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Knopp M, Appelhans D, Schönfelder M, Seiler S, Wackerhage H. Quantitative Analysis of 92 12-Week Sub-elite Marathon Training Plans. SPORTS MEDICINE - OPEN 2024; 10:50. [PMID: 38695978 PMCID: PMC11065819 DOI: 10.1186/s40798-024-00717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND A typical training plan is a mix of many training sessions with different intensities and durations to achieve a specific goal, like running a marathon in a certain time. Scientific publications provide little specific information to aid in writing a comprehensive training plan. This review aims to systematically and quantitatively analyse the last 12 weeks before a marathon as recommended in 92 sub-elite training plans. METHODS We retrieved 92 marathon training plans and linked their running training sessions to five intensity zones. Subsequently, each training plan was grouped based on the total running volume in peak week into high (> 90 km/week), middle (65-90 km/week), and low (< 65 km/week) training volume plan categories. RESULTS In the final 12 weeks before a race, recommended weekly running volume averaged 108 km, 59 km, and 43 km for high, middle, and low distance marathon training plans. The intensity distribution of these plans followed a pyramidal training structure with 15-67-10-5-3%, 14-63-18-2-3%, and 12-67-17-2-2% in zones 1, 2, 3, 4, and 5, for high, middle, and low volume training plans, respectively. CONCLUSIONS By quantitatively analysing 92 recommended marathon training plans, we can specify typical recommendations for the last 12 weeks before a marathon race. Whilst this approach has obvious limitations such as no evidence for the effectiveness of the training plans investigated, it is arguably a useful strategy to narrow the gap between science and practice.
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Affiliation(s)
- Melanie Knopp
- Department of Health and Sport Sciences, Technical University of Munich, Connollystraße 32, 80809, Munich, Germany.
- adidas Innovation, adidas AG, Adi-Dassler-Str. 1, 91074, Herzogenaurach, Germany.
| | - Daniel Appelhans
- Department of Health and Sport Sciences, Technical University of Munich, Connollystraße 32, 80809, Munich, Germany
| | - Martin Schönfelder
- Department of Health and Sport Sciences, Technical University of Munich, Connollystraße 32, 80809, Munich, Germany
| | - Stephen Seiler
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Henning Wackerhage
- Department of Health and Sport Sciences, Technical University of Munich, Connollystraße 32, 80809, Munich, Germany
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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Bakker EA, Aengevaeren VL, Lee DC, Thompson PD, Eijsvogels TMH. All-cause mortality risks among participants in mass-participation sporting events. Br J Sports Med 2024; 58:421-426. [PMID: 38316539 DOI: 10.1136/bjsports-2023-107190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Exercise transiently increases the risk for sudden death, whereas long-term exercise promotes longevity. This study assessed acute and intermediate-term mortality risks of participants in mass-participation sporting events. METHODS Data of participants in Dutch running, cycling and walking events were collected between 1995 and 2017. Survival status was obtained from the Dutch Population Register. A time-stratified, case-crossover design examined if deceased participants more frequently participated in mass-participation sporting events 0-7 days before death compared with the reference period (14-21 days before death). Mortality risks during follow-up were compared between participants and non-participants from the general population using Cox regression. RESULTS 546 876 participants (median (IQR) age 41 (31-50) years, 56% male, 72% runners) and 211 592 non-participants (41 (31-50) years, 67% male) were included. In total, 4625 participants died of which more participants had partaken in a sporting event 0-7 days before death (n=23) compared with the reference period (n=12), and the mortality risk associated with acute exercise was greater but did not reach statistical significance (OR 1.92; 95% CI 0.95 to 3.85). During 3.3 (1.1-7.4) years of follow-up, participants had a 30% lower risk of death (HR 0.70; 95% CI 0.67 to 0.74) compared with non-participants after adjustment for age and sex. Runners (HR 0.65; 95% CI 0.62 to 0.69) and cyclists (HR 0.70; 95% CI 0.64 to 0.77) had the best survival during follow-up followed by walkers (HR 0.88; 95% CI 0.80 to 0.94). CONCLUSION Participating in mass-participation sporting events was associated with a non-significant increased odds (1.92) of mortality and a low absolute event rate (4.2/100 000 participants) within 7 days post-event, whereas a 30% lower risk of death was observed compared with non-participants during 3.3 years of follow-up. These results suggest that the health benefits of mass sporting event participation outweigh potential risks.
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Affiliation(s)
- Esmée A Bakker
- Department of Medical BioSciences (Exercise Physiology Group), Radboud University Medical Center, Nijmegen, Netherlands
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Vincent L Aengevaeren
- Department of Medical BioSciences (Exercise Physiology Group), Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Thijs M H Eijsvogels
- Department of Medical BioSciences (Exercise Physiology Group), Radboud University Medical Center, Nijmegen, Netherlands
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Laily I, Wiggers TGH, van Steijn N, Bijsterveld N, Bakermans AJ, Froeling M, van den Berg-Faay S, de Haan FH, de Bruin-Bon RHACM, Boekholdt SM, Planken RN, Verhagen E, Jorstad HT. Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners. Cardiology 2024; 149:255-263. [PMID: 38325343 DOI: 10.1159/000536553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION The optimal pre-participation screening strategy to identify athletes at risk for exercise-induced cardiovascular events is unknown. We therefore aimed to compare the American College of Sports Medicine (ACSM) and European Society of Cardiology (ESC) pre-participation screening strategies against extensive cardiovascular evaluations in identifying high-risk individuals among 35-50-year-old apparently healthy men. METHODS We applied ACSM and ESC pre-participation screenings to 25 men participating in a study on first-time marathon running. We compared screening outcomes against medical history, physical examination, electrocardiography, blood tests, echocardiography, cardiopulmonary exercise testing, and magnetic resonance imaging. RESULTS ACSM screening classified all participants as "medical clearance not necessary." ESC screening classified two participants as "high-risk." Extensive cardiovascular evaluations revealed ≥1 minor abnormality and/or cardiovascular condition in 17 participants, including three subjects with mitral regurgitation and one with a small atrial septal defect. Eleven participants had dyslipidaemia, six had hypertension, and two had premature atherosclerosis. Ultimately, three (12%) subjects had a serious cardiovascular condition warranting sports restrictions: aortic aneurysm, hypertrophic cardiomyopathy (HCM), and myocardial fibrosis post-myocarditis. Of these three participants, only one had been identified as "high-risk" by the ESC screening (for dyslipidaemia, not HCM) and none by the ACSM screening. CONCLUSION Numerous occult cardiovascular conditions are missed when applying current ACSM/ESC screening strategies to apparently healthy middle-aged men engaging in their first high-intensity endurance sports event.
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Affiliation(s)
- Inarota Laily
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Collaboration on Health and Safety in Sports, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Center for Sport and Exercise Studies, Indonesian Medical Education and Research Institute, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Tom G H Wiggers
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Sports Medicine, Anna Hospital, Geldrop, The Netherlands
| | - Niels van Steijn
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Nick Bijsterveld
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Adrianus J Bakermans
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra van den Berg-Faay
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ferdinand H de Haan
- Faculty of Health, School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Rianne H A C M de Bruin-Bon
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert Verhagen
- Department of Public and Occupational Health, Amsterdam Collaboration on Health and Safety in Sports, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harald T Jorstad
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Nikolaidis PT, Knechtle B. Sedentarism in Recreational Marathon Runners. Open Access J Sports Med 2023; 14:103-109. [PMID: 38164226 PMCID: PMC10758157 DOI: 10.2147/oajsm.s444862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
Aim Although it has been previously observed that sedentary behavior (SB) was not related to training duration in marathon runners, little information existed about the relationship of SB with training, anthropometric and physiological characteristics in this population. This study aimed to investigate the prevalence of SB and its correlation with performance parameters (such as body fat percentage, maximal oxygen uptake and weekly training volume) as well as its variation by sex and day (ie, weekdays versus weekend) in recreational marathon runners. Methods A total of 151 finishers (women, n = 29; men, n = 122; age 43.1 (8.7) years, mean (standard deviation)) in the Athens marathon 2017 performed a series of anthropometric and physiological tests, and completed the Multi-context sitting time questionnaire. Results SB did not correlate with anthropometric and physiological characteristics and no difference in these characteristics was shown between low and high sedentary participants (p > 0.05). SB did not differ between women and men (p > 0.05), but differed between working and non-working days (p < 0.05). Conclusion In contrast to previous findings on the general population indicating an association of a high SB with a low cardiorespiratory and muscular fitness, our finding of no correlation between SB and physical fitness in marathon runners suggested that endurance exercise might offset the negative effects of SB.
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Affiliation(s)
- Pantelis T Nikolaidis
- School of Health and Caring Sciences, University of West Attica, Egaleo, Greece
- Exercise Physiology Laboratory, Nikaia, Greece
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen am Vadianplatz, St. Gallen, Switzerland
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Thuany M, Vieira D, Villiger E, Gomes TN, Weiss K, Nikolaidis PT, Sousa CV, Scheer V, Knechtle B. An analysis of the São Silvestre race between 2007-2021: An increase in participation but a decrease in performance. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:277-282. [PMID: 38314049 PMCID: PMC10831388 DOI: 10.1016/j.smhs.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
This study aimed to investigate the trends of finishers in the São Silvestre race in Brazil, taking into account sex, age, and performance levels. A total of 31 775 runners (women, n = 13 847; men, n = 17 928), aged (45.2 ± 16.8) years, finishers in the São Silvestre race between 2007 and 2021, were considered in the present analysis. Data (event year, date of birth, sex, and race times) were downloaded from the official race website. The man-Whitney U test, Spearman correlation, and robust regression model were computed. Participation increased over time for both sexes. Regarding age groups, "31-40 years" (women) and "> 60 years" (men) were those with the highest number of finishers. We found a decrease in performance across the years (β = 2.45; p < 0.005), as well as significant differences in race times for both sexes (U = 42.844; p < 0.001), with men presenting better performances than women. Over time, it was observed an increase in the performance gap between the sexes, but in general, the performance decreased (β = 1.76; p < 0.001). Stakeholders should consider improving the strategies to improve women and young people's participation in running events.
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Affiliation(s)
- Mabliny Thuany
- CIFI2D, Faculty of Sports, University of Porto, 4200-450, Porto, Portugal
| | - Douglas Vieira
- Post-Graduation Program of Physical Education, Federal University of Sergipe, São Cristóvão-SE, Brazil
| | - Elias Villiger
- Institute of Primary Care, University of Zurich, 8091, Zurich, Switzerland
| | - Thayse Natacha Gomes
- Post-Graduation Program of Physical Education, Federal University of Sergipe, São Cristóvão-SE, Brazil
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, 8091, Zurich, Switzerland
| | - Pantelis T. Nikolaidis
- School of Health and Caring Sciences, University of West Attica, Athens, 12243, Athens, Greece
| | - Caio Victor Sousa
- Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, USA
| | - Volker Scheer
- Ultra Sports Science Foundation, 109 Boulevard de l'Europe, 69310, Pierre-Benite, France
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
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Jamkrajang P, Suwanmana S, Limroongreungrat W, Verheul J. Spatiotemporal and kinematic adjustments in master runners may be associated with the relative physiological effort during running. Front Sports Act Living 2023; 5:1271502. [PMID: 37886221 PMCID: PMC10598343 DOI: 10.3389/fspor.2023.1271502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
Master runners maintain a similar running economy to young runners, despite displaying biomechanical characteristics that are associated with a worse running economy. This apparent paradox may be explained by a greater physiological effort-i.e., percentage of maximal oxygen uptake (VO2-max)-that master runners perform at a given speed. Moreover, age-related responses to non-exhaustive sustained running are yet underexplored. The aims of this study were, therefore, to examine if biomechanical adjustments in master runners are physiological-effort dependent, and to explore the age-related biomechanical changes during a non-exhaustive sustained run. Young (23.9 ± 6; n = 12) and master (47.3 ± 6.9; n = 12) runners performed a sustained 30-minute treadmill run matched for relative physiological effort (70% VO2-max), while spatiotemporal and lower-limb kinematic characteristics were collected during the 1st and 30th minute. Group differences were observed in step/stride length, knee touch-down angle, and knee stiffness. However, both groups of runners had a similar step frequency, vertical center of mass oscillation, and knee range of motion. Age-related adjustment in these latter characteristics may thus not be an inevitable result of the aging process but rather a strategy to maintain running economy. The relative physiological effort of runners should, therefore, be considered when examining age-related adjustments in running biomechanics.
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Affiliation(s)
- Parunchaya Jamkrajang
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Sarit Suwanmana
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
| | | | - Jasper Verheul
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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Jaworska M, Siatkowski S, Żebrowska A. The Effects of Omega-3 Fatty Acid Supplementation on the Lipid Profile and Cardiovascular Markers Following Downhill Running in Long-Distance Runners. J Hum Kinet 2023; 89:123-138. [PMID: 38053947 PMCID: PMC10694724 DOI: 10.5114/jhk/174107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 10/10/2023] [Indexed: 12/07/2023] Open
Abstract
Exercise-induced injury may intensify inflammatory response and reduce the cardiovascular protection mechanisms of omega 3 polyunsaturated fatty acids (ω 3 PUFA). Therefore, this study aimed to determine the erythrocyte content of fatty acids (ω 3 and ω 6), the levels of cardiac damage markers (CKMB, hsTnT, H - FABP), the concentration of inflammation mediators (IL-6, TNF α) in long distance runners supplemented with ω 3 PUFA. Twenty-four male long distance runners, who were randomly assigned to a placebo group (GrP) or a group supplemented (GrSuppl) with a daily dose of 3,000 mg of ω 3 PUFA for three weeks, participated in the study. Participants performed a downhill running exercise test. Blood samples were collected at rest and after the exercise protocol to analyse the levels of cardiac markers and inflammatory cytokines. The erythrocyte membrane content of EPA and DHA in the GrSuppl at the 3rd week of supplementation was significantly higher than at the baseline (p < 0.001). The erythrocyte membrane content of ω 3 PUFA in the GrSuppl was significantly higher at the completion of supplementation (p < 0.001). Supplementation with ω 3 PUFA improved blood lipid profiles and reduced the concentration of inflammation mediators measured after the eccentric exercise tests. The increased ω 3 PUFA content in the erythrocyte membrane and lower blood concentrations of cardiac damage markers and inflammation mediators in distance runners supplemented for three weeks with ω 3 PUFA suggest that the cardiovascular function has been improved.
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Affiliation(s)
- Marzena Jaworska
- Department of Physiological and Medical Sciences, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Szymon Siatkowski
- Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Aleksandra Żebrowska
- Department of Physiological and Medical Sciences, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
- Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
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Knechtle B, Valero D, Villiger E, Thuany M, Andrade MS, Nikolaidis PT, Cuk I, Weiss K. Comparing the Performance Gap Between Males and Females in the Older Age Groups in IRONMAN® 70.3: An Internet-Based Cross-Sectional Study of More Than 800,000 Race Records. SPORTS MEDICINE - OPEN 2023; 9:88. [PMID: 37733151 PMCID: PMC10514017 DOI: 10.1186/s40798-023-00636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The sex difference in the three split disciplines (swimming, cycling, and running) and overall race times in triathlon races has mainly been investigated for the Olympic distance and IRONMAN® triathlon formats, but not for the half IRONMAN® distance, i.e., the IRONMAN® 70.3. The aim of the present study was to investigate the sex differences in IRONMAN® 70.3 by age group in 5-year intervals for the split disciplines of this race. Data from 823,459 records (625,393 males and 198,066 females) of all age group finishers (in 5-year intervals) competing in all official IRONMAN® 70.3 races held worldwide between 2004 and 2020 were analyzed, and sex differences by age group and split disciplines were evaluated. RESULTS Males were faster than females in all split disciplines and all age groups. The sex difference was lower in swimming than in cycling and running and less pronounced for triathletes between 20 and 50 years of age. After the age of 60 years, females were able to reduce the sex difference to males in swimming and cycling, but not in running, where the reduction in the sex difference started after the age of 70 years. The lowest sex difference was in the age group 75 + years for swimming and cycling and in the age group 30-34 years for running. Across age groups, the sex difference was U-shaped in swimming and running, with an increase after 18-24 years in swimming and after 40-44 years in running. In contrast, the sex difference decreased continuously with the increasing age for cycling. CONCLUSIONS In conclusion, the study found that the sex difference in performance decreases with age in the IRONMAN® 70.3 race distance. However, females did not outperform males at older ages. Notably, sex differences were observed across different disciplines, with swimming displaying lower differences compared to cycling and running. These findings underscore the complex interplay between age, sex, and performance in endurance sports, emphasizing the need for additional research to understand the factors influencing these differences.
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Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland.
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | - David Valero
- Ultra Sports Science Foundation, Pierre-Benite, France
| | - Elias Villiger
- Klinik für Allgemeine Innere Medizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | | | | | - Ivan Cuk
- Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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10
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Cook JD, Gratton MKP, Bender AM, Werthner P, Lawson D, Pedlar CR, Kipps C, Bastien CH, Samuels CH, Charest J. Sleep Health, Individual Characteristics, Lifestyle Factors, and Marathon Completion Time in Marathon Runners: A Retrospective Investigation of the 2016 London Marathon. Brain Sci 2023; 13:1346. [PMID: 37759947 PMCID: PMC10527296 DOI: 10.3390/brainsci13091346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Despite sleep health being critically important for athlete performance and well-being, sleep health in marathoners is understudied. This foundational study explored relations between sleep health, individual characteristics, lifestyle factors, and marathon completion time. Data were obtained from the 2016 London Marathon participants. Participants completed the Athlete Sleep Screening Questionnaire (ASSQ) along with a brief survey capturing individual characteristics and lifestyle factors. Sleep health focused on the ASSQ sleep difficulty score (SDS) and its components. Linear regression computed relations among sleep, individual, lifestyle, and marathon variables. The analytic sample (N = 943) was mostly male (64.5%) and young adults (66.5%). A total of 23.5% of the sample reported sleep difficulties (SDS ≥ 8) at a severity warranting follow-up with a trained sleep provider. Middle-aged adults generally reported significantly worse sleep health characteristics, relative to young adults, except young adults reported significantly longer sleep onset latency (SOL). Sleep tracker users reported worse sleep satisfaction. Pre-bedtime electronic device use was associated with longer SOL and longer marathon completion time, while increasing SOL was also associated with longer marathon completion. Our results suggest a deleterious influence of pre-bedtime electronic device use and sleep tracker use on sleep health in marathoners. Orthosomnia may be a relevant factor in the relationship between sleep tracking and sleep health for marathoners.
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Affiliation(s)
- Jesse D. Cook
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Psychology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Matt K. P. Gratton
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO 66160, USA;
- Social and Behavioral Sciences, Psychology, University of Kansas, Lawrence, KS 66045, USA
| | - Amy M. Bender
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.M.B.); (P.W.); (C.H.S.); (J.C.)
| | - Penny Werthner
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.M.B.); (P.W.); (C.H.S.); (J.C.)
| | - Doug Lawson
- Centre for Sleep and Human Performance, Calgary, AB T2X 3V4, Canada;
| | - Charles R. Pedlar
- Faculty of Sport, Allied Health, and Performance Science, Twickenham, St Mary’s University, London TW1 4SX, UK;
- Institute of Sport, Exercise and Health, University College London, London WC1E 6JB, UK;
| | - Courtney Kipps
- Institute of Sport, Exercise and Health, University College London, London WC1E 6JB, UK;
| | - Celyne H. Bastien
- École de Psychologie, Université Laval, Québec City, QC G1V 0A6, Canada;
| | - Charles H. Samuels
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.M.B.); (P.W.); (C.H.S.); (J.C.)
- Centre for Sleep and Human Performance, Calgary, AB T2X 3V4, Canada;
- Faculty of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jonathan Charest
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.M.B.); (P.W.); (C.H.S.); (J.C.)
- Centre for Sleep and Human Performance, Calgary, AB T2X 3V4, Canada;
- École de Psychologie, Université Laval, Québec City, QC G1V 0A6, Canada;
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11
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Thuany M, León-Guereño P, Kipchumba K, de Souza RF, Knechtle B, Gomes TN. The frequency and performance trends of European countries in the U18 and U20 rankings for 1500 m and 3000 m between 2009-2020. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:213-219. [PMID: 37753421 PMCID: PMC10518800 DOI: 10.1016/j.smhs.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/10/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
We purpose to determine the nationality of the European middle-distance athletes under 18 years (U18) and under 20 years (U20) during the last decade, to verify the participation trend for each country, and to assess whether the place of competition can be associated with the athletes ranking position. The sample comprised 902 European male runners, ranked among the best finishers from 2009 to 2020. The athletes were divided into two categories (nU18 = 266; and nU20 = 636) of two distances (n1 500 m = 397; n3 000 m = 505). The Mantel test was used for participation trend and the Chi-square test (χ2) was used to verify differences between the ranking position and the place of competition. For both distances, the highest number of athletes were from Spain (n = 127), followed by Turkey (n = 62) and Great Britain (n = 50). No significant trends were shown for most of the countries, in both distances. A positive trend was shown for Slovenia (i.e., 3000 m) over the years. A non-significant association was verified between the countries and the ranking position, as non-significant differences were proved for the place of competition. This information may be useful to guide athlete development programs in each country.
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Affiliation(s)
| | | | - Kevin Kipchumba
- Kenyatta University, Department of Physical Education, Exercise and Sports Science, Nairobi, Kenya
| | | | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Thayse Natacha Gomes
- Department of Physical Education, Federal University of Sergipe, São Cristóvão, Brazil
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12
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Knechtle B, Witthöft A, Valero D, Thuany M, Nikolaidis PT, Scheer V, Forte P, Weiss K. Elderly female ultra-marathoners reduced the gap to male ultra-marathoners in Swiss running races. Sci Rep 2023; 13:12521. [PMID: 37532766 PMCID: PMC10397271 DOI: 10.1038/s41598-023-39690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023] Open
Abstract
Recent studies showed that female runners reduced the performance gap to male runners in endurance running with increasing age and race distance. However, the investigated samples were generally small. To investigate this further, the present study examined sex differences by age across various race distances (5, 10 km, half-marathon, marathon, and ultra-marathon) using a large dataset of over 1,100,000 race records from Switzerland over two decades (1999-2019). The study explored performance and participation disparities between male and female runners by employing diverse methods, such as descriptive statistics, histograms, scatter and line plots, correlations, and a predictive machine learning model. The results showed that female runners were more prevalent in shorter races (5, 10 km, half-marathon) and outnumbered male runners in 5 km races. However, as the race distance increased, the male-to-female ratio declined. Notably, the performance gap between sexes reduced with age until 70 years, after which it varied depending on the race distance. Among participants over 75 years old, ultra-marathon running exhibited the smallest sex difference in performance. Elderly female ultra-marathoners (75 years and older) displayed a performance difference of less than 4% compared to male ultra-marathoners, which may be attributed to the presence of highly selected outstanding female performers.
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Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland.
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | | | - David Valero
- Ultra Sports Science Foundation, Pierre-Benite, France
| | | | | | - Volker Scheer
- Ultra Sports Science Foundation, Pierre-Benite, France
| | - Pedro Forte
- CI-ISCE, Higher Institute of Educational Sciences of the Douro, Penafiel, Portugal
- Instituto Politécnico de Bragança, Bragança, Portugal
- Research Center in Sports, Health and Human Development, Covilhã, Portugal
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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13
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Santos TRT, Araújo PA, Okai-Nóbrega LA, Gomide RDS, Araújo VL, Saucedo F, Vieira MF, Fonseca ST. Vertical stiffness and lower limb inter-joint coordination in older versus younger runners. J Biomech 2023; 157:111705. [PMID: 37421910 DOI: 10.1016/j.jbiomech.2023.111705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/19/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
Older runners (OR) are increasing their participation in races. Aging may impact the adopted running pattern. Hence, the analysis of stiffness and the inter-joint lower limb coordination in the sagittal plane could contribute to investigating this impact. This study aimed to compare the vertical stiffness (Kvert) and the inter-joint lower limb coordination in the sagittal plane between younger runners (YR) and OR. This cross-sectional study recruited 15 YR males and 15 OR males. The pelvis and lower limb motions were assessed while running on a treadmill at self-selected (range OR: 1.94-3.75 m.s-1, YR: 2.08-4.17 m.s-1) and fixed speeds (3.33 m.s-1). Hip-ankle, knee-ankle, and hip-knee coupling angle (CA) and its variability (CAV) were extracted using the vector coding method. Mann-Whitney U tests compared Kvert between groups at each running speed. Watson's U2 tests compared the mean CA between groups in three intervals of the contact phase at each running speed. Statistical Parametric Mapping independent t-test compared the CAV curve between groups at each running speed. OR showed greater Kvert than YR at both speeds. Hip-ankle CA pattern differed between groups during the early stance at both speed conditions. OR showed in-phase, distal dominancy in hip-ankle CA, whereas YR showed anti-phase, proximal dominancy. Knee-ankle CA was distinct only at self-selected speed, in which OR showed in-phase, proximal dominancy, while YR exhibited anti-phase, proximal dominancy. CAV did not differ between groups. The findings showed that OR adopted a stiffer pattern characterized by distinct inter-joint lower limb CA, at early stance, during self-selected and fixed speeds.
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Affiliation(s)
| | - Priscila Albuquerque Araújo
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Liria Akie Okai-Nóbrega
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rodrigo de Sousa Gomide
- Bioengineering and Biomechanics Laboratory, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Vanessa Lara Araújo
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Sergio Teixeira Fonseca
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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14
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Turnwald J, Sousa CV, Andrade MS, Thuany M, Cuk I, Nikolaidis PT, Weiss K, Knechtle B. Participation and performance trends in short-, medium, and long-distance duathlon. Sci Rep 2023; 13:9303. [PMID: 37291186 PMCID: PMC10250310 DOI: 10.1038/s41598-023-36050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023] Open
Abstract
Participation and performance trends of male and female athletes have been thoroughly analyzed in various endurance sports. Knowing these trends can help coaches and athletes prepare for competitions and may influence their training strategy and career planning. However, duathlon events-consisted of two splits of running (Run1 and Run2) interspersed by a split of cycling (Bike)-have not been thoroughly studied, unlike other endurance sports. The present study aimed to compare participation and performance trends in duathletes who competed in duathlon races hosted by World Triathlon or affiliated National Federations between 1990 and 2021. A total of 25,130 results of age group finishers who competed in run-bike-run duathlon races of varying distances were analyzed with different general linear models. Races were divided into three distances: short-distance (up to 5.5 km run, 21 km bike, 5 km run), medium-distance (5-10 km run, 30-42 km bike, 7-11 km run) and long-distance (at least 14 km run, 60 km bike, 25 km run). On average, women represented 45.6% of all finishers in short-distance, 39.6% in medium-distance and 24.9% in long-distance duathlon races. Throughout the years, men were consistently faster than women in all three race legs (Run 1, Bike, and Run 2) in all three distances across all age groups, and women could not reduce the performance gap. Concerning the age of peak performance, duathletes of the age group 30-34 finished most often in the top three in short- and medium-distance duathlons, whereas male duathletes of the age group 25-29 and female duathletes of the age group 30-34 finished most often in the top three in long-distance duathlons. Women participated less, especially in longer distances, and were constantly slower than men. Duathletes of the age group 30-34 finished most often in the top three. Future studies should analyze participation and performance trends in further subgroups (e.g., elite athletes) and pacing behaviours.
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Affiliation(s)
- Jonas Turnwald
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Caio Victor Sousa
- Health and Human Sciences, Loyola Marymount University, Los Angeles, USA
| | | | | | - Ivan Cuk
- Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia
| | | | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland.
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Exercise-Associated Hyponatremia in Marathon Runners. J Clin Med 2022; 11:jcm11226775. [PMID: 36431252 PMCID: PMC9699060 DOI: 10.3390/jcm11226775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Exercise-associated hyponatremia (EAH) was first described as water intoxication by Noakes et al. in 1985 and has become an important topic linked to several pathological conditions. However, despite progressive research, neurological disorders and even deaths due to hyponatremic encephalopathy continue to occur. Therefore, and due to the growing popularity of exercise-associated hyponatremia, this topic is of great importance for marathon runners and all professionals involved in runners' training (e.g., coaches, medical staff, nutritionists, and trainers). The present narrative review sought to evaluate the prevalence of EAH among marathon runners and to identify associated etiological and risk factors. Furthermore, the aim was to derive preventive and therapeutic action plans for marathon runners based on current evidence. The search was conducted on PubMed, Scopus and Google Scholar using a predefined search algorithm by aggregating multiple terms (marathon run; exercise; sport; EAH; electrolyte disorder; fluid balance; dehydration; sodium concentration; hyponatremia). By this criterion, 135 articles were considered for the present study. Our results revealed that a complex interaction of different factors could cause EAH, which can be differentiated into event-related (high temperatures) and person-related (female sex) risk factors. There is variation in the reported prevalence of EAH, and two major studies indicated an incidence ranging from 7 to 15% for symptomatic and asymptomatic EAH. Athletes and coaches must be aware of EAH and its related problems and take appropriate measures for both training and competition. Coaches need to educate their athletes about the early symptoms of EAH to intervene at the earliest possible stage. In addition, individual hydration strategies need to be developed for the daily training routine, ideally in regard to sweat rate and salt losses via sweat. Future studies need to investigate the correlation between the risk factors of EAH and specific subgroups of marathon runners.
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Prevalence of Female and Male Vegan and Non-Vegan Endurance Runners and the Potential Associations of Diet Type and BMI with Performance-Results from the NURMI Study (Step 1). Nutrients 2022; 14:nu14183803. [PMID: 36145179 PMCID: PMC9501964 DOI: 10.3390/nu14183803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
This study aims to investigate vegetarian and mixed diet type prevalences among distance runners at running events around the world and associations with running-related patterns and performance. Following a cross-sectional approach, linear regression analyses were carried out to identify potential associations among body mass index (BMI), diet type, and average best performance times of half-marathon and marathon events for males and females. From a sample of 3835 runners who completed an online questionnaire, 2864 all-distance runners (age: 37 years; 57% females) were included in inferential analyses and categorized into dietary subgroups according to self-reports: 994 vegans (34.7%), 598 vegetarians (20.9%), and 1272 omnivores (44.4%). Significant associations were identified between kind of diet and best average time to finish (i) half-marathons in females where vegans (p = 0.001) took longer than omnivores, (ii) half-marathons in males where vegans (p < 0.001) and vegetarians (p = 0.002) took longer than omnivores, and (iii) marathons in males where vegans (p < 0.001) and vegetarians (p = 0.043) averaged slower than omnivores. Increased units of BMI (+1.0) in males influenced best runtimes: 2.75 (3.22−2.27) min slower for HM and 5.5 (5.69−4.31) min slower for M. The present study did not take detailed confounders into account such as runner motives or training behaviors; however, the results may provide valuable insight for running event organizers, nutrition experts, coaches, and trainers advising runners who adhere to a general diet type regarding the basic question of who participates in running events around the world.
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Watts EL, Matthews CE, Freeman JR, Gorzelitz JS, Hong HG, Liao LM, McClain KM, Saint-Maurice PF, Shiroma EJ, Moore SC. Association of Leisure Time Physical Activity Types and Risks of All-Cause, Cardiovascular, and Cancer Mortality Among Older Adults. JAMA Netw Open 2022; 5:e2228510. [PMID: 36001316 PMCID: PMC9403775 DOI: 10.1001/jamanetworkopen.2022.28510] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Higher amounts of physical activity are associated with increased longevity. However, whether different leisure time physical activity types are differentially associated with mortality risk is not established. OBJECTIVES To examine whether participation in equivalent amounts of physical activity (7.5 to <15 metabolic equivalent of task [MET] hours per week) through different activity types is associated with mortality risk and to investigate the shape of the dose-response association. DESIGN, SETTING, AND PARTICIPANTS Participants in this cohort were respondents from the National Institutes of Health-AARP Diet and Health Study who completed the follow-up questionnaire between 2004 and 2005. This questionnaire collected data on weekly durations of different types of physical activities. Mortality was ascertained through December 31, 2019. EXPOSURES MET hours per week spent participating in the following activities: running, cycling, swimming, other aerobic exercise, racquet sports, golf, and walking for exercise. MAIN OUTCOMES AND MEASURES All-cause, cardiovascular, and cancer mortality. Separate multivariable-adjusted Cox proportional hazards regression models were fitted to estimate hazard ratios (HRs) and 95% CIs of mortality for each of the 7 types of leisure time physical activities, as well as the sum of these activities. RESULTS A total of 272 550 participants (157 415 men [58%]; mean [SD] age at baseline, 70.5 [5.4] years [range, 59-82 years]) provided information on types of leisure time activity, and 118 153 (43%) died during a mean (SD) follow-up of 12.4 (3.9) years. In comparison with those who did not participate in each activity, 7.5 to less than 15 MET hours per week of racquet sports (HR, 0.84; 95% CI, 0.75-0.93) and running (HR, 0.85; 95% CI, 0.78-0.92) were associated with the greatest relative risk reductions for all-cause mortality, followed by walking for exercise (HR, 0.91; 95% CI, 0.89-0.93), other aerobic activity (HR, 0.93; 95% CI, 0.90-0.95), golf (HR, 0.93; 95% CI, 0.90-0.97), swimming (HR, 0.95; 95% CI, 0.92-0.98), and cycling (HR, 0.97; 95% CI, 0.95-0.99). Each activity showed a curvilinear dose-response association with mortality risk; low MET hours per week of physical activity for any given activity type were associated with a large reduction in mortality risk, with diminishing returns for each increment in activity thereafter. Associations were similar for cardiovascular and cancer mortality. CONCLUSIONS AND RELEVANCE This cohort study of older individuals found differences between different types of leisure time activities and mortality risk, but there were significant associations between participating in 7.5 to less than 15 MET hours per week of any activity and mortality risk.
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Affiliation(s)
- Eleanor L. Watts
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Charles E. Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Joshua R. Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Jessica S. Gorzelitz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Hyokyoung G. Hong
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Linda M. Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Kathleen M. McClain
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Pedro F. Saint-Maurice
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Eric J. Shiroma
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland
| | - Steven C. Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Sports and Health, Second Edition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148435. [PMID: 35886287 PMCID: PMC9318420 DOI: 10.3390/ijerph19148435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023]
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