Comparative electroencephalography analysis: Marathon runners during tapering versus sedentary controls reveals no significant differences

INTRODUCTION

Previous studies described various adaptive neuroplastic brain changes associated with physical activity (PA). EEG studies focused mostly on effects during or shortly after short bouts of exercise. This is the first study to investigate the capability of EEG to display PA-induced long-lasting plasticity in runners compared to a sedentary control group.

METHODS

Thirty trained runners and 30 age- and sex-matched sedentary controls (SC) were included as a subpopulation of the ReCaP (Running effects on Cognition and Plasticity) study. PA was measured with the International Physical Activity Questionnaire (IPAQ). Resting-state EEG of the runners was recorded in the tapering phase of the training for the Munich marathon 2017. Power spectrum analyses were conducted using standardized low-resolution electromagnetic tomography (sLORETA) and included the following frequency bands: delta: 1.5-6 Hz, theta: 6.5-8.0 Hz, alpha1: 8.5-10 Hz, alpha2: 10.5-12.0 Hz, beta1: 12.5-18.0 Hz, beta2: 18.5-21.0 Hz, beta3: 21.5-30.0 Hz, and total power (1.5-30 Hz).

RESULTS

PA (IPAQ) and BMI differed significantly between the groups. The other included demographic parameters were comparable. Statistical nonparametric mapping showed no significant power differences in EEG between the groups.

DISCUSSION

Heterogeneity in study protocols, especially in time intervals between exercise cessation and EEG recordings and juxtaposition of acute exercise-induced effects on EEG in previous studies, could be possible reasons for the differences in results. Future studies should record EEG at different time points after exercise cessation and in a broader spectrum of exercise intensities and forms to further explore the capability of EEG in displaying long-term exercise-induced plasticity.

Effect of Sugar- and Polyphenol-Rich, Diluted Cloudy Apple Juice on the Intestinal Barrier after Moderate Endurance Exercise and in Ultra-Marathon Runners

BACKGROUND

Exercise and the consumption of sugars result in a dysfunction of the intestinal barrier (IB). Here, we determined the effect of sugar in a natural matrix on the intestinal barrier after moderate (A) and intensive endurance exercise (B).

METHOD

The IB function was determined before (pre) and after running (post), and 120 and 180 min after consuming the drink by measuring serum endotoxin concentrations (lipopolysaccharides-LPS), IL-6, CD14, and i-FABP. In study A, nonspecifically trained participants (n = 24, males and females, age 26 ± 4) ran for one hour at 80% of their individual anaerobic threshold (IAT). After finishing, the runners consumed, in a crossover setup, either 500 mL of water, diluted cloudy apple juice (test drink), or an identical drink (placebo) without the fruit juice matrix (FJM). In study B, the participants (n = 30, males and females, age 50 ± 9) completed an ultra-marathon run, were divided into groups, and consumed one of the above-mentioned drinks.

RESULTS

Study A: Exercise resulted in a significant increase in serum LPS, i-FABP, and IL-6, which decreased fast after finishing. No impact of the different drinks on LPS i-FABP, or IL-6 could be observed, but there was an impact on CD14. Study B: The ultra-marathon resulted in a strong increase in serum LPS, which decreased fast after finishing in the water and test drink groups, but not in the placebo group.

CONCLUSIONS

The consumed drinks did not affect the kinetics of IB regeneration after moderate exercise, but impacted CD14 serum concentrations, indicating possible beneficial effects of the FJM on the immune system. After an ultra-marathon, IB function regenerates very fast. The intake of sugar (placebo) seems to have had a negative impact on IB regeneration, which was diminished by the presence of the FJM.

The effect of marathon running on the lower extremity kinematics and muscle activities during walking and running tasks

Patellofemoral pain syndrome (PFPS) is a common injury among runners, and it is thought that abnormal lower extremity biomechanics contribute to its development. However, the relationship between biomechanical changes after a marathon and PFPS injury remains limited. This study aims to investigate whether differences in knee and hip kinematics and lower extremity muscle activities exist in recreational runners before and after a marathon. Additionally, it aims to explore the relationship between these biomechanical changes and the development of PFPS injury. 12 recreational runners participated in the study. Kinematics and muscle activities of the lower extremity were recorded during walking (5 km/h) and running (10 km/h) tasks within 24 hours before and within 5 hours after a marathon. After the marathon, there was a significant decrease in peak knee flexion (walking: p = 0.006; running: p = 0.006) and an increase in peak hip internal rotation (walking: p = 0.026; running: p = 0.015) during the stance phase of both walking and running compared to before the marathon. The study demonstrates a decrease in knee flexion and an increase in hip internal rotation during the stance phase of gait tasks after completing a marathon, which may increase the risk of developing PFPS injury.

Effect of ultramarathon running on iron metabolism

BACKGROUND

Iron is a vital trace element for energy production and oxygen transportation; importantly, it is essential to athletic performance. Maintaining iron balance is tightly controlled at systemic and cellular levels. This study aimed to determine serum iron tests, hepcidin levels, and cellular iron import and export activities in peripheral blood mononuclear cells (PBMCs) in ultramarathon runners to elucidate the association of systemic inflammation response and iron metabolism.

METHODS

Sixteen amateur runners were enrolled. Blood samples were taken 1 week before, immediately, and 24 h after the run. Plasma hepcidin levels were measured by enzyme-linked immunosorbent assay. The expression levels of divalent metal iron transporter 1 (DMT1), ZRT/IRT-like protein 14 (ZIP14), transferrin receptor 1 (TfR1), and ferroportin (FPN) in PBMCs were measured using real-time quantitative reverse transcription-polymerase chain reaction.

RESULTS

Serum iron concentrations and transferrin saturation significantly decreased immediately after the race and dramatically recovered 24 h post-race. Serum ferritin levels had a statistically significant rise immediately after the race and remained high 24 h after the completion of the race. Ultramarathons were associated with increased plasma interleukin-6 concentrations corresponding to the state of severe systemic inflammation and therefore boosted plasma hepcidin levels. The expression levels of DMT1 and FPN mRNA were markedly decreased immediately and 24 h after the race. The ZIP14 and TfR1 mRNA expression in PBMCs significantly decreased immediately after the race and returned to the baseline level at 24 h post-race. Positive significant correlations were observed between plasma hepcidin and ferritin levels.

CONCLUSION

Iron homeostasis and systemic inflammatory response are closely interconnected. Cellular iron import and export mRNA activities in PBMCs were acutely inhibited during an ultramarathon.

A Narrative Analysis of the Progression in the Top 100 Marathon, Half-Marathon, and 10-km Road Race Times from 2001 to 2019

PURPOSE

This study aimed to characterize and describe finishing time trends of the fastest 100 performers in the men's and women's marathon, half-marathon, and road 10-km each year from 2001 to 2019 and assess the underlying basis for recent performance improvements.

METHODS

The top 100 performers for each sex, event, and year were partitioned into four arbitrary ranking groups: 1-10, 11-25, 26-50, and 51-100. The percent improvement in mean performance time for each year beyond 2001 was calculated for each ranking group, event, and sex. Multiple linear regression was also used to determine improvement trend for each ranking group, both sexes, and all events for each 3-yr period between Olympic years.

RESULTS

In total, 11,400 performances in the marathon, half-marathon, and 10-km road races from 2001 to 2019 were analyzed. The 3-yr period preceding the original date of the Tokyo Olympics (2017-2019) accounted for 44% and 35% of the overall improvement in marathon time from 2001 to 2019 for women and men, respectively. The years 2017-2019 featured the largest average improvement of any 3-yr period and was the only period where nearly every ranking group in every event for both sexes improved.

CONCLUSIONS

The results suggest that recent world record performances are a result of overall circumstances affecting road racing (e.g., shoe technology) rather than the outstanding physiology of individual top runners, per se.

Skeletal Muscle Mitochondrial Function after a 100-km Ultramarathon: A Case Study in Monozygotic Twins

PURPOSE

Very little research has investigated the effects of ultraendurance exercise on the bioenergetic status of muscle. The primary objective of this case study was to characterize the changes that occur in skeletal muscle mitochondria in response to a 100-km ultramarathon in monozygotic twins. A second objective was to determine whether mitochondrial function is altered by consuming a periodized low-carbohydrate, high-fat diet during training compared with a high-carbohydrate diet.

METHODS

One pair of male monozygotic twins ran 100 km on treadmills after 4 wk of training on either a high-carbohydrate or periodized low-carbohydrate, high-fat diet. Muscle biopsies were collected 4 wk before the run, as well as 4 and 52 h postrun. Blood draws were also performed immediately before as well as 4 and 52 h after the run.

RESULTS

Four hours postrun, respiratory capacity, citrate synthase activity, and mitochondrial complex protein content were decreased. Two days later, both twins showed signs of rapid recovery in several of these measures. Furthermore, blood levels of creatine phosphokinase, C-reactive protein, and aspartate transaminase were elevated 4 h after the run but partially recovered 2 d later.

CONCLUSION

Although there were some differences between the twins, the primary finding is that there is significant mitochondrial impairment induced by running 100 km, which rapidly recovers within 2 d. These results provide ample rationale for future investigations of the effects of ultraendurance activity on mitochondrial function.

Sex Differences in Neuromuscular Fatigue and Changes in Cost of Running after Mountain Trail Races of Various Distances

INTRODUCTION

Women have been shown to experience less neuromuscular fatigue than men in knee extensors (KE) and less peripheral fatigue in plantar flexors (PF) after ultratrail running, but it is unknown if these differences exist for shorter trail running races and whether this may impact running economy. The purpose of this study was to characterize sex differences in fatigability over a range of running distances and to examine possible differences in the postrace alteration of the cost of running (Cr).

METHODS

Eighteen pairs of men and women were matched by performance after completing different races ranging from 40 to 171 km, divided into SHORT versus LONG races (<60 and >100 km, respectively). Neuromuscular function and Cr were tested before and after each race. Neuromuscular function was evaluated on both KE and PF with voluntary and evoked contractions using electrical nerve (KE and PF) and transcranial magnetic (KE) stimulation. Oxygen uptake, respiratory exchange ratio, and ventilation were measured on a treadmill and used to calculate Cr.

RESULTS

Compared with men, women displayed a smaller decrease in maximal strength in KE (-36% vs -27%, respectively, P < 0.01), independent of race distance. In SHORT only, women displayed less peripheral fatigue in PF compared with men (Δ peak twitch: -10% vs -24%, respectively, P < 0.05). Cr increased similarly in men and women.

CONCLUSIONS

Women experience less neuromuscular fatigue than men after both "classic" and "extreme" prolonged running exercises but this does not impact the degradation of the energy Cr.

Supplement intake in half-marathon, (ultra-)marathon and 10-km runners - results from the NURMI study (Step 2)

The primary nutritional challenge facing endurance runners is meeting the nutrient requirements necessary to optimize the performance and recovery of prolonged training sessions. Supplement intake is a commonly used strategy by elite and recreational distance runners to meet nutritional recommendations. This study was conducted to investigate the patterns of supplement intake among different groups of distance runners and the potential association between supplement intake and sex, age, running and racing experiences.In a cross-sectional design, from a total of 317 runners participating in this survey, 119 distance runners were involved in the final sample after data clearance, assigned into three groups of 10-km runners (n = 24), half-marathoners (n = 44), and (ultra-)marathoners (n = 51). Personal characteristics, training and racing experiences, as well as patterns of supplement intake, including type, frequency, and dosage, were evaluated by questionnaire. Food Frequency Questionnaire was implemented to assess macronutrient intake. ANOVA and logistic regression were used for statistical analysis.While 50 % of total distance runners reported consuming supplements regularly, no differences between distance groups in consumption of carbohydrate/protein, mineral, or vitamin supplements were observed (p > 0.05). In addition, age, sex, running and racing experience showed no significant association with supplement intake (p > 0.05). Vitamin supplements had the highest intake rate in runners by 43 % compared to minerals (34 %) and carbohydrate/protein supplements (19 %).The present findings provide a window into the targeted approaches of long-distance runners as well as their coaches and sport nutrition specialists when applying and suggesting sustainable nutritional strategies for training and competition.Trial registration: ISRCTN73074080. Retrospectively registered 12th June 2015.

Fractal correlation properties of heart rate variability as a biomarker of endurance exercise fatigue in ultramarathon runners

Although heart rate variability (HRV) indexes have been helpful for monitoring the fatigued state while resting, little data indicate that there is comparable potential during exercise. Since an index of HRV based on fractal correlation properties, alpha 1 of detrended fluctuation analysis (DFA a1) displays overall organismic demands, alteration during exertion may provide insight into physiologic changes accompanying fatigue. Two weeks after collecting baseline demographic and gas exchange data, 11 experienced ultramarathon runners were divided into two groups. Seven runners performed a simulated ultramarathon for 6 h (Fatigue group, FG) and four runners performed daily activity over a similar period (Control group, CG). Before (Pre) and after (Post) the ultramarathon or daily activity, DFA a1, heart rate (HR), running economy (RE) and countermovement jumps (CMJ) were measured while running on a treadmill at 3 m/s. In Pre versus Post comparisons, data showed a decline with large effect size in DFA a1 post intervention only for FG (Pre: 0.71, Post: 0.32; d = 1.34), with minor differences and small effect sizes in HR (d = 0.02) and RE (d = 0.21). CG showed only minor differences with small effect sizes in DFA a1 (d = 0.19), HR (d = 0.15), and RE (d = 0.31). CMJ vertical peak force showed fatigue-induced decreases with large effect size in FG (d = 0.82) compared to CG (d = 0.02). At the completion of an ultramarathon, DFA a1 decreased with large effect size while running at low intensity compared to pre-race values. DFA a1 may offer an opportunity for real-time tracking of physiologic status in terms of monitoring for fatigue and possibly as an early warning signal of systemic perturbation.

Dynamics of Specific cfDNA Fragments in the Plasma of Full Marathon Participants

Plasma cell-free DNA (cfDNA) is frequently analyzed using liquid biopsy to investigate cancer markers. We hypothesized that this concept might be applicable in exercise physiology. Here, we aimed to identify specific cfDNA (spcfDNA) sequences in the plasma of healthy humans using next-generation sequencing (NGS) and clearly define the dynamics regarding spcfDNA-fragment levels upon extreme exercises, such as running a full marathon. NGS analysis was performed using cfDNA of pooled plasma collected from healthy participants. We confirmed that the TaqMan-qPCR assay had high sensitivity and found that the spcfDNA sequence abundance was 16,600-fold higher than that in a normal genomic region. We then used the TaqMan-qPCR assay to investigate the dynamics of spcfDNA-fragment levels upon running a full marathon. The spcfDNA fragment levels were significantly increased post-marathon. Furthermore, spcfDNA fragment levels were strongly correlated with white blood cell and plasma myoglobin concentrations. These results suggest the spcfDNA fragments identified in this study were highly sensitive as markers of extreme physical stress. The findings of this study may provide new insights into exercise physiology and genome biology in humans.

Single High-Dose Vitamin D Supplementation as an Approach for Reducing Ultramarathon-Induced Inflammation: A Double-Blind Randomized Controlled Trial

Purpose: A growing number of studies indicate the importance of vitamin D supplementation for sports performance. However, the effects of a single high-dose vitamin D supplementation on ultramarathon-induced inflammation have not been investigated. We here analyzed the effect of a single high-dose vitamin D supplementation on the inflammatory marker levels in ultramarathon runners after an ultramarathon run (maximal run 240 km). Methods: In the study, 35 runners (amateurs) were assigned into two groups: single high-dose vitamin D supplementation group, administered vitamin D (150,000 IU) in vegetable oil 24 h before the start of the run (n = 16); and placebo group (n = 19). Blood was collected for analysis 24 h before, immediately after, and 24 h after the run. Results: Serum 25(OH)D levels were significantly increased after the ultramarathon in both groups. The increase was greater in the vitamin D group than in the control group. Based on post-hoc and other analyses, the increase in interleukin 6 and 10, and resistin levels immediately after the run was significantly higher in runners in the control group than that in those in the supplementation group. Leptin, oncostatin M, and metalloproteinase tissue inhibitor levels were significantly decreased in both groups after the run, regardless of the supplementation. Conclusions: Ultramarathon significantly increases the serum 25(OH)D levels. Attenuation of changes in interleukin levels upon vitamin D supplementation confirmed that vitamin D has anti-inflammatory effect on exercise-induced inflammation.

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

INTRODUCTION/PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effects of medium- and long-distance running on cardiac damage markers in amateur runners: a systematic review, meta-analysis, and metaregression

BACKGROUND

To finish an endurance race, athletes perform a vigorous effort that induces the release of cardiac damage markers. There are several factors that can affect the total number of these markers, so the aim of this review was to analyze the effect of endurance running races on cardiac damage markers and to identify the factors that modify the levels of segregation of these cardiac damage markers.

METHODS

A systematic search of PubMed, Web of Science, and the Cochrane Library databases was performed. This analysis included studies where the acute effects of running races on cardiac damage markers (troponin I and troponin T) were analyzed, assessing the levels of these markers before and after the races.

RESULTS

The effects of running races on troponin I (mean difference = 0.0381 ng/mL) and troponin T (mean difference = 0.0256 ng/mL) levels were significant. The ages (R² = 14.4%, p = 0.033) and body mass indexes (R² = 14.5%, p = 0.045) of the athletes had a significant interaction with troponin I. In addition, gender, mean speed, time to finish the race, and type of race can affect the level of cardiac damage markers.

CONCLUSION

Endurance running races induce the release of cardiac-damage markers that remain elevated for at least 24 h after the races. In addition, young male athletes with high body mass indexes who perform races combining long duration and moderate intensity (i.e., marathons) release the highest levels of cardiac damage markers. Physicians should take into consideration these results in the diagnosis and treatment of patients admitted to the hospital days after finishing endurance running races.

Vascular Function Is Differentially Altered by Distance after Prolonged Running

PURPOSE

Ultraendurance exercise is steadily growing in popularity; however, the effect of increasingly prolonged durations of exercise on the vascular endothelium is unknown. The aim of this study was to characterize the effect of various ultramarathon running distances on vascular form and function.

METHODS

We evaluated vascular endothelial function via flow-mediated dilation (FMD) in the superficial femoral artery, as well as microvascular function, inflammatory factors, and central artery stiffness, before and after participants completed 25-km (7M:2F), 50-km (11M:10F), 80-km (9M:4F), or 160-km (9M:2F) trail races all run on the same day and course.

RESULTS

Completion required 149 ± 20, 386 ± 111, 704 ± 130, and 1470 ± 235 min, with corresponding average paces of 6.0 ± 0.8, 7.7 ± 2.2, 8.6 ± 1.3, and 9.6 ± 1.3 min·km-1, respectively. At baseline, there were no differences in participant characteristics across race distance groups. Shear rate stimulus trended toward an increase after the race (P = 0.07), but resting postrace artery diameter (P < 0.001) was elevated to a similar extent in all conditions. There was a reduction in FMD after the 50-km race (Δ -1.9% ± 2.2%, P < 0.01), but not the 25-km (Δ +0.3% ± 2.9%, P = 0.8), the 80-km (Δ -1.5% ± 3.2%, P = 0.1), or the 160-km (Δ +0.5% ± 2.5%, P = 0.5) race. Inflammatory markers increased most after 160 km, but arterial stiffness and microvascular function were not differently affected by race distance.

CONCLUSIONS

Although the superficial femoral artery baseline diameter was larger postexercise regardless of race distance, only the 50-km race reduced FMD, whereas a short-duration higher-intensity race (25 km) and longer-duration lower-intensity races (160 km) did not. Therefore, a 50-km ultramarathon may represent the intersection between higher-intensity exercise over a prolonged duration, causing reduced endothelial function not seen in shorter or longer distances.

Marathon running transiently depletes the myocardial lipid pool

Lipids, stored as intracellular triacylglycerol droplets within the myocardium, serve as an important source of energy, particularly in times of prolonged increased energy expenditure. In only a few studies, the acute effects of exercise on such ectopic myocardial lipid storage were investigated. We studied the dynamic behavior of the myocardial lipid pool in response to completing the 2017 Amsterdam Marathon using proton magnetic resonance (MR) spectroscopy (1 H-MRS). We hypothesized that the prolonged increased myocardial energy demand of running a marathon could shift the balance of myocardial triacylglycerol turnover from triacylglycerol synthesis toward lipolysis and mitochondrial fatty acid β-oxidation, and decrease the myocardial lipid pool. We employed two 3 Tesla MR systems in parallel to noninvasively examine endurance-trained healthy men (n = 8; age 50.7 [50.1-52.7] y) at 1 week prior (baseline), <6 hr after finishing the marathon (post-marathon), and 2 weeks thereafter (recovery). Exercise intensity was 89 ± 6% of the age-predicted maximal heart rate, with a finish time of 3:56 [3:37-4:42] h:min. Myocardial lipid content was 0.66 [0.58-0.87]% of the total myocardial water signal at baseline, was lower post-marathon (0.47 [0.41-0.63]% of the total myocardial water signal), and had restored to 0.55 [0.49-0.83]% of the total myocardial water signal at recovery, representing a transient marathon running-induced depletion of 29 ± 24% (p = .04). The magnitude of this myocardial lipid pool depletion did not correlate with exercise intensity (r = -0.39; p = .39), nor with marathon finishing time (ρ = 0.57; p = .15). Our data show that prolonged high-intensity exercise can induce a transient depletion of the myocardial lipid pool, reinforcing the dynamic nature of ectopic triacylglycerol storage under real-life conditions of extreme endurance exercise.

Effects of 120 vs. 60 and 90 g/h Carbohydrate Intake during a Trail Marathon on Neuromuscular Function and High Intensity Run Capacity Recovery

BACKGROUND

Current carbohydrate (CHO) intake recommendations for ultra-trail activities lasting more than 2.5 h is 90 g/h. However, the benefits of ingesting 120 g/h during a mountain marathon in terms of post-exercise muscle damage have been recently demonstrated. Therefore, the aim of this study was to analyze and compare the effects of 120 g/h CHO intake with the recommendations (90 g/h) and the usual intake for ultra-endurance athletes (60 g/h) during a mountain marathon on internal exercise load, and post-exercise neuromuscular function and recovery of high intensity run capacity.

METHODS

Twenty-six elite trail-runners were randomly distributed into three groups: LOW (60 g/h), MED (90 g/h) and HIGH (120 g/h), according to CHO intake during a 4000-m cumulative slope mountain marathon. Runners were measured using the Abalakov Jump test, a maximum a half-squat test and an aerobic power-capacity test at baseline (T1) and 24 h after completing the race (T2).

RESULTS

Changes in Abalakov jump time (ABKJT), Abalakov jump height (ABKH), half-squat test 1 repetition maximum (HST1RM) between T1 and T2 showed significant differences by Wilcoxon signed rank test only in LOW and MED (p < 0.05), but not in the HIGH group (p > 0.05). Internal load was significantly lower in the HIGH group (p = 0.017) regarding LOW and MED by Mann Whitney u test. A significantly lower change during the study in ABKJT (p = 0.038), ABKH (p = 0.038) HST1RM (p = 0.041) and in terms of fatigue (p = 0.018) and lactate (p = 0.012) within the aerobic power-capacity test was presented in HIGH relative to LOW and MED.

CONCLUSIONS

120 g/h CHO intake during a mountain marathon might limit neuromuscular fatigue and improve recovery of high intensity run capacity 24 h after a physiologically challenging event when compared to 90 g/h and 60 g/h.