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

Body composition analysis by radiological imaging - methods, applications, and prospects

BACKGROUND

 This review discusses the quantitative assessment of tissue composition in the human body (body composition, BC) using radiological methods. Such analyses are gaining importance, in particular, for oncological and metabolic problems. The aim is to present the different methods and definitions in this field to a radiological readership in order to facilitate application and dissemination of BC methods. The main focus is on radiological cross-sectional imaging.

METHODS

 The review is based on a recent literature search in the US National Library of Medicine catalog (pubmed.gov) using appropriate search terms (body composition, obesity, sarcopenia, osteopenia in conjunction with imaging and radiology, respectively), as well as our own work and experience, particularly with MRI- and CT-based analyses of abdominal fat compartments and muscle groups.

RESULTS AND CONCLUSION

 Key post-processing methods such as segmentation of tomographic datasets are now well established and used in numerous clinical disciplines, including bariatric surgery. Validated reference values are required for a reliable assessment of radiological measures, such as fatty liver or muscle. Artificial intelligence approaches (deep learning) already enable the automated segmentation of different tissues and compartments so that the extensive datasets can be processed in a time-efficient manner - in the case of so-called opportunistic screening, even retrospectively from diagnostic examinations. The availability of analysis tools and suitable datasets for AI training is considered a limitation.

KEY POINTS

  · Radiological imaging methods are increasingly used to determine body composition (BC).. · BC parameters are usually quantitative and well reproducible.. · CT image data from routine clinical examinations can be used retrospectively for BC analysis.. · Prospectively, MRI examinations can be used to determine organ-specific BC parameters.. · Automated and in-depth analysis methods (deep learning or radiomics) appear to become important in the future..

CITATION FORMAT

· Linder N, Denecke T, Busse H. Body composition analysis by radiological imaging - methods, applications, and prospects. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2263-1501.

Mobile imaging trailers: A scoping review of CT and MRI modalities

INTRODUCTION

Mobile Imaging Trailers enable moving diagnostic imaging equipment between locations requiring very little setup and configuration, example given CT-scanners and MRI-scanners. However, despite the apparent benefits of utilising these imaging capabilities, very little research on the subject exists. This study aims at gaining an overview of the current state of the literature, using the scoping review methodology.

METHODS

The systematic literature search was conducted in three databases: Scopus, Embase and PubMed. Included sources were extracted based on the objectives of the scoping review, and inspired by the by PRISMA-ScR.

RESULTS

29 papers were included.

CONCLUSION

The results of the review showed that three general categories of research on this subject exist - trailers used in research, trailers as the object of research and trailers as an element or tool of the research. Of these, the most prevalent one used is the latter - trailers used as an element or tool of the research. This; however, is an issue for the use of trailers in a clinical setting, as very little research has been conducted on how they might be used and how they compare to fixed installations. As seen during the recent COVID-19 pandemic, the potentials for the use of MITs are immense; however, with the current lack of knowledge and understanding, the full potential has not been realised, suggesting further research should be focused in this area.

IMPLICATIONS FOR PRACTICE

This study has shown that the limited research in the area does point towards a few benefits of MITs; however, there is a clear lack of sufficient research on the field to say this with confidence.

Best practice recommendations for body composition considerations in sport to reduce health and performance risks: a critical review, original survey and expert opinion by a subgroup of the IOC consensus on Relative Energy Deficiency in Sport (REDs)

BACKGROUND

The assessment of body composition (BC) in sport raises concern for athlete health, especially where an overfocus on being lighter or leaner increases the risk of Relative Energy Deficiency in Sport (REDs) and disordered eating.

METHODS

We undertook a critical review of the effect of BC on performance (29 longitudinal, prospective or intervention studies) and explored current practice related to BC considerations via a follow-up to a 2013 internationally distributed survey.

RESULTS

The review found that a higher level of body fat was negatively associated with endurance performance, while a gain in muscle mass resulted in performance benefits across sports. BC did not contribute to early talent identification, and no unique cut-off to signify a performance advantage for BC was identified. BC appears to be one of an array of variables impacting performance, and its influence should not be overstated. The survey (125 practitioners, 61 sports and 26 countries) showed subtle changes in BC considerations over time, such as an increased role for sport dietitian/nutrition practitioners as BC measurers (2013: 54%, 2022: 78%); less emphasis on reporting of body fat percentage (2013: 68%, 2022: 46%) and reduced frequency of BC assessment if ≥every fourth week (2013: 18%, 2022: 5%). Respondents remained concerned about a problematic focus on BC (2013: 69%, 2022: 78%). To address these findings, we provide detailed recommendations for BC considerations, including an overview of preferable BC methodology.

CONCLUSIONS

The 'best practice' guidelines stress the importance of a multidisciplinary athlete health and performance team, and the treatment of BC data as confidential medical information. The guidelines provide a health focus around BC, aiming to reduce the associated burden of disordered eating, problematic low energy availability and REDs.

Variability and the form-function framework in evolutionary biomechanics and human locomotion

The form-function conceptual framework, which assumes a strong relationship between the structure of a particular trait and its function, has been crucial for understanding morphological variation and locomotion among extant and fossil species across many disciplines. In biological anthropology, it is the lens through which many important questions and hypotheses have been tackled with respect to relationships between morphology and locomotor kinematics, energetics and performance. However, it is becoming increasingly evident that the morphologies of fossil hominins, apes and humans can confer considerable locomotor diversity and flexibility, and can do so with a range of kinematics depending on soft tissue plasticity and environmental and cultural factors. This complexity is not built into traditional biomechanical or mathematical models of relationships between structure and kinematics or energetics, limiting our interpretation of what bone structure is telling us about behaviour in the past. The nine papers presented in this Special Collection together address some of the challenges that variation in the relationship between form and function pose in evolutionary biomechanics, to better characterise the complexity linking structure and function and to provide tools through which we may begin to incorporate some of this complexity into our functional interpretations.

Consistency Is Key When Setting a New World Record for Running 10 Marathons in 10 Days

Background: We describe the requirements and physiological changes when running 10 consecutive marathons in 10 days at the same consistent pace by a female ultra-endurance athlete. Methods: Sharon Gayter (SG) 54 yrs, 162.5 cm, 49.3 kg maximal oxygen uptake (VO₂ max) 53 mL/kg⁻¹/min⁻¹. SG completed 42.195 km on a treadmill every day for 10 days. We measured heart rate (HR), Rating of Perceived Exertion (RPE), oxygen uptake (VO₂), weight, body composition, blood parameters, nutrition, and hydration. Results: SG broke the previous record by ~2.5 h, with a cumulative completion time of 43 h 51 min 39 s. Over the 10 days, weight decreased from 51 kg to 48.4 kg, bodyfat mass from 9.1 kg to 7.2 kg (17.9% to 14.8%), and muscle mass from 23.2 kg to 22.8 kg. For all marathons combined, exercise intensity was ~60% VO₂ max; VO₂ 1.6 ± 0.1 L.min⁻¹/32.3 ± 1.1 mL.kg⁻¹.min⁻¹, RER 0.8 ± 0, HR 143 ± 4 b.min⁻¹. Energy expenditure (EE) was 2030 ± 82 kcal/marathon, total EE for 10 days (including BMR) was 33,056 kcal, daily energy intake (EI) 2036 ± 418 kcal (20,356 kcal total), resulting an energy deficit (ED) of 12,700 kcal. Discussion: Performance and pacing were highly consistent across all 10 marathons without any substantial physiological decrements. Although overall EI did not match EE, leading to a significant ED, resulting in a 2.6 kg weight loss and decreases in bodyfat and skeletal muscle mass, this did not affect performance.

Quantitative Magnetic Resonance Imaging Assessment of the Quadriceps Changes during an Extreme Mountain Ultramarathon

INTRODUCTION/PURPOSE

Extreme ultra-endurance races are growing in popularity, but their effects on skeletal muscles remain mostly unexplored. This longitudinal study explores physiological changes in mountain ultramarathon athletes' quadriceps using quantitative magnetic resonance imaging (MRI) coupled with serological biomarkers. The study aimed to monitor the longitudinal effect of the race and recovery and to identify local inflammatory and metabolic muscle responses by codetection of biological markers.

METHODS

An automatic image processing framework was designed to extract imaging-based biomarkers from quantitative MRI acquisitions of the upper legs of 20 finishers at three time points. The longitudinal effect of the race was demonstrated by analyzing the image markers with dedicated biostatistical analysis.

RESULTS

Our framework allows for a reliable calculation of statistical data not only inside the whole quadriceps volume but also within each individual muscle head. Local changes in MRI parameters extracted from quantitative maps were described and found to be significantly correlated with principal serological biomarkers of interest. A decrease in the PDFF after the race and a stable paramagnetic susceptibility value were found. Pairwise post hoc tests suggested that the recovery process differs among the muscle heads.

CONCLUSIONS

This longitudinal study conducted during a prolonged and extreme mechanical stress showed that quantitative MRI-based markers of inflammation and metabolic response can detect local changes related to the prolonged exercise, with differentiated involvement of each head of the quadriceps muscle as expected in such eccentric load. Consistent and efficient extraction of the local biomarkers enables to highlight the interplay/interactions between blood and MRI biomarkers. This work indeed proposes an automatized analytic framework to tackle the time-consuming and mentally exhausting segmentation task of muscle heads in large multi-time-point cohorts.

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.

Self-Selected Pacing During a World Record Attempt in 40 Ironman-Distance Triathlons in 40 Days

The present case study analyzed performance, pacing, and potential predictors in a self-paced world record attempt of a professional triathlete to finish 40 Ironman-distance triathlons within 40 days. Split times (i.e., swimming, cycling, running) and overall times, body weight, daily highest temperature, wind speed, energy expenditure, mean heart rate, and sleeping time were recorded. Non-linear regressions were applied to investigate changes in split and overall times across days. Multivariate regression analyses were performed to test which variables showed the greatest influence on the dependent variables cycling, running and overall time. The athlete completed the 40×Ironman distances in a total time of 444:22 h:min. He spent 50:26 h:min in swimming, 245:37 h:min in cycling, 137:17 h:min in running and 11:02 h:min in transition times. Swimming and cycling times became slower across days, whereas running times got faster until the 20th day and, thereafter, became slower until the 40th day. Overall times got slower until the 15th day, became faster to 31st, and started then to get slower until the end. Wind speed, previous day’s race time and average heart race during cycling were significant independent variables influencing cycling time. Body weight and average heart rate during running were significant independent variables influencing running performance. Cycling performance, running performance, and body weight were significant independent variables influencing overall time. In summary, running time was influenced by body weight, cycling by wind speed, and overall time by both running and cycling performances.

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.

Nutrition for Ultramarathon Running: Trail, Track, and Road

Ultramarathon running events and participation numbers have increased progressively over the past three decades. Besides the exertion of prolonged running with or without a loaded pack, such events are often associated with challenging topography, environmental conditions, acute transient lifestyle discomforts, and/or event-related health complications. These factors create a scenario for greater nutritional needs, while predisposing ultramarathon runners to multiple nutritional intake barriers. The current review aims to explore the physiological and nutritional demands of ultramarathon running and provide general guidance on nutritional requirements for ultramarathon training and competition, including aspects of race nutrition logistics. Research outcomes suggest that daily dietary carbohydrates (up to 12 g·kg^-1·day^-1) and multiple-transportable carbohydrate intake (∼90 g·hr^-1 for running distances ≥3 hr) during exercise support endurance training adaptations and enhance real-time endurance performance. Whether these intake rates are tolerable during ultramarathon competition is questionable from a practical and gastrointestinal perspective. Dietary protocols, such as glycogen manipulation or low-carbohydrate high-fat diets, are currently popular among ultramarathon runners. Despite the latter dietary manipulation showing increased total fat oxidation rates during submaximal exercise, the role in enhancing ultramarathon running performance is currently not supported. Ultramarathon runners may develop varying degrees of both hypohydration and hyperhydration (with accompanying exercise-associated hyponatremia), dependent on event duration, and environmental conditions. To avoid these two extremes, euhydration can generally be maintained through "drinking to thirst." A well practiced and individualized nutrition strategy is required to optimize training and competition performance in ultramarathon running events, whether they are single stage or multistage.

Motivation in ultra-marathon runners

Background

In ultra-marathon running the proper motivation of the athlete is one of the milestones, not only during the races, but also during the practice sessions, which are long and very exhausting.

Purpose

The aim of this study was to examine the relationship of sport experience (expressed as number of finishes in ultra-marathons) with motivation characteristics of ultra-marathon runners.

Subjects and methods

The Motivation of Marathoners Scale examined the motivation of ultra-marathon runners compared to endurance runners of shorter distances (control group). Participants were 1,539 Polish runners, 382 women (24.7%) and 1,157 men (75.3%). Ultra-marathoners (N=425; 26.7%) finished at least one ultra-marathon, whereas the control group consisted of runners of shorter distances (N=1,114, 72.3%).

Results

Ultra-marathoners had higher scores in affiliation (3.55±1.60 vs 3.34±1.62, P<0.05), life meaning (4.20±1.40 vs 4.03±1.44, P<0.05) and lower in the areas of weight concern (4.33±1.68 vs 4.64±1.65, P<0.01), personal goal achievement (5.09±1.25 vs 4.64±1.65, P<0.001) and self-esteem (4.44±1.36 vs 4.68±1.38, P<0.01), than runners in the control group. The number of completed ultra-marathons was negatively related to the personal goal achievement, competition and recognition scale. The level of training experience was negatively correlated with the personal goal achievement scale in all participants, and with the self-esteem scale in the control group. In summary, ultra-marathoners had different motivations compared to runners of shorter race distance.

Conclusions

These findings should be considered by sport psychologists and other professionals to develop performance-tailored interventions for ultra-marathoners.

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.

Physiology and Pathophysiology in Ultra-Marathon Running

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

Changes in Cartilage Biomarker Levels During a Transcontinental Multistage Footrace Over 4486 km

BACKGROUND

Cartilage turnover and load-induced tissue changes are frequently assessed by quantifying concentrations of cartilage biomarkers in serum. To date, information on the effects of ultramarathon running on articular cartilage is scarce.

HYPOTHESIS

Serum concentrations of cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-1, MMP-3, MMP-9, COL2-3/4C long mono (C2C), procollagen type II C-terminal propeptide (CPII), and C2C:CPII will increase throughout a multistage ultramarathon.

STUDY DESIGN

Descriptive laboratory study.

METHODS

Blood samples were collected from 36 runners (4 female; mean age, 49.0 ± 10.7 years; mean body mass index, 23.1 ± 2.3 kg/m² [start] and 21.4 ± 1.9 kg/m² [finish]) before (t₀) and during (t₁: 1002 km; t₂: 2132 km; t₃: 3234 km; t₄: 4039 km) a 4486-km multistage ultramarathon. Serum COMP, MMP-1, MMP-3, MMP-9, C2C, and CPII levels were assessed using commercial enzyme-linked immunosorbent assays. Linear mixed models were used to detect significant changes in serum biomarker levels over time with the time-varying covariates of body weight, running speed, and daily running time.

RESULTS

Serum concentrations of COMP, MMP-9, and MMP-3 changed significantly throughout the multistage ultramarathon. On average, concentrations increased during the first measurement interval (MI1: t₁-t₀) by 22.5% for COMP (95% CI, 0.29-0.71 ng/mL), 22.3% for MMP-3 (95% CI, 0.24-15.37 ng/mL), and 95.6% for MMP-9 (95% CI, 81.7-414.5 ng/mL) and remained stable throughout MI2, MI3, and MI4. Serum concentrations of MMP-1, C2C, CPII, and C2C:CPII did not change significantly throughout the multistage ultramarathon. Changes in MMP-3 were statistically associated with changes in COMP throughout the ultramarathon race (MMP-3: Wald Z = 3.476, P = .001).

CONCLUSION

Elevated COMP levels indicate increased COMP turnover in response to extreme running, and the association between load-induced changes in MMP-3 and changes in COMP suggests the possibility that MMP-3 may be involved in the degradation of COMP.

CLINICAL RELEVANCE

These results suggest that articular cartilage is able to adapt even to extreme physical activity, possibly explaining why the risk of degenerative joint disease is not elevated in the running population.

[Not Available]

Zusammenfassung. Wir berichten über einen übergewichtigen Läufer mittleren Alters, der sich gezielt auf einen 24-h-Lauf vorbereitet hat mit dem Ziel, 100 Meilen (160,93 km) zu laufen und den Abbau des viszeralen Fettes zu dokumentieren. Es zeigte sich, dass der Läufer in der Lage war, konstant mit einer Geschwindigkeit von fast 7 km/h durchzulaufen, dabei mehr als 164 km erzielte und 1 kg viszerales Fett verlor. Im Alltag werden umgerechnet rund vier Marathons benötigt, um 1 kg viszerales Fett zu verlieren.

Do women reduce the gap to men in ultra-marathon running?

The aim of the present study was to examine sex differences across years in performance of runners in ultra-marathons lasting from 6 h to 10 days (i.e. 6, 12, 24, 48, 72, 144, and 240 h). Data of 32,187 finishers competing between 1975 and 2013 with 93,109 finishes were analysed using multiple linear regression analyses. With increasing age, the sex gap for all race durations increased. Across calendar years, the gap between women and men decreased in 6, 72, 144 and 240 h, but increased in 24 and 48 h. The men-to-women ratio differed among age groups, where a higher ratio was observed in the older age groups, and this relationship varied by distance. In all durations of ultra-marathon, the participation of women and men varied by age (p < 0.001), indicating a relatively low participation of women in the older age groups. In summary, between 1975 and 2013, women were able to reduce the gap to men for most of timed ultra-marathons and for those age groups where they had relatively high participation.

Sleep Management Strategy and Performance in an Extreme Mountain Ultra-marathon

We intended to assess the relationship between sleep strategies and performance during the North-Face Ultra-Trail du Mont-Blanc 2013, to test the hypothesis that sleep management can influence athletic performance. Almost all runners specifically adopted sleep management strategies before the race. Among the finishers 72% didn't sleep at all during the race and 28% took a least one break for sleep. Non-sleepers completed the race faster than the sleepers (P = 0.0008). Race time was positively correlated with drowsiness (P < 0.0001) and negatively correlated with the number participations in this race (P = 0.0039). Runners who adopted a sleep management strategy based on increased sleep time before the race completed the race faster (P = 0.0258). Most finishers seemed to be aware of the importance of developing sleep management strategies and increasing sleep time some nights before the race appeared to be the most relevant strategy to improve performance.

Performance differences between sexes in 50-mile to 3,100-mile ultramarathons

Anecdotal reports have assumed that women would be able to outrun men in long-distance running. The aim of this study was to test this assumption by investigating the changes in performance difference between sexes in the best ultramarathoners in 50-mile, 100-mile, 200-mile, 1,000-mile, and 3,100-mile events held worldwide between 1971 and 2012. The sex differences in running speed for the fastest runners ever were analyzed using one-way analysis of variance with subsequent Tukey–Kramer posthoc analysis. Changes in sex difference in running speed of the annual fastest were analyzed using linear and nonlinear regression analyses, correlation analyses, and mixed-effects regression analyses. The fastest men ever were faster than the fastest women ever in 50-mile (17.5%), 100-mile (17.4%), 200-mile (9.7%), 1,000-mile (20.2%), and 3,100-mile (18.6%) events. For the ten fastest finishers ever, men were faster than women in 50-mile (17.1%±1.9%), 100-mile (19.2%±1.5%), and 1,000-mile (16.7%±1.6%) events. No correlation existed between sex difference and running speed for the fastest ever (r²=0.0039, P=0.91) and the ten fastest ever (r²=0.15, P=0.74) for all distances. For the annual fastest, the sex difference in running speed decreased linearly in 50-mile events from 14.6% to 8.9%, remained unchanged in 100-mile (18.0%±8.4%) and 1,000-mile (13.7%±9.1%) events, and increased in 3,100-mile events from 12.5% to 16.9%. For the annual ten fastest runners, the performance difference between sexes decreased linearly in 50-mile events from 31.6%±3.6% to 8.9%±1.8% and in 100-mile events from 26.0%±4.4% to 24.7%±0.9%. To summarize, the fastest men were ~17%–20% faster than the fastest women for all distances from 50 miles to 3,100 miles. The linear decrease in sex difference for 50-mile and 100-mile events may suggest that women are reducing the sex gap for these distances.

A comparison of performance of Deca Iron and Triple Deca Iron ultra-triathletes

This study intended to compare the performance of ultra-triathletes competing in a Deca Iron ultra-triathlon (i.e. 10 times 3.8 km swimming, 180 km cycling, and 42.2 km running) with the performance of athletes competing in a Triple Deca Iron ultra-triathlon (i.e. 30 times 3.8 km swimming, 180 km cycling, and 42.2 km running). Split and overall race times of six male finishers in a Deca Iron ultra-triathlon and eight male finishers in a Triple Deca Iron ultra-triathlon were analysed using multiple t-tests, linear and non-linear regression analyses, and analysis of variance. Among the 19 starters (i.e. 17 men and two women) in the Deca Iron ultra-triathlon, six men (i.e. 35.3% of all starters) finished the race. The mean swimming, cycling, running and overall race times of the six finishers across the ten days were 1:19 ± 0:09 h:min, 6:36 ± 0:19 h:min, 6:03 ± 0:47 h:min and 14:44 ± 1:17 h:min, respectively. The times of the split disciplines and overall race time increased linearly across the ten days. Total transition times did not change significantly across the days and were equals to 48 ± 8 min. Among the 22 starters (i.e. 20 men and two women) in the Triple Deca Iron ultra-triathlon, eight men (i.e. 36.4% of all starters) finished. The mean swimming, cycling, running and overall race times of the eight finishers across the 30 days were 1:11 ± 0:07 h:min, 6:19 ± 0:32 h:min, 5:34 ± 1:15 h:min and 13:44 ± 1:50 h:min, respectively. Split and overall race times showed no change across the 30 days. Total transition times showed no change across the days and were equal to 41 ± 11 min. To summarize, the daily performance decreased across the ten days for the Deca Iron ultra-triathletes (i.e. positive pacing) while it remained unchanged across the 30 days for the Triple Deca Iron ultra-triathletes (i.e. even pacing).

Sex difference in top performers from Ironman to double deca iron ultra-triathlon

This study investigated changes in performance and sex difference in top performers for ultra-triathlon races held between 1978 and 2013 from Ironman (3.8 km swim, 180 km cycle, and 42 km run) to double deca iron ultra-triathlon distance (76 km swim, 3,600 km cycle, and 844 km run). The fastest men ever were faster than the fastest women ever for split and overall race times, with the exception of the swimming split in the quintuple iron ultra-triathlon (19 km swim, 900 km cycle, and 210.1 km run). Correlation analyses showed an increase in sex difference with increasing length of race distance for swimming (r²=0.67, P=0.023), running (r²=0.77, P=0.009), and overall race time (r²=0.77, P=0.0087), but not for cycling (r²=0.26, P=0.23). For the annual top performers, split and overall race times decreased across years nonlinearly in female and male Ironman triathletes. For longer distances, cycling split times decreased linearly in male triple iron ultra-triathletes, and running split times decreased linearly in male double iron ultra-triathletes but increased linearly in female triple and quintuple iron ultra-triathletes. Overall race times increased nonlinearly in female triple and male quintuple iron ultra-triathletes. The sex difference decreased nonlinearly in swimming, running, and overall race time in Ironman triathletes but increased linearly in cycling and running and nonlinearly in overall race time in triple iron ultra-triathletes. These findings suggest that women reduced the sex difference nonlinearly in shorter ultra-triathlon distances (ie, Ironman), but for longer distances than the Ironman, the sex difference increased or remained unchanged across years. It seems very unlikely that female top performers will ever outrun male top performers in ultratriathlons. The nonlinear change in speed and sex difference in Ironman triathlon suggests that female and male Ironman triathletes have reached their limits in performance.

Performance and sex difference in ultra-triathlon performance from Ironman to Double Deca Iron ultra-triathlon between 1978 and 2013

It was assumed that women would be able to outperform men in ultra-marathon running. The present study investigated the sex difference in performance for all ultra-triathlon distances from the Ironman distance (i.e. 3.8 km swimming, 180 km cycling and 42 km running) in the ‘Ironman Hawaii’ to the Double Deca Iron ultra-triathlon distance (i.e. 76 km swimming, 3,600 km cycling and 840 km running) between 1978 and 2013. The changes in performance and in the sex difference in performance for the annual three fastest finishers were analysed using linear, non-linear and multi-variate regression analyses from 46,123 athletes (i.e. 9,802 women and 46,123 men). Women accounted for 11.9 ± 5.8% of the total field and their percentage was highest in ‘Ironman Hawaii’ (22.1%) and lowest in Deca Iron ultra-triathlon (6.5%). In ‘Ironman Hawaii’, the sex difference decreased non-linearly in swimming, cycling, running and overall race time. In Double Iron ultra-triathlon, the sex difference increased non-linearly in overall race time. In Triple Iron ultra-triathlon, the sex difference increased non-linearly in cycling and overall race time but linearly in running. For the three fastest finishers ever, the sex difference in performance showed no change with increasing race distance with the exception for the swimming split where the sex difference increased with increasing race distance (r² = 0.93, P = 0.001). The sex differences for the three fastest finishers ever for swimming, cycling, running and overall race times for all distances from Ironman to Deca Iron ultra-triathlon were 27.0 ± 17.8%, 24.3 ± 9.9%, 24.5 ± 11.0%, and 24.0 ± 6.7%, respectively. To summarize, these findings showed that women reduced the sex difference in the shorter ultra-triathlon distances (i.e. Ironman distance) but extended the sex difference in longer distances (i.e. Double and Triple Iron ultra-triathlon). It seems very unlikely that women will ever outperform men in ultra-triathlons from Ironman to Double Iron ultra-triathlon.

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.