Ketamine vs. haloperidol for prevention of cognitive dysfunction and postoperative delirium: A phase IV multicentre randomised placebo-controlled double-blind clinical trial.

STUDY OBJECTIVE: Delirium is frequently observed in the postoperative and intensive care unit (ICU) population. Due to the multifactorial origin of delirium and according to international guidelines (e.g., American Geriatrics Society; Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) guideline), there are several but no incontestable options for prevention and symptomatic treatment. The purpose of the Baden PRIDe (Prevention and Reduction of Incidence of postoperative Delirium) trial was to determine whether postoperative cognitive dysfunction and delirium could be prevented by the combination of possible preventive agents such as haloperidol and ketamine. In addition, pre- and postoperative levels of the biomarkers cortisol, neuron specific enolase (NSE) and S100ß were measured to investigate their dynamics in delirious and non-delirious patients after surgery. DESIGN: The Baden PRIDe Trial was an investigator-initiated, phase IV, two-centre, randomised, placebo-controlled, double-blind clinical trial. SETTING: Perioperative care. PATIENTS: 182 adult patients that underwent elective or emergency surgery under general or combined (i.e., general and regional) anaesthesia. INTERVENTIONS: Pre-anaesthetic, pharmacologic prevention of postoperative brain dysfunction with haloperidol, ketamine, and the combination of both vs. placebo. MEASUREMENTS: Assessment of cognitive performance pre- and postoperatively with the MMSE, the DOS, the Nursing Delirium Screening Scale (Nu-DESC) or the Intensive Care Delirium Screening Checklist (ICDSC) during ICU stay. MAIN RESULTS: None of the three study arms - haloperidol, ketamine, or both drugs combined - was significantly superior to placebo for prevention of postoperative brain dysfunction and delirium (P = 0.39). Measured levels of postoperative cortisol were significantly higher in delirious patients. S-100ß levels were significantly higher in all postoperative outcome groups (cognitive impairment, delirium, no cognitive decline), whereas postoperative NSE levels declined in all groups. CONCLUSIONS: The study results offer no possibility for a novel recommendation for prevention of postoperative cognitive decline including delirium. Perioperative S-100ß trajectories in patients with cognitive deterioration suggest affection of glial cells in particular. TRIAL REGISTRATION: ClinicalTrials.govNCT02433041; registered on April 7, 2015.

Performance Differences Between the Sexes in the Boston Marathon From 1972 to 2017.

Knechtle, B, Di Gangi, S, Rüst, CA, and Nikolaidis, PT. Performance differences between the sexes in the Boston Marathon from 1972 to 2017. J Strength Cond Res 34(2): 566-576, 2020-The differences between the sexes in marathon running have been investigated for athletes competing in world class-level races. However, no information exists about changes in these differences since the first women officially began participating in marathons. We examined trends in participation and performance in the Boston Marathon from 1972 to 2017. A total of 371,250 different finishers (64% men) and 553,890 observations-with 187,998 (34%) being of women and 365,892 (66%) of men-were analyzed using Generalized Additive Mixed Models. The number of finishers increased over the years. Female participation started at 2.81% in 1972 and reached 45.68% in 2016. Considering all finishers, men (03:38:42 ± 00:41:43 h:min:s) were overall faster than women (04:03:28 ± 00:38:32 h:min:s) by 10.7%. Average performance worsened over the years, but the differences between the sexes decreased. For the annual 10 fastest runners, performance improved with a decrease in speed difference (18.3% overall, men: 02:13:30 ± 00:04:08 h:min:s vs. women: 02:37:42 ± 00:17:58 h:min:s). For the annual winners, performance improved with a decrease in speed difference (15.5% overall, men: 02:10:24 ± 00:03:05 h:min:s vs. women: 02:30:43 ± 00:11:05 h:min:s). For the near-elite finishers from the 21st to the 100th place and from the 101st to the 200th place, women's performance improved with a decrease in the difference to men. In summary, the trend in performance over the years depended on the methodological approach (i.e., all vs. annual 10 fastest finishers vs. annual winners), but the difference between the sexes decreased in all instances. Although men were 10.7% faster than women, the fastest men (i.e., top 10 and winners) increased the gap between men and women by an average of 18.3% for the annual 10 fastest and 15.5% for the annual winners.

A preoperative single dose of methadone for moderate-to-severely painful surgery reduces postoperative morphine consumption.

BACKGROUND: Data from patient questionnaires reveal that the intensity of postoperative pain is widely underestimated. Insufficient pain control may contribute to impaired short- and long-term outcome. Preoperative administration of methadone might potentially improve postoperative pain control due to its long pharmacological half-life. METHODS: The aim of this study was to evaluate the effect of a single dose of methadone administered at anesthesia induction on postoperative analgesic requirements in ASA I-III patients after moderate-to-severely painful surgery scheduled for ≥90 minutes. Patients were randomized to receive either a single dose of methadone (0.2 mg/kg) or fentanyl (standard, 0.003 mg/kg) intravenously (IV) at anesthesia induction. For postoperative pain control, all study patients were accommodated with morphine on the basis of patient-controlled analgesia (PCA). RESULTS: Per-protocol analysis revealed that the median cumulative morphine consumption was significantly lower in patients receiving a single dose of methadone, in the Postanesthesia Care Unit (0 mg vs. 7 mg of morphine, P<0.01) and during the first 72 hours after surgery (19 mg vs. 35 mg of morphine, P<0.05 for all days). Fentanyl consumption during surgery (0.25 mg [0.1-0.425 mg] in the study group vs. 0.3 mg [0.15-0.45 mg] in the control group, P=0.4499) was comparable among groups. Median pain scores at rest and in motion, and patient satisfaction were also similar in both groups (95.7% vs. 89.3% of patients were satisfied in the study and control group, respectively) during follow-up on postoperative days 1-3. CONCLUSIONS: A single dose of methadone administered at anesthesia induction prior to moderate-to-severely painful surgery is a possible strategy to reduce postoperative morphine consumption.

The Age-Related Performance Decline in Ironman Triathlon Starts Earlier in Swimming Than in Cycling and Running.

Käch, I, Rüst, CA, Nikolaidis, PT, Rosemann, T, and Knechtle, B. The age-related performance decline in Ironman triathlon starts earlier in swimming than in cycling and running. J Strength Cond Res 32(2): 379-395, 2018-In Ironman triathlon, the number of overall male and female finishers increased in the past 30 years, while an improvement in performance has been reported. Studies concluding these numbers only analyzed the top 10 athletes per age group instead of all finishers; therefore, a selection bias might have occurred. The aim of this study was to investigate participation, performance, and the age-related performance decline of all pro- and age-group triathletes ranked in all Ironman triathlons held worldwide between 2002 and 2015. Split and overall race times of 329,066 (80%) male and 81,815 (20%) female athletes competing in 253 different Ironman triathlon races were analyzed. The number of finishers increased in all age groups with the exception of women in age group 75-79 years. In pro athletes, performance improved in all disciplines. In age-group athletes, performance improved in younger age groups for running (from 18-24 to 40-44 years) and older age groups for swimming (from 50-54 to 65-69 years) and cycling (from 35-39 to 55-59 years), whereas it impaired in younger age groups for swimming (from 18-24 to 45-49 years) and cycling (from 18-24 to 30-34 years), and older age groups in running (from 45-49 to 70-74 years). The age-related performance decline started in women in age group 25-29 years in swimming and in age group 30-34 years in cycling, running, and overall race time, whereas it started in men in age group 25-29 years in swimming and in age group 35-39 years in cycling, running, and overall race time. For athletes and coaches, performance improved in younger age groups for running and older age groups for swimming and cycling, and the age-related decline in performance started earlier in swimming than in cycling and running. In summary, women should start competing in Ironman triathlon before the age of 30 years and men before the age of 35 years to achieve their personal best Ironman race time.

Influence of skin disinfection prior removal of perineural catheter on bacterial colonization, contamination and local inflammation: a prospective randomized study.

BACKGROUND: There is a wide variation of perineural catheter (PNC) colonization rates in the literature. The impact of skin disinfection on PNC colonization and inflammation is not clear. The objective of this prospective, randomized clinical study was to investigate the influence of alcoholic skin disinfection before PNC removal on the detection of bacteria on PNC. METHODS: Two hundred patients receiving a PNC for orthopedic surgery were randomized to receive (with-group) or not (without-group) a skin disinfection with a sprayed alcoholic solution before removal of the PNC. Bacterial colonization and contamination of the PNC and clinical signs of inflammation and infection of the PNC insertion site were evaluated. Skin disinfection with a sprayed alcoholic solution and sterile removal of the distal and subcutaneous part of the PNC was performed after 72 hours or earlier if signs of infection occurred with semiquantitative culture and enrichment culture of both parts. RESULTS: Alcoholic skin disinfection before PNC removal significantly reduced bacterial colonization with a reduction from 28% to 14% and from 32% to 17% for the tip and the subcutaneous part of the PNC, respectively (P<0.05). Clinical signs of inflammation at the PNC insertion site were similar (73%) in the two groups. The detection of colonization in 54 (27%) out of 200 PNC did not correlate with clinical signs of inflammation independently of the number of bacteria isolated. Redness was noted in 71% and 68% of patients in the without- and with-alcoholic skin disinfection-group respectively. Local pain on pressure was present in 28% and 19% in the without- and with-group respectively. CONCLUSIONS: Alcoholic skin disinfection before PNC removal reduced the detection of PNC colonisation by 50%. There was no correlation between clinical signs of inflammation and PNC colonization.

Performance Trends in Master Butterfly Swimmers Competing in the FINA World Championships.

Performance trends in elite butterfly swimmers are well known, but less information is available regarding master butterfly swimmers. We investigated trends in participation, performance and sex differences in 9,606 female and 13,250 male butterfly race times classified into five-year master groups, from 25-29 to 90-94 years, competing in the FINA World Masters Championships between 1986 and 2014. Trends in participation were analyzed using linear regression analysis. Trends in performance changes were investigated using mixed-effects regression analyses with sex, distance and a calendar year as fixed variables. We also considered interaction effects between sex and distance. Participation increased in master swimmers older than ~30-40 years. The men-to-women ratio remained unchanged across calendar years and master groups, but was lower in 200 m compared to 50 m and 100 m. Men were faster than women from 25-29 to 85-89 years (p < 0.05), although not for 90-94 years. Sex and distance showed a significant interaction in all master groups from 25-29 to 90-94 years for 200m (p < 0.05). For 50 m and 100 m, a significant sex × distance interaction was observed from 25-29 to 75-79 years (p < 0.05), but not in the older groups. In 50 m, women reduced the sex difference in master groups 30-34 to 60-64 years (p < 0.05). In 100 m, women decreased the gap to men in master groups 35-39 to 55-59 years (p < 0.05). In 200 m, the sex difference was reduced in master groups 30-34 to 40-44 years (p < 0.05). In summary, women and men improved performance at all distances, women were not slower compared to men in the master group 90-94 years; moreover, women reduced the gap to men between ~30 and ~60 years, although not in younger or older master groups.

Performance trends in 3000 m open-water age group swimmers from 25 to 89 years competing in the FINA World Championships from 1992 to 2014.

We investigated trends in participation, performance and sex difference in performance in 3000 m freestyle in age groups swimmers (25-29 to 85-89 years) competing in the Fédération Internationale de Natation World Masters Championships between 1992 and 2014. During this period, participation increased in women and men. Women and men improved race times across years in all age groups. Women were slower in age groups 25-29 to 70-74 years. In age groups 75-79 and 85-89 years, however, race times were similar for both women and men. Sex difference in performance remained unchanged across years. In summary, performance improved across years in all age groups, men were faster than women up to the age group 70-74 years and women were not able to reduce the sex difference in performance to men across years. For athletes and coaches, an increase in participation and a continuous improvement in performance can be expected in these age group athletes.

Positive pacing in elite IRONMAN triathletes.

Pacing is known to influence athletic performance. For the Ironman triathlon program, a positive pacing strategy, i.e., the continuous decrease of speed over time was recommended. By analyzing split times, we assessed the pacing strategies of the top 100 finishers of the cycling part of 13 Ironman races and of the running part of 11 Ironman races taking place in 2014. Furthermore, sex-associated differences in performance and pacing strategies were calculated. We analyzed 7,687 cycling and 11,894 running split times of 1,392 triathletes (1,263 men, 129 women). Changes in speed were assessed using mixed-effects regression analyses. A continuous decrease in speed was observed during cycling in 10/13 races, and during running in 11/11 races. In 6/13 races, women decreased their speed during cycling significantly more than men. The running part showed no significant difference of changes in speed between the sexes. In summary, in the Ironman races evaluated, a positive pacing strategy was adopted in most races. Women were slower than men in 6/13 cycling races, but there was no difference between men and women in the run splits. Women used the same pacing strategy as men.

Do women reduce the gap to men in ultra-marathon running?

The aim of the present study was to examine sex differences across years in performance of runners in ultra-marathons lasting from 6 h to 10 days (i.e. 6, 12, 24, 48, 72, 144, and 240 h). Data of 32,187 finishers competing between 1975 and 2013 with 93,109 finishes were analysed using multiple linear regression analyses. With increasing age, the sex gap for all race durations increased. Across calendar years, the gap between women and men decreased in 6, 72, 144 and 240 h, but increased in 24 and 48 h. The men-to-women ratio differed among age groups, where a higher ratio was observed in the older age groups, and this relationship varied by distance. In all durations of ultra-marathon, the participation of women and men varied by age (p < 0.001), indicating a relatively low participation of women in the older age groups. In summary, between 1975 and 2013, women were able to reduce the gap to men for most of timed ultra-marathons and for those age groups where they had relatively high participation.

[Ironman Triathlon]. / Der Ironman-Triathlon.

Every year, thousands of triathletes try to qualify for the «Ironman Hawaii¼ (3,8 km swimming, 180 km cycling and 42,195 km running), the World Championship of long-distance triathletes. In this overview, we present the recent findings in literature with the most important variables with an influence on Ironman triathlon performance. The most important performance-influencing factors for a fast Ironman race time for both women and men are a large training volume and a high intensity in training, a large volume being more important than a high intensity, a low percentage of body fat, an ideal age of 30­35 years, a fast personal best in the Olympic distance triathlon (1,5 km swimming, 40 km cycling and 10 km running), a fast personal best in marathon running and origin from the United States of America.

Increased participation and improved performance in age group backstroke master swimmers from 25-29 to 100-104 years at the FINA World Masters Championships from 1986 to 2014.

Participation and performance trends in age group athletes have been investigated for different sport disciplines, but not for master swimmers. The knowledge on this topic is still missing for a particular stroke such as backstroke. Changes in participation and performance of male and female age group backstroke swimmers (≥25 years) competing in 50, 100 and 200 m pool swimming at the FINA World Masters Championships held between 1986 and 2014 were investigated using mixed-effects regression analyses. The overall participation was n = 26,217 including n = 13,708 women and n = 12,509 men. In 50 m, female (age groups 85-89 years; p = 0.002) and male participation (age groups 55-59; p = 0.030 and 80-84 years; p = 0.002) increased, while female participation decreased in age groups 55-59 (p = 0.010) and 60-64 years (p = 0.050). In 100 and 200 m, participation increased in age groups 45-49, 50-54, 65-69, 70-74, 80-84 years. Swimmers in age groups 25-29 to 95-99 years improved performance over all distances. Women were slower than men in age groups 25-29 to 80-84 years, but not in age groups 85-89 to 95-99 years over all distances. In 50 m and 100 m, the sex difference decreased in age groups 40-44 (p = 0.007 and p = 0.005), 45-49 (p = 0.017 and p = 0.034), 50-54 (p = 0.002 and p = 0.040), to 55-59 years (p = 0.002 and p = 0.004). In 200 m, the sex difference decreased in age groups 40-44 (p = 0.044) and 90-94 (p = 0.011), but increased in age group 25-29 years (p = 0.006). In summary, in age group backstroke swimmers, (1) participation increased or remained unchanged (except women in age groups 55-59 and 60-64 years in 50 m), (2) swimming performance improved in all age groups from 25-29 to 95-99 years over all distances, (3) men were faster than women in age groups 25-29 to 80-84 years (except age groups 85-89 to 95-99 years) over time and all distances.

Male and female Ethiopian and Kenyan runners are the fastest and the youngest in both half and full marathon.

In major marathon races such as the 'World Marathon Majors', female and male East African runners particularly from Ethiopia and Kenya are the fastest. However, whether this trend appears for female and male Ethiopians and Kenyans at recreational level runners (i.e. races at national level) and in shorter road races (e.g. in half-marathon races) has not been studied yet. Thus, the aim of the present study was to examine differences in the performance and the age of female and male runners from East Africa (i.e. Ethiopians and Kenyans) between half- and full marathons. Data from 508,108 athletes (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) originating from 126 countries and competing between 1999 and 2014 in all road-based half-marathons and marathons held in one country (Switzerland) were analysed using Chi square (χ(2)) tests, mixed-effects regression analyses and one-way analyses of variance. In half-marathons, 48 women (0.038 %) and 63 men (0.019 %) were from Ethiopia and 80 women (0.063 %) and 134 men (0.040 %) from Kenya. In marathons, three women (0.029 %) and 15 men (0.034 %) were from Ethiopia and two women (0.019 %) and 33 men (0.075 %) from Kenya. There was no statistically significant association between the nationality of East Africans and the format of a race. In both women and men, the fastest race times in half-marathons and marathons were achieved by East African runners (p < 0.001). Ethiopian and Kenyan runners were the youngest in both sexes and formats of race (p < 0.001). In summary, women and men from Ethiopia and Kenya, despite they accounted for <0.1 % in half-marathons and marathons, achieved the fastest race times and were the youngest in both half-marathons and marathons. These findings confirmed in the case of half-marathon the trend previously observed in marathon races for a better performance and a younger age in East African runners from Ethiopia and Kenya.

Half-marathoners are younger and slower than marathoners.

Age and performance trends of elite and recreational marathoners are well investigated, but not for half-marathoners. We analysed age and performance trends in 508,108 age group runners (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) competing between 1999 and 2014 in all flat half-marathons and marathons held in Switzerland using single linear regression analyses, mixed-effects regression analyses and analyses of variance. The number of women and men increased across years in both half-marathons and marathons. There were 12.3 times more female half-marathoners than female marathoners and 7.5 times more male half-marathoners than male marathoners. For both half-marathons and marathons, most of the female and male finishers were recorded in age group 40-44 years. In half-marathons, women (10.29 ± 3.03 km/h) were running 0.07 ± 0.06 km/h faster (p < 0.001) than men (10.22 ± 3.06 km/h). Also in marathon, women (14.77 ± 4.13 km/h) were running 0.28 ± 0.16 km/h faster (p < 0.001) than men (14.48 ± 4.07 km/h). In marathon, women (42.18 ± 10.63 years) were at the same age than men (42.06 ± 10.45 years) (p > 0.05). Also in half-marathon, women (41.40 ± 10.63 years) were at the same age than men (41.31 ± 10.30 years) (p > 0.05). However, women and men marathon runners were older than their counterpart half-marathon runners (p < 0.001). In summary, (1) more athletes competed in half-marathons than in marathons, (2) women were running faster than men, (3) half-marathoners were running slower than marathoners, and (4) half-marathoners were younger than marathoners.

Performance trends in master freestyle swimmers aged 25-89 years at the FINA World Championships from 1986 to 2014.

Performance trends in elite freestyle swimmers are well known, but not for master freestyle swimmers. We investigated trends in participation, performance, and sex difference in performance of 65,584 freestyle master swimmers from 25-29 to 85-89 years competing in FINA World Masters Championships between 1986 and 2014. The men-to-women ratio was calculated for each age group, and the trend across age groups was analyzed using single linear regression analysis. Trends in performance changes were investigated using a mixed-effects regression model with sex, distance, and calendar year as fixed variables. Participation increased in women and men in older age groups (i.e., 40 years and older). Women and men improved race times across years in all age groups and distances. For age groups 25-29 to 75-79 years, women were slower than men, but not for age groups 80-84 to 85-89 years. In 50, 100, and 200 m, women reduced the sex difference from 1986 to 2014 in age groups 30-34 to 75-79 years. In 400 m, women reduced the gap to men across time in age groups 40-44, 45-49, and 55-59 years. In 800 m, sex difference became reduced across time in age groups 55-59 and 70-74 years. In summary, participation increased from 1986 to 2014 in women and men in older age groups, women and men improved across time performance in all distances, and women were not slower compared to men in age groups 80-84 to 85-89 years. We expect a continuous trend in increasing participation and improved performance in master freestyle swimmers.

Pacing Strategies of Ultracyclists in the "Race Across AMerica".

PURPOSE: To examine pacing strategies of ultracyclists competing in the Race Across AMerica (RAAM), the world's longest ultracycling race, covering ~4860 km from the West to the East coast of America. METHODS: Age, cycling speed at and across time stations, race distance, relative difference in altitude between time stations, wind velocity, wind gradient, and temperature at each time station were recorded for women and men competing from 2010 to 2014. Changes in cycling speed and power output of elite and age-group finishers were analyzed using mixed-effects regression analyses. RESULTS: Cycling speed decreased across time stations for women and men where men were faster than women. Power output decreased across time stations in women and men and was lower for women for all finishers, the annual 3 fastest, and age group 60-69 y but not for age groups 18-49 and 50-59 y. The change in temperature and altitude had an influence on cycling speed and power output in all finishers, the annual top 3, nonfinishers, and in all different age groups for both women and men but in the age group 50-59 y altitude had no influence on cycling speed. CONCLUSIONS: Positive pacing (ie, decrease in speed throughout the race) seemed to be the adequate strategy in the RAAM. The top 3 finishers started faster and had a higher power output at the start than less successful competitors, achieved the highest peak cycling speeds and power output, and maintained peak cycling speed and power output longer before slowing down.

Pacing in a self-paced world record attempt in 24-h road cycling.

BACKGROUND: Pacing strategy plays a major role in sport performance. However, there is a dearth of knowledge concerning pacing during ultra-endurance sport events. The present case study investigated the pacing of an ultra-cyclist in a self-paced attempt to break the world record in 24-h road cycling and, with all the caveats and the limitations affecting a case report, could be useful in generating hypotheses and further studies about pacing dynamics during prolonged sport performances. CASE DESCRIPTION: A well experienced ultra-cyclist completed laps of 11.731 km during 24 h and the support crew recorded for each lap time and power output in Watt. The trend in cycling speed and power output across laps was investigated using regression analyses. A mixed-effects regression model including lap, ambient air temperature, air pressure, air humidity and wind speed as fixed variables was used to investigate a relationship of environmental factors with cycling speed. DISCUSSION AND EVALUATION: The athlete achieved 896.173 km within the 24 h. He set a new world record by breaking the old record (Jure Robic, 2004, 834.77 km) by 61.403 km. He cycled at an average speed of 37.34 km/h with an average power output of 250.2 W. The decrease in cycling speed and power output across laps could be modelled linearly. Temperature and wind speed were related to cycling speed during the whole event. There was a significant interaction air temperature × relative humidity for the whole event. CONCLUSIONS: The athlete adopted a positive pacing (i.e. speed gradually declined throughout the event) and environmental factors (i.e. temperature and wind speed) influenced cycling speed during the event.

Nation related participation and performance trends in 'Norseman Xtreme Triathlon' from 2006 to 2014.

We investigated the nation related participation and performance trends in triathletes competing in 'Norseman Xtreme Triathlon' between 2006 and 2014 using mixed models, one-way analysis of variance and multi-variate regression analyses. A total of 1594 athletes (139 women and 1455 men) originating from 34 different countries finished the race. Most of the athletes originated from Norway, Germany, Great Britain, Sweden, USA and France. In the mixed model analysis considering all finishers (n = 1594), with calendar year, sex and country as independent and overall race time as dependent variable, calendar year (p < 0.0001), sex (p < 0.0001), country (p < 0.0001) and the interaction sex × calendar year (p = 0.012) were significant. In the model where overall race time was separated in the three disciplines, we found interactions such as country × discipline (p < 0.0001), year × discipline (p < 0.0001), sex × discipline (p < 0.0001), calendar year × sex (p = 0.044), calendar year × sex × discipline (p = 0.031). Overall race time decreased every year, above all in the year 2012. Women were slower than men, but women reduced this gender gap year after year and above all in the year 2007 (p = 0.001). Athletes from Norway and Germany were faster than those from Great Britain and other countries. Split times of the discipline decreased throughout the years. In particular, the discipline having more impact on overall race time was cycling. Most of the podiums were achieved by Norwegian women and men. For women, the fastest split and transition times were achieved by Norwegian women with exception of the run where German women were faster. Norwegian men were the fastest in split and transition times although French athletes were the fastest in swimming. Across years, the annual three fastest Norwegian women improved in cycling, running, overall race time and transition times but not Norwegian and German men. British men, however, improved running split times and transition times. To summarize, most of the finishers in 'Norseman Xtreme Triathlon' originated from Norway and the fastest race times were achieved by Norwegian women and men. Norwegian women improved race times across years but not Norwegian men.

Increase in participation but decrease in performance in age group mountain marathoners in the 'Jungfrau Marathon': a Swiss phenomenon?

Participation and performance trends for age group marathoners have been investigated for large city marathons such as the 'New York City Marathon' but not for mountain marathons. This study investigated participation and trends in performance and sex difference in the mountain marathon 'Jungfrau Marathon' held in Switzerland from 2000 to 2014 using single and mixed effects regression analyses. Results were compared to a city marathon (Lausanne Marathon) also held in Switzerland during the same period. Sex difference was calculated using the equation ([race time in women] - [race time in men]/[race time in men] × 100). Changes in sex differences across calendar years and were investigated using linear regression models. In 'Jungfrau Marathon', participation in all female and male age groups increased with exception of women in age groups 18-24 and men in age groups 30-34, 40-44 and 60-64 years where participation remained unchanged. In 'Lausanne Marathon', participation increased in women in age groups 30-34 to 40-44 years. In men, participation increased in age groups 25-29 to 44-44 years and 50-54 years. In 'Jungfrau Marathon' runners became slower across years in age groups 18-24 to 70-74 years. In 'Lausanne Marathon', runners became slower across years in age groups 18-24 and 30-34 to 65-69 years, but not for 25-29, 70-74 and 75-79 years. In 'Jungfrau Marathon', sex difference increased in age groups 25-29 (from 4 to 10 %) and 60-64 years (from 3 to 8 %) but decreased in age group 40-44 years (from 12 to 6 %). In 'Lausanne Marathon', the sex difference showed no changes. In summary, participation increased in most female and male age groups but performance decreased in most age groups for both the mountain marathon 'Jungfrau Marathon' and the city marathon 'Lausanne Marathon'. The sex differences were lower in the 'Jungfrau Marathon' (~6-7 %) compared to the 'Lausanne Marathon' where the sex difference was ~10-12 % from age groups 18-24 to 55-59 years. These unexpected findings might be a typical Swiss phenomenon. Future studies need to investigate whether this trend can also be found in other endurance sports events held in Switzerland and other mountain marathons held in other countries.

Ice swimming - 'Ice Mile' and '1 km Ice event'.

BACKGROUND: Ice swimming for 1 mile and 1 km is a new discipline in open-water swimming since 2009. This study examined female and male performances in swimming 1 mile ('Ice Mile') and 1 km ('1 km Ice event') in water of 5 °C or colder between 2009 and 2015 with the hypothesis that women would be faster than men. METHODS: Between 2009 and 2015, 113 men and 38 women completed one 'Ice Mile' and 26 men and 13 completed one '1 km Ice event' in water colder than +5 °C following the rules of International Ice Swimming Association (IISA). Differences in performance between women and men were determined. Sex difference (%) was calculated using the equation ([time for women] - [time for men]/[time for men] × 100). For 'Ice Mile', a mixed-effects regression model with interaction analyses was used to investigate the influence of sex and environmental conditions on swimming speed. The association between water temperature and swimming speed was assessed using Pearson correlation analyses. RESULTS: For 'Ice Mile' and '1 km Ice event', the best men were faster than the best women. In 'Ice Mile', calendar year, number of attempts, water temperature and wind chill showed no association with swimming speed for both women and men. For both women and men, water temperature was not correlated to swimming speed in both 'Ice Mile' and '1 km Ice event'. CONCLUSIONS: In water colder than 5 °C, men were faster than women in 'Ice Mile' and '1 km Ice event'. Water temperature showed no correlation to swimming speed.