Enhancing patient safety: detection of in-hospital hazards and effect of training on detection (by training in a low-fidelity simulation Room of Improvement based on hospital-specific CIRS cases).

IMPORTANCE: Adequate situational awareness in patient care increases patient safety and quality of care. To improve situational awareness, an innovative, low-fidelity simulation method referred to as Room of Improvement, has proven effective in various clinical settings. OBJECTIVE: To investigate the impact after 3 months of Room of Improvement training on the ability to detect patient safety hazards during an intensive care unit shift handover, based on critical incident reporting system (CIRS) cases reported in the same hospital. METHODS: In this educational intervention, 130 healthcare professionals observed safety hazards in a Room of Improvement in a 2 (time 1 vs time 2)×2 (alone vs in a team) factorial design. The hazards were divided into immediately critical and non-critical. RESULTS: The results of 130 participants were included in the analysis. At time 1, no statistically significant differences were found between individuals and teams, either overall or for non-critical errors. At time 2, there was an increase in the detection rate of all implemented errors for teams compared with time 1, but not for individuals. The detection rate for critical errors was higher than for non-critical errors at both time points, with individual and group results at time 2 not significantly different from those at time 1. An increase in the perception of safety culture was found in the pre-post test for the questions whether the handling of errors is open and professional and whether errors are discussed in the team. DISCUSSION: Our results indicate a sustained learning effect after 12 weeks, with collaboration in teams leading to a significantly better outcome. The training improved the actual error detection rates, and participants reported improved handling and discussion of errors in their daily work. This indicates a subjectively improved safety culture among healthcare workers as a result of the situational awareness training in the Room of Improvement. As this method promotes a culture of safety, it is a promising tool for a well-functioning CIRS that closes the loop.

Oral transmucosal fentanyl citrate analgesia in prehospital trauma care: an observational cohort study.

BACKGROUND: Pain is one of the major prehospital symptoms in trauma patients and requires prompt management. Recent studies have reported insufficient analgesia after prehospital treatment in up to 43% of trauma patients, leaving significant room for improvement. Good evidence exists for prehospital use of oral transmucosal fentanyl citrate (OTFC) in the military setting. We hypothesized that the use of OTFC for trauma patients in remote and challenging environment is feasible, efficient, safe, and might be an alternative to nasal and intravenous applications. METHODS: This observational cohort study examined 177 patients who were treated with oral transmucosal fentanyl citrate by EMS providers in three ski and bike resorts in Switzerland. All EMS providers had previously been trained in administration of the drug and handling of potential adverse events. RESULTS: OTFC caused a statistically significant and clinically relevant decrease in the level of pain by a median of 3 (IQR 2 to 4) in NRS units (P < 0.0001). Multiple linear regression analysis showed a significant absolute reduction in pain, with no differences in all age groups and between genders. No major adverse events were observed. CONCLUSIONS: Prehospital administration of OTFC is safe, easy, and efficient for extrication and transport across all age groups, gender, and types of injuries in alpine environments. Side effects were few and mild. This could provide a valuable alternative in trauma patients with severe pain, without the delay of inserting an intravenous line, especially in remote areas, where fast action and easy administration are important.

The role of weather conditions on running performance in the Boston Marathon from 1972 to 2018.

This study examined the relationship of weather conditions, together with sex and country of origin, with running performance in the Boston Marathon from 1972 to 2018. A total of 580,990 observations from 382,209 different finishers were analyzed using Generalized Additive Mixed Models. Different groups and subgroups were considered such as all runners, near elite 101:200 finishers, near elite 21:100, annual top ten finishers and annual winners. Weather conditions, over the hours of the event, were average air temperature (°C), total precipitations (mm), wet-bulb globe temperature (WBGT) (°C), wind speed (km/h), wind direction (head wind, side wind, tail wind) and barometric pressure (hPa). These effects were examined in a multi-variable model, together with: sex, country of origin, calendar year, an interaction term country:sex and a spline smooth term in function of calendar year and sex. The average temperature, when increasing by 1°C, was related to worsened performance (by 00:01:47 h:min:sec for all finishers and by 00:00:20 h:min:sec for annual winners). Also, the pressure and wet-bulb globe temperature, when increasing, were related to worsened performances. Tail wind improved performances of all groups. Increasing precipitation was significantly (p<0.05) related to worsened performances in all groups except annual winners. Increasing wind speed was also related to worsened performances in all finishers and near elite groups. Kenyans and Ethiopians were the fastest nationalities. The sex differences (men faster than women in all groups) were the largest in near elite groups. Our findings contributed to the knowledge of the performance in Boston Marathon across calendar years, considering as main effects weather conditions, country of origin and sex.

The Role of Environmental Conditions on Marathon Running Performance in Men Competing in Boston Marathon from 1897 to 2018.

This study investigated the effects of weather conditions on male performance during the Boston Marathon from 1897 to 2018. A total of 383,982 observations from 244,642 different finishers were analysed using Generalized Additive Mixed Models. All runners, annual top 100 finishers and annual top ten finishers were considered. Weather conditions, on race day, were: average air temperature (°C), precipitations (mm), wet-bulb globe temperature (WBGT) (°C), wind speed (km/h), wind direction (N, S, W, E) and pressure (hPa). These effects were examined in multi-variable models with spline smooth terms in function of calendar year. Temperature, when increasing by 1 °C, was related to worsened performance for all groups (i.e., by 00:01:53 h:min:sec for all finishers, p < 0.001). Wind coming from the West, compared to wind coming from other directions, was the most favourable for performance of all groups of finishers. Increasing precipitations worsened performances of top 100 (estimate 00:00:04 h:min:sec, p < 0.001) and top 10 finishers (estimate 00:00:05 h:min:sec, p < 0.001). Wind speed, when increasing by 1 km/h, was related to worsened performance for all finishers (estimate 00:00:19 h:min:sec, p < 0.001), but not for top 100 group, where performances were 00:00:09 h:min:sec faster, p < 0.001. Pressure and WBGT were examined in uni-variable models: overall, performances worsened as pressure and WBGT increased. Our findings contributed to the knowledge about the effect of weather conditions on performance level in male marathon runners.

Men's Participation and Performance in the Boston Marathon from 1897 to 2017.

This study examined men's participation and performance in the Boston Marathon. Data from all 368,940 official male finishers in the Boston Marathon from 1897 through 2017 were analyzed using different analyses and regression models for all runners, annual top hundred finishers, annual top ten finishers and annual winners. Effect of calendar year on race time was examined alone, in a uni-variable model, and together with country of origin and weather conditions (average air temperature and precipitation) in a multi-variable model. The mean race time of all finishers increased across calendar years, in line with the participation, but it decreased when we considered the annual winners, 10 and 100 fastest. Kenyans and Ethiopians were the fastest nationalities (p<0.001) when we considered all finishers and the annual top 100 fastest but not when the annual 10 fastest were considered. Air temperature≤8 °C improved (p<0.001) race times compared to air temperature>8°C. Precipitation (>0 mm) improved performance for the annual 100 fastest and annual 10 fastest (p=0.013-0.031) but not for all finishers. Our findings improved the knowledge about the evolution of male marathoners across calendar years, considering as main effects country of origin and particular weather conditions.

Performance Trends in Age Group Triathletes in the Olympic Distance Triathlon at the World Championships 2009-2014.

Performance trends in elite triathletes competing in age group classes have been investigated for Ironman triathlon in 'Ironman Hawaii' but not for short distance triathletes competing at international level in events such as the Olympic distance triathlon at the World Championships. The aim of the present study was to evaluate participation and performance trends of age group triathletes competing in the Olympic distance triathlon at the International Triathlon Union (ITU) World Championships 2009-2014. During this period, the number of participants remained constant. Swimming performance improved in athletes in age groups 25-29 years to 55-59 years, but not in younger (18-24 years) and older (> 60-64 years) age groups. Cycling performance improved in athletes in age groups 18-24 years to 70-74 years, but not in age group 75-79 years. In running, athletes in age groups 18-24 years, 30-34 years, 35-39 years and 65-69 years improved, but not in the other age groups. Overall race time was improved by athletes in age groups 18-24 to 65-69 years, but not in age groups 70-74 years and 75-79 years. Transition times were improved by all age group athletes. Women were slower than men in swimming, cycling, running and overall race time in age groups 18-24 years to 70-74 years, but not in the age group 75-79 years. For transition times, women were slower than men in age groups 18-24 years to 65-69 years, but not in age groups 70-74 years to 75-79 years. In summary, women and men improved performance in most age groups across all years, men were faster than women except in the age group 75-79 years and the sex difference between women and men remained constant. This knowledge should be considered when future age group triathletes train for and compete in Olympic distance triathlons at international level.

Differences in age of peak marathon performance between mountain and city marathon running - The 'Jungfrau Marathon' in Switzerland.

The age of the best marathon performance has been well investigated for flat city marathon running, but not for mountain marathon running. The aim of this study was to determine the age of the best mountain marathon performance and to compare to results of a flat city marathon. Race times and ages of finishers of a mountain marathon with 1,830 m of altitude change (Jungfrau Marathon, Switzerland) and two flat city marathons (Lausanne Marathon and Zurich Marathon, Switzerland) were analysed using linear, non-linear and mixed-effects regression analyses. Race times were slower in the mountain compared to the city marathon. In both the mountain marathon and the city marathons, women and men improved performance and men were faster than women when the fastest per year and all per year were considered. When the fastest runners in 1-year age intervals were considered in the mountain marathon, the fastest man (3:01 h:min) was ~35.6 years and the fastest women (3:28 h:min) ~34.5 years old. When all finishers were considered in 1-year age intervals, the fastest men (4:59 h:min) were ~29.1 years old and the fastest women (5:16 h:min) were ~25.6 years old. In the city marathons in 1-year age intervals, the fastest man (2:10 h:min) was ~23.7 years old and the fastest woman (2:36 h:min) ~32.2 years old. When all finishers were considered in 1-year age intervals, the fastest men (3:41 h:min) were ~35.0 years old and the fastest women (4:00 h:min) ~33.8 years old. In summary, the age of the fastest women and men was higher in the mountain marathon compared to the city marathons when the fastest runners were considered. However, when all finishers were considered the age of the fastest women and men was lower in the mountain marathon compared to the city marathons.

Performance and age of African and non-African runners in World Marathon Majors races 2000-2014.

The age for the fastest marathoners is well investigated, but not the age and nationality of the fastest. We investigated the age of peak marathon performance for the annual top 100 women and men competing in four races of the "World Marathon Majors" (Boston, Berlin, Chicago and New York) and the "Stockholm Marathon" between 2000 and 2014 using mixed-effects regression analyses and one-way ANOVA. Race times of Ethiopian men decreased to 2:14 h:min, but remained unchanged for Kenyan (2:14 h:min), Moroccan (2:15 h:min) and South African (2:18 h:min) men. Race times in Ethiopian (2:34 h:min), Kenyan (2:29 h:min) and South African (2:49 h:min) women showed no changes. Age increased in Ethiopian and South African men to 29.0 ± 5.0 and 32.0 ± 1.0 years, respectively. Age for Kenyan (29.9 ± 2.0 years) and Moroccan (34.9 ± 3.9 years) men remained unchanged. Age remained unchanged for Ethiopian (26.5 ± 2.0 years), Kenyan (30.0 ± 0.8 years) and South African (36.3 ± 7.0 years) women. In summary, Ethiopian men improved marathon race times, but not Ethiopian women. Age increased in Ethiopian men, but not in Ethiopian women. For practical applications, female and male marathoners from Ethiopia were the youngest and the fastest.

Performance trends in age group breaststroke swimmers in the FINA World Championships 1986-2014.

Performance trends in breaststroke swimmers competing at world class level in pool competitions are well investigated for elite swimmers, but not for age group swimmers. This study investigated trends in participation, performance and sex difference in performance in a total of 35,143 (16,160 women and 18,983 men) age group breaststroke swimmers aged 25-29 to 95-99 years competing in the Fédération Internationale de Natation (FINA) World Masters Championships between 1986 and 2014. Trends in participation were analysed using linear regression analyses and trends in performance were investigated using mixed-effects regression analyses with sex, distance and calendar year as fixed variables. Women and men improved performance in all age groups. For age groups 25-29 to 85-89 years, men were faster than women. For age groups 90-94 to 95-99 years, men were not faster than women. Sex and distance showed a significant interaction for all distances in age groups 25-29 to 80-84 years. In 50 m, women reduced the gap to men in age groups 40-44 to 70-74 years and in 100 m and 200 m, women reduced the gap in age groups 50-54 to 60-64 years. In summary, (i) women and men improved performance in all race distances and in all age groups, (ii) men were faster than women from 25 to 89 years, but not from 90 to 99 years, and (iii), women reduced the gap to men between ~40 and ~75 years, but not in younger (<40 years) or older (>75 years) age groups. Based on these findings for a time period of nearly 30 years, we may assume a further increase in participation and a further improvement in performance in the near future in age group breaststroke swimmers competing at world class level.

Performance and sex differences in 'Isklar Norseman Xtreme Triathlon'.

The performance and sex differences of long-distance triathletes competing in 'Ironman Hawaii' are well investigated. However, less information is available with regards to triathlon races of the Ironman distance held under extreme environmental conditions (e.g. extreme cold) such as the 'Isklar Norseman Xtreme Triathlon' which started in 2003. In 'Isklar Norseman Xtreme Triathlon', athletes swim at a water temperature of ~13-15°C, cycle at temperatures of ~5-20°C and run at temperatures of ~12-28°C in the valley and of ~2-12°C at Mt. Gaustatoppen. This study analysed the performance trends and sex differences in 'Isklar Norseman Xtreme Triathlon' held from 2003 to 2015 using mixed-effects regression analyses. During this period, a total of 175 women (10.6%) and 1,852 men (89.4%) successfully finished the race. The number of female (r² = 0.53, P = 0.0049) and male (r² = 0.37, P = 0.0271) finishers increased and the men-to-women ratio decreased (r² = 0.86, P < 0.0001). Men were faster than women in cycling (25.41 ± 2.84 km/h versus 24.25 ± 2.17 km/h) (P < 0.001), but not in swimming (3.06 ± 0.62 km/h vs. 2.94 ± 0.57 km/h), running (7.43 ± 1.13 km/h vs. 7.31 ± 0.93 km/h) and overall race time (874.57 ± 100.62 min vs. 899.95 ± 90.90 min) (P > 0.05). Across years, women improved in swimming and both women and men improved in cycling and in overall race time (P < 0.001). In running, however, neither women nor men improved (P > 0.05). In summary, in 'Isklar Norseman Xtreme Triathlon' from 2003 to 2015, the number of successful women increased across years, women achieved a similar performance to men in swimming, cycling and overall race time, and women improved across years in swimming, cycling and overall race time.

Improved Race Times in Marathoners Older than 75 Years in the Last 25 Years in the World's Largest Marathons.

Performance trends of elite marathoners are well investigated. However, performance of elderly marathoners (> 75 years) competing in the world's largest city marathons is not well-known. We examined marathon race data of 1,691 marathon finishes (i.e. 218 women and 1,473 men) competing between 1990 and 2014 in 5-year age groups 75-79, 80-84, 85-89, and 95-99 years in four races (Berlin, New York, Chicago and Boston) of the 'World Marathon Majors'. The number of female (r² = 0.50, P < 0.0001) and male (r² = 0.88, P < 0.0001) finishers increased significantly across years. The number of women (r² = 0.36, P = 0.0019) and men (r² = 0.88, P < 0.0001) in age group 75-79 years increased. In age group 80-84 years, the number of women (r² = 0.36, P = 0.0111) and men (r² = 0.54, P < 0.0001) also increased. In age groups 85-89 to 95-99 years, however, the number of female and male finishers remained unchanged. Across years, women (r² = 0.26, P = 0.0090) and men (r² = 0.31, P = 0.0035) reduced their race times. Women and men in age group 75-79 years improved race times. In age groups 80-84 to 90-94 years, women and men were not able to reduce race times. In summary, participation increased and performance improved in female and male marathoners competing in age groups 75-79 to 95-99 years where the largest increases in participation and the largest improvements in performance were found in women and men in age group 75-79 years.

Prevalence in running events and running performance of endurance runners following a vegetarian or vegan diet compared to non-vegetarian endurance runners: the NURMI Study.

BACKGROUND: Beneficial and detrimental effects of various vegetarian and vegan diets on the health status are well known. Considering the growing background numbers of vegetarians and vegans, the number of vegetarian and vegan runners is likely to rise, too. Therefore, the Nutrition and Running High Mileage (NURMI) Study was designed as a comparative study to investigate the prevalence of omnivores, vegetarians, and vegans in running events and to detect potential differences in running performance comparing these three subgroups. METHODS/DESIGN: The NURMI Study will be conducted in three steps following a cross-sectional design. Step 1 will determine epidemiological aspects of endurance runners (any distance) using a short standardized questionnaire. Step 2 will investigate dietary habits and running history from eligible participants (capable of running a half-marathon at least) using an extended standardized questionnaire. Step 3 will collect data after a running event on finishing time and final ranking as well as a post-race rating of perceived exertion, mood status, nutrient and fluid intake during the race. DISCUSSION: Our study will provide a major contribution to overcome the lack of data on the prevalence and running performance of vegetarian and vegan runners in endurance running events. We estimate the prevalence of vegetarians and vegans participating in a running event to be less compared to the respective proportion of vegetarians and vegans to the general population. Furthermore we will validate the subject's self-assessment of their respective diet. This comparative study may identify possible effects of dietary behavior on running performance und may detect possible differences between the respective subgroups: omnivorous, vegetarian and vegan runners. Trial registration Current controlled trials, ISRCTN73074080.

Sex Difference in Draft-Legal Ultra-Distance Events - A Comparison between Ultra-Swimming and Ultra-Cycling.

Recent studies reported that the sex difference in performance in ultra-endurance sports such as swimming and cycling changed over the years. However, the aspect of drafting in draft-legal ultra-endurance races has not yet been investigated. This study investigates the sex difference in ultra-swimming and ultra-cycling draft-legal races where drafting - swimming or cycling behind other participants to save energy and have more power at the end of the race to overtake them, is allowed. The change in performance of the annual best and the annual three best in an ultra-endurance swimming race (16-km 'Faros Swim Marathon') over 38 years and in a 24-h ultra-cycling race ('World Cycling Race') over 13 years were compared and analysed with respect to sex difference. Furthermore, performances of the fastest female and male finishers ever were compared. In the swimming event, the sex difference of the annual best male and female decreased non-significantly (P = 0.262) from 5.3% (1976) to 1.0% (2013). The sex gap of speed in the annual three fastest swimmers decreased significantly (P = 0.043) from 5.9 ± 1.6% (1979) to 4.7 ± 3.1% (2013). In the cycling event, the difference in cycling speed between the annual best male and female decreased significantly (P = 0.026) from 33.31% (1999) to 10.89% (2011). The sex gap of speed in the annual three fastest decreased significantly (P = 0.001) from 32.9 ± 0.6% (1999) to 16.4 ± 5.9% (2011). The fastest male swimmer ever (swimming speed 5.3 km/h, race time: 03:01:55 h:min:s) was 1.5% faster than the fastest female swimmer (swimming speed 5.2 km/h, race time: 03:04:09 h:min:s). The three fastest male swimmers ever (mean 5.27 ± 0.13 km/h) were 4.4% faster than the three fastest female swimmers (mean 5.05 ± 0.20 km/h) (P < 0.05). In the cycling event, the best male ever (cycling speed 45.8 km/h) was 26.4% faster than the best female (cycling speed 36.1 km/h). The three fastest male cyclists ever (45.9 km/h) (mean 45.85 ± 0.05 km/h) were 32.1% faster (P < 0.05) than the three fastest female cyclists ever (34.7 km/h) (mean 34.70 ± 1.87 km/h). In summary, in draft-legal ultra-distance events such as swimming and cycling, the sex difference in the annual top and annual top three swimmers and cyclists decreased (i.e. non-linearly in swimmers and linearly in cyclists) over the years. The sex difference of the fastest athletes ever was smaller in swimming (1.5%) than in cycling (26.4%). This finding is different from reports about races where drafting was not possible or even prohibited and where the sex difference remained stable over years.

The Age in Swimming of Champions in World Championships (1994⁻2013) and Olympic Games (1992⁻2012): A Cross-Sectional Data Analysis.

(1) Background: We investigated the age of swimming champions in all strokes and race distances in World Championships (1994⁻2013) and Olympic Games (1992⁻2012); (2) Methods: Changes in age and swimming performance across calendar years for 412 Olympic and world champions were analysed using linear, non-linear, multi-level regression analyses and MultiLayer Perceptron (MLP); (3) Results: The age of peak swimming performance remained stable in most of all race distances for world champions and in all race distances for Olympic champions. Longer (i.e., 200 m and more) race distances were completed by younger (-20 years old for women and -22 years old for men) champions than shorter (i.e., 50 m and 100 m) race distances (-22 years old for women and -24 years old for men). There was a sex difference in the age of champions of -2 years with a mean age of -21 and -23 years for women and men, respectively. Swimming performance improved in most race distances for world and Olympic champions with a larger trend of increase in Olympic champions; (4) Conclusion: Swimmers at younger ages (<20 years) may benefit from training and competing in longer race distances (i.e., 200 m and longer) before they change to shorter distances (i.e., 50 m and 100 m) when they become older (>22 years).

Feet swelling in a multistage ultraendurance triathlete: a case study.

Recent studies investigating ultraendurance athletes showed an association between excessive fluid intake and swelling of the lower limbs such as the feet. To date, this association has been investigated in single-stage ultraendurance races, but not in multistage ultraendurance races. In this case study, we investigated a potential association between fluid intake and feet swelling in a multistage ultraendurance race such as a Deca Iron ultratriathlon with ten Ironman triathlons within 10 consecutive days. A 49-year-old well-experienced ultratriathlete competed in autumn 2013 in the Deca Iron ultratriathlon held in Lonata del Garda, Italy, and finished the race as winner within 129:33 hours:minutes. Changes in body mass (including body fat and lean body mass), foot volume, total body water, and laboratory measurements were assessed. Food and fluid intake during rest and competing were recorded, and energy and fluid turnovers were estimated. During the ten stages, the volume of the feet increased, percentage body fat decreased, creatinine and urea levels increased, hematocrit and hemoglobin values decreased, and plasma [Na(+)] remained unchanged. The increase in foot volume was significantly and positively related to fluid intake during the stages. The poststage volume of the foot was related to poststage total body water, poststage creatinine, and poststage urea. This case report shows that the volume of the foot increased during the ten stages, and the increase in volume was significantly and positively related to fluid intake during the stages. Furthermore, the poststage volume of the foot was related to poststage total body water, poststage creatinine, and poststage urea. The continuous feet swelling during the race was most probably due to a combination of a high fluid intake and a progressive decline in renal function (ie, continuous increase in creatinine and urea), leading to body fluid retention (ie, increase in total body water).

Variables that influence Ironman triathlon performance - what changed in the last 35 years?

OBJECTIVE: This narrative review summarizes findings for Ironman triathlon performance and intends to determine potential predictor variables for Ironman race performance in female and male triathletes. METHODS: A literature search was performed in PubMed using the terms "Ironman", "triathlon", and "performance". All resulting articles were searched for related citations. RESULTS: Age, previous experience, sex, training, origin, anthropometric and physiological characteristics, pacing, and performance in split disciplines were predictive. Differences exist between the sexes for anthropometric characteristics. The most important predictive variables for a fast Ironman race time were age of 30-35 years (women and men), a fast personal best time in Olympic distance triathlon (women and men), a fast personal best time in marathon (women and men), high volume and high speed in training where high volume was more important than high speed (women and men), low body fat, low skin-fold thicknesses and low circumference of upper arm (only men), and origin from the United States of America (women and men). CONCLUSION: These findings may help athletes and coaches to plan an Ironman triathlon career. Age and previous experience are important to find the right point in the life of a triathlete to switch from the shorter triathlon distances to the Ironman distance. Future studies need to correlate physiological characteristics such as maximum oxygen uptake with Ironman race time to investigate their potential predictive value and to investigate socio-economic aspects in Ironman triathlon.

Participation and performance trends in elderly marathoners in four of the world's largest marathons during 2004-2011.

Performance and age of elite marathoners is well known. Participation and performance trends of elderly marathoners (75 years and older) are not well investigated. This study investigated participation and performance trends in elderly marathoners older than 75 years competing during 2004-2011 in four races (Berlin, New York, Chicago and Boston) of the 'World Marathon Majors' using mixed-effects regression models. Participation for women and men remained unchanged at 17 and 114, respectively, during the investigated period. For all finishers, marathon race times showed a significant and positive trend for gender, calendar year and age. For the annual fastest, calendar year and age showed a significant and positive trend. For the annual three fastest, gender, calendar year and age showed a significant and positive trend. The gender difference for the annual fastest and the annual three fastest showed no change across years. For the annual fastest and the annual three fastest, race times were fastest in the youngest age group (75-79 years) and slowest in the oldest age group (85-89 and 80-84 years, respectively). The gender difference in marathon race times remained unchanged across years at 19.7 ± 11.2, 28.1 ± 23.8 and 41.9 ± 22.6 % for the annual fastest in age groups 75-79, 80-84 and 85-89 years, respectively. For the annual three fastest men and women in age groups 75-79 and 80-84 years, the values were 23.7 ± 3.2 and 30.0 ± 13.2 %, respectively. In summary, for marathoners older than 75 years participating during 2004-2011 in four of the largest marathons in the world, participation for female and male runners remained unchanged, the fastest women and men became slower across years and the gender difference in performance remained unchanged. These findings might be the results of the relatively short period of time of 8 years. Future studies might investigate the performance trends in a large city marathon across a longer period of time.

Women cross the 'Catalina Channel' faster than men.

Open-water ultra-distance swimming has a long history where the 'English Channel' (~33 km) was crossed in 1875 for the first time. Nowadays, the three most challenging open-water swims worldwide are the 21-miles (34 km) 'English Channel Swim', the 20.1-miles (32.2 km) 'Catalina Channel Swim' and the 28.5-miles (45.9 km) 'Manhattan Island Marathon Swim', also called the 'Triple Crown of Open Water Swimming'. Recent studies showed that women were able to achieve men's performance in the 'English Channel Swim' or to even outperform men in the 'Manhattan Island Marathon Swim'. However, the analysis of the 'Catalina Channel Swim' as part of the 'Triple Crown of Open Water Swimming' is missing. We investigated performance and sex difference in performance for successful women and men crossing the 'Catalina Channel' between 1927 and 2014. The fastest woman ever was ~22 min faster than the fastest man ever. Although the three fastest women ever were ~20 min faster than the three fastest men ever, the difference reached not statistical significance (p > 0.05). Similarly for the ten fastest ever, the ~1 min difference for women was not significant (p > 0.05). However, when the swimming times of the annual fastest women (n = 39) and the annual fastest men (n = 50) competing between 1927 and 2014 were compared, women (651 ± 173 min) were 52.9 min (16 ± 12%) faster than men (704 ± 279 min) (p < 0.0001). Across years, swimming times decreased non-linearly in the annual fastest men (polynomial 2nd degree) and women (polynomial 3rd degree) whereas the sex difference decreased linearly from 52.4% (1927) to 7.1% (2014). In summary, the annual fastest women crossed the 'Catalina Channel' faster than the annual fastest men. The non-linear decrease in swimming times suggests that female and male swimmers have reached a limit in this event. However, the linear decrease in the sex difference may indicate that women continuously narrow the gap to men.

The aspect of experience in ultra-triathlon races.

Previous experience seems to be an important predictor for endurance and ultra-endurance performance. The present study investigated whether the number of previously completed races and/or the personal best times in shorter races is more predictive for performance in longer non-stop ultra-triathlons such as a Deca Iron ultra-triathlon. All female and male ultra-triathletes who had finished between 1985 and 2014 at least one Double Iron ultra-triathlon (i.e. 7.6 km swimming, 360 km cycling and 84.4 km running), one Triple Iron ultra-triathlon (i.e. 11.4 km swimming, 540 km cycling and 126.6 km running), one Quintuple Iron ultra-triathlon (i.e. 19 km swimming, 900 km cycling and 221 km running) and one Deca Iron ultra-triathlon (i.e. 38 km swimming, 1,800 km cycling and 422 km running) were identified and their best race times for each distance were recorded. Multiple regression analysis (stepwise, forward selection, p of F for inclusion <0.05, p of F for exclusion >0.1, listwise deletion) was used to determine all variables correlating to overall race time and performance in split disciplines for both Quintuple and Deca Iron ultra-triathlon. The number of finished shorter races (i.e. Double and Triple Iron ultra-triathlon) was not associated with the number of finished longer races (i.e. Quintuple and Deca Iron ultra-triathlon) whereas both split and overall race times correlated to split and overall race times of the longer races with the exception of the swimming split times in Double Iron ultra-triathlon showing no correlation with swimming split times in both Quintuple and Deca Iron ultra-triathlon. In summary, previous experience seemed of importance in performance for longer ultra-triathlon races (i.e. Quintuple and Deca Iron ultra-triathlon) where the personal best times of shorter races (i.e. Double and Triple Iron ultra-triathlon) were important, but not the number of previously finished races. For athletes and coaches, fast race times in shorter ultra-triathlon races (i.e. Double and Triple Iron ultra-triathlon) are more important than a large of number finished races in order to achieve a fast race time in a longer ultra-triathlon (i.e. Quintuple and Deca Iron ultra-triathlon).

What predicts performance in ultra-triathlon races? - a comparison between Ironman distance triathlon and ultra-triathlon.

OBJECTIVE: This narrative review summarizes recent intentions to find potential predictor variables for ultra-triathlon race performance (ie, triathlon races longer than the Ironman distance covering 3.8 km swimming, 180 km cycling, and 42.195 km running). Results from studies on ultra-triathletes were compared to results on studies on Ironman triathletes. METHODS: A literature search was performed in PubMed using the terms "ultra", "triathlon", and "performance" for the aspects of "ultra-triathlon", and "Ironman", "triathlon", and "performance" for the aspects of "Ironman triathlon". All resulting papers were searched for related citations. Results for ultra-triathlons were compared to results for Ironman-distance triathlons to find potential differences. RESULTS: Athletes competing in Ironman and ultra-triathlon differed in anthropometric and training characteristics, where both Ironmen and ultra-triathletes profited from low body fat, but ultra-triathletes relied more on training volume, whereas speed during training was related to Ironman race time. The most important predictive variables for a fast race time in an ultra-triathlon from Double Iron (ie, 7.6 km swimming, 360 km cycling, and 84.4 km running) and longer were male sex, low body fat, age of 35-40 years, extensive previous experience, a fast time in cycling and running but not in swimming, and origins in Central Europe. CONCLUSION: Any athlete intending to compete in an ultra-triathlon should be aware that low body fat and high training volumes are highly predictive for overall race time. Little is known about the physiological characteristics of these athletes and about female ultra-triathletes. Future studies need to investigate anthropometric and training characteristics of female ultra-triathletes and what motivates women to compete in these races. Future studies need to correlate physiological characteristics such as maximum oxygen uptake (VO2max) with ultra-triathlon race performance in order to investigate whether these characteristics are also predictive for ultra-triathlon race performance.