Cold-Water Immersion and Lower Limb Muscle Oxygen Consumption as Measured by Near-Infrared Spectroscopy in Trained Endurance Athletes

CONTEXT

Cold-water immersion (CWI) has been reported to reduce tissue metabolism postimmersion, but physiological data are lacking regarding the muscle metabolic response to its application. Near-infrared spectroscopy (NIRS) is a noninvasive optical technique that can inform muscle hemodynamics and tissue metabolism.

OBJECTIVE

To investigate the effects of CWI at 2 water temperatures (10°C and 15°C) on NIRS-calculated measurements of muscle oxygen consumption (mVO2).

DESIGN

Crossover study.

SETTING

University sports rehabilitation center.

PATIENTS OR OTHER PARTICIPANTS

A total of 11 male National Collegiate Athletic Association Division II long-distance runners (age = 23.4 ± 3.4 years, height = 1.8 ± 0.1 m, mass = 68.8 ± 10.7 kg, mean adipose tissue thickness = 6.7 ± 2.7 mm).

INTERVENTION(S)

Cold-water immersion at 10°C and 15°C for 20 minutes.

MAIN OUTCOME MEASURE(S)

We calculated mVO2 preimmersion and postimmersion at water temperatures of 10°C and 15°C. Changes in tissue oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), total hemoglobin (tHb), hemoglobin difference (Hbdiff), and tissue saturation index (TSI %) were measured during the 20-minute immersion at both temperatures.

RESULTS

We observed a decrease in mVO2 after immersion at both 10°C and 15°C (F1,9 = 27.7801, P = .001). During the 20-minute immersion at both temperatures, we noted a main effect of time for O2Hb (F3,27 = 14.227, P = .001), HHb (F3,27 = 5.749, P = .009), tHb (F3,27 = 24.786, P = .001), and Hbdiff (F3,27 = 3.894, P = .020), in which values decreased over the course of immersion. Post hoc pairwise comparisons showed that these changes occurred within the final 5 minutes of immersion for tHb and O2Hb.

CONCLUSIONS

A 20-minute CWI at 10°C and 15°C led to a reduction in mVO2. This was greater after immersion at 10°C. The reduction in mVO2 suggests a decrease in muscle metabolic activity (ie, O2 use after CWI). Calculating mVO2 via the NIRS-occlusion technique may offer further insight into muscle metabolic responses beyond what is attainable from observing the NIRS primary signals.

Differences in running technique between runners with better and poorer running economy and lower and higher milage: An artificial neural network approach

BACKGROUND

Prior studies investigated selected discrete sagittal-plane outcomes (e.g., peak knee flexion) in relation to running economy, hereby discarding the potential relevance of running technique parameters during noninvestigated phases of the gait cycle and in other movement planes.

PURPOSE

Investigate which components of running technique distinguish groups of runners with better and poorer economy and higher and lower weekly running distance using an artificial neural network (ANN) approach with layer-wise relevance propagation.

METHODS

Forty-one participants (22 males and 19 females) ran at 2.78 m∙s-1 while three-dimensional kinematics and gas exchange data were collected. Two groups were created that differed in running economy or weekly training distance. The three-dimensional kinematic data were used as input to an ANN to predict group allocations. Layer-wise relevance propagation was used to determine the relevance of three-dimensional kinematics for group classification.

RESULTS

The ANN classified runners in the correct economy or distance group with accuracies of up to 62% and 71%, respectively. Knee, hip, and ankle flexion were most relevant to both classifications. Runners with poorer running economy showed higher knee flexion during swing, more hip flexion during early stance, and more ankle extension after toe-off. Runners with higher running distance showed less trunk rotation during swing.

CONCLUSION

The ANN accuracy was moderate when predicting whether runners had better, or poorer running economy, or had a higher or lower weekly training distance based on their running technique. The kinematic components that contributed the most to the classification may nevertheless inform future research and training.

Change of Seasons: Boston Marathon Wet Bulb Globe Temperature Index in October

INTRODUCTION

The importance of providing wet bulb globe temperature (WBGT) heat stress flag category measurements in real time is well recognized by road race directors, and it is bound to become even more important with the rise of extreme weather and pandemic outbreaks. The purpose of this paper is to describe the WBGT index and its components measured during the 125th running of the Boston Marathon on October 11, 2021, for qualitative comparison to measurements made similarly on its traditional April date, 2014 to 2019.

METHODS

Monitoring occurred at the 7 km, 18 km, and 32 km marks of the race in the towns of Ashland, Natick-Wellesley, and Newton. The outdoor WBGT index was calculated from direct hourly measurements of the dry bulb, black globe, and natural wet bulb temperatures from 0900 to 1500 h.

RESULTS

The WBGT index was not different among towns; thus, the average hourly values for the 3 towns were compared to historical data averaged identically. Although the black globe temperature fluctuated considerably in response to changing cloud cover, on average, partly cloudy skies kept the solar load comparable to what has been observed in April. Dry bulb and wet bulb temperatures were higher than those on most April dates shown, which resulted in a yellow (or amber) flag day for most of the race.

CONCLUSIONS

The historic October Boston Marathon was among the warmest in recent history. Like the impact of COVID-19 on the 2021 Boston Marathon, future climate challenges around outdoor activities could necessitate rescheduling; they underscore the importance of real-time WBGT index measures.

Apple puree as a natural fructose source provides an effective alternative carbohydrate source for fuelling half-marathon running performance

Carbohydrate supplementation during endurance exercise is known to improve performance, but the effects of food-based approaches in running exercise are understudied. Therefore, this study investigated the performance and gastrointestinal (GI) effects of a carbohydrate supplement containing a natural fructose source compared with a highly processed fructose source in a combined glucose-fructose supplement, during a half-marathon. Eleven trained runners (9 males, 2 females; age 32 ± 8 y, 89:53 ± 13:28 min half-marathon personal record) completed a familiarisation (8 miles) and two experimental trials (13.1 miles) on an outdoor running course, with blood and urine samples collected before and after the run. Subjective GI measures were made throughout the run. Carbohydrate was provided as a natural fructose source in the form of apple puree (AP) or highly processed crystalline fructose (GF) in a 2:1 glucose-to-fructose ratio (additional required glucose was provided through maltodextrin). Half-marathon performance was not different between carbohydrate sources (AP 89:52 ± 09:33 min, GF 88:44 ± 10:09 min; P = 0.684). There were no interaction effects for GI comfort (P = 0.305) or other GI symptoms (P ≥ 0.211). There were no differences between carbohydrate sources in ad libitum fluid intake (AP 409 ± 206 mL; GF 294 ± 149 mL; P = 0.094) or any other urinary (P ≥ 0.724), blood-based (P ≥ 0.215) or subjective (P ≥ 0.421) measures. Apple puree as a natural fructose source was equivalent to crystalline fructose in supporting half-marathon running performance without increasing GI symptoms.HighlightsResearch examining food-first and food-based approaches to carbohydrate supplementation and endurance running performance are limited. Therefore, this study aimed to compare carbohydrate supplements either containing a natural or highly processed fructose source as part of a glucose-fructose supplement on half-marathon running performance and gastrointestinal comfort in trained runners.Running performance (apple puree 89:52 ± 09:33 min vs. crystalline fructose 88:44 ± 10:09 min), gastrointestinal comfort and symptoms were not different between the two fructose sources.Apple puree can be effectively used as a carbohydrate source to fuel half-marathon running performance.

Impact of advanced footwear technology on elite men's in the evolution of road race performance

Advanced footwear technology (AFT) changed footwear design concepts by using a curved carbon fibre plate in combination with new, more compliant and resilient foams. The aim of this study was (1) to examine the individual effects of AFT on the evolution of the main road events and (2) to re-assess the impact of AFT on the world's top-100 performance in men's 10k, half-marathon and marathon events. Data from the top-100 men's 10k, half-marathon and marathon performances were collected between 2015 and 2019. The shoes used by the athletes were identified in 93.1% of the cases by publicly available photographs. Runners wearing AFT had an average performance of 1671 ± 22.28 s compared to 1685 ± 18.97 s of runners not using AFT in 10k (0.83%) (p < 0.001), 3589 ± 29.79 s compared to 3607 ± 30.49 s in half-marathon (0.50%) (p < 0.001) and 7563 ± 86.10 s compared to 7637 ± 72.51 s in the marathon (0.97%) (p < 0.001). Runners wearing AFTs were faster by ~1% in the main road events compared to non-users. Individual analysis showed that ~25% of the runners did not benefit from the use of this type of footwear. The results of this study suggest that AFT has a clear positive impact on running performance in main road events.

Female Endurance Runners Have a Healthier Diet than Males-Results from the NURMI Study (Step 2)

Sex has been recognized to be an important indicator of physiological, psychological, and nutritional characteristics among endurance athletes. However, there are limited data addressing sex-based differences in dietary behaviors of distance runners. The aim of the present study is to explore the sex-specific differences in dietary intake of female and male distance runners competing at >10-km distances. From the initial number of 317 participants, 211 endurance runners (121 females and 90 males) were selected as the final sample after a multi-level data clearance. Participants were classified to race distance (10-km, half-marathon, marathon/ultra-marathon) and type of diet (omnivorous, vegetarian, vegan) subgroups. An online survey was conducted to collect data on sociodemographic information and dietary intake (using a comprehensive food frequency questionnaire with 53 food groups categorized in 14 basic and three umbrella food clusters). Compared to male runners, female runners had a significantly greater intake in four food clusters, including “beans and seeds”, “fruit and vegetables”, “dairy alternatives”, and “water”. Males reported higher intakes of seven food clusters, including “meat”, “fish”, “eggs”, “oils”, “grains”, “alcohol”, and “processed foods”. Generally, it can be suggested that female runners have a tendency to consume healthier foods than males. The predominance of females with healthy dietary behavior can be potentially linked to the well-known differences between females and males in health attitudes and lifestyle patterns.

Training Periodization, Methods, Intensity Distribution, and Volume in Highly Trained and Elite Distance Runners: A Systematic Review

PURPOSE

This review aimed to determine (1) performance and training characteristics such as training intensity distribution (TID), volume, periodization, and methods in highly trained/elite distance runners and (2) differences in training volume and TID between event distances in highly trained/elite distance runners.

METHODS

A systematic review of the literature was carried out using the PubMed/MEDLINE, Scopus, and Web of Science databases.

RESULTS

Ten articles met the inclusion criteria. Highly trained/elite distance runners typically follow a pyramidal TID approach, characterized by a decreasing training volume from zone 1 (at or below speed at first ventilatory/lactate threshold [LT]) to zone 2 (between speeds associated with either both ventilatory thresholds or 2 and 4 mmol·L-1 LTs [vLT1 and vLT2, respectively]) and zone 3 (speed above vVT2/vLT2). Continuous-tempo runs or interval training sessions at vLT2 in zone 2 (ie, medium and long aerobic intervals) and those in zone 3 (ie, anaerobic or short-interval training) were both used at least once per week each in elite runners, and they were used to increase the number of either vLT2 or z3 sessions to adopt either a pyramidal or a polarized approach, respectively. More pyramidal- and polarized-oriented approaches were used by marathoners and 1500-m runners, respectively.

CONCLUSIONS

Highly trained and elite middle- and long-distance runners are encouraged to adopt a traditional periodization pattern with a hard day-easy day basis, consisting in a shift from a pyramidal TID used during the preparatory and precompetitive periods toward a polarized TID during the competitive period.

Medical Encounters Among 94,033 Race Starters During a 16.1-km Running Event Over 3 Years in the Netherlands: SAFER XXVI

BACKGROUND

There are limited data on the medical encounters (MEs) occurring during mass community-based running events of shorter distances (10-21.1 km). The aim of this study was to determine the incidence and nature of MEs during the largest mass participation running event in the Netherlands.

HYPOTHESIS

We hypothesize that the incidence and nature of MEs will be similar to other running events.

STUDY DESIGN

Descriptive epidemiological study over 3 years of a 16.1-km (10-mile) running event.

LEVEL OF EVIDENCE

Level 4.

METHODS

We investigated a total of 94,033 race starters at the 2017-2019 Dam tot Damloop (16.1 km), a point-to-point road race from Amsterdam to Zaandam, the Netherlands. All MEs were recorded by race medical staff on race day each year. MEs were retrospectively coded by severity, organ system, and final specific diagnosis (2019 consensus statement definition on mass community-based events). Incidence (I) per 1000 starters (95% CIs) were calculated for all MEs and serious/life-threatening MEs.

RESULTS

The overall incidence (per 1000 starters) of all MEs was 2.75 (95% CI, 2.44-3.11), the overall incidence of serious/life-threatening MEs was 1.20 (95% CI, 1.00-1.45; 44% of MEs). Heat illnesses accounted for most MEs: hypothermia I = 0.54 (95% CI, 0.41-0.71) and hyperthermia I = 0.46 (95% CI, 0.34-0.62). Central nervous system MEs were also common (dizziness/nausea, I = 0.79; 95% CI 0.63-0.99), followed by the cardiovascular system MEs (exercise-associated postural hypotension, I = 0.36; 95% CI, 0.26-0.51).

CONCLUSION

The overall incidence of MEs was low compared with longer-distance races (21.1-90 km), but the incidence and relative frequency of serious/life-threatening MEs (44% of all MEs) was much higher. Heat illness (hypothermia and exertional heat stroke) accounted for most serious/life-threatening MEs.

CLINICAL RELEVANCE

There is a need to implement prevention strategies and interventions by specialized medical practitioners in this and similar events.

Youth Distance Running and Lower Extremity Injury: A Systematic Review

Distance running is a popular youth sport. This systematic review identified and examined the effects of youth distance running and lower extremity musculoskeletal injury. Scientific databases were searched from database inception to May 2020. Two hundred and fifty-eight full texts were screened, with nine articles retained for data extraction. Seven of the studies were case reports or case series. Two case reports involved an apophyseal hip fracture. No correlation was found between running mileage or gender and sustaining an injury. Middle school runners reported fewer injuries than high school runners. Cross country accounted for less than 10% of injuries in youth under 15 compared to other track activities. The main finding was a paucity of research. Available literature suggests youth can participate in distance running with minimal adverse effects. One exception may be increased vulnerability to growth plate injury. Additional research is needed, especially in those under 10, as literature in this population is nonexistent.

Racing Clean in a Tainted World: A Qualitative Exploration of the Experiences and Views of Clean British Elite Distance Runners on Doping and Anti-Doping

Background: Doping has been a prominent issue for the sport of athletics in recent years. The endurance disciplines, which currently account for 56% of the global anti-doping rule violations in athletics, appear to be particularly high risk for doping. Objective: Using this high-risk, high-pressure context, the main purpose of this study was to investigate the human impact of doping and anti-doping on "clean" athletes. The secondary aim of the study was to better understand the reasons for, and barriers to, competing "clean" among this group of athletes. Method: Semi-structured interviews were conducted with 11 elite distance runners from the UK to explore: (1) the reasons and motivations for competing clean. (2) Perceptions of the anti-doping system, and experiences of being part of that system. (3) Views on the prevalence and causes of doping and the impact of doping on the lives of clean athletes. The interviews were audio-recorded, transcribed verbatim, and analysed using Reflexive Thematic Analysis. Results: Four major themes were identified: (1) The participants in this study have not been tempted to use prohibited substances or methods; they compete in their sport for the personal satisfaction of seeing how good they can be, rather than in pursuit of winning at all costs. (2) Anti-doping does not currently prevent doping effectively and is not implemented evenly across the globe. (3) Doping was perceived as a major issue and was felt to be borne out of certain sporting cultures in which doping is enabled. (4) Doping has impacted the careers of clean athletes in irreversible ways and presents a continuing challenge to the psychological preparation for competition. Conclusions: Clean athletes suffer negative consequences from both doping and anti-doping. ADOs must collaborate across borders to ensure a more even implementation of anti-doping activities, to facilitate a more level playing field on the global stage. ADOs must also acknowledge the existence of a large group of athletes who would never consider deliberately doping and make anti-doping work for these athletes too.

Development and Validation of Prediction Equation of "Athens Authentic Marathon" Men's Race Speed

Aim

Despite the increasing popularity of outdoor endurance running races of different distances, little information exists about the role of training and physiological characteristics of recreational runners. The aim of the present study was (a) to examine the role of training and physiological characteristics on the performance of recreational marathon runners and (b) to develop a prediction equation of men’s race time in the “Athens Authentic Marathon.”

Methods

Recreational male marathon runners (n = 130, age 44.1 ± 8.6 years)—who finished the “Athens Authentic Marathon” 2017—performed a series of anthropometry and physical fitness tests including body mass index (BMI), body fat percentage (BF), maximal oxygen uptake (VO₂max), anaerobic power, squat, and countermovement jump. The variation of these characteristics was examined by quintiles (i.e., five groups consisting of 26 participants in each) of the race speed. An experimental group (EXP, n = 65) was used to develop a prediction equation of the race time, which was verified in a control group (CON, n = 65).

Results

In the overall sample, a one-way ANOVA showed a main effect of quintiles on race speed on weekly training days and distance, age, body weight, BMI, BF, and VO₂max (p ≤ 0.003, η² ≥ 0.121), where the faster groups outscored the slower groups. Running speed during the race correlated moderately with age (r = −0.36, p < 0.001) and largely with the number of weekly training days (r = 0.52, p < 0.001) and weekly running distance (r = 0.58, p < 0.001), but not with the number of previously finished marathons (r = 0.08, p = 0.369). With regard to physiological characteristics, running speed correlated largely with body mass (r = −0.52, p < 0.001), BMI (r = −0.60, p < 0.001), BF (r = −0.65, p < 0.001), VO₂max (r = 0.67, p < 0.001), moderately with isometric muscle strength (r = 0.42, p < 0.001), and small with anaerobic muscle power (r = 0.20, p = 0.021). In EXP, race speed could be predicted (R² = 0.61, standard error of the estimate = 1.19) using the formula “8.804 + 0.111 × VO₂max + 0.029 × weekly training distance in km −0.218 × BMI.” Applying this equation in CON, no bias was observed (difference between observed and predicted value 0.12 ± 1.09 km/h, 95% confidence intervals −0.15, 0.40, p = 0.122).

Conclusion

These findings highlighted the role of aerobic capacity, training, and body mass status for the performance of recreational male runners in a marathon race. The findings would be of great practical importance for coaches and trainers to predict the average marathon race time in a specific group of runners.

Injury Prediction in Competitive Runners With Machine Learning

PURPOSE

Staying injury free is a major factor for success in sports. Although injuries are difficult to forecast, novel technologies and data-science applications could provide important insights. Our purpose was to use machine learning for the prediction of injuries in runners, based on detailed training logs.

METHODS

Prediction of injuries was evaluated on a new data set of 74 high-level middle- and long-distance runners, over a period of 7 years. Two analytic approaches were applied. First, the training load from the previous 7 days was expressed as a time series, with each day's training being described by 10 features. These features were a combination of objective data from a global positioning system watch (eg, duration, distance), together with subjective data about the exertion and success of the training. Second, a training week was summarized by 22 aggregate features, and a time window of 3 weeks before the injury was considered.

RESULTS

A predictive system based on bagged XGBoost machine-learning models resulted in receiver operating characteristic curves with average areas under the curves of 0.724 and 0.678 for the day and week approaches, respectively. The results of the day approach especially reflect a reasonably high probability that our system makes correct injury predictions.

CONCLUSIONS

Our machine-learning-based approach predicts a sizable portion of the injuries, in particular when the model is based on training-load data in the days preceding an injury. Overall, these results demonstrate the possible merits of using machine learning to predict injuries and tailor training programs for athletes.

Factors Associated With Self-Selected Step Rates Between Collegiate and High School Cross Country Runners

Introduction: Cross country is a popular high school and collegiate sport with a high rate of running-related injuries (RRI). Among high school runners, higher step rates have been associated with greater running experience and decreased body height, and lower step rates have been prospectively associated with increased risk of shin RRI. These associations have not been reported in collegiate cross country runners. The purpose of this study was to compare step rates between collegiate and high school cross country runners. Secondary objectives included determining if step rates in collegiate runners were related to experience and anthropometric variables, and whether their self-selected step rates were prospectively related to lower extremity RRI. Materials and methods: Twenty-nine NCAA Division III collegiate cross country runners (13 females, mean ± SD age 19.7 ± 1.3 years) completed a survey and ran at their self-selected speed. Step rate was assessed with Polar RCX5 wristwatches and S3+ Stride Sensors™ on the first day of the season. Runners were followed during the season for occurrence of time-loss lower extremity RRI. A cohort of 68 high school runners was used for comparison of step rates at their self-selected speeds. Results: Collegiate runners' self-selected step rates (177.1 ± 7.2 spm [steps per minute]) were higher than high school runners' (171.3 ± 8.3 spm) (p = 0.01). Collegiate runners ran at higher self-selected speeds (4.6 ± 0.5 m/s) than the high school runners (3.8 ± 0.5 m/s) (p < 0.001). A lower percentage of collegiate runners ran at ≤166 spm than high school runners. Body mass was negatively correlated with step rate in collegiate runners. During the season, 41.3% of collegiate runners experienced lower extremity RRI. Step rates for collegiate runners who did not experience RRI (178.9 ± 7.7 spm) were not significantly higher than runners who did experience RRI (174.5 ± 5.7 spm) (p = 0.10). Discussion: Higher step rates were found in collegiate than high school runners, but the difference was partially explained by higher self-selected running speeds. Thus, variations in step rate between high school and collegiate runners may be expected based on experience, speed, and body mass.

Effect of photobiomodulation therapy on performance and running economy in runners: A randomized double-blinded placebo-controlled trial

The objective of this study was to evaluate effects of photobiomodulation therapy (PBMT) on the 3000 m running performance (primary outcome), running economy (RE), metabolic cost and ratings of perceived exertion during running (secondary outcomes). Twenty male endurance athletes performed 4-min treadmill rectangular test at 12 km.h-1 monitored by a gas analyser. After that, PBMT or placebo in each lower limb was applied, followed performed a maximum test of 3000 m. Immediately after 3000 m test, the athletes repeated the treadmill test. Another application of PBMT/placebo was done after the treadmill test, and athletes went back to the laboratory 24 h later to repeat the treadmill test. After a 72 h interval, athletes repeated all procedures with another treatment intervention (PBMT/placebo). Athletes performed the 3000 m running test ~7s faster when treated with PBMT with similar effort score compared placebo condition. The RE remains unchanged immediately post 3000 m running test, nonetheless RE measured post-24 h improved by 5% with PBMT application without changes in metabolic cost. The PBMT pre- and post-conditioning enhanced the 3000 m running performance and improved RE 24 h following the 3000 m test. However, no changes on ratings of perceived exertion and metabolic cost with the application of PBMT.

Effects of Foot Strike Techniques on Running Biomechanics: A Systematic Review and Meta-analysis

CONTENT

Distance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect biomechanical variables related to RRI risks.

OBJECTIVE

To determine the effects of foot strike techniques on running biomechanics.

DATA SOURCES

The databases of Web of Science, PubMed, EMBASE, and EBSCO were searched from database inception through November 2018.

STUDY SELECTION

The initial electronic search found 723 studies. Of these, 26 studies with a total of 472 participants were eligible for inclusion in this meta-analysis.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Means, standard deviations, and sample sizes were extracted from the eligible studies, and the standard mean differences (SMDs) were obtained for biomechanical variables between forefoot strike (FFS) and rearfoot strike (RFS) groups using a random-effects model.

RESULTS

FFS showed significantly smaller magnitude (SMD, -1.84; 95% CI, -2.29 to -1.38; P < 0.001) and loading rate (mean: SMD, -2.1; 95% CI, -3.18 to -1.01; P < 0.001; peak: SMD, -1.77; 95% CI, -2.21 to -1.33; P < 0.001) of impact force, ankle stiffness (SMD, -1.69; 95% CI, -2.46 to -0.92; P < 0.001), knee extension moment (SMD, -0.64; 95% CI, -0.98 to -0.3; P < 0.001), knee eccentric power (SMD, -2.03; 95% CI, -2.51 to -1.54; P < 0.001), knee negative work (SMD, -1.56; 95% CI, -2.11 to -1.00; P < 0.001), and patellofemoral joint stress (peak: SMD, -0.71; 95% CI, -1.28 to -0.14; P = 0.01; integral: SMD, -0.63; 95% CI, -1.11 to -0.15; P = 0.01) compared with RFS. However, FFS significantly increased ankle plantarflexion moment (SMD, 1.31; 95% CI, 0.66 to 1.96; P < 0.001), eccentric power (SMD, 1.63; 95% CI, 1.18 to 2.08;P < 0.001), negative work (SMD, 2.60; 95% CI, 1.02 to 4.18; P = 0.001), and axial contact force (SMD, 1.26; 95% CI, 0.93 to 1.6; P < 0.001) compared with RFS.

CONCLUSION

Running with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.

The accurate prediction of sweat rate from energy expenditure and air temperature: a proof-of-concept study

This proof-of-concept study used a web application to predict runner sweat losses using only energy expenditure and air temperature. A field study (FS) of n = 37 runners was completed with n = 40 sweat loss observations measured over 1 h (sweat rate, SR). Predictions were also compared with 10 open literature (OL) studies in which individual runner SR was reported (n = 82; 109 observations). Three prediction accuracy metrics were used: for FS, the mean absolute error (MAE) and concordance correlation coefficient (CCC) were calculated to include a 95% confidence interval [CI]; for OL, the percentage concordance (PC) was examined against calculation of accumulated under- and over-drinking potential. The MAE for FS runners was 0.141 kg [0.105, 0.177], which was less than estimated scale weighing error on 85% of occasions. The CCC was 0.88 [0.82, 0.93]. The PC for OL was 96% for avoidance of both under- and over-drinking and 93% overall. All accuracy metrics and their CIs were below acceptable error tolerance. Input errors of ±10% and ±1 °C for energy expenditure and air temperature dropped the PC to between 84% and 90%. This study demonstrates the feasibility of accurately predicting SR from energy expenditure and air temperature alone. Novelty Results demonstrate that accurate runner SR prediction is possible with knowledge of only energy expenditure and air temperature. SR prediction error was smaller than scale weighing error in 85% of observations. Accurate runner SR prediction could help mitigate the common risks of over- and under-drinking.

Sacral Stress Fractures: A Rare but Curable Cause of Back Pain in Athletes

BACKGROUND

Stress fractures of the sacrum are an uncommon cause of low back and buttock pain in athletes. They have been described in a few case reports, with the injury occurring most often in female distance runners. Given the rarity of this condition, there is a general lack of awareness of this injury, which may lead to a missed or delayed diagnosis.

STUDY DESIGN

Case series.

LEVEL OF EVIDENCE

Level 5.

METHODS

The 5 cases were identified by performing a medical records search within the practices of the senior authors over a 3-year period from January 2016 to December 2018.

RESULTS

Three of 5 patients (1 male, 2 females) returned to regular activity after diagnosis and treatment. Two (1 male, 1 female) have yet to return to regular activity. Magnetic resonance imaging was the key modality in all diagnoses. All 3 female patients had components of the female athlete triad-menstrual irregularity, disordered eating, and decreased bone mineral density.

CONCLUSION

A high index of suspicion is required to make the correct diagnosis and initiate treatment for this rare condition given its association with low body mass index, vitamin D insufficiency, disordered eating, and malabsorption disorders. Appropriate treatment includes rest from the causative activity, nutritional support, and biomechanical optimization. In severe, chronic, or recurrent cases, referral for nutritional counseling, hormonal replacement therapies, and mental health support may be necessary.

CLINICAL RELEVANCE

Sacral stress fractures, though uncommon, should be included prominently in the differential diagnosis for runners with low back pain, especially if the athlete has a history of prior stress fracture or the female athlete triad.

Risk Taking Runners Slow More in the Marathon

Much research has explored the physiological, energetic, environmental, and psychological factors that influence pacing in endurance events. Although this research has generally neglected the role of psychological variation across individuals, recent studies have hinted at its importance. Here we conducted an online survey of over 1,300 marathon runners, testing whether any of five psychological constructs - competitiveness, goal achievement, risk taking in pace (RTP), domain-specific risk taking, and willingness to suffer in the marathon - predicted slowing in runners' most recent marathons. Analyses revealed that RTP - the extent to which runners agreed that they began the marathon at a pace that was so fast that it would jeopardize their capacity to maintain this pace throughout the event - was a robust predictor of marathon slowing. RTP proved a substantial predictor even in regression models controlling for the other psychological constructs, training, experience, and other known pacing correlates. This result suggests that marathoners consider trade-offs when making pacing decisions, and that individuals vary in their pacing decision making.

The Effects of Submaximal and Maximal Exercise on Heart Rate Variability

The purpose of this study was to examine heart rate variability (HRV) at rest, and during submaximal (100 bpm) and maximal exercise in collegiate distance runners. We predicted there would be less HRV during exercise. Eight collegiate runners (19-22 yrs) were recruited for participation. The participants were equipped with a standard Lead II EKG to record HRV at rest. The participants then performed an incremental VO_2max test while running on a treadmill. EKG was recorded throughout the exercise test and HRV was later calculated during the submaximal and maximal exercise. To assess HRV the standard deviation of R-R intervals (SDNN) was calculated at rest and during submaximal and maximal exercise. A one-way ANOVA was used to determine HRV differences between these three states. The average R-R interval was 0.961 ± 0.155 s (64 bpm), 0.413 ± 0.018 s (146 bpm), and 0.321 ± 0.008 s (187 bpm) for rest, submaximal, and maximal exercise, respectively. There were significant differences in SDNN from rest to submaximal (0.108 ± 0.055 to 0.008 ± 0.002 s, p < 0.05), and from rest to maximal exercise (0.108 ± 0.055 to 0.006 ± 0.002 s, p < 0.05). When comparing HRV between the resting and exercise states it seems that the parasympathetic nervous system (PNS) influence at rest contributes to greater HRV, whereas the sympathetic nervous system (SNS) influence during both submaximal and maximal exercise corresponds to a reduced HRV. These effects may be related to the enhanced automaticity effects of norepinephrine acting on its B₁ receptor sites in the heart.

Effect of downhill running grade on lower extremity loading in female distance runners

Hill running is often used as a foundational training mechanism to build strength and speed. Distance runners in particular are at an increased likelihood of encountering steep hills during training runs. There is limited research regarding downhill running, and there is no research available on the biomechanics of females specifically during downhill running. The purpose of this study was to quantify the differences in loading when running downhill at different grades compared to a level surface in female distance runners to determine the potential risk for injury. Fifteen female distance runners (age: 23.5 ± 4.9 y), who ran 56.3 ± 20.9 km a week participated in this study. Participants ran on a force-instrumented treadmill at 4.0 m/s for 2 min at 0%, -5%, -10%, -15%, and -20% grades, with 5 min of rest between conditions. Study findings showed increased impact forces (p < 0.001), and increased loading rates (p < 0.001) with increasing downhill grades compared to level. These results indicate a significantly greater risk of overuse injury to the lower extremity with steeper downhill grades. Individuals need to be aware of these risks to plan and implement training programmes that will increase performance while minimising injury risk.

Acute Reduction in Spirometry Values After Prolonged Exercise Among Recreational Runners

BACKGROUND

Prolonged endurance running may acutely reduce spirometric lung values. This study examined changes in spirometry before and immediately after prolonged endurance exercise (running and/or walking). Specifically, we examined potential factors that predict the presence of at least a 10% postexercise reduction in FEV₁.

METHODS

After institutional review board approval, recruitment occurred at a pre-race exposition, where informed consent was obtained. Pre-and post-race spirometry measurements were taken from 79 study subjects who competed in a half-marathon (n = 66) or a marathon (n = 13). Spirometry was performed 1-2 days before the marathon or half-marathon and 25 min after finish the race.

RESULTS

We identified a subgroup of 23 subjects with a postexercise decrease in FEV₁ of ≥10%. In this subgroup, the mean post-race values for FEV₁, FVC, and peak expiratory flow were 19-24% lower than the pre-race values. In the 56 subjects with a change in FEV₁ of <10%, the mean post-race changes in spirometry values were not >6%. There was no difference between the 2 groups in sex distribution or between subjects who completed the half-marathon or the full marathon. For every 1-y increase in age, the likelihood of developing a postexercise reduction in FEV₁ of at least 10% decreased by nearly 10% (R² = 0.15, P = .003).

CONCLUSIONS

Exercise-induced bronchoconstriction (EIB) is the most probable explanation for the reduction in post-race FEV₁. Prolonged endurance exercise reduced spirometric lung function by ∼20% in those with EIB. Age was the only predictor for EIB, and EIB did not affect the finish times among recreational runners and/or walkers.

Towards a complex systems approach in sports injury research: simulating running-related injury development with agent-based modelling

OBJECTIVES

There have been recent calls for the application of the complex systems approach in sports injury research. However, beyond theoretical description and static models of complexity, little progress has been made towards formalising this approach in way that is practical to sports injury scientists and clinicians. Therefore, our objective was to use a computational modelling method and develop a dynamic simulation in sports injury research.

METHODS

Agent-based modelling (ABM) was used to model the occurrence of sports injury in a synthetic athlete population. The ABM was developed based on sports injury causal frameworks and was applied in the context of distance running-related injury (RRI). Using the acute:chronic workload ratio (ACWR), we simulated the dynamic relationship between changes in weekly running distance and RRI through the manipulation of various 'athlete management tools'.

RESULTS

The findings confirmed that building weekly running distances over time, even within the reported ACWR 'sweet spot', will eventually result in RRI as athletes reach and surpass their individual physical workload limits. Introducing training-related error into the simulation and the modelling of a 'hard ceiling' dynamic resulted in a higher RRI incidence proportion across the population at higher absolute workloads.

CONCLUSIONS

The presented simulation offers a practical starting point to further apply more sophisticated computational models that can account for the complex nature of sports injury aetiology. Alongside traditional forms of scientific inquiry, the use of ABM and other simulation-based techniques could be considered as a complementary and alternative methodological approach in sports injury research.

Prediction of lactate threshold using the modified Conconi test in distance runners

This study aimed to examine the validity of the modified Conconi test (CT) to predict lactate threshold (LT) during running. Twelve distance runners randomly performed the modified CT and the incremental test in which LT was determined directly by measuring blood lactate (BLa). Mean values of heart rate (HR) and running speed (RS) at heart rate deflection point (HR_DP) obtained through the modified CT were compared with those at LT. Subsequently, the runners who showed a HR_DP in the modified CT performed a 30-min prolonged exercise test (PET) at a RS corresponding to HR_DP. During this test, the kinetics of BLa and HR were analyzed to determine whether a steady state in these variables could be attained. We succeeded in identifying HR_DP in nine of our runners, whereas the remaining three runners showed entirely linear HR response. In those nine runners, no significant difference was found between HR and RS at HR_DP and those at LT. Significant correlation was found between HR at HR_DP and HR at LT (r = 0.84, p = 0.005), but RS at HR_DP was not significantly correlated with RS at LT (r = 0.63, p = 0.07). All nine runners were able to complete the PET with steady state conditions being achieved for both BLa and HR. In conclusion, these findings indicate that the modified CT has a potential to be used as an alternative method for assessment of LT in distance runners presenting a HR_DP.

Epidemiology of National Collegiate Athletic Association Men's and Women's Cross-Country Injuries, 2009-2010 Through 2013-2014

CONTEXT

Recent injury-surveillance data for collegiate-level cross-country athletes are limited.

OBJECTIVE

To describe the epidemiology of National Collegiate Athletic Association (NCAA) men's and women's cross-country injuries during the 2009-2010 through 2013-2014 academic years.

DESIGN

Descriptive epidemiology study.

SETTING

Aggregate injury and exposure data collected from 25 men's and 22 women's cross-country programs, providing 47 and 43 seasons of data, respectively.

PATIENTS OR OTHER PARTICIPANTS

Collegiate student-athletes participating in men's and women's cross-country during the 2009-2010 through 2013-2014 academic years.

MAIN OUTCOME MEASURE(S)

Injury rates; injury rate ratios (RRs); injury proportions by body site, diagnosis, and apparatus; and injury proportion ratios were reported with 95% confidence intervals (CIs).

RESULTS

The Injury Surveillance Program captured 216 injuries from men's cross-country and 260 injuries from women's cross-country, leading to injury rates of 4.66/1000 athlete-exposures (AEs) for men (95% CI = 4.04, 5.28) and 5.85/1000 AEs for women (95% CI = 5.14, 6.56). The injury rate in women's cross-country was 1.25 times that of men's cross-country (95% CI = 1.05, 1.50). Most injuries affected the lower extremity (men = 90.3%, women = 81.9%). The hip/groin-injury rate in women (0.65/1000 AEs) was higher than that in men (0.15/1000 AEs; RR = 4.32; 95% CI = 1.89, 9.85). The ankle-injury rate in men (0.60/1000 AEs) was higher than that in women (0.29/1000 AEs; RR = 2.07; 95% CI = 1.07, 3.99). Common diagnoses were strains (men = 19.9%, women = 20.4%) and inflammation (men = 18.1%, women = 23.8%). The majority of injuries were classified as overuse (men = 57.6%, women = 53.3%).

CONCLUSIONS

Consistent with prior research, injury distributions varied between male and female athletes, and the injury rate among females was higher. Understanding the epidemiology of these cross-country injuries may be important for developing appropriate preventive interventions.

Oxygen consumption of elite distance runners on an anti-gravity treadmill®

Lower body positive pressure (LBPP), or 'anti-gravity' treadmills® have become increasingly popular among elite distance runners. However, to date, few studies have assessed the effect of body weight support (BWS) on the metabolic cost of running among elite runners. This study evaluated how BWS influenced the relationship between velocity and metabolic cost among 6 elite male distance runners. Participants ran three- 16 minute tests consisting of 4 stages of 4 minutes at 8, 7, 6 and 5 min·mile(-1) pace (3.35, 3.84, 4.47 and 5.36 m·s(-1)), while maintaining an aerobic effort (Respiratory Exchange Ratio ≤1.00). One test was run on a regular treadmill, one on an anti-gravity treadmill with 40% BWS and one with 20% BWS being provided. Expired gas data were collected and regression equations used to determine and compare slopes. Significant decreases in oxygen uptake (V̇O2) were found with each increase in BWS (p < 0.001). At 20% BWS, the average decrease in net VO2 was greater than proportional (34%), while at 40% BWS, the average net reduction in VO2 was close to proportional (38%). Across velocities, the slope of the relationship between VO2 and velocity (ΔV̇O2/Δv) was steeper with less support. The slopes at both the 20% and 40% BWS conditions were similar, especially when compared to the regular treadmill. Variability in VO2 between athletes was much greater on the LBPP treadmill and was greater with increased levels of BWS. In this study we evaluated the effect of body weight support on V̇O2 among elite distance runners. We have shown that oxygen uptake decreased with support, but not in direct proportion to that support. Further, because of the high variability in oxygen uptake between athletes on the LBPP treadmill, prediction equations may not be reliable and other indicators (heart rate, perceived exertion or directly measured oxygen uptake) should be used to guide training intensity when training on the LBPP treadmill. Key pointsWith increasing amounts of body weight-support (BWS), the slope of the relationship between velocity and oxygen consumption (ΔVO2/Δv) decreases significantly. This means the change in oxygen consumption (VO2) is significantly smaller over a given change in velocity at higher amounts of BWS.There is a non-linear decrease in VO2 with increasing BWS. As such, with each increment in the amount of BWS provided, the reduction in VO2 becomes increasingly smaller.This paper provides first of its kind data on the effects of BWS on the cost of running among highly trained, elite runners. The outcomes of this study are in line with previous findings among non-elite runners.

Impact of age on haematological markers pre- and post-marathon running

This study investigated whether haematological markers differ between young and masters marathon participants, running at similar performance levels. Nine young (31.89 ± 4.96 years) and eight masters (63.13 ± 4.61 years) runners participated. At five time points (pre-race through 54 h post-race), a complete blood cell count, basic metabolic panel and creatine kinase (CK) isoenzyme panel were assessed. Race performance was standardised using the World Masters Association Age Grading Performance Tables. Total CK levels were elevated for all participants at all time points post-race (P < 0.001). The CK-isoenzyme MB% was elevated across groups at 6, 30 and 54 h post-race (P < 0.01, P < 0.01 and P < 0.05), with masters runners having a higher CK-MB% at 30 and 54 h (P < 0.05, P < 0.05). Total white blood cell and neutrophil counts were elevated through 6 h post-race (P < 0.001), with higher levels found in younger runners (P < 0.001). When considering all blood work, masters runners had a higher number of abnormal values at 6, 30 and 54 h post-race (P < 0.05, P < 0.01 and P < 0.05). In conclusion, masters runners demonstrated sustained CK-MB elevation, which may suggest greater cardiac stress. However, future studies using additional cardiac markers should be completed to confirm these findings. In addition, masters runners showed an increased number of laboratory values outside normal range, indicating the body's reduced capacity to respond to marathon running.

U.S. masters track participation reveals a stable sex difference in competitiveness

It is well established that men are more likely than women to engage in direct competition, but it is unclear if this reflects social structural conditions or evolved predispositions. These hypotheses can be addressed by quantifying competitiveness in sports and testing if the sex difference is decreasing over time in the U.S., a society where social roles have converged. Study 1 assessed participation and the occurrence of relatively fast performances by masters runners (40-74 years old) at recent road races and track meets. Fast performances occurred over 20 times more often at track meets than at road races. Women comprised 55% of finishers at roads races but only 15-28% of finishers at track meets. Thus, the sex difference in masters track participation can serve as a measure of the sex difference in competitiveness. Study 2 used data from national championship meets and yearly rankings lists to test whether the sex difference in masters track participation decreased from 1988-2012. The sex difference decreased overall, but there was no evidence of change since the late 1990s. Therefore, the sex difference in the willingness to engage in direct sports competition appears to reflect both social structural conditions and evolved predispositions.

The relationship between age and running time in elite marathoners is U-shaped

Several investigations have demonstrated that running performance gradually decreases with age by using runners >25 years grouped in 5-year age brackets. The aim of this study was to determine the relationship between race time in marathon and age in elite marathoners by including all ages and 1-year intervals. Running times of the top ten men and women at 1-year intervals (from 18 to 75 years) in the New York City marathon were analyzed for the 2010 and 2011 races. Gender differences in performance times were analyzed between 18 and 70 years of age. The relationship between running time and runner's age was U-shaped: the lowest race time was obtained at 27 years (149 ± 14 min) in men and at 29 years (169 ± 17 min) in women. Before this age (e.g., 27 years for men and 29 years for women), running time increased by 4.4 ± 4.0 % per year in men and 4.4 ± 4.3 % per year in women. From this age on, running time increased by 2.4 ± 8.1 % per year in men and 2.5 ± 9.9 % per year in women. The sex difference in running time remained stable at ~18.7 ± 3.1 % from 18 to 57 years of age. After this, sex difference progressively increased with advancing age. In summary, endurance runners obtained their best performance in the marathon at 27 years in men and 29 in women. Thus, elite marathon runners should program their long-term training to obtain maximal performance during their late 20s.

Influence of gait manipulation on running economy in female distance runners

The aim of this investigation was to determine if gait manipulation influences running economy. Following 30 minutes of accommodation to level treadmill running at 3.35 m·s(-1) and determination of VO2peak, nine female distance runners (age = 23.3 ± 4.2 years; body mass = 57.5 ± 5.2 kg; height = 1.64 ± 0.10 m; body fat = 11.4 ± 2.4 %; VO2peak = 54.9 ± 4.1 ml·kg(-1)·min(-1)) completed two treadmill running sessions. In each session, standing VO2 was measured and subjects ran for 6 minutes at 3.35 m·s(-1) under 4 randomly-selected conditions: a) normal running (NL), b) hands behind back (BK), c) hands on head (HD), and d) running with exaggerated vertical oscillation (VOSC). During the last 2 minutes of each running bout, samples of expired air were analyzed to determine oxygen uptake (VO2). Data obtained by averaging gross VO2 values across sessions indicated that VOSC (51.0 ± 2.5 ml·kg(-1)·min(-1)) and HD (46.1 ± 2.0 ml·kg(-1)·min(-1)) resulted in significantly (p < 0.05) elevated VO2 values compared to BK (43.9 ± 2.4 ml·kg(-1)·min(-1)) and NL (43.4 2.6 ml·kg(-1)·min(-1)). VO2 measured during VOSC was also higher compared to HD. Viewed in concert, these results suggest that specific gait manipulations can produce marked decrements in running economy among trained female distance runners. Key pointsThis investigation demonstrates that specific biomechanical manipulations can produce substantive increases in the oxygen cost (VO2) of submaximal running in female distance runners.The magnitude of increases in VO2 reported in this study raises the intriguing possibility that meaningful improvements in running economy might be achieved by manipulating the gait of distance runners who exhibit specific aspects of running style that deviate markedly from the optimum.