The TransEurope FootRace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486 km transcontinental ultramarathon

Foot and Ankle Bone Marrow Edema Assessment in Long Distance Runners

BACKGROUND

The clinical significance of foot and ankle bone marrow edema (BME) is poorly understood.

METHODS

Magnetic resonance imaging (MRI) and the visual analog scale (VAS) pain scores were collected for 17 runners who participated in the Twin Cities Marathon, immediately postmarathon and at a 6-week follow-up. Bone marrow edema lesions were classified using lesion frequency, anatomical location, and grading scale change to calculate a BME score for each affected bone. Spearman rank correlation coefficient test was used to identify a possible correlation between VAS and postmarathon BME. A paired Student t test was used to detect differences between total mileage ran 6 weeks postmarathon in participants with or without BME.

RESULTS

After completing the marathon, 8 BME lesions were identified in 5 participants (29.4%; 5/17), 3 were men, and 2 were women, with a mean age of 33.8 years (range: 24-52), and BMI of 22.9 ± 4. All lesions were resolved on 6-week follow-up imaging. VAS pain scores did not correlate with postmarathon BME. A significant difference in total miles logged over 6 weeks postmarathon could not be found among participants with and without BME.

CONCLUSION

Foot and ankle BME changes identified by MRI were not correlated to clinical symptoms and may resolve with self-directed activity in less time than other areas of the lower extremity.

LEVEL OF EVIDENCE

Level II, Prospective Cohort Study.

Adiponectin, leptin, cortisol, neuropeptide Y and profile of mood states in athletes participating in an ultramarathon during winter: An observational study

Background: The Montane^® Yukon Arctic Ultra (YAU) is one of the longest (690 km) and coldest (+10.6°C-43.9°C) ultramarathons worldwide. Taking part in an ultramarathon is associated with great physiological and psychological stress, which can affect one's mood, level of hormones, and peptides. The current study aimed to identify relationships between peptides, hormones, and mood states in participants during this ultramarathon. Methods: The study cohort consisted of 36 participants (19 men, 17 women, 38.64 ± 9.12 years) split into a finisher (n = 10), non-finisher (n = 19), and control group (n = 7). Data were collected at four time points: baseline (PRE), during (D1 after 277 km, D2 after 383 km), and after the race (POST). Questionnaires were used to assess ratings of perceived exertion (RPE), total quality of recovery (TQR), and profile of mood states (POMS-SF). Serum NPY, leptin, adiponectin, and cortisol were measured. Results: Among non-finishers, scores for confusion, anger, depression, and tension-anxiety (PRE vs. D2, p < 0.05) increased, while vigor decreased (PRE vs. D1, p < 0.05). In contrast, finishers' tension-anxiety scores decreased (PRE vs. D1, p < 0.05). Fatigue increased in finishers (PRE vs. POST, p < 0.05) and non-finishers (PRE vs. D1, p < 0.05). In non-finishers, depressive mood correlated positively with leptin, anger, and confusion at several time points (p < 0.001). In finishers, NPY correlated with TQR at PRE (p < 0.05), while leptin correlated negatively with TQR at POST (p < 0.05). Tension-anxiety correlated highly with perceived exertion in non-finishers (p < 0.001) and with cortisol in finishers (p < 0.05) and non-finishers (p < 0.001). In finishers, confusion correlated negatively with NPY (p < 0.01). Conclusion: The study reveals an essential interplay between hormones and mood states affecting performance: Leptin was associated with anger and a depressive mood state in non-finishers and worse recovery in finishers. In contrast, NPY appeared linked to a lower confusion score and heightened recovery in finishers. A simultaneous increase in depressed mood, anger, tension-anxiety, and confusion might harm performance and lead to race failure.

T2*-Mapping of Knee Cartilage in Response to Mechanical Loading in Alpine Skiing: A Feasibility Study

Purpose: This study intends to establish a study protocol for the quantitative magnetic resonance imaging (qMRI) measurement of biochemical changes in knee cartilage induced by mechanical stress during alpine skiing with the implementation of new spring-loaded ski binding. Methods: The MRI-knee-scans (T2*-mapping) of four skiers using a conventional and a spring-loaded ski binding system, alternately, were acquired before and after 1 h/4 h of exposure to alpine skiing. Intrachondral T2* analysis on 60 defined regions of interest in the femorotibial knee joint (FTJ) was conducted. Intra- and interobserver variability and relative changes in the cartilage T2* signal and thickness were calculated. Results: A relevant decrease in the T2* time after 4 h of alpine skiing could be detected at the majority of measurement times. After overnight recovery, the T2* time increased above baseline. Although, the total T2* signal in the superficial cartilage layers was higher than that in the lower ones, no differences between the layers in the T2* changes could be detected. The central and posterior cartilage zones of the FTJ responded with a stronger T2* alteration than the anterior zones. Conclusions: For the first time, a quantitative MRI study setting could be established to detect early knee cartilage reaction due to alpine skiing. Relevant changes in the T2* time and thus in the intrachondral collagen microstructure and the free water content were observed.

Mountain Ultra-Marathon (UTMB) Impact on Usual and Emerging Cardiac Biomarkers

The number of participants in ultra-marathons is increasing. However, the data regarding the impact of this type of exercise on the cardiovascular system are contradictory. In our study, 28 ultra-trail runners were enrolled. Blood samples were collected at three time points: immediately before, immediately after, and 7 days after the ultra-marathon. Different biomarkers were measured. Immediately after the race, the blood concentrations of the different cardiac and inflammatory biomarkers increased significantly. Interestingly, some biomarkers remained high even after 7 days of recovery.

Kinetics of Cardiac Remodeling and Fibrosis Biomarkers During an Extreme Mountain Ultramarathon

Objectives

The effects of ultra-distance on cardiac remodeling and fibrosis are unclear. Moreover, there are no data reporting the kinetics of cardiac alterations throughout the event and during recovery. Our aim was to investigate the kinetics of biological markers including new cardiac fibrosis biomarkers suppression of tumorigenicity 2 (ST2) and galectin-3 (Gal-3) during and after an extreme mountain ultramarathon.

Methods

Fifty experienced runners participating in one of the most challenging mountain ultramarathons (330 km, D+ 25,000 m) were enrolled in our study. Blood samples were collected at four time points: before (Pre-), at 148 km (Mid-), at the finish line (Post-), and 3 days after the recovery period (Recov-).

Results

The cardiac fibrosis biomarkers (ST2 and Gal-3) increased from Pre- to Mid-. During the second half, ST2 remained higher than pre-values as opposed to Gal-3. Necrosis, ischemia, and myocyte injury biomarkers increased until Mid- then decreased but remained higher at Recov- than Pre-values. Oxidative stress appeared at Mid-. Lipid peroxides remained higher at Recov- compared to Pre-. The maximal value in most of these biomarkers was observed at Mid- and not at Post-.

Conclusions

The present study supports biphasic kinetics of cardiac fibrosis biomarkers, with a relative recovery during the second half of the event that seems specific to this extreme event. Overall, performing at such an extreme ultramarathon seems less deleterious for the heart than shorter events.

Patellar and Achilles Tendon Thickness Differences among Athletes with Different Numbers of Meals per Day: A Cross-Sectional Study

The objective of this study is to analyse differences in the thickness of the patellar (PT) and Achilles tendons (AT) among athletes with different number of meals per day. The design is a cross-sectional, observational study. A total of thirty-six male athletes (with mean age groups ranging from 31 to 40) were recruited and divided into three groups based on the number of daily meals they had (3, 4 or 5 meals). PT and AT were assessed by ultrasound. There were statistically significant differences in PT when comparing groups 1 and 3, at both longitudinal (p < 0.03) and transversal (p < 0.002) planes. There were no differences when comparing groups 1 and 2 or groups 2 and 3. There was a negative correlation between the number of meals per day and tendon thicknesses in both PT (longitudinal plane: r = −0.384; p = 0.02/transversal plane: r = −0.406; p = 0.01) and AT (transversal plane: r = −0.386; p = 0.02). In conclusion, there were patellar tendon thickness differences between participants and the number of daily meals could play a key role in tendon thickness, healing and performance.

Inter-rater and inter-session reliability of lumbar paraspinal muscle composition in a mobile MRI device

Objective:

To assess the reliability of measurements of paraspinal muscle transverse relaxation times (T2 times) between two observers and within one observer on different time points.

Methods:

14 participants (9f/5m, 33 ± 5 years, 176 ± 10 cm, 73 ± 12 kg) underwent 2 consecutive MRI scans (M1,M2) on the same day, followed by 1 MRI scan 13–14 days later (M3) in a mobile 1.5 Tesla MRI. T2 times were calculated in T₂ weighted turbo spin-echo-sequences at the spinal level of the third lumbar vertebrae (11 slices, 2 mm slice thickness, 1 mm interslice gap, echo times: 20, 40, 60, 80, 100 ms) for M. erector spinae (ES) and M. multifidius (MF). The following reliability parameter were calculated for the agreement of T2 times between two different investigators (OBS1 & OBS2) on the same MRI (inter-rater reliability, IR) and by one investigator between different MRI of the same participant (intersession variability, IS): Test–Retest Variability (TRV, Differences/Mean*100); Coefficient of Variation (CV, Standard deviation/Mean*100); Bland–Altman Analysis (systematic bias = Mean of the Differences; Upper/Lower Limits of Agreement = Bias+/−1.96*SD); Intraclass Correlation Coefficient 3.1 (ICC) with absolute agreement, as well as its 95% confidence interval.

Results:

Mean TRV for IR was 2.6% for ES and 4.2% for MF. Mean TRV for IS was 3.5% (ES) and 5.1% (MF). Mean CV for IR was 1.9 (ES) and 3.0 (MF). Mean CV for IS was 2.5% (ES) and 3.6% (MF). A systematic bias of 1.3 ms (ES) and 2.1 ms (MF) were detected for IR and a systematic bias of 0.4 ms (ES) and 0.07 ms (MF) for IS. ICC for IR was 0.94 (ES) and 0.87 (MF). ICC for IS was 0.88 (ES) and 0.82 (MF).

Conclusion:

Reliable assessment of paraspinal muscle T2 time justifies its use for scientific purposes. The applied technique could be recommended to use for future studies that aim to assess changes of T2 times, e.g. after an intense bout of eccentric exercises.

Feasibility Analysis of Fifth-generation (5G) Mobile Networks for Transmission of Medical Imaging Data

Next to higher data rates and lower latency, the upcoming fifth-generation mobile network standard will introduce a new service ecosystem. Concepts such as multi-access edge computing or network slicing will enable tailoring service level requirements to specific use-cases. In medical imaging, researchers and clinicians are currently working towards higher portability of scanners. This includes i) small scanners to be wheeled inside the hospital to the bedside and ii) conventional scanners provided via trucks to remote areas. Both use-cases introduce the need for mobile networks adhering to high safety standards and providing high data rates. These requirements could be met by fifth-generation mobile networks. In this work, we analyze the feasibility of transferring medical imaging data using the current state of development of fifth-generation mobile networks (3GPP Release 15). We demonstrate the potential of reaching 100Mbit/s upload rates using already available consumer-grade hardware. Furthermore, we show an effective average data throughput of 50Mbit/s when transferring medical images using out-of-the-box open-source software based on the Digital Imaging and Communications in Medicine (DICOM) standard. During transmissions, we sample the radio frequency bands to analyse the characteristics of the mobile radio network. Additionally, we discuss the potential of new features such as network slicing that will be introduced in forthcoming releases.

Assessment Methods of Body Fat in Recreational Marathon Runners: Bioelectrical Impedance Analysis versus Skinfold Thickness

The aim of the present study was to examine (a) the relationship of body fat (BF) assessed by bioimpedance analysis (BIA) and skinfold thickness (SKF) and (b) the variation of BF by age depending on the assessment method. Participants were 32 women and 134 men recreational marathon runners, who were tested for BF using both assessment methods (BIA and SKF). Rc between BIA and SKF assessment methods was 0.803 (95% CI; 0.640, 0.897) in women and 0.568 (95% CI; 0.481, 0.644) in men. A large main effect of the assessment method on BF was observed (p < 0.001, η² = 0.156) with SKF presenting higher BF than BIA by 2.9%. The difference between SKF and BIA was 3.9 ± 2.7% (95% confidence intervals, CI; 3.4; 4.3, p < 0.001) in men, whereas no difference was found in women (−0.9 ± 2.9%; 95% CI; -1.9; -0.2, p = 0.101). BF correlated with age with small magnitude (BIA, r = 0.18, p = 0.036; SKF, r = 0.23, p = 0.007) in men, i.e., the older the age, the higher the BF. A similar trend of moderate magnitude was observed in women for BIA (r = 0.45, p = 0.011), but not for SKF (r = 0.33, p = 0.067). In conclusion, practitioners involved in the training of recreational runners would be advised to consider that BIA elicits a lower BF value than the SKF method in men.

Musculoskeletal Injuries in Ultra-Endurance Running: A Scoping Review

Ultra-endurance running (UER) has seen an important increase in participation over the last few decades. Long hours of UER can lead to excessive stress on the body, resulting in musculoskeletal injuries (MSKI). UER is not a uniform sport and events can differ considerably in distance (over 42.195 km), time (e.g., events over 6 h) and multi-day or multi-stage events on various surfaces (e.g., track, on-road, off-road). The aims of this scoping review were therefore: (1) to examine the current evidence of MSKI, providing a synthesis of the most common MSKI by anatomical region and specific diagnosis; (2) categorize MSKI by type of UER activity (competition: time-limited; multi-stage; continuous UER events and training); (3) describe knowledge gaps in the literature and provide advice on potential further research. Our electronic literature search (PubMed, SPORTDiscus, Web of Science) identified a total of 13 studies (9 in competition, and 4 in training). Anatomical site, diagnosis and rate of injuries differ between competition and training as well as between different UER types. MSKI are observed in 18% of multi-stage events (0.7-1.8 injuries/runner and 7.2 injuries/1000 h). Most MSKI involve the lower leg (35.0%), ankle (16.8%), knee (13.1%) and foot (12.6%), with main diagnosis of medial tibial stress syndrome (30.1%) and patella femoral pain syndrome (PFPS; 7.2%). Single, continuous UER events differ between a 1005 km road race with almost all of the injuries due to overuse, with the main anatomical site of the knee (31%), ankle (28%) and lower leg (14%) and main diagnosis of PFPS (15.6%), compared to a 65 km trail race, with 32.8% of MSKI, mainly on the foot [plantar fasciitis (28.6%)], ankle [sprain (28.6%)] and knee. Timed-UER events (injury rate of 2.1 injuries/athlete) observed most injuries on the ankle (36%) and knee (19%), with the main diagnosis of tendinitis of the foot dorsiflexors (30%). Injuries during training most commonly affect, the back (42%), and knee (40%) and bone stress injuries (22%). Main diagnoses include ankle sprain (18%), iliotibial band injury (16%) and Achilles tendinopathy (11%). Future considerations include examining MSKI in different UER events, environments and surfaces, and on larger study populations. Establishing risk factors, examining sex differences and using a standard reporting system of MSKI in UER are also important.

Predictors of Athlete's Performance in Ultra-Endurance Mountain Races

Background: In previous studies, ultra-endurance performance has been associated with training and psychological variables. However, performance under extreme conditions is understudied, mainly due to difficulties in making field measures. Aim: The aim of this study was to analyze the role of training, hydration, nutrition, oral health status, and stress-related psychological factors in athletes’ performance in ultra-endurance mountain events. Methods: We analyzed the variables of race time and training, hydration state, nutrition, oral health status, and stress-related psychological factors in 448 ultra-endurance mountain race finishers divided into three groups according to race length (less than 45 km, 45–90 km, and greater than 90 km), using a questionnaire. Results: Higher performance in ultra-endurance mountain races was associated with better oral health status and higher accumulative altitude covered per week as well as higher positive accumulative change of altitude per week during training. In longer distance races, experience, a larger volume of training, and better hydration/nutrition prior to the competition were associated with better performance. Conclusions: Ultra-endurance mountain athletes competing in longer races (>90 km) have more experience and follow harder training schedules compared with athletes competing in shorter distances. In longer races, a larger fluid intake before the competition was the single best predictor of performance. For races between 45 and 90 km, training intensity and volume were key predictors of performance, and for races below 45 km, oral health status was a key predictor of performance. Psychological factors previously reported as ultra-endurance mountain race performance predictors were inconsistent or failed to predict the performance of athletes in the present research.

Long distance running - Can bioprofiling predict success in endurance athletes?

The TransEuropeFootRace (TEFR) was one of the most extreme multistage competitions worldwide. The ultramarathon took the runners over a distance of 4487 km, from Bari, Italy, to the North Cape, Norway, in 64 days. The participating ultra-long-distance runners had to complete almost two marathons per day (~70 km). The race was accompanied by a research team analysing adaptations of different organ systems of the human body that were exposed to a chronic lack of regeneration time. Here, we analyzed runner's urine using mass spectrometric profiling of thousands of low-molecular weight compounds. The results indicated that pre-race molecular factors can predict finishers and separate them from nonfinishers already before the race. These observations were related to the training volume as finishers ran about twice as many kilometers per week before TEFR than nonfinishers, thus apparently achieving a higher performance level and resistance against overuse. While this hypothesis needs to be validated in future long-distance races, the bioprofiling experiments suggest that the competition readiness of the runners is measurable and might be adjustable.

A mobile MRI field study of the biochemical cartilage reaction of the knee joint during a 4,486 km transcontinental multistage ultra-marathon using T2* mapping

Nearly nothing is known about the consequences of ultra-long-distance running on knee cartilage. In this mobile MRI field study, we analysed the biochemical effects of a 4,486 km transcontinental multistage ultra-marathon on femorotibial joint (FTJ) cartilage. Serial MRI data were acquired from 22 subjects (20 male, 18 finisher) using a 1.5 T MR scanner mounted on a 38-ton trailer, travelling with the participants of the TransEurope FootRace (TEFR) day by day over 64 stages. The statistical analyses focused on intrachondral T2* behaviour during the course of the TEFR as the main outcome variable of interest. T2* mapping (sagittal FLASH T2* weighted gradient echo) is a validated and highly accurate method for quantitative compositional cartilage analysis of specific weightbearing areas of the FTJ. T2* mapping is sensitive to changes in the equilibrium of free intrachondral water, which depends on the content and orientation of collagen and the proteoglycan content in the extracellular cartilage matrix. Within the first 1,100 km, a significant running load-induced T2* increase occurred in all joint regions: 44.0% femoral-lateral, 42.9% tibial-lateral, 34.9% femoral-medial, and 25.1% tibial-medial. Osteochondral lesions showed no relevant changes or new occurrence during the TEFR. The reasons for stopping the race were not associated with knee problems. As no further T2* elevation was found in the second half of the TEFR but a decreasing T2* trend (recovery) was observed after the 3,500 km run, we assume that no further softening of the cartilage occurs with ongoing running burden over ultra-long distances extending 4,500 km. Instead, we assume the ability of the FTJ cartilage matrix to reorganize and adapt to the load.

Heart of the World's Top Ultramarathon Runner-Not Necessarily Much Different from Normal

The impact of ultramarathon (UM) runs on the organs of competitors, especially elite individuals, is poorly understood. We tested a 36-year-old UM runner before, 1–2 days after, and 10–11 days after winning a 24-h UM as a part of the Polish Championships (258.228 km). During each testing session, we performed an electrocardiogram (ECG), transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (MRI), cardiac ³¹P magnetic resonance spectroscopy (³¹P MRS), and blood tests. Initially, increased cholesterol and low-density lipoprotein cholesterol (LDL-C) levels were identified. The day after the UM, increased levels of white blood cells, neutrophils, fibrinogen, alanine aminotransferase, aspartate aminotransferase, creatine kinase, C-reactive protein, and N-terminal type B natriuretic propeptide were observed. Additionally, decreases in hemoglobin, hematocrit, cholesterol, LDL-C, and hyponatremia were observed. On day 10, all measurements returned to normal levels, and cholesterol and LDL-C returned to their baseline abnormal values. ECG, TTE, MRI, and ³¹P MRS remained within the normal ranges, demonstrating physiological adaptation to exercise. The transient changes in laboratory test results were typical for the extreme efforts of the athlete and most likely reflected transient but massive striated muscle damage, liver cell damage, activation of inflammatory processes, effects on the coagulation system, exercise-associated hyponatremia, and cytoprotective or growth-regulatory effects. These results indicated that many years of intensive endurance training and numerous UMs (including the last 24-h UM) did not have a permanent adverse effect on this world-class UM runner’s body and heart. Transient post-competition anomalies in laboratory test results were typical of those commonly observed after UM efforts.

Multidisciplinary Analysis of Differences Between Finisher and Non-finisher Ultra-Endurance Mountain Athletes

Ultra-endurance races are one of the most physically and psychologically demanding sports, depending performance on several elements. The aims of the present study were (i) to analyze differences in selected psychophysiological parameters between finisher and non-finisher ultra-endurance mountain athletes, and (ii) to analyze modifications in psychophysiological parameters before and after an ultra-endurance mountain event. Selected psychophysiological variables were assessed in 46 finishers and 24 non-finishers in two over 100 km ultra-endurance races were examined. We found how an ultra-endurance mountain race produced dehydration, a decrease in systolic blood pressure, weight and leg strength muscle values, as well as an increase in heart rate and rate of perceived exertion values. Finishers presented lower systolic blood pressure, weight, body mass index, half marathon time and fluid intake before competition day compared to non-finishers. In addition, body mass index, pre-race hydration, and performance in lower distance races were predictors of performance in these ultra-endurance mountain races.

Cardiac structure and function in response to a multi-stage marathon over 4486 km

Aims

To investigate whether participation in the Trans Europe Foot Race 2009 (TEFR), an ultramarathon race held over 64 consecutive days and 4486 km, led to changes in cardiac structure and function.

Methods

Cardiac magnetic resonance imaging was performed in 20 of 67 participating runners (two women; mean ± SD age 47.8 ± 10.4 years) at three time points (baseline scan at 294 ± 135 km (B), scan two at 1735 ± 86 km (T1) and scan three at 3370 ± 90 km (T2)) during the TEFR. Imaging included an assessment of left ventricular structure (mass) and function (strain). In parallel, cardiac troponin I, NT-pro-BNP, myostatin and GDF11 were determined in venous blood samples. A subsample of ten runners returned for a follow-up scan eight months after the race.

Results

Left ventricular mass increased significantly (B, 158.5 ± 23.8 g; T1, 165.1 ± 23.2 g; T2, 167 ± 24.6 g; p &lt; 0.001) over the course of the race, although no significant change was seen in the remaining structural and functional parameters. Serum concentrations of cardiac troponin I and NT-proBNP significantly increased 1.5 - and 3.5-fold, respectively, during the first measurement interval, with no further increase thereafter (cardiac troponin I, 6.8 ± 3.1 (B), 16.9 ± 10.4 (T1) and 17.1 ± 9.7 (T2); NT-proBNP, 30.3 ± 22.8 (B), 135.9 ± 177.5 (T1) and 111.2 ± 87.3 (T2)), whereas the growth markers myostatin and GDF11 did not change. No association was observed with functional parameters, including the ejection fraction and the volume of both ventricles. The follow-up scans showed a reduction to baseline values (left ventricular mass 157 ± 19.3 g).

Conclusions

High exercise-induced cardiac volume load for &gt;2 months in ultra-endurance runners results in a physiological structural adaptation with no sign of adverse cardiovascular remodelling.

Pre-race determinants influencing performance and finishing of a transcontinental 4486-km ultramarathon

BACKGROUND

Pre-race determinants influencing performance and finishing of one of the largest transcontinental multistage ultramarathons were investigated.

METHODS

Forty-four participants of the TransEurope FootRace 2009 (TEFR), running 4486 km in 64 stages (average 70.1 km daily) were analyzed regarding training and running history. This included years of regular endurance running (PRY), number of finished marathons, ultramarathons (UM) and multistage ultramarathons (MSUM), pre-race records (PRR) for marathon and specific UM races and the extent of pre-race training (PRT) in the last year before TEFR: volume (km/week), duration (h/week) and intensity (km/h).

RESULTS

Mean total running speed during TEFR was 8.25 km/h.Seventy-one percent of subjects finished the race. The mean PRT-volume extends 5500 km. Finishers and non-finishers of the TEFR did not show significant difference in any tested pre-race determinants. There was no association between PRY, number of finished marathons, UM, and MSUM and TEFR performance. There was very strong positive correlation between PRT-intensity and TEFR performance. PRT volume correlated with a medium effect size to TEFR performance. PRR in specific ultra-races (6-hour, 50-km, 100-km races) showed a high correlation to TEFR performance. Performance in ultramarathon correlates inversely with age.

CONCLUSIONS

Like in other endurance disciplines with shorter distances, in ultra-long multistage endurance running the athletes also need a stage-specific pre-race experience, training and adaptation if he wants to end up with a good performance. But dropping out of a MSUM seems not to be consistent with regard to specific pre-race experience. Further research results of TEFR project may reveal potential risk factors for non-finishing a transcontinental footrace.

Psychophysiological Stress Response of a Paralympic Athlete During an Ultra-Endurance Event. A Case Study

Psychophysiological response of athletes with spinal cord injurie has not been reported yet in scientific literature. The aim of this study is to examine the psychophysiological stress response of Paralympic athlete during competitive activities. We collected the following psychophysiological measurements: anxiety-trait, anxiety-state, locus of control, perceived psychological stress, stress-copying style, rate of perceived exertion, perceived muscle pain, body temperature, forced vital capacity, blood oxygen saturation, blood glucose and lactate concentrations, isometric hand strength, cortical arousal, heart rate variability, heart rate and velocities of a female Paralympic spinal cord injured athlete in a 11 h and 44 min ultraendurance mountain event. An ultraendurance mountain even produced an increase in the sympathetic autonomous modulation, heart rate, lactate, muscular pain and rated of perceived exertion and a decrease in cortical arousal, hand strength and respiratory muscle in a spinal cord injurie female athlete during. The Paralympic athletes presented a low psychological inflexibility, high life engagement, strong internal locus of control, a low trait and state anxiety and medium perceived psychological stress. These results are consistent with the expected response during a highly stressful situation and consistent with previous findings in athletes without spinal cord injurie.

Lesions in the legs do not preclude ultra-marathon running for 100 days without pain: case report

There is an increasing interest in participation in ultra-endurance events and a concomitant need to understand their effects on health. The effects of extremely prolonged running on leg joints, ligaments, tendons and menisci have not been explored sufficiently. The aim of the present single case study was to use ultrasonography to estimate the effects of a self-paced 8-10 hours daily running for 100 days on the morphology of joints in an experienced 47-year-old ultra-marathon runner. Examination before the start of the 100 days of running revealed already multiple but mostly mild, painless lesions in different joints of both legs. The presence of these lesions did not significantly exacerbate or cause pain during the racing. Iliotibial band bursitis and Achilles paratenonitis were however aggravated, and mild semitendinosus bursitis was a novel finding during the examination after running 8000 km in 100 days. These results are impressive because preparation for this 8000 km running was only ~5 weekly hours of training. In conclusion, this runner displayed multiple lesions in the leg joints at the start but was able to increase running volume by ~10-fold for >100 consecutive days without significantly exacerbating the pre-existing skeletomuscular abnormalities or inducing pain.

The role of the nervous system in neuromuscular fatigue induced by ultra-endurance exercise

Ultra-endurance events are not a recent development but they have only become very popular in the last 2 decades, particularly ultramarathons run on trails. The present paper reviews the role of the central nervous system in neuromuscular fatigue induced by ultra-endurance exercise. Large decreases in voluntary activation are systematically found in ultra-endurance running but are attenuated in ultra-endurance cycling for comparable intensity and duration. This indirectly suggests that afferent feedback, rather than neurobiological changes within the central nervous system, is determinant in the amount of central fatigue produced. Whether this is due to inhibition from type III and IV afferent fibres induced by inflammation, disfacilitation of Ia afferent fibers owing to repeated muscle stretching or other mechanisms still needs to be determined. Sleep deprivation per se does not seem to play a significant role in central fatigue although it still affects performance by elevating ratings of perceived exertion. The kinetics of central fatigue and recovery, the influence of muscle group (knee extensors vs plantar flexors) on central deficit as well as the limitations related to studies on central fatigue in ultra-endurance exercise are also discussed in the present article. To date, no study has quantified the contribution of spinal modulations to central fatigue in ultra-endurance events. Future investigations utilizing spinal stimulation (i.e., thoracic stimulation) must be conducted to assess the role of changes in motoneuronal excitability on the observed central fatigue. Recovery after ultra-endurance events and the effect of sex on neuromuscular fatigue must also be studied further.

[Ultramarathon with Type 1 Diabetes]

Ultramarathon with Type 1 Diabetes Abstract. We report the case of a 63-year-old runner with type 1 diabetes mellitus requiring insulin since the age of 21. At the age of 32, he ran his first marathon, and at the age of 34 the first ultramarathon. So far, he has finished more than 90 marathons and ultramarathons. Thanks to an insulin pump and continuous glucose monitoring, he has so far completed 48 24-h-runs with an average distance of 133 km. The analysis of running volume and HbA1c values showed a significant increase in monthly exercise volume, a significant decrease in HbA1c values over the years, and a significant correlation between monthly running kilometers and HbA1c values.

Ultra-obligatory running among ultramarathon runners

Participants in the Ultrarunners Longitudinal TRAcking (ULTRA) Study were asked to answer "yes" or "no" to the question "If you were to learn, with absolute certainty, that ultramarathon running is bad for your health, would you stop your ultramarathon training and participation?" Among the 1349 runners, 74.1% answered "no". Compared with those answering "yes", they were younger (p < 0.0001), less likely to be married (p = 0.019), had less children (p = 0.0095), had a lower health orientation (p < 0.0001) though still high, and higher personal goal achievement (p = 0.0066), psychological coping (p < 0.0001) and life meaning (p = 0.0002) scores on the Motivations of Marathoners Scales. Despite a high health orientation, most ultramarathon runners would not stop running if they learned it was bad for their health as it appears to serve their psychological and personal achievement motivations and their task orientation such that they must perceive enhanced benefits that are worth retaining at the risk of their health.

Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review

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.

Accurate Measurement of Cross-Sectional Area of Femoral Artery on MRI Sequences of Transcontinental Ultramarathon Runners Using Optimal Parameters Selection

In clinics an accurate vessel segmentation method is important to quantize the vessel volume change with respect to time for artery elasticity measurement. This study proposes a modified version on 3D-expanded dynamic programming to find an optimal surface in a 3D matrix. The aim of this study is to discover the robustness against noises in measuring the cross-sectional area of the femoral artery on MRI datasets of ultra-endurance runners as accurately as possible. To do this, we use phantom images with different added noises and different image contrasts to find out the optimal parameters using grid search. The contrast between the vessel lumen and its background in phantom study is changed to simulate the real MRI dataset. We also add a plaque in phantom images to test the accuracy of the proposed algorithm in dealing pathologic cases. The phantom studies and grid search on selecting optimal parameters can offer an alternative way on parameter selection. In application to MRI, the accuracy is performed via comparisons between the manual tracings of experts and automated results. The mean relative error is 2.1 % ± 2.1 % on testing 11 MRI datasets (total 550 images). The phantom studies and grid search on selecting optimal parameters can offer an alternative way on parameter selection.

Moving in extreme environments: extreme loading; carriage versus distance

This review addresses human capacity for movement in the context of extreme loading and with it the combined effects of metabolic, biomechanical and gravitational stress on the human body. This topic encompasses extreme duration, as occurs in ultra-endurance competitions (e.g. adventure racing and transcontinental races) and expeditions (e.g. polar crossings), to the more gravitationally limited load carriage (e.g. in the military context). Juxtaposed to these circumstances is the extreme metabolic and mechanical unloading associated with space travel, prolonged bedrest and sedentary lifestyle, which may be at least as problematic, and are therefore included as a reference, e.g. when considering exposure, dangers and (mal)adaptations. As per the other reviews in this series, we describe the nature of the stress and the associated consequences; illustrate relevant regulations, including why and how they are set; present the pros and cons for self versus prescribed acute and chronic exposure; describe humans' (mal)adaptations; and finally suggest future directions for practice and research. In summary, we describe adaptation patterns that are often U or J shaped and that over time minimal or no load carriage decreases the global load carrying capacity and eventually leads to severe adverse effects and manifest disease under minimal absolute but high relative loads. We advocate that further understanding of load carrying capacity and the inherent mechanisms leading to adverse effects may advantageously be studied in this perspective. With improved access to insightful and portable technologies, there are some exciting possibilities to explore these questions in this context.

Exercise behavior of ultramarathon runners: baseline findings from the ULTRA study

Little is known about exercise habits of those who compete in foot races longer than the standard 42-km marathon distance. The purpose of this work was to describe the past-year and lifetime exercise patterns of a large cohort of ultramarathon runners. Information on exercise history was collected on 1,345 current and former ultramarathon runners as baseline data for participation in a longitudinal observational study. Median age at the first ultramarathon was 36 years, and the median number of years of regular running before the first ultramarathon was 7 (interquartile range, 3-15). Age at first ultramarathon did not change across the past several decades, but there was evidence of an inverse relationship (r = -0.13, p < 0.0001) between number of years of regular running before the first ultramarathon and calendar year. The active ultramarathon runners (n = 1,212) had a previous year median running distance of 3,347 km, which was minimally related to age (r = -0.068, p = 0.018), but mostly related to their longest ultramarathon competition of the year (p < 0.0001). Running injuries represented the most common reason for discontinuation of regular running, whereas work and family commitments were reported as the main reasons for not running an ultramarathon in the previous year among those who were regularly running and intending to run ultramarathons again. We conclude that runners tend to be well into adulthood and with several years of running experience before running their first ultramarathon, but 25% have only been regularly running for 3 years or less at the time of their first ultramarathon.

Biochemical cartilage alteration and unexpected signal recovery in T2* mapping observed in ankle joints with mobile MRI during a transcontinental multistage footrace over 4486 km

OBJECTIVE

The effect of ultra-long distance running on the ankle cartilage with regard to biochemical changes, thickness and lesions is examined in the progress of a transcontinental ultramarathon over 4486 km.

METHOD

In an observational field study, repeated follow-up scanning of 22 participants of the TransEurope FootRace (TEFR) with a 1.5 T MRI mounted on a mobile unit was performed. For quantitative biochemical and structural evaluation of cartilage a fast low angle shot (FLASH) T2* weighted gradient-echo (GRE)-, a turbo-inversion-recovery-magnitude (TIRM)- and a fat-saturated proton density (PD)-weighted sequence were utilized. Statistical analysis of cartilage T2* and thickness changes was obtained on the 13 finishers (12 male, mean age 45.4 years, BMI 23.5 kg/m²). None of the nine non-finisher (eight male, mean age 53.8 years, BMI 23.4 kg/m²) stopped the race due to ankle problems.

RESULTS

From a mean of 17.0 ms for tibial plafond and 18.0 ms for talar dome articular cartilage at baseline, nearly all observed regions of interest (ROIs) of the ankle joint cartilage showed a significant T2*-signal increase (25.6% in mean), with standard error ranging from 19% to 33% within the first 2500 km of the ultra-marathon. This initial signal behavior was followed by a signal decrease. This signal recovery (30.6% of initial increase) showed a large effect size. No significant morphological or cartilage thickness changes (at baseline 2.9 mm) were observed.

CONCLUSION

After initial T2*-increase during the first 2000-2500 km, a subsequent T2*-decrease indicates the ability of the normal cartilage matrix to partially regenerate under ongoing multistage ultramarathon burden in the ankle joints.

Age group performances in 100 km and 100 miles ultra-marathons

Improved performance has been reported for master runners (i.e. athletes older than 40 years) in both single marathons and single ultra-marathons. This study investigated performance trends of age group ultra-marathoners competing in all 100 km and 100 miles races held worldwide between 1971 and 2013. Changes in running speeds across years were investigated for the annual ten fastest 5-year age group finishers using linear, non-linear and multi-level regression analyses. In 100 km, running speed remained unchanged in women in 25–29 years, increased non-linearly in 30–34 to 55–59 years, and linearly in 60–64 years. In men, running speed increased non-linearly in 18–24 to 60–64 years and linearly in 65–69 to 75–79 years. In 100 miles, running speed increased in women linearly in 25–29 and 30–34 years, non-linearly in 35–39 to 45–49 years, and linearly in 50–54 and 55–59 years. For men, running speed increased linearly in 18–24 years, non-linearly in 25–29 to 45–49 years, and linearly in 50–54 to 65–69 years. Overall, the faster race times over the last 30 years are a result of all top ten finishers getting faster. These findings suggest that athletes in younger to middle age groups (i.e. 25–35 to 50–65 years depending upon sex and distance) have reached their limits due to a non-linear increase in running speed whereas runners in very young (i.e. younger than 25–35 years) and older age groups (i.e. older than 50–65 years) depending upon sex and distance might still improve their performance due to a linear increase in running speed.

Alterations in postural control during the world's most challenging mountain ultra-marathon

We investigated postural control (PC) effects of a mountain ultra-marathon (MUM): a 330-km trail run with 24000 m of positive and negative change in elevation. PC was assessed prior to (PRE), during (MID) and after (POST) the MUM in experienced ultra-marathon runners (n = 18; finish time = 126 ± 16 h) and in a control group (n = 8) with a similar level of sleep deprivation. Subjects were instructed to stand upright on a posturographic platform over a period of 51.2 seconds using a double-leg stance under two test conditions: eyes open (EO) and eyes closed (EC). Traditional measures of postural stability (center of pressure trajectory analysis) and stabilogram-diffusion analysis (SDA) parameters were analysed. For the SDA, a significantly greater short-term effective diffusion was found at POST compared with PRE in the medio-lateral (ML; Dxs) and antero-posterior (AP) directions (Dys) in runners (p<0.05) The critical time interval (Ctx) in the ML direction was significantly higher at MID (p<0.001) and POST (p<0.05) than at PRE in runners. At MID (p<0.001) and POST (p<0.05), there was a significant difference between the two groups. The critical displacement (Cdx) in the ML was significantly higher at MID and at POST (p<0.001) compared with PRE for runners. A significant difference in Cdx was observed between groups in EO at MID (p<0.05) and POST (p<0.005) in the ML direction and in EC at POST in the ML and AP directions (p<0.05). Our findings revealed significant effects of fatigue on PC in runners, including, a significant increase in Ctx (critical time in ML plan) in EO and EC conditions. Thus, runners take longer to stabilise their body at POST than at MID. It is likely that the mountainous characteristics of MUM (unstable ground, primarily uphill/downhill running, and altitude) increase this fatigue, leading to difficulty in maintaining balance.

Regionally accentuated reversible brain grey matter reduction in ultra marathon runners detected by voxel-based morphometry

Background

During the 4,487 km ultra marathon TransEurope-FootRace 2009 (TEFR09), runners showed catabolism with considerable reduction of body weight as well as reversible brain volume reduction. We hypothesized that ultra marathon athletes might have developed changes to grey matter (GM) brain morphology due to the burden of extreme physical training. Using voxel-based morphometry (VBM) we undertook a cross sectional study and two longitudinal studies.

Methods

Prior to the start of the race 13 runners volunteered to participate in this study of planned brain scans before, twice during, and 8 months after the race. A group of matched controls was recruited for comparison. Twelve runners were able to participate in the scan before the start of the race and were taken into account for comparison with control persons. Because of drop-outs during the race, VBM could be performed in 10 runners covering the first 3 time points, and in 7 runners who also had the follow-up scan after 8 months. Volumetric 3D datasets were acquired using an MPRAGE sequence. A level of p < 0.05, family-wise corrected for multiple comparisons was the a priori set statistical threshold to infer significant effects from VBM.

Results

Baseline comparison of TEFR09 participants and controls revealed no significant differences regarding GM brain volume. During the race however, VBM revealed GM volume decreases in regionally distributed brain regions. These included the bilateral posterior temporal and occipitoparietal cortices as well as the anterior cingulate and caudate nucleus. After eight months, GM normalized.

Conclusion

Contrary to our hypothesis, we did not observe significant differences between TEFR09 athletes and controls at baseline. If this missing difference is not due to small sample size, extreme physical training obviously does not chronically alter GM.

However, during the race GM volume decreased in brain regions normally associated with visuospatial and language tasks. The reduction of the energy intensive default mode network as a means to conserve energy during catabolism is discussed. The changes were reversible after 8 months.

Despite substantial changes to brain composition during the catabolic stress of an ultra marathon, the observed differences seem to be reversible and adaptive.

Alterations of Neuromuscular Function after the World's Most Challenging Mountain Ultra-Marathon

We investigated the physiological consequences of the most challenging mountain ultra-marathon (MUM) in the world: a 330-km trail run with 24000 m of positive and negative elevation change. Neuromuscular fatigue (NMF) was assessed before (Pre-), during (Mid-) and after (Post-) the MUM in experienced ultra-marathon runners (n = 15; finish time  = 122.43 hours ±17.21 hours) and in Pre- and Post- in a control group with a similar level of sleep deprivation (n = 8). Blood markers of muscle inflammation and damage were analyzed at Pre- and Post-. Mean ± SD maximal voluntary contraction force declined significantly at Mid- (−13±17% and −10±16%, P<0.05 for knee extensor, KE, and plantar flexor muscles, PF, respectively), and further decreased at Post- (−24±13% and −26±19%, P<0.01) with alteration of the central activation ratio (−24±24% and −28±34% between Pre- and Post-, P<0.05) in runners whereas these parameters did not change in the control group. Peripheral NMF markers such as 100 Hz doublet (KE: −18±18% and PF: −20±15%, P<0.01) and peak twitch (KE: −33±12%, P<0.001 and PF: −19±14%, P<0.01) were also altered in runners but not in controls. Post-MUM blood concentrations of creatine kinase (3719±3045 Ul·¹), lactate dehydrogenase (1145±511 UI·L⁻¹), C-Reactive Protein (13.1±7.5 mg·L⁻¹) and myoglobin (449.3±338.2 µg·L⁻¹) were higher (P<0.001) than at Pre- in runners but not in controls. Our findings revealed less neuromuscular fatigue, muscle damage and inflammation than in shorter MUMs. In conclusion, paradoxically, such extreme exercise seems to induce a relative muscle preservation process due likely to a protective anticipatory pacing strategy during the first half of MUM and sleep deprivation in the second half.

Characteristics, changes and influence of body composition during a 4486 km transcontinental ultramarathon: results from the TransEurope FootRace mobile whole body MRI-project

BACKGROUND

Almost nothing is known about the medical aspects of runners doing a transcontinental ultramarathon over several weeks. The results of differentiated measurements of changes in body composition during the Transeurope Footrace 2009 using a mobile whole body magnetic resonance (MR) imager are presented and the proposed influence of visceral and somatic adipose and lean tissue distribution on performance tested.

METHODS

22 participants were randomly selected for the repeated MR measurements (intervals: 800 km) with a 1.5 Tesla MR scanner mounted on a mobile unit during the 64-stage 4,486 km ultramarathon. A standardized and validated MRI protocol was used: T1 weighted turbo spin echo sequence, echo time 12 ms, repetition time 490 ms, slice thickness 10 mm, slice distance 10 mm (breath holding examinations). For topographic tissue segmentation and mapping a modified fuzzy c-means algorithm was used. A semi-automatic post-processing of whole body MRI data sets allows reliable analysis of the following body tissue compartments: Total body volume (TV), total somatic (TSV) and total visceral volume (TVV), total adipose (TAT) and total lean tissue (TLT), somatic (SLT) and visceral lean tissue (VLT), somatic (SAT) and visceral adipose tissue (VAT) and somatic adipose soft tissue (SAST). Specific volume changes were tested on significance. Tests on difference and relationship regarding prerace and race performance and non-finishing were done using statistical software SPSS.

RESULTS

Total, somatic and visceral volumes showed a significant decrease throughout the race. Adipose tissue showed a significant decrease compared to the start at all measurement times for TAT, SAST and VAT. Lean adipose tissues decreased until the end of the race, but not significantly. The mean relative volume changes of the different tissue compartments at the last measurement compared to the start were: TV -9.5% (SE 1.5%), TSV -9.4% (SE 1.5%), TVV -10.0% (SE 1.4%), TAT -41.3% (SE 2.3%), SAST -48.7% (SE 2.8%), VAT -64.5% (SE 4.6%), intraabdominal adipose tissue (IAAT) -67.3% (SE 4.3%), mediastinal adopose tissue (MAT) -41.5% (SE 7.1%), TLT -1.2% (SE 1.0%), SLT -1.4% (SE 1.1%). Before the start and during the early phase of the Transeurope Footrace 2009, the non-finisher group had a significantly higher percentage volume of TVV, TAT, SAST and VAT compared to the finisher group. VAT correlates significantly with prerace training volume and intensity one year before the race and with 50 km- and 24 hour-race records. Neither prerace body composition nor specific tissue compartment volume changes showed a significant relationship to performance in the last two thirds of the Transeurope Footrace 2009.

CONCLUSIONS

With this mobile MRI field study the complex changes in body composition during a multistage ultramarathon could be demonstrated in detail in a new and differentiated way. Participants lost more than half of their adipose tissue. Even lean tissue volume (mainly skeletal muscle tissue) decreased due to the unpreventable chronic negative energy balance during the race. VAT has the fastest and highest decrease compared to SAST and lean tissue compartments during the race. It seems to be the most sensitive morphometric parameter regarding the risk of non-finishing a transcontinental footrace and shows a direct relationship to prerace-performance. However, body volume or body mass and, therefore, fat volume has no correlation with total race performances of ultra-athletes finishing a 4,500 km multistage race.

Analysis of participation and performance in athletes by age group in ultramarathons of more than 200 km in length

Background

Participation and performance trends for athletes by age group have been investigated for marathoners and ultramarathoners competing in races up to 161 km, but not for longer distances of more than 200 km.

Methods

Participation and performance trends in athletes by age group in the Badwater (217 km) and Spartathlon (246 km) races were compared from 2000 to 2012.

Results

The number of female and male finishers increased in both races across years (P < 0.05). The age of the annual five fastest men decreased in Badwater from 42.4 ± 4.2 years to 39.8 ± 5.7 years (r² = 0.33, P = 0.04). For women, the age remained unchanged at 42.3 ± 3.8 years in Badwater (P > 0.05). In Spartathlon, the age of the annual five fastest finishers was unchanged at 39.7 ± 2.4 years for men and 44.6 ± 3.2 years for women (P > 0.05). In Badwater, running speed increased in men from 7.9 ± 0.7 km/hour to 8.7 ± 0.6 km/hour (r² = 0.51, P < 0.01) and in women from 5.4 ± 1.1 km/hour to 6.6 ± 0.5 km/hour (r² = 0.61, P < 0.01). In Spartathlon, running speed remained unchanged at 10.8 ± 0.7 km/hour in men and 8.7 ± 0.5 km/hour in women (P > 0.05). In Badwater, the number of men in age groups 30–34 years (r² = 0.37, P = 0.03) and 40–44 years (r² = 0.75, P < 0.01) increased. In Spartathlon, the number of men increased in the age group 40–44 years (r² = 0.33, P = 0.04). Men in age groups 30–34 (r² = 0.64, P < 0.01), 35–39 (r² = 0.33, P = 0.04), 40–44 (r² = 0.34, P = 0.04), and 55–59 years (r² = 0.40, P = 0.02) improved running speed in Badwater. In Spartathlon, no change in running speed was observed.

Conclusion

The fastest finishers in ultramarathons more than 200 km in distance were 40–45 years old and have to be classified as “master runners” by definition. In contrast to reports of marathoners and ultramarathoners competing in races of 161 km in distance, the increase in participation and the improvement in performance by age group were less pronounced in ultramarathoners competing in races of more than 200 km.

Ultra-marathon runners are different: investigations into pain tolerance and personality traits of participants of the TransEurope FootRace 2009

INTRODUCTION

Susceptibility to pain varies among individuals and may predispose to a higher risk for pain disorders. Thus, it is of interest to investigate subjects who exhibit higher resistance to pain. We therefore tested pain tolerance and assessed personality traits of ultra-marathon athletes who are able to run 4487 km (2789 mi) over 64 days without resting days and compare the results to controls.

METHODS

After approval of the local ethics committee and with informed consent, 11 participants of the TransEurope FootRace (TEFR09 participants) and 11 matched (age, sex, and ethnicity) controls without marathon experience in the last 5 years were enrolled. They were tested for cold pain tolerance (cold pressor [CP] test), and the 240 item trait and character inventory (TCI) as well as the general self-efficacy (GSE) test were obtained.

RESULTS

TransEurope FootRace participants had a highly significant greater cold pain tolerance in the CP test than controls (P = 0.0002). While the GSE test showed no differences, the TCI test provided TEFR09 participants to be less cooperative and reward dependent but more spiritually transcendent than the controls. Significant positive correlations were found between the CP test pain score at 180 seconds and several TCI subscales showing that higher pain scores correlate with higher reward dependence, dependence, cooperativeness, empathy, and pure-hearted conscience.

CONCLUSIONS

Personality profiles as well as pain tolerance of our sample of TEFR09 participants differ from normal controls and-as obtained in previous studies-probably also from chronic pain patients. Low pain perception may predispose a person to become a long-distance runner. It remains unclear, however, whether low pain perception is cause or consequence of continuous extreme training.

Substantial and reversible brain gray matter reduction but no acute brain lesions in ultramarathon runners: experience from the TransEurope-FootRace Project

BACKGROUND

During the extremely challenging 4,487 km ultramarathon TransEurope-FootRace 2009, runners showed considerable reduction of body weight. The effects of this endurance run on brain volume changes but also possible formation of brain edema or new lesions were explored by repeated magnetic resonance imaging (MRI) studies.

METHODS

A total of 15 runners signed an informed consent to participate in this study of planned brain scans before, twice during, and about 8 months after the race. Because of dropouts, global gray matter volume analysis could only be performed in ten runners covering three timepoints, and in seven runners who also had a follow-up scan. Scanning was performed on three identical 1.5 T Siemens MAGNETOM Avanto scanners, two of them located at our university. The third MRI scanner with identical sequence parameters was a mobile MRI unit escorting the runners. Volumetric 3D datasets were acquired using a magnetization prepared rapid acquisition gradient echo (MPRAGE) sequence. Additionally, diffusion-weighted (DWI) and fluid attenuated inversion recovery (FLAIR) imaging was performed.

RESULTS

Average global gray matter volume as well as body weight significantly decreased by 6% during the race. After 8 months, gray matter volume returned to baseline as well as body weight. No new brain lesions were detected by DWI or FLAIR imaging.

CONCLUSIONS

Physiological brain volume reduction during aging is less than 0.2% per year. Therefore a volume reduction of about 6% during the 2 months of extreme running appears to be substantial. The reconstitution in global volume measures after 8 months shows the process to be reversible. As possible mechanisms we discuss loss of protein, hypercortisolism and hyponatremia to account for both substantiality and reversibility of gray matter volume reductions. Reversible brain volume reduction during an ultramarathon suggests that extreme running might serve as a model to investigate possible mechanisms of transient brain volume changes. However, despite massive metabolic load, we found no new lesions in trained athletes participating in a multistage ultramarathon.See related commentary http://www.biomedcentral.com/1741-7015/10/171.

Ultramarathon is an outstanding model for the study of adaptive responses to extreme load and stress

Ultramarathons comprise any sporting event involving running longer than the traditional marathon length of 42.195 km (26.2 miles). Studies on ultramarathon participants can investigate the acute consequences of ultra-endurance exercise on inflammation and cardiovascular or renal consequences, as well as endocrine/energetic aspects, and examine the tissue recovery process over several days of extreme physical load. In a study published in BMC Medicine, Schütz et al. followed 44 ultramarathon runners over 4,487 km from South Italy to North Cape, Norway (the Trans Europe Foot Race 2009) and recorded daily sets of data from magnetic resonance imaging, psychometric, body composition and biological measurements. The findings will allow us to better understand the timecourse of degeneration/regeneration of some lower leg tissues such as knee joint cartilage, to differentiate running-induced from age-induced pathologies (for example, retropatelar arthritis) and finally to assess the interindividual susceptibility to injuries. Moreover, it will also provide new information about the complex interplay between cerebral adaptations/alterations and hormonal influences resulting from endurance exercise and provide data on the dose-response relationship between exercise and brain structure/function. Overall, this study represents a unique attempt to investigate the limits of the adaptive response of human bodies.Please see related article: http://www.biomedcentral.com/1741-7015/10/78.