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Golubjatnikov M, Walker A. Endurance Sporting Events. Emerg Med Clin North Am 2024; 42:581-596. [PMID: 38925776 DOI: 10.1016/j.emc.2024.02.017] [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] [Indexed: 06/28/2024]
Abstract
Endurance sports encompass a broad range of events from marathons and triathlons to ultramarathons, long-distance cycling, skiing, and swimming. As these events have experienced a surge in popularity, we have a greater need to understand the associated medical risks. This article reviews the history of endurance races, reviews the most critical and common causes of cardiovascular, heat, electrolyte, and musculoskeletal injuries/illnesses, and discusses considerations for medical directors/personnel associated with such events.
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Affiliation(s)
- Matt Golubjatnikov
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA
| | - Anne Walker
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA.
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Tiemeier L, Nikolaidis PT, Chlíbková D, Wilhelm M, Thuany M, Weiss K, Knechtle B. Ultra-Cycling- Past, Present, Future: A Narrative Review. SPORTS MEDICINE - OPEN 2024; 10:48. [PMID: 38679655 PMCID: PMC11056358 DOI: 10.1186/s40798-024-00715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/06/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Ultra-endurance events are gaining popularity in multiple exercise disciplines, including cycling. With increasing numbers of ultra-cycling events, aspects influencing participation and performance are of interest to the cycling community. MAIN BODY The aim of this narrative review was, therefore, to assess the types of races offered, the characteristics of the cyclists, the fluid and energy balance during the race, the body mass changes after the race, and the parameters that may enhance performance based on existing literature. A literature search was conducted in PubMed, Scopus, and Google Scholar using the search terms 'ultracycling', 'ultra cycling', 'ultra-cycling', 'ultra-endurance biking', 'ultra-bikers' and 'prolonged cycling'. The search yielded 948 results, of which 111 were relevant for this review. The studies were classified according to their research focus and the results were summarized. The results demonstrated changes in physiological parameters, immunological and oxidative processes, as well as in fluid and energy balance. While the individual race with the most published studies was the Race Across America, most races were conducted in Europe, and a trend for an increase in European participants in international races was observed. Performance seems to be affected by characteristics such as age and sex but not by anthropometric parameters such as skin fold thickness. The optimum age for the top performance was around 40 years. Most participants in ultra-cycling events were male, but the number of female athletes has been increasing over the past years. Female athletes are understudied due to their later entry and less prominent participation in ultra-cycling races. A post-race energy deficit after ultra-cycling events was observed. CONCLUSION Future studies need to investigate the causes for the observed optimum race age around 40 years of age as well as the optimum nutritional supply to close the observed energy gap under consideration of the individual race lengths and conditions. Another research gap to be filled by future studies is the development of strategies to tackle inflammatory processes during the race that may persist in the post-race period.
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Affiliation(s)
- Lucas Tiemeier
- Centre for Rehabilitation & Sports Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | - Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, 61669, Brno, Czech Republic
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | - 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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Silvino VO, Batista MCC, Neto MM, Ribeiro ALB, Nascimento PPD, Barros EML, Moura RCD, Sales KCG, Galvão LMV, Nunes LCC, Durazzo A, Silva AS, Pereira dos Santos MA. Effect of a cajuína hydroelectrolytic drink on the physical performance and hydration status of recreational runners. Curr Res Physiol 2024; 7:100119. [PMID: 38357495 PMCID: PMC10864873 DOI: 10.1016/j.crphys.2024.100119] [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: 06/24/2022] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Cajuína is a processed drink derived from cashew and is widely consumed in the northeast region of Brazil. This study evaluated the effect of a cajuína-based hydroelectrolytic drink on the aerobic performance and hydration status of recreational runners. Seventeen males (31.9 ± 1.6 years, 51.0 ± 1.4 ml/kg/min) performed three time-to-exhaustion running sessions on a treadmill at 70% VO2max, ingesting cajuína hydroelectrolytic drink (CJ), high carbohydrate commercial hydroelectrolytic drink (CH) and mineral water (W) every 15 min during the running test. The participants ran 80.3 ± 8.4 min in CJ, 70.3 ± 6.8 min in CH and 71.8 ± 6.9 min in W, with no statistical difference between procedures. Nevertheless, an effect size of η2 = 0.10 (moderate) was observed. No statistical difference was observed in the concentrations of sodium, potassium, and osmolality in both serum and urine between the three conditions. However, the effect size was moderate (urine sodium) and high (serum sodium, potassium, and osmolality). Urine specific gravity, sweating rate and heart rate were not significantly different between drinks. The cajuína-based hydroelectrolytic drink promotes similar effects compared to commercial hydroelectrolytic drink and water, considering specific urine gravity, heart rate, sweating, and time to exhaustion in recreational runners.
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Affiliation(s)
- Valmir Oliveira Silvino
- Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Brazil
- Rede Nordeste de Biotecnologia (RENORBIO), Federal University of Piaui, Teresina, Brazil
- Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Brazil
| | | | - Manoel Miranda Neto
- Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | | | | | - Esmeralda Maria Lustosa Barros
- Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Brazil
- Rede Nordeste de Biotecnologia (RENORBIO), Federal University of Piaui, Teresina, Brazil
| | | | | | - Luanne Morais Vieira Galvão
- Rede Nordeste de Biotecnologia (RENORBIO), Federal University of Piaui, Teresina, Brazil
- Department of Technology in Gastronomy, Federal Institute of Piauí, Teresina, Brazil
| | - Lívio César Cunha Nunes
- Rede Nordeste de Biotecnologia (RENORBIO), Federal University of Piaui, Teresina, Brazil
- Department of Pharmacy, Federal University of Piauí, Teresina, Brazil
| | - Alessandra Durazzo
- CREA-Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | | | - Marcos Antonio Pereira dos Santos
- Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Brazil
- Rede Nordeste de Biotecnologia (RENORBIO), Federal University of Piaui, Teresina, Brazil
- Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Brazil
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Amawi A, AlKasasbeh W, Jaradat M, Almasri A, Alobaidi S, Hammad AA, Bishtawi T, Fataftah B, Turk N, Saoud HA, Jarrar A, Ghazzawi H. Athletes' nutritional demands: a narrative review of nutritional requirements. Front Nutr 2024; 10:1331854. [PMID: 38328685 PMCID: PMC10848936 DOI: 10.3389/fnut.2023.1331854] [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: 11/01/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024] Open
Abstract
Nutrition serves as the cornerstone of an athlete's life, exerting a profound impact on their performance and overall well-being. To unlock their full potential, athletes must adhere to a well-balanced diet tailored to their specific nutritional needs. This approach not only enables them to achieve optimal performance levels but also facilitates efficient recovery and reduces the risk of injuries. In addition to maintaining a balanced diet, many athletes also embrace the use of nutritional supplements to complement their dietary intake and support their training goals. These supplements cover a wide range of options, addressing nutrient deficiencies, enhancing recovery, promoting muscle synthesis, boosting energy levels, and optimizing performance in their respective sports or activities. The primary objective of this narrative review is to comprehensively explore the diverse nutritional requirements that athletes face to optimize their performance, recovery, and overall well-being. Through a thorough literature search across databases such as PubMed, Google Scholar, and Scopus, we aim to provide evidence-based recommendations and shed light on the optimal daily intakes of carbohydrates, protein, fats, micronutrients, hydration strategies, ergogenic aids, nutritional supplements, and nutrient timing. Furthermore, our aim is to dispel common misconceptions regarding sports nutrition, providing athletes with accurate information and empowering them in their nutritional choices.
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Affiliation(s)
- Adam Amawi
- Department of Exercise Science and Kinesiology, School of Sport Science, The University of Jordan, Amman, Jordan
| | - Walaa AlKasasbeh
- Department of Physical and Health Education, Faculty of Educational Sciences, Al-Ahliyya Amman University, Amman, Jordan
| | - Manar Jaradat
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Amani Almasri
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Sondos Alobaidi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Aya Abu Hammad
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Taqwa Bishtawi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Batoul Fataftah
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Nataly Turk
- Department of Family and Community Medicine, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Hassan Al Saoud
- Department of Exercise Science and Kinesiology, School of Sport Science, The University of Jordan, Amman, Jordan
| | - Amjad Jarrar
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Oxford Brookes Center for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Hadeel Ghazzawi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
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Yao Y, DiNenna MA, Chen L, Jin S, He S, He J. Hypothesized mechanisms of death in swimming: a systematic review. BMC Sports Sci Med Rehabil 2024; 16:6. [PMID: 38167168 PMCID: PMC10763430 DOI: 10.1186/s13102-023-00799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The study aims to update the specific classification of mechanisms of death in swimming and to demonstrate these categories are reasonable, by analyzing more characteristics of death cases, evaluating the available evidence and determining their quality. METHODS Original articles were queried from PubMed, Web of Science, Embase databases, Cochrane Library, and Scopus. Included studies, which were evaluated as level 4 evidence or higher according to the Oxford Centre for Evidence-Based Medicine, discussed hypothesized mechanisms of death in swimming. Parameters analyzed in this study included decedents' characteristics, outcome measures, findings, methodological index for non-randomized studies (MINORS), and critical evaluation of each study classified by death mechanism. RESULTS A total of twenty-five studies were included for further analysis: fourteen were associated with cardiovascular diseases, two were about cerebrovascular diseases, two contained respiratory diseases, seven were about hazardous conditions and three contained other drownings, which provided evidence for mechanisms of death. CONCLUSIONS It is found that cardiovascular disease is the main cause or contributing factor of death in swimming. Respiratory diseases and cerebrovascular diseases are difficult to be definitive mechanism categories due to insufficient evidence. Hazardous conditions appear to be one of the possible risk factors because there are more cases of deaths from unsafe environments in swimming, but further statistics and research are still needed to support this view. Our study may have important implications for developing potential prevention strategies for sports and exercise medicine. TRIAL REGISTRATION PROSPERO ID (CRD42021267330). Registered Aug 13th 2021.
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Affiliation(s)
- Yunheng Yao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Michael A DiNenna
- Department of Mechanical and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Lili Chen
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Shirong Jin
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Sixian He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Jinshen He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
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Tsur A, Spierer R, Cohen R, Blatch D, Eyal S, Honig A, Ekstein D. First unprovoked seizures among soldiers recruited to the Israeli Defense Forces during 10 consecutive years: A population-based study. Epilepsia 2024; 65:127-137. [PMID: 37597251 DOI: 10.1111/epi.17750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The management of patients after a first unprovoked seizure (FUS) can benefit from stratification of the average 50% risk for further seizures. We characterized subjects with FUSs, out of a large generally healthy homogenous population of soldiers recruited by law to the Israeli Defense Forces, to investigate the role of the type of service, as a trigger burden surrogate, in the risk for additional seizures. METHODS Soldiers recruited between 2005 and 2014, who experienced an FUS during their service, were identified from military records. Subjects with a history of epilepsy or lack of documentation of FUS characteristics were excluded from the study. Data on demographics and military service and medical details were extracted for the eligible soldiers. RESULTS Of 816 252 newly recruited soldiers, representing 2 138 000 person-years, 346 had an FUS, indicating an incidence rate of 16.2 per 100 000 person-years. The FUS incidence rate was higher in combat versus noncombat male and female soldiers (p < .0001). Most subjects (75.7%) were prescribed antiseizure medications (ASMs), and 29.2% had additional seizures after the FUS. Service in combat units, abnormal magnetic resonance imaging, and being prescribed ASMs were correlated with a lower risk of having multiple seizures (95% confidence interval [CI] = .48-.97, .09-.86, .15-.28, respectively). On multivariate analysis, service in combat units (odds ratio [OR] = .48 for seizure recurrence, 95% CI = .26-.88) and taking medications (OR = .46, 95% CI = .24-.9) independently predicted not having additional seizures. SIGNIFICANCE FUS incidence rate was higher in combat soldiers, but they had a twofold lower risk of additional seizures than noncombat soldiers, emphasizing the value of strenuous triggers as negative predictors for developing epilepsy. This suggests a shift in the perception of epilepsy from a "yes or no" condition to a continuous trend of predisposition to seizures, warranting changes in the ways etiologies of epilepsy are weighted and treatments are delivered.
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Affiliation(s)
- Adili Tsur
- Israeli Defense Forces Medical Corps, Tel Aviv, Israel
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Ronen Spierer
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Renana Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Blatch
- International Center for Multimorbidity and Complexity, University of Zurich, Zurich, Switzerland
- Department of Psychosomatic Medicine, University Hospital Basel and Merian Iselin Klinik Basel, Basel, Switzerland
| | - Sara Eyal
- Institute for Drug Research, School of Pharmacy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asaf Honig
- Department of Neurology, Soroka Medical Center, Beer Sheva, Israel
| | - Dana Ekstein
- Department of Neurology, Agnes Ginges Center for Human Neurogenetics, Hadassah Medical Organization, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gauckler P, Kesenheimer JS, Leierer J, Kruus M, Schreinlechner M, Theurl F, Bauer A, Denicolò S, Egger A, Seeber B, Mayer G, Kolbinger FR, Kronbichler A. Exercise-Induced Fluid Retention, Cardiac Volume Overload, and Peripheral Edema in Ultra-Distance Cyclists. Kidney Int Rep 2024; 9:152-161. [PMID: 38312776 PMCID: PMC10831365 DOI: 10.1016/j.ekir.2023.10.025] [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: 07/20/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Ultracyclists expose themselves to extreme physical challenges. This study aimed to elucidate the effects of ultracycling on electrolyte and fluid balance and investigate the potential occurrence of peripheral edema. Methods A total of 4 clinical visits were performed before, during, and after a 6-day bicycle ride in 13 ultracyclists (5 female, 8 male) including serial laboratory analyses of blood and urine, bioelectrical impedance, and echocardiography. Throughout the ride, participants continuously tracked fluid intake, measured extremity circumferences daily, and self-tested urinary electrolytes using a point-of-care testing device. Portrait photos were judged by 20 physicians for occurrence of facial and eyelid edema. Results Participants covered a mean distance of 1205 km and 19,417 vertical meters. From baseline to day 6, body weight remained stable (P = 0.479); however, body composition changed with increasing total body water (TBW) (+1.98 l ± 1.37, P = 0.003) and plasma volume (+18.86 % ± 10.7, P < 0.001). A significant increase in N-terminal pro brain natriuretic peptide (NT-proBNP) (+297.99 ng/l ± 190.42, P < 0.001) until day 6 indicates concomitant cardiac volume overload. Swelling of face and eyelids peaked on day 5 (both P ≤ 0.033). On recovery, changes partly resolved. Although urinary sodium concentration showed a nadir on day 4 (-32.18 mmol/l ± 23.88, P = 0.022), plasma osmolality (+5.69 mmosmol/kg ± 5.88, P = 0.004) and copeptin (+38.28 pg/ml ± 18.90, P < 0.001) increased steadily until day 6. Conclusion Ultracycling over multiple days induces extracellular volume expansion, peripheral edema, and cardiac volume overload. Renal sodium and water retention is likely contributing to this condition.
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Affiliation(s)
- Philipp Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | | | - Johannes Leierer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Maren Kruus
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Michael Schreinlechner
- Department of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Theurl
- Department of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Sara Denicolò
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Alexander Egger
- Central Institute of Medical and Chemical Laboratory Diagnostics (ZIMCL), University Hospital of Innsbruck, Innsbruck, Austria
| | - Beata Seeber
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Fiona R. Kolbinger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise. Eur J Appl Physiol 2024; 124:1-145. [PMID: 37796292 DOI: 10.1007/s00421-023-05276-3] [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: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 10/06/2023]
Abstract
In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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Gilloteaux J, De Swert K, Suain V, Nicaise C. Thalamic Neuron Resilience during Osmotic Demyelination Syndrome (ODS) Is Revealed by Primary Cilium Outgrowth and ADP-ribosylation factor-like protein 13B Labeling in Axon Initial Segment. Int J Mol Sci 2023; 24:16448. [PMID: 38003639 PMCID: PMC10671465 DOI: 10.3390/ijms242216448] [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: 10/22/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
A murine osmotic demyelinating syndrome (ODS) model was developed through chronic hyponatremia, induced by desmopressin subcutaneous implants, followed by precipitous sodium restoration. The thalamic ventral posterolateral (VPL) and ventral posteromedial (VPM) relay nuclei were the most demyelinated regions where neuroglial damage could be evidenced without immune response. This report showed that following chronic hyponatremia, 12 h and 48 h time lapses after rebalancing osmolarity, amid the ODS-degraded outskirts, some resilient neuronal cell bodies built up primary cilium and axon hillock regions that extended into axon initial segments (AIS) where ADP-ribosylation factor-like protein 13B (ARL13B)-immunolabeled rod-like shape content was revealed. These AIS-labeled shaft lengths appeared proportional with the distance of neuronal cell bodies away from the ODS damaged epicenter and time lapses after correction of hyponatremia. Fine structure examination verified these neuron abundant transcriptions and translation regions marked by the ARL13B labeling associated with cell neurotubules and their complex cytoskeletal macromolecular architecture. This necessitated energetic transport to organize and restore those AIS away from the damaged ODS core demyelinated zone in the murine model. These labeled structures could substantiate how thalamic neuron resilience occurred as possible steps of a healing course out of ODS.
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Affiliation(s)
- Jacques Gilloteaux
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
- Department of Anatomical Sciences, St George’s University School of Medicine, Newcastle upon Tyne NE1 JG8, UK
| | - Kathleen De Swert
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
| | - Valérie Suain
- Laboratoire d’Histologie Générale, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Bruxelles, Belgium;
| | - Charles Nicaise
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
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10
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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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11
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Kelly CPMG. Is There Evidence for the Development of Sex-Specific Guidelines for Ultramarathon Coaches and Athletes? A Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:6. [PMID: 36695958 PMCID: PMC9877268 DOI: 10.1186/s40798-022-00533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is evidence of sex differences in the physiology of endurance exercise, yet most of the advice and guidelines on training, racing, nutrition, and recovery for ultramarathons are based on research that has largely excluded female athletes. The objective was therefore to review the current knowledge of sex differences in ultramarathon runners and determine if sufficient evidence exists for providing separate guidelines for males and females. METHODS This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases were searched for studies investigating differences in elite and recreational male and female ultramarathon runners. Studies were included if they compared males and females and looked at outcomes relating to the performance or health of ultramarathon runners. The quality of the included studies was determined using the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. RESULTS The search strategy identified 45 studies that met the inclusion criteria. Most studies were observational in design, with only three papers based on randomised controlled trials. The overall quality of the evidence was low. Sex differences in the predictors of ultramarathon performance; physiological responses to training, racing, and recovery; chronic and acute health issues; and pacing strategies were found. There were areas with contradictory findings, and very few studies examined specific interventions. CONCLUSION The results from this review suggest that the development of sex-specific guidelines for ultramarathon coaches and athletes could have a significant effect on the performance and health of female runners. At present, there is insufficient high-quality evidence on which to formulate these guidelines, and further research is required.
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Affiliation(s)
- Claudia P M G Kelly
- College of Medicine and Health, The University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
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12
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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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13
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Martin-Grace J, Tomkins M, O’Reilly MW, Thompson CJ, Sherlock M. Approach to the Patient: Hyponatremia and the Syndrome of Inappropriate Antidiuresis (SIAD). J Clin Endocrinol Metab 2022; 107:2362-2376. [PMID: 35511757 PMCID: PMC9282351 DOI: 10.1210/clinem/dgac245] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Indexed: 12/31/2022]
Abstract
Hyponatremia is the most common electrolyte disturbance seen in clinical practice, affecting up to 30% of acute hospital admissions, and is associated with significant adverse clinical outcomes. Acute or severe symptomatic hyponatremia carries a high risk of neurological morbidity and mortality. In contrast, chronic hyponatremia is associated with significant morbidity including increased risk of falls, osteoporosis, fractures, gait instability, and cognitive decline; prolonged hospital admissions; and etiology-specific increase in mortality. In this Approach to the Patient, we review and compare the current recommendations, guidelines, and literature for diagnosis and treatment options for both acute and chronic hyponatremia, illustrated by 2 case studies. Particular focus is concentrated on the diagnosis and management of the syndrome of inappropriate antidiuresis. An understanding of the pathophysiology of hyponatremia, along with a synthesis of the duration of hyponatremia, biochemical severity, symptomatology, and blood volume status, forms the structure to guide the appropriate and timely management of hyponatremia. We present 2 illustrative cases that represent common presentations with hyponatremia and discuss the approach to management of these and other causes of hyponatremia.
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Affiliation(s)
- Julie Martin-Grace
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maria Tomkins
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael W O’Reilly
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chris J Thompson
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Sherlock
- Correspondence: Mark Sherlock, MD, PhD, Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin 9, Ireland. E-mail:
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14
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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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15
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Schenk K, Rauch S, Procter E, Grasegger K, Mrakic-Sposta S, Gatterer H. Changes in Factors Regulating Serum Sodium Homeostasis During Two Ultra-Endurance Mountain Races of Different Distances: 69km vs. 121km. Front Physiol 2021; 12:764694. [PMID: 34867470 PMCID: PMC8637410 DOI: 10.3389/fphys.2021.764694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Overdrinking and non-osmotic arginine vasopressin release are the main risk factors for exercise-associated hyponatremia (EAH) in ultra-marathon events. However, particularly during ultra-marathon running in mountainous regions, eccentric exercise and hypoxia, which have been shown to modulate inflammation, hormones regulating fluid homeostasis (hypoxia), and oxidative stress, could contribute to serum sodium changes in a dose-dependent manner. To the best of our knowledge, the contribution of these factors, the extent of which depends on the duration and geographical location of the race, has not been well studied. Twelve male participants (11 finishers) of the short (69km, 4,260m elevation-gain) and 15 male participants (seven finishers) of the long (121km, 7,554m elevation-gain) single-stage Südtirol Ultra Sky-Race took part in this observational field study. Venous blood was drawn immediately before and after the race. Analyses included serum sodium concentration, copeptin (a stable marker for vasopressin), markers of inflammation, muscle damage and oxidative stress. Heart rate was measured during the race and race time was obtained from the race office. During the short and the long competition two and one finishers, respectively showed serum sodium concentrations >145mmol/L. During the long competition, one athlete showed serum sodium concentrations <135mmol/L. Only during the short competition percent changes in serum sodium concentrations of the finishers were related to percent changes in body mass (r=-0.812, p=0.002), total time (r=-0.608, p=0.047) and training impulse (TRIMP) (r=-0.653, p=0.030). Data show a curvilinear (quadratic) relationship between percent changes in serum sodium concentration and body mass with race time when including all runners (short, long, finishers and non-finishers). The observed prevalence of hypo- and hypernatremia is comparable to literature reports, as is the relationship between serum sodium changes and race time, race intensity and body mass changes of the finishers of the short race. The curvilinear relationship indicates that there might be a turning point of changes in serum sodium and body mass changes after a race time of approximately 20h. Since the turning point is represented mainly by non-finishers, regardless of race duration slight decrease in body mass and a slight increase in serum sodium concentration should be targeted to complete the race. Drinking to the dictate of thirst seems an adequate approach to achieve this goal.
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Affiliation(s)
- Kai Schenk
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,Department of Anaesthesiology and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy
| | - Emily Procter
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Katharina Grasegger
- Department of Anaesthesiology and Intensive Care Medicine, BG Klinik Murnau, Murnau, Germany
| | - Simona Mrakic-Sposta
- National Research Council-Institute of Clinical Physiology (CNR-IFC), Milan, Italy
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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16
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Gauckler P, Kesenheimer JS, Kronbichler A, Kolbinger FR. Edema-like symptoms are common in ultra-distance cyclists and driven by overdrinking, use of analgesics and female sex - a study of 919 athletes. J Int Soc Sports Nutr 2021; 18:73. [PMID: 34863204 PMCID: PMC8643017 DOI: 10.1186/s12970-021-00470-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Ultra-endurance cyclists regularly report various extents of bodily decline during long-distance bicycle rides, including potential kidney function-related symptoms such as swelling of body parts and urine changes. This study aimed to assess the prevalence of these symptoms in a representative cohort of ultra-endurance cyclists and shed light on potential predictors related to the ride, the rider and the rider’s behavior. Methods Between November 26 and December 14, 2020, 1350 people participated in an online survey investigating potential kidney-related symptoms of ultra-distance cycling. Frequency and severity of edema-like (“swelling”) symptoms and perceived changes in urine output, concentration and quality were associated with ride-related factors, demographic parameters and rider behavior-related variables. Results A total of 919 participants met the predefined inclusion criteria. The majority (N = 603, 65.6%) stated that they suffered from at least one potential kidney function-related symptom, out of which 498 (54.2%) stated one or more edema-like (“swelling”) symptoms. In correlational and multiple regression analyses, female sex, intake of analgesics and drinking strategies correlated with swelling symptoms. Further analyses indicated that drinking due to thirst and/or drinking adapted to ambient sweating and temperature negatively correlated with swelling symptoms, whereas “drinking as much as possible” enhanced these. Intake of analgesics was moderately positively correlated with swelling symptoms. Conclusions According to our survey, edema-like symptoms occur in the majority of ultra-distance cyclists and female sex, drinking strategy and intake of analgesic drugs are major predictors thereof. Studies are needed to investigate the underlying pathophysiological processes of such symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s12970-021-00470-0.
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Affiliation(s)
- Philipp Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | | | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Fiona R Kolbinger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
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17
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Khodaee M, Saeedi A, Harris-Spinks C, Hew-Butler T. Incidence of exercise-associated hyponatremia during a high-altitude 161-km ultramarathon. Phys Act Nutr 2021; 25:16-22. [PMID: 34727684 PMCID: PMC8580585 DOI: 10.20463/pan.2021.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022] Open
Abstract
[Purpose] Exercise-associated hyponatremia (EAH) is a well-known condition among endurance athletes at low altitudes. The incidence of EAH during ultramarathons at high altitudes warrants further investigation. This prospective observational study was conducted on the participants of the Leadville Trail 100 run, a 161-km race held at a high altitude (2,800 m-3,840 m). [Methods] Venous blood samples were collected before and immediately after the race. The participants completed an electronic survey after the race. Our main outcome measure was the post-race serum sodium ([Na+]) level. [Results] Of the 672 athletes who started the race, 351 (52%) successfully completed the event within the 30-hour cut-off. Post-race blood samples were collected from 84 runners (66 finishers). Both pre- and post-race blood samples were collected from 37 participants. Twenty percent of the post-race participants had EAH. Only one post-race participant had a [Na+] level of <130 mmol/L. All participants with EAH were asymptomatic. One participant had an abnormal pre-race [Na+] level (134 mmol/L). Female participants had a significantly higher rate of EAH than male participants (40% vs. 16%; p=0.039). Age, body mass index, weight changes, race completion status, nonsteroidal anti-inflammatory drug use, and urine specific gravity were not associated with the development of EAH. Lower postrace [Na+] levels were associated with higher serum creatine kinase values (R2=0.1, p<0.005). [Conclusion] High altitude (3,840 m peak) does not appear to enhance the incidence of EAH after an ultramarathon footrace. This suggests that ambient temperature (low temperatures reduce risk), sex (female predilection), endurance running, and overhydration are more prominent risk factors for EAH than high altitude.
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Affiliation(s)
- Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine and Orthopedics, Denver, USA
| | - Anahita Saeedi
- University of Massachusetts, Department of Biostatistics, MA, USA
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18
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Huang MK, Chang KS, Kao WF, Li LH, How CK, Wang SH, Lin YK, Hwang YS, Chien DK, Chiu YH. Visual hallucinations in 246-km mountain ultra-marathoners: An observational study. CHINESE J PHYSIOL 2021; 64:225-231. [PMID: 34708714 DOI: 10.4103/cjp.cjp_57_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ultra-marathons are typically held over harsh terrains such as mountains, deserts, or other wilderness, and place severe demands on the physical and psychological capabilities of participants. Adventure-race competitors commonly report hallucinations. The goal of this study was to gain insight into visual hallucinations (VHs) during a mountain ultra-marathon. Thirty-one Taiwanese runners who participated in the 2018 Run Across Taiwan Ultra-Marathon, which spans 246 km with an altitude difference of 3266 m and an overall cut-off time of 44 h, volunteered for this study. Self-reported questionnaires on sleep duration, hallucinatory experiences, clinical symptoms of cold- and heat-related illnesses, and the 2018 Lake Louise Acute Mountain Sickness (AMS) Score were recorded prerace, during the summit, immediately postrace, and 3-days postrace. Hematological samples were collected 1 week before, immediately after, and 3 days after the race. Eight ultra-marathoners (six males and two females; seven finishers and one withdrawer) were recruited. Three out of eight (37.5%) subjects (two males and one female) reported experiencing VHs during the last 60 km. Three out of five (60%) lower-ranked subjects experienced VHs. All eight runners slept for <30 min during the race. None of the runners presented with headache either during or after the race to meet the criteria for AMS. None of the runners suffered an abnormal thermoregulatory response or a hypoglycemic episode throughout the ultra-marathon. The changes in blood osmolality immediately postrace were subclinical, despite being statistically significant. Among the three runners with VHs, none presented with severe dehydration or dysnatremia immediately postrace. High-altitude exposure, hyper/hypothermia, dehydration, dysnatermia, or hypoglycemia did not seem to contribute to hallucination onset in our subjects during the event. VHs of ultra-marathoners may be associated with excessive physical exertion and sleep deprivation.
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Affiliation(s)
- Ming-Kun Huang
- Department of Emergency Medicine, Mackay Memorial Hospital; Department of Electronic Engineering, National Taipei University of Technology, Taipei; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Kuo-Song Chang
- Department of Emergency Medicine, Mackay Memorial Hospital; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Wei-Fong Kao
- Department of Emergency and Critical Care Medicine, Taipei Medical University Hospital; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Hua Li
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital; Program of Medical Biotechnology, Taipei Medical University, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Emergency Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei; Department of Emergency Medicine, Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan
| | | | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Yuh-Shyan Hwang
- Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Ding-Kuo Chien
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Hui Chiu
- Department of Emergency Medicine, Mackay Memorial Hospital; Department of Medicine, Mackay Medical College, New Taipei City; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review. Sports Med 2021; 52:725-740. [PMID: 34542868 PMCID: PMC8450723 DOI: 10.1007/s40279-021-01561-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/14/2022]
Abstract
It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.
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20
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Methodological Considerations for Studies in Sport and Exercise Science with Women as Participants: A Working Guide for Standards of Practice for Research on Women. Sports Med 2021; 51:843-861. [PMID: 33725341 PMCID: PMC8053180 DOI: 10.1007/s40279-021-01435-8] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/25/2022]
Abstract
Until recently, there has been less demand for and interest in female-specific sport and exercise science data. As a result, the vast majority of high-quality sport and exercise science data have been derived from studies with men as participants, which reduces the application of these data due to the known physiological differences between the sexes, specifically with regard to reproductive endocrinology. Furthermore, a shortage of specialist knowledge on female physiology in the sport science community, coupled with a reluctance to effectively adapt experimental designs to incorporate female-specific considerations, such as the menstrual cycle, hormonal contraceptive use, pregnancy and the menopause, has slowed the pursuit of knowledge in this field of research. In addition, a lack of agreement on the terminology and methodological approaches (i.e., gold-standard techniques) used within this research area has further hindered the ability of researchers to adequately develop evidenced-based guidelines for female exercisers. The purpose of this paper was to highlight the specific considerations needed when employing women (i.e., from athletes to non-athletes) as participants in sport and exercise science-based research. These considerations relate to participant selection criteria and adaptations for experimental design and address the diversity and complexities associated with female reproductive endocrinology across the lifespan. This statement intends to promote an increase in the inclusion of women as participants in studies related to sport and exercise science and an enhanced execution of these studies resulting in more high-quality female-specific data.
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21
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Plakida AL. Changes in immunological parameters in ultramarathon runners depending on the duration of the load. J Sports Med Phys Fitness 2020; 61:261-268. [PMID: 33092321 DOI: 10.23736/s0022-4707.20.11150-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In recent decades, there has been an increasing interest in long-distance running, not only to the classic marathon distances but also to an ultramarathon -100 km, 250 km, and multi-day races. One of the most reactive body systems in conditions of prolonged muscular loads is the immune system. The work aimed to investigate the changes in immunological parameters in runners for extra-long distances of various durations. METHODS We examined 73 male athletes specializing in long-distance and ultra-long-distance running. The design of the survey included the study of immunological status during the marathon race, 100 km run, and six-day run. We studied the dynamics of leukocyte formula; subpopulations of lymphocytes; fractions of immunoglobulins: IgA, IgM, IgG; phagocytic activity. RESULTS During the marathon run, athletes' immunological changes are manifested by the development of neutrophilic leukocytosis with a decrease in the phagocytic activity of neutrophils. There was a sharp increase in the NLR and decrease in the LMR. A 100-km race caused a decrease in the absolute and relative number of T-lymphocytes. NLR increased almost ten times, and LMR, on the contrary, decreased nearly five times. On the first day of the 6-days run, there is a sharp increase in NLR and a decrease in LMR, after which there is a relative stabilization of both indicators. CONCLUSIONS Changes in immunological parameters during jogging are closely related to the duration of the load. The most pronounced changes are observed on the part of neutrophils and lymphocytes.
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Affiliation(s)
- Alexander L Plakida
- Department of Physical Rehabilitation, Sports Medicine, Physical Training and Valeology, Odessa National Medical University, Odessa, Ukraine -
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22
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Paternoster N, Baggio E, Pelosi E. Personalized hydratation status in endurance and ultra-endurance: A review. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2020. [DOI: 10.3233/mnm-200434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This review aims to investigate the physiological mechanisms that underlie the hydro-electrolyte balance of the human body and the most appropriate hydration modalities for individuals involved in physical and sports activities, with a focus on ultra-endurance events. The role of effective hydration in achieving optimal sports performance is also investigated. An adequate pre-hydration is essential to perform physical and sporting activity in a condition of eu-hydration and to mantain physiologic levels of plasma electrolyte. To achieve these goals, athletes need to consume adequate drinks together with consuming meals and fluids, in order to provide an adequate absorption of the ingested fluids and the expulsion of those in excess through diuresis. Therefore, there are important differences between individuals in terms of sweating rates, the amount of electrolytes loss and the specific request of the discipline practiced and the sporting event to pursue.
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Affiliation(s)
- Nicolò Paternoster
- Centro di Medicina, Venice, Italy
- Centro Medico Fisioterapico, Magenta, Padova, Italy
| | | | - Ettore Pelosi
- Poliambulatorio Vitalia, Torino, Italy
- Centro PET Irmet – Affidea, Torino, Italy
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23
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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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Huang WC, Tung YT, Wu MS, Liu MC, Lin TJ, Yang MT. Low-Osmolality Carbohydrate-Electrolyte Solution Ingestion Avoid Fluid Loss and Oxidative Stress After Exhaustive Endurance Exercise. Antioxidants (Basel) 2020; 9:antiox9040336. [PMID: 32326004 PMCID: PMC7222420 DOI: 10.3390/antiox9040336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023] Open
Abstract
Low-osmolality carbohydrate–electrolyte solution (LCS) ingestion can replace losses from exercise-induced dehydration, but the benefits of LCS ingestion strategy after exhaustive endurance exercise (EEE) remain unknown. The present study evaluated the effects of LCS ingestion on dehydration, oxidative stress, renal function, and aerobic capacity after EEE. In our study with its double-blind, crossover, counterbalanced design, 12 healthy male participants were asked to consume LCS (150 mL four times per hour) or placebo (water) 1 h before and 1 h after EEE. All participants completed a graded exercise test to exhaustion on a treadmill for the determination of maximal oxygen consumption (V˙O2max), applied to further intensity calibration, and then completed the EEE test. The average heart rate, maximal heart rate, running time to exhaustion, and peak oxygen uptake (VO2peak) were recorded during the exercise period. The participants’ body weight was recorded at different time points before and after the EEE to calculate the dehydration rate. Blood samples were drawn at baseline and before, immediately after, 1 h after, and 2 h after EEE to determine indicators of oxidative stress and renal function. The results indicated that the dehydration rates in participants with LCS ingestion at 15 min, 30 min, and 45 min after EEE were significantly lower than in participants with placebo ingestion (−1.86 ± 0.47% vs. −2.24 ± 0.72%; −1.78 ± 0.50% vs. −2.13 ± 0.74%; −1.54 ± 0.51% vs. −1.94 ± 0.72%, respectively; p < 0.05). In addition, the concentration of catalase in participants with LCS ingestion immediately after EEE was significantly higher than in participants with placebo ingestion (2046.21 ± 381.98 nmol/min/mL vs. 1820.37 ± 417.35 nmol/min/mL; p < 0.05). Moreover, the concentration of protein carbonyl in participants with LCS ingestion immediately after EEE was slightly lower than in participants with placebo ingestion (2.72 ± 0.31 nmol carbonyl/mg protein vs. 2.89 ± 0.43 nmol carbonyl/mg protein; p = 0.06). No differences were noted for other variables. Our findings conclude that LCS ingestion can effectively avoid fluid loss and oxidative stress after EEE. However, LCS ingestion had no benefits for renal function or aerobic capacity.
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Affiliation(s)
- Wen-Ching Huang
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan;
| | - Yu-Tang Tung
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei 11301, Taiwan;
| | - Mai-Szu Wu
- TMU Research Center of Urology and Kidney, Taipei Medicine University, Taipei 110301, Taiwan;
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110301, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
| | - Ming-Che Liu
- Department of Urology, Taipei Medical University Hospital, Taipei 110301, Taiwan;
- Clinical Research Center, Taipei Medical University Hospital, Taipei 110301, Taiwan
- School of Dental Technology, College of oral Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Tsai-Jung Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Ming-Ta Yang
- Center for General Education, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence: ; Tel.: +886-2-27361661 (ext. 2275)
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