Physiological and Pathophysiological Responses to Ultramarathon Running in Non-elite Runners

Abstract

Ultramarathon running represents a major physical challenge even for elite athletes. Runners wellbeing may be challenged by fluid and electrolyte disturbances, hemolysis and skeletal muscle damage, decline in hepatic function and kidney injury. We hypothesized that these effects may even be exacerbated in non-elite runners. Physiological, hematological and biochemical parameters of ten males (26–45 years, weekly training time 8.5 h), participating in a mountain ultramarathon (67 km; approximately 4,500 m of total ascent), were determined before (PRE), immediately after finishing the ultramarathon (POST), and 24 h after the individual finish (REC). Race times of the 8 finishers (2 drop-outs due to hot ambient temperature) varied between 10.4 and 16.1 h, which almost represents the range of the entire starter field (8.82 h–17.47 h). The following changes in mean values of selected markers for skeletal muscle damage and kidney injury were observed from PRE to POST: creatine kinase (CK) + 1289%, lactate dehydrogenase (LDH) + 87%, serum creatinine (CR) + 72%, blood urea nitrogen (BUN) + 96%, and estimated glomerular filtration rate (eGFR) – 45%. Values of CK + 1447%, LDH + 56%, and BUN + 71% remained elevated at REC. White blood cells were increased (+ 137%) only POST. In conclusion, CK and LDH levels and leucocytosis may be considered to be relatively harmless “side-effects” of prolonged running in this group of male subjects with rather moderate ultramarathon experience and training status. However, acute kidney injury may become clinically relevant in this population under the certain conditions, which should be considered by responsible race managers and medical advisors.

Effect of mountain ultramarathon distance competition on biochemical variables, respiratory and lower-limb fatigue

“…Concerning muscle damage, LDH release pattern was consistent following both races and coincides with previous studies in MUM [4,18,21]. It peaked immediately post-race and dropped at 24 h post-race, although its values remained significantly different from pre-race.…”

“…Moreover, no UT runner and only one LT runner met the criteria for AKI at 24-h post race. Similar results at post-race and 24-h post-race have been previously described following a multi-stage ultramarathon [17], a 104-km MUM [16], a 67-km MUM [18], a road marathon [32,54] and a road half-marathon [55]. Therefore, it seems that no long-term renal function repercussions are expected following either road half & full marathons, or MUM.…”

“…The popularity of mountain ultramarathons (MUM) has grown exponentially during the last few years [1,2] and they constitute an outstanding model for the study of the acute consequences of ultra-endurance exercise on human body physiology [3]. Indeed, several investigations have documented the effects of running a MUM on lower-limb neuromuscular fatigue [4][5][6][7], respiratory fatigue [8,9], cardiac damage [10][11][12][13], renal function and inflammatory activity [4,[14][15][16][17][18]. These data is important for both medical and coaching communities, to increase the knowledge of potential side effects and a harmful influence on health of running a MUM [19], on one hand; and, on the other hand, to help coaches to better plan their athletes' training sessions following the race [20].…”

Post-Exercise Hypotension and Reduced Cardiac Baroreflex after Half-Marathon Run: In Men, but Not in Women

“…Unfortunately, only men were involved in these previous studies, and for instance, Senitko et al [ 27 ] did not evaluate cardiac BRS in their comparison of sedentary and trained women and men after 1 h of cycling. No sex differences in cardiac BRS have been reported after ultra-endurance exercise (135 ± 50 km, over 28 ± 9 h) [ 30 ] but in that case, the nature of the exercise stimuli is very different from the present study (beyond the important duration, the intensity for such race is low (e.g., [ 57 ])). Hence, to date, sex differences in post-exercise cardiac BRS responses have been poorly studied and do not specifically relate to endurance exercise [ 49 , 58 ], making comparison with the existing literature difficult.…”

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

“…The different distances run by participants range from mountain marathons (42,195 m) to multistage ultra-marathons (up to 350 km), with an accumulative altitude gain of 24,000 m during the most extreme events [ 2 ]. In addition, mountain athletes are exposed to different environmental conditions, such as irregular terrains with a variety of geographical and topographic characteristics, climatic conditions, altitude exposure and temperature fluctuations [ 2 , 3 , 4 ]. This results in extreme physiological demands which may cause, among other things, negative energy balance, dehydration, decrease in blood glucose levels, muscle and hepatic glycogen depletion, exercise induced muscle damage (EIMD) and inflammation [ 2 , 3 , 4 , 5 ], and therefore might induce high levels of neuromuscular fatigue [ 2 , 6 ].…”