Sex-Specific Physiological Responses to Ultramarathon

Abstract

Purpose: Despite a growing body of literature on the physiological responses to ultramarathon, there is a paucity of data in females. This study assessed the female physiological response to ultramarathon and compared the frequency of perturbations to a group of race-and time-matched males. Methods: Data were collected from 53 contestants of an ultramarathon trail race at the Ultra-Trail du Mont-Blanc (UTMB®) in 2018/19. Before and within 2 h of the finish, participants underwent physiological assessments, including blood sampling for biomarkers (creatine kinase-MB isoenzyme [CK-MB], cardiac troponin I [cTnI], brain natriuretic peptide [BNP], and creatinine [Cr]), pulmonary function testing (spirometry, exhaled NO, diffusing capacities, and mouth pressures), and transthoracic ultrasound (lung comet tails, cardiac function). Data from eight female finishers (age = 36.6 ± 6.9 yr; finish time = 30:57 ± 11:36 h:min) were compared with a group of eight time-matched males (age = 40.3 ± 8.3 yr; finish time = 30:46 ± 10:32 h:min). Results: Females exhibited significant pre-to postrace increases in BNP (25.8 ± 14.6 vs 140.9 ± 102.7 pg•mL −1 ; P = 0.007) and CK-MB (3.3 ± 2.4 vs 74.6 ± 49.6 IU•L −1 ; P = 0.005), whereas males exhibited significant pre-to postrace increases in BNP (26.6 ± 17.5 vs 96.4 ± 51.9 pg•mL −1 ; P = 0.002), CK-MB (7.2 ± 3.9 vs 108.8 ± 37.4 IU•L −1 ; P = 0.002), and Cr (1.06 ± 0.19 vs 1.23 ± 0.24 mg•dL −1 ; P = 0.028). Lung function declined in both groups, but males exhibited additional reductions in lung diffusing capacities (DL CO = 34.4 ± 5.7 vs 29.2 ± 6.9 mL⋅min −1 ⋅mm Hg −1 , P = 0.004; DL NO = 179.1 ± 26.2 vs 152.8 ± 33.4 mL⋅min −1 ⋅mm Hg −1 , P = 0.002) and pulmonary capillary blood volumes (77.4 ± 16.7 vs 57.3 ± 16.1 mL; P = 0.002). Males, but not females, exhibited evidence of mild postrace pulmonary edema. Pooled effect sizes for within-group pre-to postrace changes, for all variables, were generally larger in males versus females (d = 0.86 vs 0.63). Conclusions: Ultramarathon negatively affects a range of physiological functions but generally evokes more frequent perturbations, with larger effect sizes, in males compared to females with similar race performances.

Is There Evidence for the Development of Sex-Specific Guidelines for Ultramarathon Coaches and Athletes? A Systematic Review

“…In contrast, two studies involving shorter distances (55 km or 70 km) reported a lower incidence of ECHO changes indicative of cardiac fatigue in females [ 39 , 40 ]. Tiller et al measured stroke volume and cardiac output before and after a 171 km race and reported the only significant change to be an increase in cardiac output in females [ 42 ].…”

“…Females: only reduced LV dimension ( p = 0.05) and increased RV diameter ( p = 0.012) were significant Picco et al[ 40 ] 24 athletes (5 females aged 38 ± 4 years, and 19 males aged 42 ± 12 years) who completed a 55 km mountain ultramarathon ECHO, serum lactate and CPK Cohort study Low Females had lower incidence of ECHO features of exercise induced cardiac fatigue for the right ventricle ( p = 0.3) and the left ventricle ( p < 0.001) Females had significantly lower serum lactate post-race (2.63 mmol/L vs 4.37 mmol/L, p = 0.018). No difference in CPK Cote et al[ 41 ] 25 athletes (8 females aged 45.9 ± 10.2 years, and 17 males aged 44.8 ± 6.6 years) who completed either a 100 km or 160 km ultramarathon ECHO Cohort study Low No significant sex differences in the cardiac response to an ultramarathon Tiller et al[ 42 ] 16 athletes (8 females and 8 performance-matched males) who completed either the UTMB or CCC races in 2018 or 2019. Average age 38.4 ± 7.6 years.…”

“…This study investigated the frequency of pre- to post-race physiological perturbations in race time-matched males and females and found that participation in ultramarathon resulted in biomarker derangement, decrements in pulmonary function, and the development of lung comet tails on ultrasound in both groups. However, only the male group demonstrated a statistically significant reduction in lung diffusing capacities and pulmonary capillary blood volume [ 42 ]. Additionally, the frequency and effect size of alterations in biomarkers and lung comet tails were smaller in the female cohort [ 42 ].…”

“…Four studies utilised echocardiography (ECHO) to examine cardiac changes in response to ultramarathons (Table 4) [39][40][41][42]. One of these studies also employed transthoracic ultrasound to detect the presence of lung comet tails (an indicator of pulmonary oedema) and measured various blood biomarkers associated with cardiac, renal, and skeletal muscle function [42]. Concerning ECHO changes, the results were heterogeneous.…”

Gender Characteristics of the Levels of Cardiac Troponins in Blood Serum and the Importance of Using Information About them in the Tactics of Diagnosis of Acute Coronary Syndrome (Literature Review)

“…В дополнение к этому в исследовании N. Tiller с соавт. также отметили более выраженные нарушения физиологии сердечно-сосудистой системы у мужчин, чем у женщин, после ультрамарафона [59]. Потенциально данные негативные эффекты могли привести к большему высвобождению сердечных тропонинов у мужчин, по сравнению с лицами женского пола.…”