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Pannone E, Abbott R. What is known about the health effects of non-steroidal anti-inflammatory drug (NSAID) use in marathon and ultraendurance running: a scoping review. BMJ Open Sport Exerc Med 2024; 10:e001846. [PMID: 38318269 PMCID: PMC10840051 DOI: 10.1136/bmjsem-2023-001846] [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] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
This systematic scoping review aimed to understand the extent and scope of evidence on the health risks of non-steroidal anti-inflammatory drug (NSAID) use in marathon and ultraendurance running. NSAIDs are commonly consumed by runners to combat pain and inflammation; however, the health risks of consuming these drugs during marathon and ultrarunning events are currently not fully understood. Four databases (Cochrane Library, PubMed, MEDLINE and SPORTDiscus) were searched to identify articles focusing on running events of 26.2 miles or further, and they must have reported on the health risks of NSAID use. There was no restriction on the study design or the date of publication. Thirty studies were ultimately included: 4 randomised controlled trials, 1 cross-sectional study, 11 retrospective reviews, 4 case reports, 1 non-randomised control trial, and 9 prospective observational studies. The literature showed that potential health concerns of NSAID use could be split into five categories: electrolyte balance and hyponatraemia; acute kidney injury (AKI); gastrointestinal disturbances; oxidative stress, inflammation and muscle damage; other medical concerns. None of these sections had clear statistically significant links with NSAID use in ultraendurance running. However, potential links were shown, especially in AKI and electrolyte balance. This review suggests there is very limited evidence to show that NSAIDs have a negative impact on the health of ultrarunning athletes. Indications from a few non-randomised studies of a possible effect on kidney function need exploring with more high-quality research.
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Affiliation(s)
- Eve Pannone
- Medical School, University of Exeter, Exeter, UK
| | - Rebecca Abbott
- Medical School, University of Exeter, Exeter, UK
- Evidence Synthesis Team, NIHR Applied Research Collaboration South West (PenARC), University of Exeter, Exeter, UK
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2
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Qian Y, Cai C, Sun M, Lv D, Zhao Y. Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2707-2723. [PMID: 38034468 PMCID: PMC10683659 DOI: 10.2147/copd.s433183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is the exacerbation of a range of respiratory symptoms during the stable phase of chronic obstructive pulmonary disease (COPD). AECOPD is thus a dangerous stage and key event in the course of COPD, as its deterioration and frequency seriously affects the quality of life of patients and shortens their survival. Acute exacerbations occur and develop due to many factors such as infection, tobacco smoke inhalation, air pollution, comorbidities, airflow limitation, various biomarkers, history of previous deterioration, natural killer cell abnormalities, immunoglobulin G deficiency, genetics, abnormal muscle and nutritional status, negative psychology, and seasonal temperature changes. There is relatively limited research on the impact of the role of standardized management on the alleviation of AECOPD. However, with the establishment of relevant prevention and management systems and the promotion of artificial intelligence technology and Internet medical approaches, long-term effective and standardized management of COPD patients may help to achieve the quality of life and disease prognosis in COPD patients and reduce the risk of AE.
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Affiliation(s)
- Yang Qian
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Chenting Cai
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Mengqing Sun
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Dan Lv
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yun Zhao
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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3
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Johnson KB, Connolly CP, Cho SP, Miller TK, Sallis RE, Hiller WDB. Clinical presentation of exercise-associated hyponatremia in male and female IRONMAN® triathletes over three decades. Scand J Med Sci Sports 2023; 33:1841-1849. [PMID: 37204065 DOI: 10.1111/sms.14401] [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: 01/17/2023] [Revised: 04/16/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Exercise-associated hyponatremia (EAH) is common in ultra-endurance events and severe cases are more common in females. The purpose of this paper is to compare the clinical presentation of EAH between male and female triathletes in ultra-endurance competitions. METHODS Medical records with sodium concentrations (n = 3138) from the IRONMAN® World Championships over the timeframe of 1989-2019 were reviewed for both male (n = 2253) and female (n = 885) competitors. Logistic regression was used to explore the relationships between sex, sodium concentration, and various clinical presentations. RESULTS When comparing male and female triathletes, clinical variables found to have a different relationship with sodium concentration include altered mental status (inversely related in males and not related in females), abdominal pain, muscle cramps, hypotension, and tachycardia (directly related in males and not related in females), and vomiting and hypokalemia (not related in males and inversely related in females). Overall, males lost significantly more weight than females, and notably, approximately half of all athletes were dehydrated and lost weight. CONCLUSIONS Altered mental status, vomiting, abdominal pain, muscle cramps, hypotension, tachycardia, and hyperkalemia appear to present differently between sexes when comparing hyponatremic to eunatremic athletes. Although overhydration is the most common etiology of hypervolemic hyponatremia, hypovolemic hyponatremia comprises a significant amount of hyponatremic triathletes. Further understanding of how EAH presents helps athletes and medical professionals identify it early and prevent life-threatening complications.
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Affiliation(s)
- Kasey B Johnson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | - Stephanie P Cho
- College of Education, Washington State University, Pullman, WA, USA
| | - Thomas K Miller
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Robert E Sallis
- UC Riverside School of Medicine, Riverside, California, USA
- Kaiser Permanente, Sports Medicine, Fontana, California, USA
| | - W Douglas B Hiller
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- John A. Burns College of Medicine at University of Hawai'i, Honolulu, Hawaii, USA
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Fan L, Sun D, Yang J, Shi X, Shen F, Chen K, Yang J. Association Between Serum Sodium and Long-Term Mortality in Critically Ill Patients with Comorbid Chronic Obstructive Pulmonary Disease: Analysis from the MIMIC-IV Database. Int J Chron Obstruct Pulmon Dis 2022; 17:1143-1155. [PMID: 35586119 PMCID: PMC9112792 DOI: 10.2147/copd.s353741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Liming Fan
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Deyang Sun
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Jia Yang
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xiawei Shi
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Fenglin Shen
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ke Chen
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Junchao Yang
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Correspondence: Junchao Yang, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou City, Zhejiang Province, People’s Republic of China, Tel +86-13858036093, Email
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Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063651. [PMID: 35329337 PMCID: PMC8955583 DOI: 10.3390/ijerph19063651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
The majority of reviews on sports nutrition issues focus on macronutrients, often omitting or paying less attention to substances such as sodium. Through the literature, it is clear that there are no reviews that focus entirely on the effects of sodium and in particular on endurance sports. Sodium intake, both at high and low doses, has been found to be associated with health and performance issues in athletes. Besides, there have been theories that an electrolyte imbalance, specifically sodium, contributes to the development of muscle cramps (EAMC) and hyponatremia (EAH). For this reason, it is necessary to create this systematic review, in order to report extensively on the role of sodium consumption in the population and more specifically in endurance and ultra-endurance athletes, the relationship between the amount consumed and the occurrence of pathological disorders, the usefulness of simultaneous hydration and whether a disturbance of this substance leads to EAH and EAMC. As a method of data collection, this study focused on exploring literature from 2000–2021. The search was conducted through the research engines PubMed and Scopus. In order to reduce the health and performance effects in endurance athletes, simultaneous emphasis should be placed on both sodium and fluid intake.
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Feletti F, Saini G, Naldi S, Casadio C, Mellini L, Feliciani G, Zamprogno E. Injuries in Medium to Long-Distance Triathlon: A Retrospective Analysis of Medical Conditions Treated in Three Editions of the Ironman Competition. J Sports Sci Med 2022; 21:58-67. [PMID: 35250334 PMCID: PMC8851118 DOI: 10.52082/jssm.2022.58] [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: 03/22/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Triathlon's popularity is rapidly increasing, and epidemiological data relating to its related medical conditions is crucial to the development of proper medical plans and safety guidelines for it. This study examined the data from the medical reports collected during three consecutive editions of Ironman Italy, from 2017 to 2019. Out of 10,653 race-starters, 3.3% required medical attention sustaining 472 medical conditions. A significantly higher injury risk was found for females versus males (χ2 = 9.78, p = 0.02) and in long-distance (IR: 4.09/1,000hours) rather than in Olympic/middle distance races (IR: 1.75/1,000hours). Most (68.4%) conditions (including muscular exhaustion, hypothermia, and dehydration) were systemic, whilst only 10.2% were acute traumatic injuries. Of a total of 357 triathletes requiring medical assistance, 8.1% were a candidate for hospitalisation. The equipment and personnel that are required for the medical assistance in future triathlon events were estimated based on Maurer's algorithm, and ten practical recommendations for triathlon medical support were formulated.
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Affiliation(s)
- Francesco Feletti
- Department of Diagnostic Imaging, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna Italy
| | - Gaia Saini
- Department of Emergency, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Stefano Naldi
- Department of Surgery, Unit of Emergency Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Carlo Casadio
- Associazione dietetica e nutrizione clinica italiana, Rome, Italy
- Comitato di Ravenna, Croce Rossa Italiana, Ravenna, Italy
| | - Lorenzo Mellini
- Department of Diagnostic Imaging, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna Italy
| | - Giacomo Feliciani
- Istituto Scientifico Romagnolo per lo studio e la cura dei tumori - IRCCS, Meldola (FC), Italy
| | - Emanuela Zamprogno
- Critical Care Team I-Help BSO
- Confederazione Nazionale Misericordie d'Italia
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Lavoué C, Siracusa J, Chalchat É, Bourrilhon C, Charlot K. Analysis of food and fluid intake in elite ultra-endurance runners during a 24-h world championship. J Int Soc Sports Nutr 2020; 17:36. [PMID: 32652998 PMCID: PMC7353765 DOI: 10.1186/s12970-020-00364-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/22/2020] [Indexed: 01/03/2023] Open
Abstract
Background Properly replacing energy and fluids is a challenge for 24-h ultramarathoners because such unusually high intake may induce adverse effects (gastrointestinal symptoms [GIS] and exercise-associated hyponatremia [EAH]). We analyzed such intake for 12 twelve elite athletes (6 males and 6 females; age: 46 ± 7 years, height: 170 ± 9 cm, weight: 61.1 ± 9.6 kg, total distance run: 193–272 km) during the 2019 24-h World Championships and compared it to the latest nutritional recommendations described by the International Society of Sports Nutrition in 2019. We hypothesized that these elite athletes would easily comply these recommendations without exhibiting detrimental adverse symptoms. Methods Ad libitum food and fluid intake was recorded in real-time and energy, macronutrient, sodium, and caffeine intake then calculated using a spreadsheet in which the nutritional composition of each item was previously recorded. GIS, markers of dehydration (body mass modifications, plasma and urine osmolality, and plasma volume; samples obtained 26 h before and just after the race) and EAH (plasma and urine sodium concentrations) were also assessed. Results Fluid, energy, and carbohydrate intake of the 11 finishers was 16.4 ± 6.9 L, 35.1 ± 15.7 MJ, and 1.49 ± 0.71 kg, respectively. Individual analyses showed that all but one (for fluid intake) or two (for energy and carbohydrate intake) consumed more than the minimum recommendations. The calculated energy balance remained, however, largely negative (− 29.5 ± 16.1 MJ). Such unusually high intake was not accompanied by detrimental GIS (recorded in 75%, but only transiently [3.0 ± 0.9 h]) or EAH (0%). The athletes were not dehydrated, shown by the absence of significant body mass loss (− 0.92 ± 2.13%) and modifications of plasma osmolality and an increase in plasma volume (+ 19.5 ± 15.8%). Performance (distance ran) positively correlated with energy intake (ρ = 0.674, p = 0.023) and negatively (ρ = − 0.776, p = 0.005) with fluid intake. Conclusions Overall, almost all of these elite 24-h ultramarathoners surpassed the nutritional recommendations without encountering significant or the usual adverse effects.
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Affiliation(s)
- Chloé Lavoué
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, 1 place Général Valérie André, 91223, Bretigny-Sur-Orge, France.,LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France
| | - Julien Siracusa
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, 1 place Général Valérie André, 91223, Bretigny-Sur-Orge, France.,LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France
| | - Émeric Chalchat
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, 1 place Général Valérie André, 91223, Bretigny-Sur-Orge, France.,LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France
| | - Cyprien Bourrilhon
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, 1 place Général Valérie André, 91223, Bretigny-Sur-Orge, France.,LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France
| | - Keyne Charlot
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, 1 place Général Valérie André, 91223, Bretigny-Sur-Orge, France. .,LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025, Evry, France.
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Knechtle B, Chlíbková D, Papadopoulou S, Mantzorou M, Rosemann T, Nikolaidis PT. Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E537. [PMID: 31455034 PMCID: PMC6780610 DOI: 10.3390/medicina55090537] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 12/05/2022]
Abstract
Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110-115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon-Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).
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Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland.
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
| | - Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, 61669 Brno, Czech Republic
| | - Sousana Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57001 Thessaloniki, Greece
| | - Maria Mantzorou
- Food Science and Nutrition Department, University of the Aegean, 81400 Myrina, Greece
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | - Pantelis T Nikolaidis
- Exercise Physiology Laboratory, 18450 Nikaia, Greece
- School of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
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Knechtle B, Chlíbková D, Nikolaidis PT. [Exercise-Associated Hyponatremia in Endurance Performance]. PRAXIS 2019; 108:615-632. [PMID: 31288661 DOI: 10.1024/1661-8157/a003261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.
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Affiliation(s)
- Beat Knechtle
- 1 Medbase St. Gallen Am Vadianplatz, St. Gallen
- 2 Institut für Hausarztmedizin, Universität Zürich, Zürich
| | - Daniela Chlíbková
- 3 Centre of Sports Activities, Brno University of Technology, Brno, Tschechien
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Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants-SAFER Study VI. Clin J Sport Med 2018; 28:427-434. [PMID: 29944515 DOI: 10.1097/jsm.0000000000000619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use. DESIGN Cross-sectional study. SETTING 21.1-km and 56-km races. PARTICIPANTS Seventy-six thousand six hundred fifty-four race entrants. METHODS Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history. MAIN OUTCOME MEASURES Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)]. RESULTS Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P < 0.0001). During races, nonsteroidal anti-inflammatory drugs (NSAIDs) (5.3%; 5.1-5.5) and paracetamol (2.6%; 2.4-2.7) were used mostly. Independent factors (adjusted PR for sex, age, and race distance; P < 0.0001) associated with AAIM use were running injury (2.7; 2.6-2.9), EAMC (2.0; 1.9-2.1), cardiovascular disease (CVD) symptoms (2.1; 1.8-2.4), known CVD (1.7; 1.5-1.9), CVD risk factors (1.6; 1.5-1.6), allergies (1.6; 1.5-1.7), cancer (1.3; 1.1-1.5), and respiratory (1.7; 1.6-1.8), gastrointestinal (2.0; 1.9-2.2), nervous system (1.9; 1.7-2.1), kidney/bladder (1.8; 1.6-2.0), endocrine (1.5; 1.4-1.7), and hematological/immune (1.5; 1.2-1.8) diseases. CONCLUSIONS 12.2% runners use AAIM before and/or during races, mostly NSAIDs. Factors (independent of sex, age, and race distance) associated with AAIM use were history of injuries, EAMC, and numerous chronic diseases. We suggest a pre-race screening and educational program to reduce AAIM use in endurance athletes to promote safer races.
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Abstract
It is well known that elderly people up to 90 years of age are able to finish a marathon. We have no knowledge, however, how runners at the age of 90 years or older pace during a long run. In this case report, we describe the pacing of a 94-year-old man competing in a 6-hour run in order to prepare for a marathon at the age of 95 years in category M95. In the “6-Stunden-Lauf ” held in Brugg, Switzerland, participants have to run as many laps of 0.934 km as possible on a completely flat circuit within 6 hours to achieve as many kilometers as possible. Before and after the competition we measured body weight, percentage of body fat, fat-free mass and percentage of body water using a bioelectrical impedance scale. On the day before the start, 24 hours after the finish and then every 24 hours for the following 4 days, capillary blood samples at a fingertip were drawn to determine hemoglobin, hematocrit, leukocytes, platelets, C-reactive protein, creatine kinase, creatinine and potassium and sodium. The runner achieved 26 laps during the 6 hours, equal to 24.304 km. Lap times increased continuously and running speed decreased nearly linearly. A large main effect of time point (hours) of the race on running speed was observed (p=0.015, η2=0.48) with running speed being slower in the last hour than that in the first hour (3.5±1.4 km/h versus 5.3±0.4 km/h). Body mass decreased by 0.6%, percent body fat by 1.4% and fat-free mass by 0.7%. During recovery, hemoglobin, hematocrit and the number of thrombocytes increased, whereas the number of leukocytes remained unchanged. C-reactive protein was highest on day 1 after the race and decreased by day 4 nearly to zero. Creatine kinase was slightly elevated pre-race, highest the day after the race and remained slightly elevated until day 4. Creatinine and potassium were increased pre-race but returned to normal values during recovery. Sodium remained within normal values on all days. Based on the linear decrease in running speed, we extrapolated for the marathon distance to run a marathon in age group M95 (i.e., male marathoners aged 95–99 years). In the worst-case scenario (i.e., the athlete develops maximal fatigue), he would stop the race before 40 km, in the best scenario (i.e., the athlete develops minimal fatigue), he would achieve an overall race time of ~8.3 hours and in the most probable scenario (i.e., the athlete can continue in the same manner), the final race time will be longer than 11 hours.
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Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland.,Institute of Primary Care, University of Zurich, Zurich, Switzerland
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12
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Bonde L, Boedtkjer E. Extracellular acidosis and very low [Na + ] inhibit NBCn1- and NHE1-mediated net acid extrusion from mouse vascular smooth muscle cells. Acta Physiol (Oxf) 2017; 221:129-141. [PMID: 28319329 DOI: 10.1111/apha.12877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/20/2017] [Accepted: 03/14/2017] [Indexed: 12/28/2022]
Abstract
AIM The electroneutral Na+ , HCO3- cotransporter NBCn1 and Na+ /H+ exchanger NHE1 regulate acid-base balance in vascular smooth muscle cells (VSMCs) and modify artery function and structure. Pathological conditions - notably ischaemia - can dramatically perturb intracellular (i) and extracellular (o) pH and [Na+ ]. We examined effects of low [Na+ ]o and pHo on NBCn1 and NHE1 activity in VSMCs of small arteries. METHODS We measured pHi by 2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein-based fluorescence microscopy of mouse mesenteric arteries and induced intracellular acidification by NH4+ prepulse technique. RESULTS NBCn1 activity - defined as Na+ -dependent, amiloride-insensitive net base uptake with CO2 /HCO3- present - was inhibited equally when pHo decreased from 7.4 (22 mm HCO3-/5% CO2 ) by metabolic (pHo 7.1/11 mm HCO3-: 22 ± 8%; pHo 6.8/5.5 mm HCO3-: 61 ± 7%) or respiratory (pHo 7.1/10% CO2 : 35 ± 11%; pHo 6.8/20% CO2 : 56 ± 7%) acidosis. Extracellular acidosis more prominently inhibited NHE1 activity - defined as Na+ -dependent net acid extrusion without CO2 /HCO3- present - at both pHo 7.1 (45 ± 9%) and 6.8 (85 ± 5%). Independently of pHo , lowering [Na+ ]o from 140 to 70 mm reduced NBCn1 and NHE1 activity <20% whereas transport activities declined markedly (25-50%) when [Na+ ]o was reduced to 35 mm. Steady-state pHi decreased more during respiratory (ΔpHi /ΔpHo = 71 ± 4%) than metabolic (ΔpHi /ΔpHo = 30 ± 7%) acidosis. CONCLUSION Extracellular acidification inhibits NBCn1 and NHE1 activity in VSMCs. NBCn1 is equivalently inhibited when pCO2 is raised or [HCO3-]o decreased. Lowering [Na+ ]o inhibits NBCn1 and NHE1 markedly only below the typical physiological and pathophysiological range. We propose that inhibition of Na+ -dependent net acid extrusion at low pHo protects against cellular Na+ overload at the cost of intracellular acidification.
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Affiliation(s)
- L. Bonde
- Department of Biomedicine; Aarhus University; Aarhus Denmark
| | - E. Boedtkjer
- Department of Biomedicine; Aarhus University; Aarhus Denmark
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Abstract
The brain operates in an extraordinarily intricate environment which demands precise regulation of electrolytes. Tight control over their concentrations and gradients across cellular compartments is essential and when these relationships are disturbed neurologic manifestations may develop. Perturbations of sodium are the electrolyte disturbances that most often lead to neurologic manifestations. Alterations in extracellular fluid sodium concentrations produce water shifts that lead to brain swelling or shrinkage. If marked or rapid they can result in profound changes in brain function which are proportional to the degree of cerebral edema or contraction. Adaptive mechanisms quickly respond to changes in cell size by either increasing or decreasing intracellular osmoles in order to restore size to normal. Unless cerebral edema has been severe or prolonged, correction of sodium disturbances usually restores function to normal. If the rate of correction is too rapid or overcorrection occurs, however, new neurologic manifestations may appear as a result of osmotic demyelination syndrome. Disturbances of magnesium, phosphate and calcium all may contribute to alterations in sensorium. Hypomagnesemia and hypocalcemia can lead to weakness, muscle spasms, and tetany; the weakness from hypophosphatemia and hypomagnesemia can impair respiratory function. Seizures can be seen in cases with very low concentrations of sodium, magnesium, calcium, and phosphate.
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Affiliation(s)
- M Diringer
- Department of Neurology, Washington University, St. Louis, MO, USA.
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