Ultra-marathon running is frequently associated with muscle fibre damage. However, ultra-marathon related information is scarce. The present study evaluated muscle and cartilage biomarkers, and cytokine secretion during a 200 km running event. Venous blood samples from 54 trained male ultra-marathon runners (mean +/- SD, 45.7 +/- 5.1 years). Plasma creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate, glucose, high-sensitivity C-reactive protein (Hs-CRP), interleukin-6 (IL-6), TNF- proportional, variant and serum cartilage oligomeric matrix protein (COMP) content were determined before, midway and immediately after the race. CPK increased 90-fold (19-fold at 100 km) from pre-race value and LDH increased 3.7-fold (2.2-fold at 100 km). AST increased 15-fold (5-fold at 100 km) and ALT increased 3.9-fold (2-fold at 100 km). Blood lactate and glucose levels did not change significantly. Hs-CRP increased 23-fold (3-fold at 100 km) and IL-6 increased 121-fold at 100 km, and then remained stable up to 200 km, whereas TNF- proportional, variant did not change significantly. Serum COMP increased 3-fold (1.3-fold at 100 km). Post-run CPK was correlated with LDH (r = 0.62, P < 0.001), Hs-CRP (r = 0.45, P < 0.001), ALT (r = 0.89, P < 0.001), AST (r = 0.97, P < 0.001), and IL-6 (r = 0.61, P < 0.001). The present study demonstrated that blood biomarkers related to muscle and cartilage damage and inflammation were increased during a 200 km run and that this was particularly marked during the second half of the event. Ultra-marathon running clearly has a major impact on muscle and cartilage structures.

Marathon running is frequently associated with numerous cellular changes, but little information is available on the effects of exercise-mediated prolonged impact-stress on cartilage integrity. This study was undertaken to evaluate muscle and cartilage damage with different running distances. Twenty male marathoners and ultra-marathoners participated in the study. Serum COMP and plasma CPK and hs-CRP were measured as markers of cartilage and muscle damage and inflammation. Serum COMP was increased 1.6-fold at 10 km during a marathon race and declined to the pre-race level after 2 days recovery. In contrast, serum COMP was increased 1.9-fold after a 200-km race and maintained until day 3 of recovery, only returning to the pre-race level on day 6. Plasma CPK was increased at 10 km of the marathon race and up to threefold at the end of the race. This was further increased on day 1, only returning to pre-race level on day 6. Plasma CPK was increased 35-fold at the end of the 200-km race and remained increased until day 5. There was no change in plasma hs-CRP during the marathon race, but this was increased 3.4-fold by day 1, returning to the pre-race level on day 4. Plasma hs-CRP increased 40-fold by the end of the 200-km race and was still increased on day 6 of recovery. Therefore, longer distance running may induce more impact-stress both on muscle and cartilage. Further, the required time for recovery may vary with running distance and the tissue type, e.g. cartilage or skeletal muscle as in this case.

SummaryThis study was conducted to study left ventricular hypertrophy (LVH), diastolic dysfunction, pulse pressure (PP), and plasma endothelin (ET)-1 level in amateur marathon runners with an exaggerated blood pressure response (EBPR) to exercise. The study participants included normotensive marathon runners (NM, n = 15), EBPR marathon runners (EBPR, n = 17), normotensive sedentary individuals (CON, n = 13), and hypertensive patients (HTN, n = 14). An integrated M-mode/2-dimensional echocardiographic analysis was performed. Plasma ET-1 levels at resting were measured using a commercial ELISA kit. LV wall thickness and end-diastolic dimensions as well as LV mass index (LVMI) were higher in EBPR than in CON. There were no differences in systolic function among the groups. Analysis of diastolic function, such as lower Em and higher E/Em ratio on TDI, showed a worse relaxation pattern in EBPR. Despite LVH, NM subjects showed no abnormality of LV diastolic dysfunction. HTN subjects in the early stage of their disease showed a slightly modified LV structural and diastolic function, but there was no statistical difference compared with CON. The E/Em ratio was significantly correlated with PP and LVMI. LVMI was significantly correlated with PP. There was a significant difference in plasma ET-1 concentration between marathon runners and hypertensive subjects. We demonstrated that marathon runners with EBPR showed an increase in LVMI and diastolic dysfunction more than HTN subjects in the early stage. PP was significantly related to these two variables. Caution should be exercised when connecting LVH and diastolic dysfunction with plasma ET-1 concentration in all marathon runners. (Int Heart J 2013; 54: 82-87)Key words: Endothelin-1, Marathon A thlete's heart is a well known condition characterized by structural, electrical, and functional adaptations of the myocardium consequent to regular physical training and consistent with the intensity, duration, and type of activity.1,2) To date, conflicting data have been reported concerning the nature (physiologic versus pathologic) of left ventricular hypertrophy (LVH) in master athletes and veterans. [3][4][5][6] Exaggerated blood pressure response (EBPR) during exercise is associated with increased risk of worsening hypertension in normotensives, as well as in subjects with high normal blood pressure (BP). 7,8) Moreover, EBPR might be related to adverse cardiovascular outcomes, partially due to its association with indices of target-organ damage such as LVH, abnormal geometry, or carotid atherosclerosis. [9][10][11] In addition, diastolic dysfunction of the LV frequently accompanies EBPR. 12)However, we do not know whether EBPR in athletes would show the same features associated with abnormal LV remodeling and diastolic dysfunction. Recently, we have unofficially found numerous cases of EBPR to exercise in Korean nonathletic marathon runners. Marathons have become a popular leisure activity in Korea during the last 2 decades and rank first in popularity as a public sport. We t...