultramarathon (17 studies, n=568 participants) events. Where follow-up tests were conducted, SCr returned to baseline within 48 hours. Rises in biomarkers suggest potential parenchymal insult, rather than simply muscle breakdown. However, evidence of long-term deleterious effects is lacking. CONCLUSIONS Raised levels of SCr are reported immediately after endurance events. It is not clear whether this is either clinically significant, or if repeated participation predisposes to long-term sequelae. The aetiology of severe exercise-associated AKI is usually multifactorial, with risk factors generally identified in the rare cases reported. On-site biochemistry, urine analysis and biomarkers of AKI may help identify collapsed runners who are at significant short-term risk and allow suitable follow-up.
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Affiliation(s)
- LE Hodgson
- Department of Anaesthesia, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
| | - E Walter
- Department of Emergency Medicine, Royal Sussex County Hospital, East Sussex, UK
| | - RM Venn
- Department of Anaesthesia, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
| | - R Galloway
- Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - Y Pitsiladis
- Department of Emergency Medicine, Royal Sussex County Hospital, East Sussex, UK
| | - F Sardat
- Department of Intensive Care, Surrey Peri-operative Anaesthesia Critical care collaborative Research group (SPACeR), Royal Surrey County Hospital, Surrey, UK
| | - LG Forni
- Department of Emergency Medicine, Royal Sussex County Hospital, East Sussex, UK
- The centre for sport and exercise science and medicine (SESAME), Sport and Service Management, Eastbourne, UK
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10
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Hew-Butler T, Loi V, Pani A, Rosner MH. Exercise-Associated Hyponatremia: 2017 Update. Front Med (Lausanne) 2017; 4:21. [PMID: 28316971 PMCID: PMC5334560 DOI: 10.3389/fmed.2017.00021] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/16/2017] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Valentina Loi
- SC Nephrology and Dialysis, Brotzu Hospital , Cagliari , Italy
| | - Antonello Pani
- SC Nephrology and Dialysis, Brotzu Hospital , Cagliari , Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System , Charlottesville, VA , USA
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11
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Martin-Beaulieu JP, Myrick KM, Martin T, Pata RW, Feinn RS. Common electrocardiogram variations pre- and post-marathon. Clin Case Rep 2016; 4:944-947. [PMID: 27761243 PMCID: PMC5054467 DOI: 10.1002/ccr3.650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/11/2016] [Indexed: 11/12/2022] Open
Abstract
Electrocardiographic changes can be present in marathon runners. These findings may be misinterpreted as malignant by healthcare providers. For example, incomplete right bundle branch block, early ventricular repolarization, and left ventricular hypertrophy by voltage criteria alone are quite common in athletes, yet considered benign.
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Affiliation(s)
- John P Martin-Beaulieu
- Department of Nursing Quinnipiac University North Haven Campus, 370 Bassett Rd - Room 470M North Haven Connecticut 06473 USA
| | - Karen M Myrick
- Department of Nursing Joint Appointment Frank Netter School of Medicine Quinnipiac University North Haven Campus, 370 Bassett Rd - Room 470M North Haven Connecticut 06473 USA
| | - Thomas Martin
- Department of Biomedical Sciences Quinnipiac University North Haven Campus, 370 Bassett Rd - Room 270G North Haven Connecticut 06473 USA
| | - Rachel W Pata
- Department of Physical Therapy Quinnipiac University North Haven Campus, 370 Bassett Rd - Room 300B North Haven Connecticut 06473 USA
| | - Richard S Feinn
- Department of Medical Sciences Quinnipiac University North Haven Campus, 370 Bassett Rd - Room 307F North Haven Connecticut 06473 USA
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Sedgwick PE, Wortley GC, Wright JM, Asplund C, William OR, Usman S. Medical Clearance for Desert and Land Sports, Adventure, and Endurance Events. Wilderness Environ Med 2016; 26:S47-54. [PMID: 26617378 DOI: 10.1016/j.wem.2015.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/12/2015] [Indexed: 11/15/2022]
Abstract
Endurance events are increasing in popularity in wilderness and remote settings, and participants face a unique set of potential risks for participation. The purpose of this article is to outline these risks and allow the practitioner to better guide the wilderness adventurer who is anticipating traveling to a remote or desert environment.
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Affiliation(s)
- Peter E Sedgwick
- Central Maine Sports Medicine (A Clinical Division of CMMC), Lewiston, Maine (Dr Sedgwick).
| | - George C Wortley
- Lynchburg Family Medicine Residency, Lynchburg, Virginia (Dr Wortley)
| | - Justin M Wright
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, El Paso, Texas (Dr Wright)
| | - Chad Asplund
- Family Medicine, Georgia Regents University, Augusta, Georgia (Dr Asplund)
| | - O Roberts William
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota (Dr Roberts)
| | - Saif Usman
- Primary Care Sports Medicine, Marymount University, MedStar Medical Group, Arlington, Virginia (Dr Usman)
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Abstract
Endurance events are increasing in popularity in wilderness and remote settings, and participants face a unique set of potential risks for participation. The purpose of this article is to outline these risks and allow the practitioner to better guide the wilderness adventurer who is anticipating traveling to a remote or desert environment.
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14
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Hou SK, Chiu YH, Tsai YF, Tai LC, Hou PC, How CK, Yang CC, Kao WF. Clinical Impact of Speed Variability to Identify Ultramarathon Runners at Risk for Acute Kidney Injury. PLoS One 2015; 10:e0133146. [PMID: 26176768 PMCID: PMC4503592 DOI: 10.1371/journal.pone.0133146] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/23/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ultramarathon is a high endurance exercise associated with a wide range of exercise-related problems, such as acute kidney injury (AKI). Early recognition of individuals at risk of AKI during ultramarathon event is critical for implementing preventative strategies. OBJECTIVES To investigate the impact of speed variability to identify the exercise-related acute kidney injury anticipatively in ultramarathon event. METHODS This is a prospective, observational study using data from a 100 km ultramarathon in Taipei, Taiwan. The distance of entire ultramarathon race was divided into 10 splits. The mean and variability of speed, which was determined by the coefficient of variation (CV) in each 10 km-split (25 laps of 400 m oval track) were calculated for enrolled runners. Baseline characteristics and biochemical data were collected completely 1 week before, immediately post-race, and one day after race. The main outcome was the development of AKI, defined as Stage II or III according to the Acute Kidney Injury Network (AKIN) criteria. Multivariate analysis was performed to determine the independent association between variables and AKI development. RESULTS 26 ultramarathon runners were analyzed in the study. The overall incidence of AKI (in all Stages) was 84.6% (22 in 26 runners). Among these 22 runners, 18 runners were determined as Stage I, 4 runners (15.4%) were determined as Stage II, and none was in Stage III. The covariates of BMI (25.22 ± 2.02 vs. 22.55 ± 1.96, p = 0.02), uric acid (6.88 ± 1.47 vs. 5.62 ± 0.86, p = 0.024), and CV of speed in specific 10-km splits (from secondary 10 km-split (10th - 20th km-split) to 60th - 70th km-split) were significantly different between runners with or without AKI (Stage II) in univariate analysis and showed discrimination ability in ROC curve. In the following multivariate analysis, only CV of speed in 40th - 50th km-split continued to show a significant association to the development of AKI (Stage II) (p = 0.032). CONCLUSIONS The development of exercise-related AKI was not infrequent in the ultramarathon runners. Because not all runners can routinely receive laboratory studies after race, variability of running speed (CV of speed) may offer a timely and efficient tool to identify AKI early during the competition, and used as a surrogate screening tool, at-risk runners can be identified and enrolled into prevention trials, such as adequate fluid management and avoidance of further NSAID use.
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Affiliation(s)
- Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Yu-Hui Chiu
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yi-Fang Tsai
- Department of General Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Chen Tai
- Department of General Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peter C. Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chorng-Kuang How
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Fong Kao
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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15
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Hew-Butler T, Rosner MH, Fowkes-Godek S, Dugas JP, Hoffman MD, Lewis DP, Maughan RJ, Miller KC, Montain SJ, Rehrer NJ, Roberts WO, Rogers IR, Siegel AJ, Stuempfle KJ, Winger JM, Verbalis JG. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin J Sport Med 2015; 25:303-20. [PMID: 26102445 DOI: 10.1097/jsm.0000000000000221] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Tamara Hew-Butler
- *Exercise Science Program, Oakland University, Rochester, Michigan; †Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia; ‡Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; §The Vitality Group, Chicago, Illinois; ¶Department of Physical Medicine and Rehabilitation, VA Northern California Health Care System and University of California Davis, Sacramento, California; ‖Family Medicine Residency Program, Via Christi Hospitals Wichita, Inc, Wichita, Kansas; **Department of Sport and Exercise Nutrition, Loughborough University, Leicestershire, United Kingdom; ††Athletic Training Program, Central Michigan University, Mount Pleasant, Michigan; ‡‡Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts; §§School of Physical Education, Sport and Exercise Science, University of Otago, Dunedin, New Zealand; ¶¶Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; ‖‖Department of Emergency Medicine, St John of God Murdoch Hospital and University of Notre Dame, Perth, Western Australia; ***Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts; †††Health Sciences Department, Gettysburg College, Gettysburg, Pennsylvania; ‡‡‡Department of Family Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois; and §§§Department of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, District of Columbia
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16
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Martin TG, Pata RW, D'Addario J, Yuknis L, Kingston R, Feinn R. Impact of age on haematological markers pre- and post-marathon running. J Sports Sci 2015; 33:1988-97. [PMID: 25789424 DOI: 10.1080/02640414.2015.1024712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated whether haematological markers differ between young and masters marathon participants, running at similar performance levels. Nine young (31.89 ± 4.96 years) and eight masters (63.13 ± 4.61 years) runners participated. At five time points (pre-race through 54 h post-race), a complete blood cell count, basic metabolic panel and creatine kinase (CK) isoenzyme panel were assessed. Race performance was standardised using the World Masters Association Age Grading Performance Tables. Total CK levels were elevated for all participants at all time points post-race (P < 0.001). The CK-isoenzyme MB% was elevated across groups at 6, 30 and 54 h post-race (P < 0.01, P < 0.01 and P < 0.05), with masters runners having a higher CK-MB% at 30 and 54 h (P < 0.05, P < 0.05). Total white blood cell and neutrophil counts were elevated through 6 h post-race (P < 0.001), with higher levels found in younger runners (P < 0.001). When considering all blood work, masters runners had a higher number of abnormal values at 6, 30 and 54 h post-race (P < 0.05, P < 0.01 and P < 0.05). In conclusion, masters runners demonstrated sustained CK-MB elevation, which may suggest greater cardiac stress. However, future studies using additional cardiac markers should be completed to confirm these findings. In addition, masters runners showed an increased number of laboratory values outside normal range, indicating the body's reduced capacity to respond to marathon running.
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Affiliation(s)
- Thomas G Martin
- a Department of Biomedical Sciences , Quinnipiac University , Hamden , CT , USA
| | - Rachel W Pata
- b Department of Physical Therapy , Quinnipiac University , Hamden , CT , USA
| | - Johanna D'Addario
- c Department of Physician Assistant Studies , Quinnipiac University , Hamden , CT , USA
| | - Lauren Yuknis
- b Department of Physical Therapy , Quinnipiac University , Hamden , CT , USA
| | - Rebecca Kingston
- b Department of Physical Therapy , Quinnipiac University , Hamden , CT , USA
| | - Richard Feinn
- d Frank H. Netter MD School of Medicine , Quinnipiac University , Hamden , CT , USA
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17
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Variation of red blood cell distribution width and mean platelet volume after moderate endurance exercise. Adv Hematol 2014; 2014:192173. [PMID: 25197280 PMCID: PMC4147199 DOI: 10.1155/2014/192173] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/02/2014] [Accepted: 08/03/2014] [Indexed: 11/18/2022] Open
Abstract
Although physical exercise strongly influences several laboratory parameters, data about the hematological changes after medium distance running are scarce. We studied 31 middle-trained athletes (mean training regimen 217 ± 32 min/week) who performed a 21.1 km, half-marathon run. Blood samples were collected before the run, at the end, and 3 and 20 hours thereafter. The complete blood count was performed on Advia 2120 and included red blood cell (RBC), reticulocyte, and platelet counts; hemoglobin; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); reticulocyte haemoglobin content (Ret CHR); RBC distribution width (RDW), mean platelet volume (MPV). No significant variations were observed for MCH and Ret CHR. The RBC, reticulocyte, and hemoglobin values modestly decreased after the run. The MCV significantly increased at the end of running but returned to baseline 3 hours thereafter. The RDW constantly increased, reaching a peak 20 hours after the run. The platelet count and MPV both increased after the run and returned to baseline 3 hours thereafter. These results may have implications for definition of reference ranges and antidoping testing, and may also contribute to explaining the relationship between endurance exercise and mortality, since previous studies reported that RDW and MPV may be significantly associated with cardiovascular disease.
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18
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Sanchis-Gomar F, Lippi G. Physical activity - an important preanalytical variable. Biochem Med (Zagreb) 2014; 24:68-79. [PMID: 24627716 PMCID: PMC3936967 DOI: 10.11613/bm.2014.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/11/2013] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia; Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
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