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

Abstract

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.

Acute Kidney Injury Biomarkers and Hydration Outcomes at the Boston Marathon

“…Distance runners are often viewed as healthy individuals due to their cardiovascular fitness, habitual training volume, and large calorie expenditure ( Mansour et al, 2019 ). However, the prevalence of acute kidney injury (AKI) has been considered as a potential negative consequence of long-distance running but long-term effects are unknown ( McCullough et al, 2011 ; Hewing et al, 2015 ; Mansour et al, 2017 ; Knechtle and Nikolaidis, 2018 ; Poussel et al, 2020 ; Scheer et al, 2021 ). AKI is an abrupt decrease in kidney function and can involve structural damage and impairment ( Makris and Spanou, 2016 ).…”

Renal Function Recovery Strategies Following Marathon in Amateur Runners

“…Given the increase of marathon running popularity, the physiological alterations caused by performing such a demanding effort have increased the interest of the scientific community ( Scheer, 2019 ; Rojas-Valverde et al, 2021b ; Scheer et al, 2021 ). Running a long-distance race demands a vigorous physical effort, which has been shown to generate transient elevation of biomarkers associated with pathological conditions such as muscle damage, inflammation, heart damage, and renal failure ( Briviba et al, 2005 ; Khodaee et al, 2015 ; Belli et al, 2018 ; Knechtle and Nikolaidis, 2018 ; Nikolaidis et al, 2018 ; Bernat-Adell et al, 2019 , 2020 ; Martínez-Navarro et al, 2020a , c ; Scheer et al, 2021 ).…”

Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review

“…Research around ultra-trails has sparked great interest in recent years, with a focus mainly on analyzing success with regard to performance-influencing variables [ 6 ]. However, due to the increased popularity that these events have been experiencing [ 7 ], it is of great interest to understand their consequences on participants’ health not only in the short [ 8 , 9 ] but also in the long term [ 10 ]. This could even include analyzing the incidence of medical conditions induced by the races and the type of medical care provided during and after the race [ 11 , 12 ].…”