MRI Brain Changes After Marathon Running: Results of the Berlin Beat of Running Study

Abstract

Several studies report neurological complications such as brain injury induced by ischemia or edema following exhaustive endurance sport. We aimed to detect the frequency of acute brain lesions after a marathon race. In the prospective observational Berlin Beat of Running study, 110 experienced endurance athletes underwent 3-Tesla brain MRI exams 2–3 days prior and within 2 days after a marathon run. MRI results were compared to an age- and sex-matched control group of 68 non-athletes, including the “Age-Related White Matter Changes” (ARWMC) scale to assess white matter lesions (WML) in the brain. 108 athletes (median age 48 years, 24% female, 8% with hypertension; 0% with diabetes) completed the race. No athlete reported neurological deficits, but a single acute ischemic lesion was detected in diffusion-weighted MRI after the race in one athlete. No other acute brain lesions compared to prior MRI were found. An ARWMC score ≥4 was found in 15% of athletes and 12% of non-athletic controls (p=0.7). Chronic ischemic lesions were not found in athletes but in four controls (6%) (p=0.02). In conclusion, acute ischemic brain lesions may be found in endurance runners. Every seventh endurance athlete and every ninth control showed evidence for substantial white matter lesions.

Widespread drastic reduction in brain myelin content upon marathon running

“…Subtle reversible volume decreases in global gray matter, but not in white matter, in ultramarathon multistage runners have been reported earlier with no other signs of brain changes and damage, as determined by MRI and evaluations for neurological complications. [20][21][22][23] This reduction and subsequent recovery were paralleled by a similar loss in body weight and was gained following a period of rest. 21 Interestingly, EEG activity increases bilaterally in all brain lobes during graded exercise, correlates with its intensity, and returns to resting levels quickly after cessation of exercise.…”

Cardiovascular Disease Risk Factor Profile of Experienced Male Amateur Marathon Runners: A Systematic Review

“…Möhlenkamp et al 32 reported initial findings in 2008 and then 3 other studies later provided further analysis concerning the MRFs. 23,33,35 Similarly, Haeusler et al 19,20 later reported findings in 2 related papers that provided information in relation to the aims of the study and follow-up data. Finally, Schwartz et al 53 provided subsequent analysis in a related paper on the MRFs of marathon runners.…”

“…The assessment for MRFs varied across the 5 studies. 18,22,32,53,57 Most of the studies used a combination of the following: medical history 18,22,32,53,57 ; marathon race history 18,22,32,53,57 ; physical examination 18,22,32,53,57 ; blood analyses 18,22,32,53,57 ; sociodemographic history 18,19,20 ; Framingham risk score (FRS) 23,32,33,35 ; Rose angina questionnaire 23,32,33,35 ; nonvalidated questionnaires, 23,32,33,35 for example on lifestyle, 48,53 health, nutrition, exercise, and psychosocial and socioeconomic risk factors; interviews 23,32,33,35 ; Prospective Cardiovascular Münster (PROCAM) cardiovascular study CV risk score 57 ; BORG rating of perceived exertion scale 22 ; and an exercise treadmill stress test (GXT). 22 It was difficult to compare these data as not all studies followed specific criteria that can be noted in their measurement of BP and recall data, which could influence bias.…”

“…There were 5 studies, and additional data were reported in 6 related papers that described MRFs and CVD. [18][19][20]22,23,32,33,35,48,53,57 The most compelling finding was that excessive training and marathon running may cause a reduction in the benefits received from exercise, whereas moderate training appears to have a more profound positive effect on health. 18,22,32,53,57 The next most striking finding was that, although marathon running can exert many positive health benefits, it does not override the negative effects of long-term exposure to an unhealthy lifestyle.…”

Widespread drastic reduction of brain myelin content upon prolonged endurance exercise

“…A possible confounding effect on assimilating MWF to myelin content is brain edema, which may occur in strenuous exercise like high mountain ultramarathons but has not been observed in 42.195 m marathons ( 54, 55 ). Moreover, edema/inflammation during new lesion formation in multiple sclerosis has a minor impact, if any, on MWF ( 56 ).…”