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      Physiology and Pathophysiology in Ultra-Marathon Running

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          Abstract

          In this overview, we summarize the findings of the literature with regards to physiology and pathophysiology of ultra-marathon running. The number of ultra-marathon races and the number of official finishers considerably increased in the last decades especially due to the increased number of female and age-group runners. A typical ultra-marathoner is male, married, well-educated, and ~45 years old. Female ultra-marathoners account for ~20% of the total number of finishers. Ultra-marathoners are older and have a larger weekly training volume, but run more slowly during training compared to marathoners. Previous experience (e.g., number of finishes in ultra-marathon races and personal best marathon time) is the most important predictor variable for a successful ultra-marathon performance followed by specific anthropometric (e.g., low body mass index, BMI, and low body fat) and training (e.g., high volume and running speed during training) characteristics. Women are slower than men, but the sex difference in performance decreased in recent years to ~10–20% depending upon the length of the ultra-marathon. The fastest ultra-marathon race times are generally achieved at the age of 35–45 years or older for both women and men, and the age of peak performance increases with increasing race distance or duration. An ultra-marathon leads to an energy deficit resulting in a reduction of both body fat and skeletal muscle mass. An ultra-marathon in combination with other risk factors, such as extreme weather conditions (either heat or cold) or the country where the race is held, can lead to exercise-associated hyponatremia. An ultra-marathon can also lead to changes in biomarkers indicating a pathological process in specific organs or organ systems such as skeletal muscles, heart, liver, kidney, immune and endocrine system. These changes are usually temporary, depending on intensity and duration of the performance, and usually normalize after the race. In longer ultra-marathons, ~50–60% of the participants experience musculoskeletal problems. The most common injuries in ultra-marathoners involve the lower limb, such as the ankle and the knee. An ultra-marathon can lead to an increase in creatine-kinase to values of 100,000–200,000 U/l depending upon the fitness level of the athlete and the length of the race. Furthermore, an ultra-marathon can lead to changes in the heart as shown by changes in cardiac biomarkers, electro- and echocardiography. Ultra-marathoners often suffer from digestive problems and gastrointestinal bleeding after an ultra-marathon is not uncommon. Liver enzymes can also considerably increase during an ultra-marathon. An ultra-marathon often leads to a temporary reduction in renal function. Ultra-marathoners often suffer from upper respiratory infections after an ultra-marathon. Considering the increased number of participants in ultra-marathons, the findings of the present review would have practical applications for a large number of sports scientists and sports medicine practitioners working in this field.

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          Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis

          Background No systematic review has identified the incidence of running-related injuries per 1000 h of running in different types of runners. Objective The purpose of the present review was to systematically search the literature for the incidence of running-related injuries per 1000 h of running in different types of runners, and to include the data in meta-analyses. Data Sources A search of the PubMed, Scopus, SPORTDiscus, PEDro and Web of Science databases was conducted. Study Selection Titles, abstracts, and full-text articles were screened by two blinded reviewers to identify prospective cohort studies and randomized controlled trials reporting the incidence of running-related injuries in novice runners, recreational runners, ultra-marathon runners, and track and field athletes. Study Appraisal and Synthesis Methods Data were extracted from all studies and comprised for further analysis. An adapted scale was applied to assess the risk of bias. Results After screening 815 abstracts, 13 original articles were included in the main analysis. Running-related injuries per 1000 h of running ranged from a minimum of 2.5 in a study of long-distance track and field athletes to a maximum of 33.0 in a study of novice runners. The meta-analyses revealed a weighted injury incidence of 17.8 (95 % confidence interval [CI] 16.7–19.1) in novice runners and 7.7 (95 % CI 6.9–8.7) in recreational runners. Limitations Heterogeneity in definitions of injury, definition of type of runner, and outcome measures in the included full-text articles challenged comparison across studies. Conclusion Novice runners seem to face a significantly greater risk of injury per 1000 h of running than recreational runners. Electronic supplementary material The online version of this article (doi:10.1007/s40279-015-0333-8) contains supplementary material, which is available to authorized users.
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            Historical analysis of participation in 161 km ultramarathons in North America.

            Participation trends in 100 m (161 km) ultramarathon running competitions in North America were examined from race results from 1977 through 2008. A total of 32, 352 finishes accounted for by 9815 unique individuals were identified. The annual number of races and number of finishes increased exponentially over the study period. This growth in number of finishes occurred through a combination of (1) an increase in participation among runners >40 years of age from less than 40% of the finishes prior to the mid-1980s to 65-70% of the finishes since 1996, (2) a growth (p < 0.0001) in participation among women from virtually none in the late 1970s to nearly 20% since 2004, and (3) an increase in the average annual number of races completed by each individual to 1.3. While there has been considerable growth in participation, the 161 km ultramarathon continues to attract a relatively small number of participants compared with running races of shorter distances.
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              What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis

              Background Many runners suffer from injuries. No information on high-risk populations is available so far though. Objectives The aims of this study were to systematically review injury proportions in different populations of runners and to compare injury locations between these populations. Data Sources An electronic search with no date restrictions was conducted up to February 2014 in the PubMed, Embase, SPORTDiscus and Web of Science databases. The search was limited to original articles written in English. The reference lists of the included articles were checked for potentially relevant studies. Study Eligibility Criteria Studies were eligible when the proportion of running injuries was reported and the participants belonged to one or more homogeneous populations of runners that were clearly described. Study selection was conducted by two independent reviewers, and disagreements were resolved in a consensus meeting. Study Appraisal and Synthesis Methods Details of the study design, population of runners, sample size, injury definition, method of injury assessment, number of injuries and injury locations were extracted from the articles. The risk of bias was assessed with a scale consisting of eight items, which was specifically developed for studies focusing on musculoskeletal complaints. Results A total of 86 articles were included in this review. Where possible, injury proportions were pooled for each identified population of runners, using a random-effects model. Injury proportions were affected by injury definitions and durations of follow-up. Large differences between populations existed. The number of medical-attention injuries during an event was small for most populations of runners, except for ultra-marathon runners, in which the pooled estimate was 65.6 %. Time-loss injury proportions between different populations of runners ranged from 3.2 % in cross-country runners to 84.9 % in novice runners. Overall, the proportions were highest among short-distance track runners and ultra-marathon runners. Limitations The results were pooled by stratification of studies according to the population, injury definition and follow-up/recall period; however, heterogeneity was high. Conclusions Large differences in injury proportions between different populations of runners existed. Injury proportions were affected by the duration of follow-up. A U-shaped pattern between the running distance and the time-loss injury proportion seemed to exist. Future prospective studies of injury surveillance are highly recommended to take running exposure and censoring into account. Electronic supplementary material The online version of this article (doi:10.1007/s40279-015-0331-x) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Journal
                Front Physiol
                Front Physiol
                Front. Physiol.
                Frontiers in Physiology
                Frontiers Media S.A.
                1664-042X
                01 June 2018
                2018
                : 9
                : 634
                Affiliations
                [1] 1Institute of Primary Care, University of Zurich , Zurich, Switzerland
                [2] 2Exercise Physiology Laboratory , Nikaia, Greece
                Author notes

                Edited by: Hassane Zouhal, University of Rennes 2–Upper Brittany, France

                Reviewed by: Samuel Verges, Joseph Fourier University, France; Andrew Renfree, University of Worcester, United Kingdom

                *Correspondence: Beat Knechtle beat.knechtle@ 123456hispeed.ch

                This article was submitted to Exercise Physiology, a section of the journal Frontiers in Physiology

                Article
                10.3389/fphys.2018.00634
                5992463
                29910741
                07265e61-a8ce-449b-86bf-54dbb85abc3a
                Copyright © 2018 Knechtle and Nikolaidis.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 01 March 2018
                : 11 May 2018
                Page count
                Figures: 5, Tables: 10, Equations: 0, References: 343, Pages: 33, Words: 27285
                Categories
                Physiology
                Review

                Anatomy & Physiology
                extreme endurance,pathophysiology,performance,injury,gender
                Anatomy & Physiology
                extreme endurance, pathophysiology, performance, injury, gender

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