1
|
Goulet EDB, Claveau P, Simoneau IL, Deshayes TA, Jolicoeur-Desroches A, Aloui F, Hoffman MD. Repeatability of Ad Libitum Water Intake during Repeated 1 h Walking/Jogging Exercise Sessions Conducted under Hot Ambient Conditions. Nutrients 2023; 15:4500. [PMID: 37960153 PMCID: PMC10650651 DOI: 10.3390/nu15214500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
A drinking strategy aiming to replace a given percentage of the sweat losses incurred during exercise should result in reproducible fluid intake volume and, hence, fluid balance from one exercise session to the other performed under similar scenarios. Whether this may also be the case with ad libitum drinking during exercise is unclear. We characterized the repeatability of ad libitum water intake during repeated 1 h exercise sessions and examined its effect over time on fluid balance and selected physiological functions and perceptual sensations. Twelve (3 women) healthy individuals participated in this study. At weekly intervals, they completed four 2 × 30 min walking/jogging exercise bouts (55% V˙O2max, 40 °C, 20-30% relative humidity) interspersed by a 3 min recovery period. During exercise, participants consumed water (20 °C) ad libitum. There were no significant differences among the four exercise sessions for absolute water intake volume (~1000 mL·h-1), percent body mass loss (~0.4%), sweat rate (~1300 mL·h-1) and percent of sweat loss replaced by water intake (~80%). Heart rate, rectal temperature, and perceived thirst and heat stress did not differ significantly between the first and fourth exercise sessions. Perceived exertion was significantly lower during the fourth vs. the first exercise session, but the difference was trivial (<1 arbitrary unit). In conclusion, ad libitum water intake during four successive identical 1 h walking/jogging sessions conducted in the heat will result in similar water intake volumes and perturbations in fluid balance, heart rate, rectal temperature, and perceived thirst, heat stress and exertion.
Collapse
Affiliation(s)
- Eric D. B. Goulet
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, PQ J1K 2R1, Canada; (P.C.); (T.A.D.); (A.J.-D.); (F.A.)
- Research Center on Aging, University of Sherbrooke, Sherbrooke, PQ J1H 4C4, Canada
| | - Pascale Claveau
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, PQ J1K 2R1, Canada; (P.C.); (T.A.D.); (A.J.-D.); (F.A.)
| | - Ivan L. Simoneau
- Centre de Recherche et de Formation par Simulation, Cégep of Sherbrooke, Sherbrooke, PQ J1E 4K1, Canada;
| | - Thomas A. Deshayes
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, PQ J1K 2R1, Canada; (P.C.); (T.A.D.); (A.J.-D.); (F.A.)
- Research Center on Aging, University of Sherbrooke, Sherbrooke, PQ J1H 4C4, Canada
| | - Antoine Jolicoeur-Desroches
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, PQ J1K 2R1, Canada; (P.C.); (T.A.D.); (A.J.-D.); (F.A.)
| | - Fedi Aloui
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, PQ J1K 2R1, Canada; (P.C.); (T.A.D.); (A.J.-D.); (F.A.)
| | | |
Collapse
|
2
|
Jastifer JR, Hoffman MD. The Foot and Ankle in Ultramarathon Runners: Results of the Ultrarunners Longitudinal TRAcking (ULTRA) Study. Foot Ankle Orthop 2023; 8:24730114231198832. [PMID: 37767007 PMCID: PMC10521274 DOI: 10.1177/24730114231198832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Background The foot and ankle play a critical role in ultramarathon running. Because foot and ankle injuries are the most common location of injury in this group, proper care is essential for prevention. In this sport, small issues can become big problems over such long distances, and understanding the preventative measures taken by ultramarathon runners may provide insight for other athletes looking to avoid similar problems. The purpose of this study was to examine the routine and preventative care of the foot and ankle, as well as injury rates, in this group of high-risk athletes. Methods The Ultrarunners Longitudinal TRAcking (ULTRA) Study is the largest known prospective longitudinal study of ultramarathon runners. In this portion of the study, participants reported general health status, running behavior and performance, as well as foot and ankle care, injuries, stretching frequency, and shoewear. Results A total of 734 ultramarathon runners participated in the study. This group ran a median of 40.2 km per week. Overall, 71.2% of active ultramarathon runners reported a foot or ankle injury in the previous 12 months. The most common injuries reported were plantar fasciitis (36.3%), Achilles tendinitis (24.0%), nonspecific foot pain (14.0%), and stress fractures (13.4%). Sit and reach flexibility test showed that 63.7% of runners could not reach past their toes. There were no significant correlations for sit and reach flexibility or stretching frequency with injury rate. Conclusion The high prevalence of foot and ankle injuries in ultramarathon runners does not appear to be influenced by arch type, foot strike pattern, orthotic usage, stretching behavior, or actual flexibility. A high percentage of the study runners used comfort as a shoe selection method, independent of alignment or foot strike pattern. These findings guide the clinician in shared decision making with runners about routine care, including injury prevention and shoe selection. Level of Evidence Level II, prospective study.
Collapse
Affiliation(s)
- James R. Jastifer
- Department of Orthopedic Surgery, Ascension Borgess Hospital, Kalamazoo, MI, USA
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | | |
Collapse
|
3
|
Jeker D, Claveau P, Abed MEF, Deshayes TA, Lajoie C, Gendron P, Hoffman MD, Goulet EDB. Programmed vs. Thirst-Driven Drinking during Prolonged Cycling in a Warm Environment. Nutrients 2021; 14:nu14010141. [PMID: 35011016 PMCID: PMC8747324 DOI: 10.3390/nu14010141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
We compared the effect of programmed (PFI) and thirst-driven (TDFI) fluid intake on prolonged cycling performance and exercise associated muscle cramps (EAMC). Eight male endurance athletes (26 ± 6 years) completed two trials consisting of 5 h of cycling at 61% V˙O2peak followed by a 20 km time-trial (TT) in a randomized crossover sequence at 30 °C, 35% relative humidity. EAMC was assessed after the TT with maximal voluntary isometric contractions of the shortened right plantar flexors. Water intake was either programmed to limit body mass loss to 1% (PFI) or consumed based on perceived thirst (TDFI). Body mass loss reached 1.5 ± 1.0% for PFI and 2.5 ± 0.9% for TDFI (p = 0.10). Power output during the 20 km TT was higher (p < 0.05) for PFI (278 ± 41 W) than TDFI (263 ± 39 W), but the total performance time, including the breaks to urinate, was similar (p = 0.48) between conditions. The prevalence of EAMC of the plantar flexors was similar between the drinking conditions. Cyclists competing in the heat for over 5 h may benefit from PFI aiming to limit body mass loss to <2% when a high intensity effort is required in the later phase of the race and when time lost for urination is not a consideration.
Collapse
Affiliation(s)
- David Jeker
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (D.J.); (P.C.); (M.E.F.A.); (T.A.D.)
| | - Pascale Claveau
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (D.J.); (P.C.); (M.E.F.A.); (T.A.D.)
| | - Mohamed El Fethi Abed
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (D.J.); (P.C.); (M.E.F.A.); (T.A.D.)
| | - Thomas A. Deshayes
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (D.J.); (P.C.); (M.E.F.A.); (T.A.D.)
- Research Center on Aging, University of Sherbrooke, Sherbrooke, QC J1H 4C4, Canada
| | - Claude Lajoie
- Department of Physical Activity Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada; (C.L.); (P.G.)
| | - Philippe Gendron
- Department of Physical Activity Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada; (C.L.); (P.G.)
| | - Martin D. Hoffman
- Department of Physical Medicine & Rehabilitation, University of California Davis, Sacramento, CA 95817, USA;
- Ultra-Endurance Sports Science & Medicine, Duluth, MN 55811, USA
| | - Eric D. B. Goulet
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (D.J.); (P.C.); (M.E.F.A.); (T.A.D.)
- Research Center on Aging, University of Sherbrooke, Sherbrooke, QC J1H 4C4, Canada
- Correspondence:
| |
Collapse
|
4
|
Khodaee M, Irion B, Spittler J, Saeedi A, Hoffman MD. Characteristics of runners meeting acute kidney injury criteria following a 161‐km ultramarathon. Translational Sports Med 2021. [DOI: 10.1002/tsm2.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine & Orthopedics University of Colorado School of Medicine Denver USA
| | - Bjørn Irion
- Western Orthopedics and Sports Medicine Grand Junction CO USA
| | - Jack Spittler
- Department of Family Medicine & Orthopedics University of Colorado School of Medicine Denver USA
| | - Anahita Saeedi
- Department of Biostatistics School of Public Health & Health Sciences University of Massachusetts Amherst MA USA
| | | |
Collapse
|
5
|
Affiliation(s)
- Martin D Hoffman
- Ultra-Endurance Sports Science and Medicine, Duluth, MN, USA. .,Department of Physical Medicine and Rehabilitation, University of California Davis, Sacramento, CA, USA.
| |
Collapse
|
6
|
Shah AB, Torguson R, Alexander K, Khan U, Zhang C, Fisher C, Hoffman MD, Sedgley M, Lincoln A, Baggish AL. Cardiovascular risk among ultra-endurance runners. J Sports Med Phys Fitness 2021; 61:1700-1705. [PMID: 33586930 DOI: 10.23736/s0022-4707.21.11903-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Our objective was to determine the prevalence and clinical correlates of conventional cardiovascular risk factors among ultra-endurance marathon runners. METHODS An electronic internet survey to characterize modifiable cardiovascular risk factors including diabetes, hypertension, dyslipidemia, tobacco exposure and obesity (BMI >30) among competitive ultra-endurance runners. RESULTS Among 290 respondents (mean ± SD, 42 ± 11 years, 31.4% female), 106 (36.6%) had at least one established cardiovascular risk factor. Female sex, younger age and participation in competitive high school or collegiate sports were associated with freedom from cardiovascular risk factors. There were no significant associations between risk factor status and either hours per week of running training (risk factor negative = 10 ±7 vs. risk factor positive = 11 ± 8 hours, p=0.42) or years of ultra-endurance competition (6 ± 8 vs. 7 ± 9 years, p=0.38). Runners with at least one cardiovascular risk factor were more likely to have had personal or peer concerns about excessive alcohol use. CONCLUSIONS Conventional cardiovascular risk factors are common among ultra-endurance runners. Early life participation in competitive sports, rather than adult exercise habits, is associated with freedom from the development of cardiovascular risk factors during middle age. Determining mechanistic explanations for the legacy effect of early life exercise as a means to reduce cardiovascular risk among aging athletes represents an important area of future work.
Collapse
Affiliation(s)
- Ankit B Shah
- Sports & Performance Cardiology Program, MedStar Health, Baltimore, MD, USA -
| | - Rebecca Torguson
- Sports & Performance Cardiology Program, MedStar Health, Baltimore, MD, USA
| | | | - Umar Khan
- Sports & Performance Cardiology Program, MedStar Health, Baltimore, MD, USA
| | - Cheng Zhang
- Sports & Performance Cardiology Program, MedStar Health, Baltimore, MD, USA
| | - Casey Fisher
- Sports & Performance Cardiology Program, MedStar Health, Baltimore, MD, USA
| | - Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, University of California Davis, Sacramento, CA, USA
| | - Matthew Sedgley
- Sports & Performance Cardiology Program, MedStar Health, Baltimore, MD, USA
| | - Andrew Lincoln
- MedStar Sports Medicine Research Center, Baltimore, MD, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
7
|
Abstract
PURPOSE Urine dipstick analysis (UDA) is a useful tool in clinical practices. Abnormalities in UDA parameters have been observed as a result of extreme exercise. The exact incidence of UDA abnormalities, particularly proteinuria, as the result of running ultramarathons is unknown. The purpose of this study was to estimate the incidence of proteinuria and to identify the characteristics of those with proteinuria. METHODS We conducted a prospective observational study using urine samples from volunteer athletes before and immediately after the Leadville Trail 100 Run in August 2014. There were 33 runners with both pre-race and post-race samples and a total of 70 provided post-race samples. Demographic information was collected as a part of a larger study. RESULTS At least one abnormality was demonstrated in 89% of post-race urine samples. Twenty-one (30%) runners had post-race proteinuria (≥1+). Serum creatine kinase concentration (CK) was the only variable that was significantly correlated with the incidence of proteinuria in a multiple logistic regression model. CONCLUSION A majority of runners developed abnormalities in their UDA. Proteinuria was common and found to be associated with serum CK concentration.
Collapse
Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine & Orthopedics, University of Colorado School of Medicine , Denver, CO, USA
| | - Anahita Saeedi
- Department of Biostatistics, Shahid Beheshti University , Tehran, Iran
| | - Bjørn Irion
- Western Orthopedics and Sports Medicine , Grand Junction, CO, USA
| | - Jack Spittler
- Department of Family Medicine & Orthopedics, University of Colorado School of Medicine , Denver, CO, USA
| | - Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, University of California Davis , Sacramento, CA, USA
| |
Collapse
|
8
|
Hoffman MD. State of the Science on Ultramarathon Running After a Half Century: A Systematic Analysis and Commentary. Int J Sports Physiol Perform 2020; 15:1052-1056. [PMID: 32580165 DOI: 10.1123/ijspp.2020-0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To systematically examine scientific publishing related to ultramarathon running. METHODS PubMed-indexed publications through 2019 were identified in which the work involved data collection at or in association with an ultramarathon running event, included experimental running trials of ultramarathon duration using human subjects, focused on human ultramarathon runners as the study participants, or were directed at discussing some aspect of ultramarathon running or ultramarathon runners. The characteristics of each publication were tabulated. RESULTS A total of 616 indexed publications were identified, with the first being in 1970. A rapid increase in publications was seen by 2010 in association with increased participation in ultramarathon running, followed by a plateauing at around 49 annual publications from 2014 to 2018. Most (83.3%) publications were observational, and the mean annual number of 1.6 experimental studies did not change (P = .20) from 1999 to 2019. Most of the publications were related to physiological issues, and race performance was the largest topic area (21.8%). The largest percentage of publications came from authors from the United States, followed by authors from Switzerland. CONCLUSIONS Research related to ultramarathon running has had a small presence in sport science and offers potential for further development. At present, publishing appears to be stable and without recent increased emphasis on experimental studies. Worthwhile research opportunities remain, particularly those where ultramarathons serve as a model for stress and could offer relevance to a wider population than ultramarathon runners, but such research appears challenged by relatively small participation in the activity and limited funding opportunities.
Collapse
|
9
|
Henderson LJ, Scheer V, Hoffman MD. Extent Of Childhood Participation In Ultramarathon Running Does Not Negatively Impact Continued Running. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000680580.21650.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
10
|
Scheer V, Hoffman MD. Too much too early? An analysis of worldwide childhood ultramarathon participation and attrition in adulthood. J Sports Med Phys Fitness 2019; 59:1363-1368. [PMID: 31373190 DOI: 10.23736/s0022-4707.19.09495-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Physical inactivity is associated with chronic disease and premature death, but excessive exercise can also lead to injury. Ultramarathon running is popular among adults but has not been assessed in children. To analyze ultramarathon participation in children and to determine if they continue running ultramarathons into adulthood provide some evidence of associated health risks. METHODS Race results databases were used to identify ultramarathon finishers under the age of 19 between 1960-2017. Participation trends across calendar years, age groups and different race distances were analyzed and continued participation into adulthood examined. RESULTS A total of 7775 finishes by 5418 individual children were recorded worldwide with an increase in ultramarathon finishers over time (P<0.0001), with the greatest number among older age groups (>16 years) and the 50 and 100 km race distances. Less than 25% of childhood ultramarathon runners continued running ultramarathons into adulthood and approximately 12% continued beyond 20 years. CONCLUSIONS Childhood participants has been growing exponentially over the last 20 years. While few of those children continue to complete ultramarathons into adulthood, the finding that some have continued well into adulthood suggests there is no obligate serious adverse physical impairment resulting from childhood ultramarathon participation.
Collapse
Affiliation(s)
- Volker Scheer
- Ultra Sports Science Foundation, Pierre Benite, France - .,British Forces Germany, RRU Sennelager, Normandy Barracks, BFPO 16, Sennelager, Germany -
| | - Martin D Hoffman
- Ultra Sports Science Foundation, Pierre Benite, France.,Unit of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, USA.,Department of Physical Medicine and Rehabilitation, Davis Medical Center, University of California, Sacramento, CA, USA
| |
Collapse
|
11
|
Hoffman MD. Participant Opinions and Expectations about Medical Services at Ultramarathons: Findings from the Ultrarunners Longitudinal TRAcking (ULTRA) Study. Cureus 2019; 11:e5800. [PMID: 31728247 PMCID: PMC6827872 DOI: 10.7759/cureus.5800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background This work explores the opinions and expectations of ultramarathon runners about medical services and their perceived quality during ultramarathons. Methods Focused questions related to medical services at ultramarathons were included in the 2018 survey of Ultrarunners Longitudinal TRAcking (ULTRA) Study enrollees. Results Among the 1,156 respondents, 83.2% agreed that ultramarathons should provide at least a minimum level of medical support with basic first aid and emergency transport services rated as the most important medical services, and individuals with basic first aid training rated as the most important medical providers at ultramarathons. Participant safety was felt to largely be the responsibility of each runner as well as the race and/or medical director. Among 832 respondents having completed an ultramarathon in 2016-2018, their impression of medical services at 4,853 ultramarathons was generally favorable. Of the four percent of times in which medical support was needed, it met expectations 74% of the time. Of the total of 240 different medical issues for which medical support was needed, blister management was the most common, accounting for 26.7% of issues. Conclusions Even though medical services receive minimal utilization during ultramarathons, ultramarathon runners largely believe that these events should provide at least a minimum level of medical support. Ultramarathon runners place a high onus for safety during ultramarathons on themselves, but they also place a high level of responsibility on race and medical directors, so it is prudent for the race and medical directors to consider this information and avoid a mismatch between runner expectations and the medical services actually provided.
Collapse
Affiliation(s)
- Martin D Hoffman
- Physical Medicine and Rehabilitation, University of California, Davis, USA
| |
Collapse
|
12
|
Hoffman MD, White MD. Belief in the need for sodium supplementation during ultramarathons remains strong: findings from the Ultrarunners Longitudinal TRAcking (ULTRA) study. Appl Physiol Nutr Metab 2019; 45:118-122. [PMID: 31163112 DOI: 10.1139/apnm-2019-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the past, ultramarathon runners have commonly believed that consuming sodium supplements, as capsules or tablets, will prevent exercise-associated hyponatremia (EAH), dehydration, muscle cramping, and nausea, but accumulating evidence indicates that sodium supplementation during ultramarathons is not necessary and may be potentially dangerous. In this work, beliefs about whether sodium supplements should be made available at ultramarathons were assessed during 2018 among 1152 participants of the Ultrarunners Longitudinal TRAcking (ULTRA) study, of which 85.2% had completed an ultramarathon during 2014-2018. Two-thirds (66.4%) of study participants indicated that sodium supplements should be made available at ultramarathons, supported by beliefs that they prevent EAH (65.5%) and muscle cramping (59.1%). Of those indicating that sodium supplements should not be made available, 85.0% indicated it is because runners can provide their own, 27.9% indicated it is because they are not necessary, and 12.1% indicated they could increase thirst drive and cause overhydration. In general, there was a tendency for those who were older, less active in running ultramarathons in recent years, and with a longer history of ultramarathon running to be less likely to know that sodium supplements do not help prevent EAH, muscle cramping, and nausea. Novelty Ultramarathon runners continue to have misunderstandings about the need for sodium supplementation during ultramarathons. Few ultramarathon runners recognize that supplementing sodium intake beyond that in food and drink is generally not necessary during ultramarathons or that it could result in overhydration. Continued educational efforts are warranted to help ensure safe participation in the sport.
Collapse
Affiliation(s)
- Martin D Hoffman
- Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA 95655, USA.,Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA
| | - Matthew D White
- Laboratory for Exercise and Environmental Physiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| |
Collapse
|
13
|
Hoffman MD, Longobardi C, Burt C, Nardi T. GPS Tracker-Enabled Rescue of a Lost Runner During a Wilderness Ultramarathon: A Case Report. Curr Sports Med Rep 2019; 17:332-334. [PMID: 30300194 DOI: 10.1249/jsr.0000000000000523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Martin D Hoffman
- Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA.,Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA.,Ultra Sports Science Foundation, El Dorado Hills, CA
| | | | | | | |
Collapse
|
14
|
Affiliation(s)
- Volker Scheer
- Ultra Sports Science Foundation, Pierre Benite, France and El Dorado Hills, CA.,British Forces Germany, RRU Sennelager, Normandy Barracks, BFPO 16
| | - Martin D Hoffman
- Ultra Sports Science Foundation, Pierre Benite, France and El Dorado Hills, CA.,Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA.,Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, Sacramento, CA
| |
Collapse
|
15
|
Hoffman MD. Predicted Risk for Exacerbation of Exercise-Associated Hyponatremia from Indiscriminate Postrace Intravenous Hydration of Ultramarathon Runners. J Emerg Med 2018; 56:177-184. [PMID: 30545731 DOI: 10.1016/j.jemermed.2018.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Asymptomatic or mildly symptomatic exercise-associated hyponatremia (EAH) can be exacerbated by aggressive hydration. OBJECTIVE This work predicts the percentage of athletes at risk for exacerbation of EAH from indiscriminate hydration after an ultramarathon. METHODS Postrace serum sodium, creatinine, creatine kinase (CK), and urea nitrogen concentrations were determined for 161-km ultramarathon participants. Body mass was measured prior to and immediately after the race. Incidents when serum CK was > 20,000 U/L or creatinine ≥ 1.5 times estimated baseline were considered to be "at risk for receiving I.V. hydration" if presenting to a hospital. Those with EAH without body mass loss during the race were considered "overhydrated" and "at risk for EAH exacerbation." RESULTS Among 627 finishers, 16 (2.6%) were at risk for EAH exacerbation. Considering 421 observations at risk for receiving I.V. hydration, 16 (47.1%) of the 34 observations with EAH were at risk for EAH exacerbation. Among those at risk for receiving I.V. hydration and with EAH, serum urea nitrogen and creatine concentration as a multiple of estimated baseline were lower (p < 0.05) for those at risk for EAH exacerbation, compared with those without overhydration, but there were no clinically useful laboratory findings to distinguish these two groups due to considerable overlap of values. CONCLUSIONS Whether in the field or hospital setting, I.V. hydration of an athlete after an ultramarathon carries a notable risk for exacerbating EAH, so clinicians should use caution when hydrating athletes after endurance events.
Collapse
Affiliation(s)
- Martin D Hoffman
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, California; University of California Davis Medical Center, Sacramento, California; Ultra Sports Science Foundation, El Dorado Hills, California
| |
Collapse
|
16
|
Hebert JJ, Le Cara EC, Koppenhaver SL, Hoffman MD, Marcus RL, Dempsey AR, Albert WJ. Predictors of clinical success with stabilization exercise are associated with lower levels of lumbar multifidus intramuscular adipose tissue in patients with low back pain. Disabil Rehabil 2018; 42:679-684. [PMID: 30508498 DOI: 10.1080/09638288.2018.1506510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: Investigate the construct validity of prognostic factors purported to predict clinical success with stabilization exercise for low back pain by exploring their associations with lumbar multifidus composition.Methods: Patients with low back pain were recruited from a hospital imaging department. The presence of fivepredictors (age <40 years, positive prone instability test, aberrant trunk flexion movements, straight leg raise range of motion >91°, spinal hypermobility) were identified by standardized physical examination. Predictors were grouped by total positive findings and status on a clinical prediction rule. The proportion of lower lumbar multifidus intramuscular adipose tissue was measured with 3.0 T magnetic resonance imaging. Univariate and multivariate associations were examined with linear regression and reported with standardized beta coefficients (β) and 95% confidence intervals.Results: Data from 62 patients (11 female) with mean (SD) age of 45.2 (11.8) years were included. Total number of predictors (β[95% CI] = -0.37[-0.61,-0.12]; R2 = 0.12), positive prediction rule status (β[95% CI] = -0.57[-0.79,-0.35]; R2 = 0.30), and age <40 years were associated with lower intramuscular adipose tissue (β[95% CI] = -0.55[-0.77,-0.33]; R2 = 0.27). No other individual factors were associated with lumbar multifidus intramuscular adipose tissue.Conclusions: These findings support the construct validity of the grouped prognostic criteria. Future research should examine the clinical utility of these criteria. Implications for RehabilitationLow back pain is the single largest cause of disability worldwide and exercise therapy is recommended by international low back pain treatment guidelines.Lower levels of lumbar multifidus intramuscular adipose tissue were associated with predictors of clinical success with stabilization exercise.Higher proportions of lumbar multifidus intramuscular adipose tissue may help identify patients who require longer duration exercise training, or those who are unlikely to respond to stabilization exercise.
Collapse
Affiliation(s)
- Jeffrey J Hebert
- Faculty of Kinesiology, University of New Brunswick, Canada.,School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Edward C Le Cara
- Faculty of Health Sciences, Rocky Mountain University of Health Professions, Provo, United States
| | | | - Martin D Hoffman
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, United States.,Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, United States
| | - Robin L Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, United States
| | - Alasdair R Dempsey
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Wayne J Albert
- Faculty of Kinesiology, University of New Brunswick, Canada
| |
Collapse
|
17
|
Hoffman MD, Goulet EDB, Maughan RJ. Considerations in the Use of Body Mass Change to Estimate Change in Hydration Status During a 161-Kilometer Ultramarathon Running Competition. Sports Med 2018; 48:243-250. [PMID: 28895063 DOI: 10.1007/s40279-017-0782-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hydration guidelines found in the scientific and popular literature typically advise that body mass losses beyond 2% should be avoided during exercise. In this work, we demonstrate that these guidelines are not applicable to prolonged exercise of several hours where body mass loss does not reflect an equivalent loss of body water due to the effects of body mass change from substrate use, release of water bound with muscle and liver glycogen, and production of water during substrate metabolism. These effects on the body mass loss required to maintain body water balance are shown for a 161-km mountain ultramarathon running competition participant utilizing published data for the total energy cost, exogenous energy consumption and percentage from each fuel source, average participant body mass, and the extent of soft tissue fluid accumulation during an ultramarathon. We assumed that total energy derived from protein ranges from 5 to 10%, all exogenous energy is used to support the energy cost of the race, glycogen utilization ranges from 300 to 500 g, water linked with glycogen ranges from 1 to 3 g per g of glycogen, and the mass of the bladder and gastrointestinal tract is unchanged from pre-race to post-race body mass measurements. These calculations show that the average participant of 68.8 kg must lose 1.9-5.0% body mass to maintain the water supporting body water balance while also avoiding overhydration. Future hydration guidelines should consider these findings so that the proper hydration message is conveyed to those who participate in prolonged exercise.
Collapse
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, 10535 Hospital Way, Sacramento, CA, 95655-1200, USA. .,Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA. .,Ultra Sports Science Foundation, El Dorado Hills, CA, USA.
| | - Eric D B Goulet
- Research Centre on Aging and Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | | |
Collapse
|
18
|
Khodaee M, Changstrom BG, Hoffman MD. Commercialised portable intravenous fluids in sports: placing vulnerable athletes at risk. Br J Sports Med 2018; 53:226-227. [PMID: 30413426 DOI: 10.1136/bjsports-2018-099855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine & Orthopedics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Bradley G Changstrom
- Department of Internal Medicine & Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, California, USA.,Department of Veterans Affairs, NorthernCalifornia Health Care System, Physical Medicine and Rehabilitation Service, Sacramento, California, USA.,Ultra Sports Science Foundation, El Dorado Hills, California, USA
| |
Collapse
|
19
|
Hoffman MD, Goulet EDB, Maughan RJ. Correction to: Considerations in the Use of Body Mass Change to Estimate Change in Hydration Status During a 161-Kilometer Ultramarathon Running Competition. Sports Med 2018; 48:2893-2894. [PMID: 30311080 DOI: 10.1007/s40279-018-1000-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In Table 2 of the original publication, an error was made in the calculations for endogenous substrate oxidation which, subsequently, altered the values for total change in body mass.
Collapse
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, 10535 Hospital Way, Sacramento, CA, 95655-1200, USA.
- Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA.
- Ultra Sports Science Foundation, El Dorado Hills, CA, USA.
| | - Eric D B Goulet
- Research Centre on Aging and Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | | |
Collapse
|
20
|
Scheer V, Hoffman MD. Exercise-associated hyponatremia: practical guide to its recognition, treatment and avoidance during prolonged exercise. Dtsch Z Sportmed 2018. [DOI: 10.5960/dzsm.2018.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
21
|
Abstract
It is not unusual for those participating in ultra-endurance (> 4 hr) events to develop varying degrees of either hypohydration or hyperhydration. Yet, it is important for ultra-endurance athletes to avoid the performance limiting and potentially fatal consequences of these conditions. During short periods of exercise (< 1 hr), trivial effects on the relationship between body mass change and hydration status result from body mass loss due to oxidation of endogenous fuel stores, and water supporting the intravascular volume being generated from endogenous fuel oxidation and released with glycogen oxidation. However, these effects have meaningful implications during prolonged exercise. In fact, body mass loses well over 2% may be required during some ultra-endurance activities to avoid hyperhydration. Therefore, the typical hydration guidelines to avoid more than 2% body mass loss do not apply in ultra-endurance activities and can potentially result in hyperhydration. Fortunately, achieving the balance of proper hydration during ultra-endurance activities need not be complicated and has been well demonstrated to generally be achieved by simply drinking to thirst and avoiding excessive sodium supplementation with intention of replacing all sodium losses during the exercise.
Collapse
Affiliation(s)
- Martin D Hoffman
- a Physical Medicine and Rehabilitation Service, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,b Department of Physical Medicine and Rehabilitation , University of California Davis Medical Center , Sacramento , CA , USA.,c Ultra Sports Science Foundation , El Dorado Hills , CA , USA
| | | | - Ricardo J S Costa
- e Department of Nutrition Dietetics and Food , Monash University , Notting Hill , Victoria , Australia
| |
Collapse
|
22
|
Abstract
Ultra-endurance activities (≥ 4h) present unique challenges that, beyond fatigue, may be exacerbated by sub-optimal nutrition during periods of increased requirements and compromised gastrointestinal function. The causes of fatigue during ultra-endurance exercise are multi-factorial. However, mechanisms can potentially include central or peripheral fatigue, thermal stress, dehydration, and/or endogenous glycogen store depletion; of which optimising nutrition and hydration can partially attenuate. If exercise duration is long enough (e.g. ≥ 10h) and exercise intensity low enough (e.g. 45-60% of maximal oxygen uptake), it is bio-energetically plausible that ketogenic adaptation may enhance ultra-endurance performance, but this requires scientific substantiation. Conversely, the scientific literature has consistently demonstrated that daily dietary carbohydrates (3-12g/kg/day) and carbohydrate intake (30-110g/h) during ultra-endurance events can enhance performance at individually tolerable intake rates. Considering gastrointestinal symptoms are common in ultra-endurance activities, effective dietary prevention and management strategies may provide functional, histological, systemic, and symptomatic benefits. Taken together, a well-practiced and individualized fuelling approach is required to optimize performance in ultra-endurance events.
Collapse
Affiliation(s)
- Ricardo J S Costa
- a Department of Nutrition Dietetics and Food , Monash University , Notting Hill, Victoria , Australia
| | - Martin D Hoffman
- b Physical Medicine and Rehabilitation Service, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,c Department of Physical Medicine and Rehabilitation , University of California Davis Medical Center , Sacramento , CA , USA.,d Ultra Sports Science Foundation , El Dorado CA , USA
| | | |
Collapse
|
23
|
Affiliation(s)
- Tracy B Høeg
- Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA
- Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, USA
- Ultra Sports Science Foundation, El Dorado Hills, CA, USA
| |
Collapse
|
24
|
Heapy AM, Hoffman MD, Verhagen HH, Thompson SW, Dhamija P, Sandford FJ, Cooper MC. A randomized controlled trial of manual therapy and pneumatic compression for recovery from prolonged running - an extended study. Res Sports Med 2018. [PMID: 29513036 DOI: 10.1080/15438627.2018.1447469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Manual therapy (MT) and intermittent pneumatic compression (IPC) are recovery methods used by endurance athletes with little evidence supporting effectiveness. This randomized controlled trial evaluated effectiveness of four daily post-race treatments of a specific MT protocol and IPC compared with supine rest on recovery following an ultramarathon among 56 ultramarathoners. Groups were comparable across all characteristics examined, including post-race plasma creatine kinase concentration. Subject completed timed 400 m runs before the race and on days three, five, seven and 14 post- race, and also provided muscle pain and soreness ratings and fatigue scores immediately before and after treatments, and during the 14 days post- race. Daily subjective measures and 400 m run times were not improved by either treatment, but both treatments reduced (p < .05) muscular fatigue scores acutely after treatment following the race and on post-race day 1, and MT improved (p < .05) muscle pain and soreness acutely following the race.
Collapse
Affiliation(s)
- Amanda M Heapy
- a Department of Health and Sport , Toi Ohomai Institute of Technology , Rotorua , New Zealand
| | - Martin D Hoffman
- b Department of Physical Medicine & Rehabilitation, Department of Veteran Affairs , Northern California Health Care System , Sacramento , CA , USA.,c Department of Physical Medicine & Rehabilitation , University of California Davis Medical Center, Sacramento , CA , USA.,d Ultra Sports Science Foundation , USA
| | - Heidie H Verhagen
- e Department of Rehabilitation , Fortebody Reconditioning , Rotorua , New Zealand
| | - Samuel W Thompson
- a Department of Health and Sport , Toi Ohomai Institute of Technology , Rotorua , New Zealand
| | - Pavitra Dhamija
- a Department of Health and Sport , Toi Ohomai Institute of Technology , Rotorua , New Zealand
| | - Fiona J Sandford
- f Department of Massage Therapy , QE Health , Rotorua , New Zealand
| | - Mary C Cooper
- a Department of Health and Sport , Toi Ohomai Institute of Technology , Rotorua , New Zealand
| |
Collapse
|
25
|
Hoffman MD, Agnish V. Functional outcome from sacroiliac joint prolotherapy in patients with sacroiliac joint instability. Complement Ther Med 2018; 37:64-68. [PMID: 29609940 DOI: 10.1016/j.ctim.2018.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Examine the effectiveness of sacroiliac (SI) joint prolotherapy for SI joint instability, and characterize the patients most likely to benefit from this treatment. DESIGN Retrospective cohort study. SETTING Department of Veterans Affairs outpatient physical medicine clinic. INTERVENTIONS Patients referred for low back pain and diagnosed with SI joint instability received a series of three SI joint prolotherapy injections (15% dextrose in lidocaine) at approximately a one-month interval. The outcome of those completing treatment was retrospectively examined, and characteristics were compared between those with at least a minimum clinically important improvement and those without improvement. MAIN OUTCOME MEASURES Patients completed the Oswestry Disability Index (ODI) before treatment was initiated, immediately preceding each prolotherapy injection, and at 3-4 month follow-up. RESULTS Of 103 treated patients returning for post-treatment follow-up at a median of 117 days, 24 (23%) showed a minimum clinically important improvement despite a median of 2 years with low back pain and a mean (±SD) pre-intervention ODI of 54 ± 15 points. Much of the improvement was evident after the initial prolotherapy injection, and a 15-point improvement in ODI prior to the second prolotherapy injection had a sensitivity of 92% and specificity of 80% for determining which patients would improve. CONCLUSIONS A satisfactory proportion of patients with symptomatic SI joint instability as an etiology of low back pain can have clinically meaningful functional gains with prolotherapy treatment. The patients who are not likely to improve with prolotherapy are generally evident by lack of improvement following the initial prolotherapy injection.
Collapse
Affiliation(s)
- Martin D Hoffman
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, United States; Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, Sacramento, CA, United States; Ultra Sports Science Foundation, United States.
| | - Vikram Agnish
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, United States
| |
Collapse
|
26
|
Abstract
Participants in the Ultrarunners Longitudinal TRAcking (ULTRA) Study were asked to answer "yes" or "no" to the question "If you were to learn, with absolute certainty, that ultramarathon running is bad for your health, would you stop your ultramarathon training and participation?" Among the 1349 runners, 74.1% answered "no". Compared with those answering "yes", they were younger (p < 0.0001), less likely to be married (p = 0.019), had less children (p = 0.0095), had a lower health orientation (p < 0.0001) though still high, and higher personal goal achievement (p = 0.0066), psychological coping (p < 0.0001) and life meaning (p = 0.0002) scores on the Motivations of Marathoners Scales. Despite a high health orientation, most ultramarathon runners would not stop running if they learned it was bad for their health as it appears to serve their psychological and personal achievement motivations and their task orientation such that they must perceive enhanced benefits that are worth retaining at the risk of their health.
Collapse
Affiliation(s)
- Martin D Hoffman
- a Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,b Ultra Sports Science Foundation , El Dorado Hills , CA , USA.,c Department of Physical Medicine and Rehabilitation , University of California Davis Medical Center , Sacramento , CA , USA
| | - Rhonna Krouse
- d Exercise and Health Science Department , College of Western Idaho , Nampa , ID , USA
| |
Collapse
|
27
|
Rothwell O, George K, Somauroo J, Lord R, Stembridge M, Shave R, Hoffman MD, Wilson M, Ashley E, Haddad F, Eijsvogels TMH, Oxborough D. Right Ventricular Structure and Function in the Veteran Ultramarathon Runner: Is There Evidence for Chronic Maladaptation? J Am Soc Echocardiogr 2018; 31:598-605.e1. [PMID: 29305036 DOI: 10.1016/j.echo.2017.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND It has been proposed that chronic exposure to prolonged strenuous exercise may result in maladaptation of the right ventricle (RV). The aim of this study was to establish RV structure and function, including septal insertion points, using conventional echocardiography and myocardial strain (ε) imaging in a veteran population of ultramarathon runners (UR) and age- and sex-matched controls. METHODS A retrospective study design provided 40 UR (>35 years old; mean ± SD training experience, 18 ± 12 years) and 24 sedentary controls who had previously undergone conventional two-dimensional, tissue Doppler and speckle-tracking echocardiography to measure RV size and function. Peak RV ε and strain rate (SR) were assessed from the base, mid, and apical lateral wall. SR were assessed during systole (SRs'), early diastole (SRe') and late diastole (SRa'). Regional assessment of RV insertion points was made at the basal inferoseptum and apical septum using left ventricular (LV) longitudinal ε and at the anteroseptum and inferoseptum using LV circumferential and radial ε. RESULTS All structural indices of RV size were significantly larger in UR. RV regional and global peak ε were not different between groups, whereas basal RV SR was significantly lower in UR. UR had significantly higher peak LV circumferential ε (anteroseptum, -26% ± 8% vs -21% ± 6%; inferoseptum, -25% ± 6% vs -16% ± 9%) and higher peak LV longitudinal ε (apical septum, -28% ± 7% vs -22% ± 4%) compared with controls. There was regional heterogeneity in UR that was not observed in controls with significantly lower longitudinal ε at the basal inferoseptal insertion point when compared with the global ε (-19% ± 2% vs -22% ± 4%). CONCLUSIONS Myocardial ε imaging highlights no overt maladaptation in this cohort of veteran UR, although lower insertion point ε, compared with global ε, in UR may warrant further investigation.
Collapse
Affiliation(s)
- Oliver Rothwell
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rachel Lord
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Mike Stembridge
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Rob Shave
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, Northern California Health Care System, University of California Davis Medical Center, Sacramento, California; Department of Veterans Affairs, Northern California Health Care System, University of California Davis Medical Center, Sacramento, California
| | - Mathew Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Euan Ashley
- Stanford University School of Medicine, Falk Cardiovascular Research Centre, Stanford, California
| | - Francois Haddad
- Stanford University School of Medicine, Falk Cardiovascular Research Centre, Stanford, California
| | - Thijs M H Eijsvogels
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
| |
Collapse
|
28
|
Hoffman MD, Cotter JD, Goulet ÉD, Laursen PB. REBUTTAL from "Yes". Wilderness Environ Med 2017; 27:198-200. [PMID: 27291701 DOI: 10.1016/j.wem.2016.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA.
| | - James D Cotter
- Exercise and Environmental Physiology, School of Physical Education, Sport and Exercise Sciences, Division of Sciences, University of Otago, Dunedin, New Zealand(Dr Cotter)?>
| | - Éric D Goulet
- Research Centre on Aging, Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC, Quebec, Canada
| | - Paul B Laursen
- High Performance Sport New Zealand, and Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Aukland, Auckland, New Zealand
| |
Collapse
|
29
|
Hoffman MD, Weiss RH. The Presented Evidence to Support Symptomatic Hypovolemic-Associated EAH Is Not Convincing. Curr Sports Med Rep 2017; 16:464-466. [PMID: 29135648 DOI: 10.1249/jsr.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, University of California Davis Medical Center, Sacramento, CA, Ultra Sports Science Foundation, El Dorado Hills, CA. Departments of Medicine, Department of Veterans Affairs, Northern California Health Care System, and Division of Nephrology; Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA
| | | |
Collapse
|
30
|
Abstract
Dehydration and exercise-associated hyponatremia (EAH) are both relatively common conditions during wilderness endurance events. Whereas dehydration is treated with fluids, EAH is appropriately managed with fluid restriction and a sodium bolus but can worsen with isotonic or hypotonic fluids. Therefore, caution is recommended in the provision of postevent rehydration in environments where EAH is a potential consideration because accurate field assessment of hydration status can be challenging, and measurement of blood sodium concentration is rarely possible in the wilderness. Dehydration management with oral rehydration is generally adequate and preferred to intravenous rehydration, which should be reserved for athletes with sustained orthostasis or inability to tolerate oral fluid ingestion after some rest. In situations where intravenous hydration is initiated without known blood sodium concentration or hydration status, an intravenous concentrated sodium solution should be available in the event of acute neurological deterioration consistent with the development of EAH encephalopathy.
Collapse
Affiliation(s)
- Martin D Hoffman
- 1Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA; 2Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY; 3St. John of God Murdoch Hospital & University of Notre Dame, Murdoch, WA, Australia
| | | | | |
Collapse
|
31
|
Affiliation(s)
- Eric D B Goulet
- Faculty of Physical Activity Sciences Research Centre on Aging University of Sherbrooke Sherbrooke, Quebec, CANADA Faculty of Physical Activity Sciences University of Sherbrooke Sherbrooke, Quebec, CANADA Department of Physical Medicine and Rehabilitation Department of Veterans Affairs Northern California Health Care System and University of California Davis Medical Center Sacramento, CA
| | | | | |
Collapse
|
32
|
Hoffman MD, Cotter JD, Goulet ÉD, Laursen PB. VIEW: Is Drinking to Thirst Adequate to Appropriately Maintain Hydration Status During Prolonged Endurance Exercise? Yes. Wilderness Environ Med 2017; 27:192-5. [PMID: 27291699 DOI: 10.1016/j.wem.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/03/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA, USA (Dr Hoffman)
| | - James D Cotter
- Exercise and Environmental Physiology, School of Physical Education, Sport and Exercise Sciences Division of Sciences, University of Otago, Dunedin New Zealand (Dr Cotter)
| | - Éric D Goulet
- Research Centre on Aging, Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC Canada (Dr Goulet)
| | - Paul B Laursen
- High Performance Sport New Zealand, and Sports Performance Research Institute New Zealand (SPRINZ) Auckland University of Technology, Auckland New Zealand (Dr Laursen)
| |
Collapse
|
33
|
Hoeg TB, Corrigan GK, Hoffman MD. Alterations In Intraocular Pressure And Corneal Thickness Immediately Following A 161-km Foot Race. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519477.01135.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
34
|
Schwellnus MP, Hoffman MD. Transient receptor potential channels and exercise-associated muscle cramping: A tale of multiple complexities. Muscle Nerve 2017; 56:355-357. [PMID: 28437833 DOI: 10.1002/mus.25668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/12/2017] [Accepted: 04/14/2017] [Indexed: 01/03/2023]
Affiliation(s)
- M P Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences, Section Sports Medicine, University of Pretoria Sports Campus, Burnett Street, Hatfield, Pretoria, 0020, South Africa.,IOC Research Centre, South Africa
| | - M D Hoffman
- Department of Veterans Affairs, Northern California Health Care System, Sacramento, California, USA.,Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, California, USA
| |
Collapse
|
35
|
Hoffman MD, Valentino TR, Stuempfle KJ, Hassid BV. A Placebo-Controlled Trial of Riboflavin for Enhancement of Ultramarathon Recovery. Sports Med Open 2017; 3:14. [PMID: 28349501 PMCID: PMC5368102 DOI: 10.1186/s40798-017-0081-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/16/2017] [Indexed: 11/23/2022]
Abstract
Background Riboflavin is known to protect tissue from oxidative damage but, to our knowledge, has not been explored as a means to control exercise-related muscle soreness. This study investigated whether acute ingestion of riboflavin reduces muscle pain and soreness during and after completion of a 161-km ultramarathon and improves functional recovery after the event. Methods In this double-blind, placebo-controlled trial, participants of the 2016 161-km Western States Endurance Run were assigned to receive a riboflavin or placebo capsule shortly before the race start and when reaching 90 km. Capsules contained either 100 mg of riboflavin or 95 mg of maltodextrin and 5 mg of 10% ß-carotene. Subjects provided muscle pain and soreness ratings before, during, and immediately after the race and for the 10 subsequent days. Subjects also completed 400-m runs at maximum speed on days 3, 5, and 10 after the race. Results For the 32 (18 in the riboflavin group, 14 in the placebo group) race finishers completing the study, muscle pain and soreness ratings during and immediately after the race were found to be significantly lower (p = .043) for the riboflavin group. Analysis of the 400-m run times also showed significantly faster (p < .05) times for the riboflavin group than the placebo group at post-race days 3 and 5. Both groups showed that muscle pain and soreness had returned to pre-race levels by 5 days after the race and that 400-m run times had returned to pre-race performance levels by 10 days after the race. Conclusions This preliminary work suggests that riboflavin supplementation before and during prolonged running might reduce muscle pain and soreness during and at the completion of the exercise and may enhance early functional recovery after the exercise.
Collapse
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, USA. .,Ultra Sports Science Foundation, El Dorado Hills, CA, USA.
| | - Taylor R Valentino
- Department of Kinesiology, San Francisco State University, San Francisco, CA, USA
| | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE Because inappropriate recommendations about hydration during exercise appear widespread and potentially dangerous, we assessed the quality of a sampling of information currently available to the public on the Internet. METHODS Internet searches using the Google search engine were conducted using the terms "hydration," "hydration guidelines," "drinking fluids" and "drinking guidelines" combined with "and exercise." From the first 50 websites for each search phrase, duplicates were removed yielding 141 unique websites that were categorized by source and examined for specific hydration related information and recommendations. RESULTS Correct endorsement was as follows (reported as percent endorsing the concept relative to the number of websites addressing the issue): some weight loss should be expected during exercise (69.5% of 95), fluid consumption during exercise should be based upon thirst (7.3% of 110), electrolyte intake is not generally necessary during exercise (10.4% of 106), dehydration is not generally a cause of heat illness (3.4% of 58) or exercise-associated muscle cramping (2.4% of 42), exercise-associated muscle cramping is not generally related to electrolyte loss (0.0% of 16), and overhydration is a risk for hyponatremia (100.0% of 61). Comparison of website information from medical or scientific sources with that from other sources revealed no differences (p = 0.4 to 1.0) in the frequency of correct endorsement of the examined criteria. CONCLUSION Prevalent misinformation on the Internet about hydration needs during exercise and the contribution of hydration status to the development of heat illness and muscle cramping fosters overhydration. In general, those websites that should be most trusted by the public were no better than other websites at providing accurate information, and the potential risk of hyponatremia from overhydration was noted by less than half the websites. Since deaths from exercise-associated hyponatremia should be preventable through avoidance of overhydration, dissemination of a more appropriate hydration message is important.
Collapse
Affiliation(s)
- Martin D Hoffman
- a Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System, University of California Davis Medical Center , Sacramento , CA , USA
| | - Theodore L Bross
- b Wright State University, Boonshoft School of Medicine , Dayton , OH , USA
| | - R Tyler Hamilton
- c The School of Education and Behavioral Studies , Palm Beach Atlantic University , West Palm Beach , FL , USA
| |
Collapse
|
37
|
Abstract
The primary purpose of this work was to gain further insight into the need for sodium supplementation for maintenance of appropriate hydration during prolonged exercise under hot conditions. Participants of a 161-km ultramarathon (ambient temperature reaching 39° C) underwent body weight measurements immediately before, during, and after the race, and completed a postrace questionnaire about supplemental sodium intake and drinking strategies during 4 race segments. The postrace questionnaire was completed by 233 (78.7%) race finishers. Significant direct relationships were found for percentage weight change during the race with intake rate (r = 0.18, p = 0.0058) and total amount (r = 0.24, p = 0.0002) of sodium in supplements. Comparing those using no sodium supplements throughout the race (n = 15) with those using sodium supplements each race segment (n = 138), body weight change across the course showed significant group (p = 0.022), course location (p < 0.0001), and interaction (p = 0.0098) effects. Posttests revealed greater weight loss at 90 km (p = 0.016, -3.2 ± 1.6% vs. -2.2 ± 1.5%, mean ± SD) and the finish (p = 0.014, -3.2 ± 1.5% vs. -1.9 ± 1.9%) for those using no sodium supplements compared with those using sodium supplements each segment. Six runners who used no sodium supplements, drank to thirst, and only drank water or a mixture of mostly water with some electrolyte-containing drink finished with mean weight change of -3.4%. Although the use of supplemental sodium enhanced body weight maintenance, those not using sodium supplements maintained a more appropriate weight than those consistently using sodium supplements. Therefore, we conclude that the supplemental sodium is unnecessary to maintain appropriate hydration during prolonged exercise in the heat.
Collapse
Affiliation(s)
- Martin D Hoffman
- 1Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, California; and2Health Sciences Department, Gettysburg College, Gettysburg, Pennsylvania
| | | |
Collapse
|
38
|
Abstract
OBJECTIVE Examine whether the acute kidney injury (AKI) commonly observed among ultramarathon participants places the individual at risk for subsequent AKI of worse magnitude. DESIGN Observational. SETTING Western States Endurance Run. PARTICIPANTS Race finishers with postrace blood studies. INDEPENDENT VARIABLE Acute kidney injury after 1 race. MAIN OUTCOME MEASURES Extent of AKI in subsequent race. RESULTS Among 627 finishes in which serum creatinine values were known, 36.2% met "risk" or "injury" criterion with this group characterized by having faster finish times, greater body weight loss during the race, and higher postrace serum creatine kinase and urea nitrogen concentrations when compared with those not meeting the criteria. We identified 38 runners who had undergone postrace blood analyses at multiple races among which 16 (42.1%) met the risk or injury criterion at the first race. Of those 16 runners, 12 (75%) met the criteria at a subsequent race, an incidence that was higher (P = 0.0026) than the overall 36.2% incidence. For most (56.2%) of the 16 runners meeting the criteria at the first race, the subsequent race caused less increase in serum creatinine concentration and decrement in estimated glomerular filtration rate than the first race. CONCLUSIONS Mild AKI is common in 161-km ultramarathons, but there was no evidence that previous AKI caused greater renal dysfunction from a subsequent exercise stimulus of similar magnitude. This offers some reassurance to runners and their physicians that mild to moderate AKI in the setting of an ultramarathon is not cumulative or without complete recovery of kidney function when stressed.
Collapse
Affiliation(s)
- Martin D. Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA, United States
| | - Robert H. Weiss
- Department of Medicine, Department of Veterans Affairs, Northern California Health Care System, and Division of Nephrology, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, United States
| |
Collapse
|
39
|
Lord R, George K, Somauroo J, Stembridge M, Jain N, Hoffman MD, Shave R, Haddad F, Ashley E, Jones H, Oxborough D. Alterations in Cardiac Mechanics Following Ultra-Endurance Exercise: Insights from Left and Right Ventricular Area-Deformation Loops. J Am Soc Echocardiogr 2016; 29:879-887.e1. [DOI: 10.1016/j.echo.2016.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Indexed: 12/14/2022]
|
40
|
|
41
|
Abstract
It is advised that individuals should avoid losing >2% of their body mass during exercise in order to prevent hyperthermia. This study sought to assess whether a loss of >2% body mass leads to elevations in core temperature during an ultramarathon. Thirty runners agreed to take part in the study. Body mass and core temperature were measured at the start, at three locations during the race and the finish. Core temperature was not correlated with percent body mass change (p = 0.19) or finish time (p = 0.11). Percent body mass change was directly associated with finish time (r = 0.58, p < 0.01), such that the fastest runners lost the most mass (~3.5-4.0%). It appears that a loss of >3% body mass does not contribute to rises in core temperature. An emphasis on fluid replacement for body mass losses of this magnitude during prolonged exercise is not justified as a preventative measure for heat-related illnesses.
Collapse
Affiliation(s)
- Taylor R Valentino
- a Department of Kinesiology , San Francisco State University , San Francisco , CA , USA
| | | | - Marialice Kern
- a Department of Kinesiology , San Francisco State University , San Francisco , CA , USA
| | - Martin D Hoffman
- c Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System, and University of California Davis Medical Center , Sacramento , CA , USA.,d Department of Physical Rehabilitation , Sarcomento VA Medical Center , Sacromento , CA , USA
| |
Collapse
|
42
|
Abstract
PURPOSE This work examines whether sodium supplementation is important in prevention of hyponatremia during continuous exercise up to 30 h and whether any distinguishing characteristics of those developing hyponatremia could be identified. METHODS Participants of the 161-km Western States Endurance Run underwent body weight measurements before, during, and after the race, completed a postrace questionnaire about drinking strategies and use of sodium supplementation during four race segments, and underwent analysis of postrace serum sodium concentration. RESULTS The postrace questionnaire was completed by 74.5% of the 376 starters, a postrace blood sample was provided by 61.1% of the 296 finishers, and 53.0% of finishers completed the postrace survey and also provided a postrace blood sample. Among this population, the incidence of hyponatremia among finishers was 6.6% and sodium supplements were used by 93.9% of the runners. Postrace serum sodium concentration was found to be directly related to the rate of sodium intake in supplements (r = 0.24, P = 0.0027) and indirectly related to the percentage change in body weight from immediately before the race start (r = -0.19, P = 0.010). There was no difference in rate of sodium intake in supplements between the hyponatremic and normonatremic finishers, and none of the hyponatremic finishers lost >4.3% body weight. Hyponatremic finishers were not distinguished from normonatremic or hypernatremic finishers by other runner characteristics considered, drinking strategies, or gastrointestinal symptoms of nausea and vomiting. CONCLUSIONS We conclude that a low sodium intake in supplements has minimal responsibility for development of hyponatremia during continuous exercise up to 30 h, whereas overhydration is the primary characteristic of those developing hyponatremia. Therefore, avoiding overhydration seems to be the most important means for preventing hyponatremia under these conditions.
Collapse
Affiliation(s)
- Martin D Hoffman
- 1Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA; and 2Health Sciences Department, Gettysburg College, Gettysburg, PA
| | | |
Collapse
|
43
|
Abstract
The primary study objective was to identify determinants of short-term recovery from a 161-km ultramarathon. Participants completed 400 m runs at maximum speed before the race and on days 3 and 5 post-race, provided a post-race blood sample for plasma creatine kinase (CK) concentration, and provided lower body muscle pain and soreness ratings (soreness, 10-point scale) and overall muscular fatigue scores (fatigue, 100-point scale) pre-race and for 7 days post-race. Among 72 race finishers, soreness and fatigue had statistically returned to pre-race levels by 5 days post-race; and 400 m times at days 3 and 5 remained 26% (P = 0.001) and 12% (P = 0.01) slower compared with pre-race, respectively. CK best modelled soreness, fatigue and per cent change in post-race 400 m time. Runners with the highest CKs had 1.5 points higher (P < 0.001) soreness and 11.2 points higher (P = 0.006) fatigue than runners with the lowest CKs. For the model of 400 m time, a significant interaction of time with CK (P < 0.001) indicates that higher CKs were linked with a slower rate of return to pre-race 400 m time. Since post-race CK was the main modifiable determinant of recovery following the ultramarathon, appropriate training appears to be the optimal approach to enhance ultramarathon recovery.
Collapse
Affiliation(s)
- Martin D Hoffman
- a Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,b University of California Davis Medical Center , Sacramento , CA , USA
| | - Natalie Badowski
- c Department of Emergency Medicine , Stanford University School of Medicine , Stanford , CA , USA
| | - Joseph Chin
- d State University of New York Upstate Medical University , Syracuse , NY , USA
| | | | - Carol A Parise
- f Sutter Institute for Medical Research , Sacramento , CA , USA
| |
Collapse
|
44
|
Lord R, George K, Somauroo J, Jain N, Reese K, Hoffman MD, Haddad F, Ashley E, Jones H, Oxborough D. Exploratory insights from the right-sided electrocardiogram following prolonged endurance exercise. Eur J Sport Sci 2016; 16:1014-22. [DOI: 10.1080/17461391.2016.1165292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
45
|
Abstract
This work examines whether nausea or vomiting during an ultramarathon are due to a fluid or electrolyte imbalance, and if these symptoms can be reduced through the use of buffered sodium supplements. Starters (n = 376) of a 161.3-km ultramarathon underwent body weight measurements, 74.5% completed a post-race questionnaire, and 53.0% also underwent a post-race blood draw. The incidence of nausea or vomiting progressively increased during the race, and affected 60% of runners overall. Weight change and rate of sodium intake in supplements or in buffered sodium supplements did not differ between those with and without nausea or vomiting. Post-race serum sodium concentration also did not differ between those with and without symptoms in the last race segment. We conclude that weight change, the rate of sodium intake in supplements or in buffered sodium supplements, and serum sodium concentration are not related to symptoms of nausea or vomiting during a 161-km ultramarathon.
Collapse
Affiliation(s)
- Martin D Hoffman
- a Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System, and University of California Davis Medical Center , Sacramento , CA , USA
| | | |
Collapse
|
46
|
Hoffman MD, Hew-Butler T, Roberts WO, Rogers IR, Rosner MH. Is Postevent Intravenous Hydration an Appropriate Service at Endurance Competitions? Wilderness Environ Med 2016; 27:7-9. [PMID: 26948551 DOI: 10.1016/j.wem.2015.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System and University of California Davis Medical Center, Sacramento, CA
| | | | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Ian R Rogers
- Department of Emergency Medicine, St John of God Murdoch Hospital and University of Notre Dame, Perth, Western Australia, Australia
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System,Charlottesville, VA
| |
Collapse
|
47
|
Hoffman MD. Where’s the “E” in WEM? Wilderness Environ Med 2016. [DOI: 10.1016/j.wem.2015.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
48
|
Abstract
This study explored possible contributing factors to gastrointestinal distress, including endotoxemia, hyperthermia, dehydration and nutrition, during a 161-km ultramarathon. Thirty runners participated in the study and 20 finished the race. At three checkpoints and the finish, runners were interviewed to assess the incidence and severity of 12 gastrointestinal symptoms and to determine dietary intake. Core temperature was measured at the same locations. Runners were weighed pre-race, at the three checkpoints and the finish to monitor hydration status. Blood markers for endotoxemia (sCD14) and inflammation (interleukin-6 and C-reactive protein) were measured pre- and post-race. Gastrointestinal symptoms were experienced by most runners (80%), with nausea being the most common complaint (60%). Runners with nausea experienced significantly greater (P = 0.02) endotoxemia than those without nausea (sCD14 mean increase 0.7 versus 0.5 µg · mL(-1)). There was a significant positive correlation (r = 0.652, P = 0.005) between nausea severity and endotoxemia level. Inflammatory response, core temperature, hydration level and race diet were similar between runners with and without nausea. This study links endotoxemia to nausea in ultramarathon runners. Other possible contributing factors to nausea such as hyperthermia, dehydration and nutrition did not appear to play a role in the symptomatic runners in this study.
Collapse
Affiliation(s)
| | - Taylor Valentino
- b Department of Kinesiology , San Francisco State University , San Francisco , CA , USA
| | - Tamara Hew-Butler
- c Exercise Science, School of Health Science , Oakland University , Rochester , MI , USA
| | - Frederick M Hecht
- d Department of Medicine, School of Medicine , University of California at San Francisco , San Francisco , CA , USA
| | - Martin D Hoffman
- e Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System, and University of California Davis Medical Center , Sacramento , CA , USA
| |
Collapse
|
49
|
Hoffman MD, Stuempfle KJ, Valentino T. Sodium Intake During an Ultramarathon Does Not Prevent Muscle Cramping, Dehydration, Hyponatremia, or Nausea. Sports Med Open 2015; 1:39. [PMID: 26709371 PMCID: PMC4688305 DOI: 10.1186/s40798-015-0040-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/16/2015] [Indexed: 11/18/2022]
Abstract
Background Ultramarathon runners commonly believe that sodium replacement is important for prevention of muscle cramping, dehydration, hyponatremia, and nausea during prolonged continuous exercise. The purpose of this study was to measure total sodium intake to determine if these beliefs are supported. Methods Participants of a 161-km ultramarathon (air temperature reaching 39 °C) provided full dietary information during the race, underwent body weight measurements before and after the race, completed a post-race questionnaire about muscle cramping and nausea or vomiting during the race, and had post-race plasma sodium concentration measured. Results Among 20 finishers providing dietary data, mean (±SD) total sodium intake was 13,651 ± 8444 mg (range 2541–38,338 mg), and sodium in food and drink accounted for 66 % of the sodium when averaged across subjects (range 34–100 %). Sodium intake rates were similar when comparing the 10 % of subjects who were hyponatremic with those who were not hyponatremic, the 39 % with muscle cramping or near cramping with those without cramping, and the 57 % who reported having symptoms of nausea or vomiting with those without these symptoms. Weight change between race start and finish was significantly related to rate of sodium intake (r = 0.49, p = 0.030) and total sodium intake (r = 0.53, p = 0.016), but the maximum weight loss among those taking the least total sodium (<4400 mg total sodium during the race) was 4–5 % below the weight measured immediately pre-race. Conclusions Exercise-associated muscle cramping, dehydration, hyponatremia, and nausea or vomiting during exercise up to 30 h in hot environments are unrelated to total sodium intake, despite a common belief among ultramarathon runners that sodium is important for the prevention of these problems.
Collapse
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Sacramento VA Medical Center, Northern California Health Care System, 10535 Hospital Way, Sacramento, CA 95655-1200 USA ; Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, Sacramento, CA USA
| | | | - Taylor Valentino
- Department of Kinesiology, San Francisco State University, San Francisco, CA USA
| |
Collapse
|
50
|
Hoffman MD. Can We Get There From Here? Wilderness Environ Med 2015; 26:449-50. [PMID: 26642908 DOI: 10.1016/j.wem.2015.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 08/31/2015] [Indexed: 11/24/2022]
|