Trends in Participation, Sex Differences and Age of Peak Performance in Time-Limited Ultramarathon Events: A Secular Analysis.

Background and Objectives: Increases in the number of participants in time-limited ultra-marathons have been reported. However, no information is available regarding the trends in participation, performance and age in 12 h and 24 h time-limited events. The aim of the study was to describe the trends in runners' participation, performance and age in 12 h and 24 h ultra-marathons for both sexes and to identify the age of peak performance, taking into account the ranking position and age categories. Materials and Methods: The sample comprised 210,455 runners in time-limited ultra-marathons (female 12 h = 23,706; female 24 h = 28,585; male 12 h = 61,594; male 24 h = 96,570) competing between 1876 and 2020 and aged 18 to 86 years. The age of peak performance was tested according to their ranking position (first-third; fourth-tenth and >tenth position) and taking into account their running speed in different age categories (<30 years; 31-40 years; 41-50 years; 51-60 years; >60 years), using the Kruskal-Wallis test, followed by the Bonferroni adjustment. Results: An increase in the number of participants and a decrease in running speed were observed across the years. For both events, the sex differences in performance decreased over time. The sex differences showed that male runners performed better than female runners, but the lowest differences in recent years were observed in the 24 h ultra-marathons. A positive trend in age across the years was found with an increase in mean age ("before 1989" = 40.33 ± 10.07 years; "1990-1999" = 44.16 ± 10.37 years; "2000-2009" = 45.99 ± 10.33 years; "2010-2020" = 45.62 ± 10.80 years). Male runners in 24 h races were the oldest (46.13 ± 10.83 years), while female runners in 12 h races were the youngest (43.46 ± 10.16 years). Athletes ranked first-third position were the youngest (female 12 h = 41.19 ± 8.87 years; female 24 h = 42.19 ± 8.50 years; male 12 h = 42.03 ± 9.40 years; male 24 h = 43.55 ± 9.03 years). When age categories were considered, the best performance was found for athletes aged between 41 and 50 years (female 12 h 6.48 ± 1.74 km/h; female 24 h 5.64 ± 1.68 km/h; male 12 h 7.19 ± 1.90 km/h; male 24 h 6.03 ± 1.78 km/h). Conclusion: A positive trend in participation in 12 h and 24 h ultra-marathons was shown across the years; however, athletes were becoming slower and older. The fastest athletes were the youngest ones, but when age intervals were considered, the age of peak performance was between 41 and 50 years.

Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review.

It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.

The Impact of the COVID-19 Pandemic on Endurance and Ultra-Endurance Running.

Background and objectives: The COVID-19 outbreak has become a major health and economic crisis. The World Health Organization declared it a pandemic in March 2020, and many sporting events were canceled. Materials and Methods: We examined the effects of the COVID-19 pandemic on endurance and ultra-endurance running (UER) and analyzed finishes and events during the COVID-19 pandemic (observation period March 2020-October 2020) to the same time period pre-COVID-19 outbreak (March 2019-October 2019). Results: Endurance finishes decreased during the pandemic (459,029 to 42,656 (male: 277,493 to 25,582; female 181,536 to 17,074; all p < 0.001). Similarly, the numbers of endurance events decreased (213 vs. 61 events; p < 0.001). Average marathon finishing times decreased during the pandemic in men (5:18:03 ± 0:16:34 vs. 4:43:08 ± 0:25:08 h:min:s (p = 0.006)) and women (5:39:32 ± 0:19:29 vs. 5:14:29 ± 0:26:36 h:min:s (p = 0.02)). In UER, finishes decreased significantly (580,289 to 110,055; p < 0.001) as did events (5839 to 1791; p < 0.001). Popular event locations in United States, France, UK, and Germany decreased significantly (p < 0.05). All distance and time-limited UER events saw significant decreases (p < 0.05). Conclusions: The COVID-19 pandemic has had a significant effect on endurance and UER, and it is unlikely that running activities return to pre-pandemic levels any time soon. Mitigation strategies and safety protocols should be established.