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Marathon sports events and those who participate in them have grown over the last years, reflecting notably an augmentation of women and master runners’ participation. The aim of the present narrative review was to briefly present the results of studies on anthropometric, physiological, and training characteristics, as well as predictors of performance, in marathon runners. It was observed that performance was better in runners with a small body weight, body mass index, body fat percentage, and rate of endomorphy. Regarding physiology, an increased maximal oxygen uptake, anaerobic threshold, and improved running economy could result in a faster race time. The training variables that could predict performance involved weekly training volume (distance) and intensity (running speed), as well as history of training (years). A combination of these three broad categories of characteristics may offer an approximate estimation of the race speed considering that other aspects (e.g., nutrition, biomechanics, and motivation) influence race performance, too. In summary, the findings of the present study provided an overview of the anthropometric, physiological, and training characteristics associated with marathon race times; thus, optimization of any of these characteristics would be expected to improve the race time.

Abstract The study aimed to investigate the effects of acute ingestion of saffron (SAF) on physiological (i.e., heart rate and blood lactate) and perceptual (i.e., ratings of perceived exertion [RPE] and feeling scale) measures in response to a repeated-sprint ability test (RSS) in healthy young males (N = 22; mean ± SD: age, 21.7 ± 1.24 yrs.). All participants completed two experimental trials with a one-week washout period using a double-blind, placebo-controlled, crossover design. In each session, the participants were randomly chosen to receive either a capsule of saffron (300 mg) (SAF session) or a capsule of lactose (PLB session) two hours before performing the RSS. No significant differences (p > 0.05) were found for heart rate, RPE, and feeling scale between the SAF or PLB sessions at pre- and post-RSS. There were no significant changes (p > 0.05) in peak time, total time, fatigue index, and blood lactate in either the SAF or PLB sessions. Acute SAF ingestion did not significantly improve RSS performance nor physiological and perceptual measures in active young males. Future trials should address the topic by using shortened/prolonged higher doses of SAF on biological, physical, physiological, and perceptual responses to acute and chronic exercise.

Abstract The majority of participants in Ironman triathlon races are age group athletes. We have extensive knowledge about recreational athletes’ training and competition participation. Nonetheless, Ironman age group triathletes must achieve fast race times to qualify for the Ironman World Championship in Hawaii. They can, therefore, benefit from knowing where the fastest Ironman racecourses in the world are. The aim of the present study was to investigate where the fastest Ironman racecourses for age group triathletes are located in the world. Data from 677,702 Ironman age group finishers’ records (544,963 from men and 132,739 from women) originating from 228 countries and participating in 444 events across 66 different Ironman race locations between 2002 and 2022 were analyzed. Data was analyzed through traditional descriptive statistics and with machine learning regression models. Four algorithms were tested (Random Forest Regressor, XG Boost Regressor, Cat Boot Regressor, and Decision Tree Regressor). The models used gender, age group, country of origin, environmental factors (average air and water temperatures), and the event location as independent variables to predict the final overall race time. Despite the majority of successful Ironman age group triathletes originating from the USA (274,553), followed by athletes from the United Kingdom (55,410) and Canada (38,264), these countries exhibited average overall race times that were significantly slower compared to the fastest countries. Most of the triathletes competed in Ironman Wisconsin (38,545), followed by Ironman Florida (38,157) and Ironman Lake Placid (34,341). The fastest overall race times were achieved in Ironman Copenhagen (11.68 ± 1.38 h), followed by Ironman Hawaii (11.72 ± 1.86 h), Ironman Barcelona (11.78 ± 1.43 h), Ironman Florianópolis (11.80 ± 1.52 h), Ironman Frankfurt (12.03 ± 1.38 h) and Ironman Kalmar (12.08 ± 1.47 h). The fastest athletes originated from Belgium (11.48 ± 1.47 h), followed by athletes from Denmark (11.59 ± 1.40 h), Switzerland (11.62 ± 1.49 h), Austria (11.68 ± 1.50), Finland (11.68 ± 1.40 h) and Germany (11.74 ± 15.1 h). Flat running and cycling courses were associated with faster overall race times. Three of the predictive models identified the ‘country’ and ‘age group’ variables as the most important predictors. Environmental characteristics showed the lowest influence regarding the other variables. The origin of the athlete was the most predictive variable whereas environmental characteristics showed the lowest influence. Flat cycling and flat running courses were associated with faster overall race times. The fastest overall race times were achieved mainly in European races such as Ironman Copenhagen, Ironman Hawaii, Ironman Barcelona, Ironman Florianópolis, Ironman Frankfurt and Ironman Kalmar. The fastest triathletes originated from European countries such as Belgium, Denmark, Switzerland, Austria, Finland, and Germany.

Abstract Therapeutic apheresis aims to selectively remove pathogenic substances, such as antibodies that trigger various symptoms and diseases. Unfortunately, current apheresis devices cannot handle small blood volumes in infants or small animals, hindering the testing of animal model advancements. This limitation restricts our ability to provide treatment options for particularly susceptible infants and children with limited therapeutic alternatives. Here, we report our solution to these challenges through an acoustofluidic-based therapeutic apheresis system designed for processing small blood volumes. Our design integrates an acoustofluidic device with a fluidic stabilizer array on a chip, separating blood components from minimal extracorporeal volumes. We carried out plasma apheresis in mouse models, each with a blood volume of just 280 μL. Additionally, we achieved successful plasmapheresis in a sensitized mouse, significantly lowering preformed donor-specific antibodies and enabling desensitization in a transplantation model. Our system offers a new solution for small-sized subjects, filling a critical gap in existing technologies and providing potential benefits for a wide range of patients.

Beat Knechtle,1 Matthias Alexander Zingg,2 Patrizia Knechtle,1 Thomas Rosemann,2 Christoph Alexander Rüst2 1Gesundheitszentrum St Gallen, St Gallen, 2Institute of Primary Care, University of Zurich, Zurich, Switzerland Abstract: 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). Keywords: swimming, cycling, running, fluid

Wet-cupping therapy (WCT) is one of the oldest known medical techniques, used as a traditional and complementary therapy with a wide application all around the world for general health. Research on the effects of WCT on sports performance are sparse and inconsistent. Thus, we aimed to explore the effects of WCT on repeated sprint ability, wellness, and exertion in young active males. Forty-nine active adult males (age: [28 ​± ​5] years; body height [177 ​± ​8] cm; body mass: [79 ​± ​7] kg; body mass index: [25.4 ​± ​1.8] kg/m2) were selected for the study. The participants performed a running-based sprint test on two separate occasions (Control and Post-WCT). WCT was performed 24 ​h before the testing session. They completed the Hooper questionnaire to assess their well-being (i.e., sleep, stress, fatigue, and soreness) before each session. The rating of perceived exertion (RPE) was collected after each testing session. A higher maximum power (p ​

Mohannad Abou Shoak,1 Beat Knechtle,1,2 Patrizia Knechtle,2 Christoph Alexander Rüst,1 Thomas Rosemann,1 Romuald Lepers31Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, FranceBackground: Participation and performance trends have been investigated in ultramarathons and ultratriathlons but not in ultracycling. The aim of the present study was to investigate (1) participation and performance trends in ultraendurance cyclists, (2) changes in cycling speed over the years, and (3) the age of the fastest male and female ultraendurance cyclists.Methods: Participation and performance trends in the 5000 km Race Across America (RAAM) and in two RAAM-qualifier races – the 818 km Furnace Creek 508 in the United States and the 715 km Swiss Cycling Marathon in Europe – were investigated using linear regression analyses and analyses of variance.Results: On average, ~41% of participants did not finish either the RAAM or the Furnace Creek 508, whereas ~26% did not finish the Swiss Cycling Marathon. Female finishers accounted for ~11% in both the RAAM and the Furnace Creek 508 but only ~3% in the Swiss Cycling Marathon. The mean cycling speed of all finishers remained unchanged during the studied periods. The winner’s average speed was faster for men than for women in the RAAM (22.6 ± 1.1 km · h-1 versus 18.4 ± 1.7 km · h-1, respectively; average speed difference between male and female winners, 25.0% ± 11.9%), the Swiss Cycling Marathon (30.8 ± 0.8 km · h-1 versus 24.4 ± 1.9 km · h-1, respectively; average speed difference between male and female winners, 27.8% ± 9.4%), and the Furnace Creek 508 (27.4 ± 1.6 km · h-1 versus 23.4 ± 3.0 km · h-1, respectively; average speed difference between male and female winners, 18.4% ± 13.9%). In both the Furnace Creek 508 and the Swiss Cycling Marathon, ~46% of the finishers were aged between 35 and 49 years. The mean age of winners, both male and female, across the years in the Furnace Creek 508 and in the Swiss Cycling Marathon was 37 ± 10 years.Conclusion: These findings in ultracycling races showed that (1) ~26%–40% of starters were unable to finish, (2) the percentage of female finishers was ~3%–11%, (3) the gender difference in performance was ~18%–28%, and (4) ~46% of the successful finishers were master athletes. Future studies need to investigate the reasons for the low female participation and focus on the age-related performance decline in other ultraendurance events in order to confirm that master athletes are predisposed to ultraendurance performances.Keywords: ultraendurance, finisher, speed, gender difference, master athlete, cycling

Christoph Alexander Rüst,1 Beat Knechtle,1,2 Patrizia Knechtle,2 Thomas Rosemann,1 Romuald Lepers31Institute of General Practice and for Health Services Research, University of Zurich, 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, FranceBackground: The age of peak performance in elite endurance athletes has been investigated for elite marathoners, but not for elite Ironman triathletes. The aim of this study was to analyze the age of peak performance in swimming (3.8 km), cycling (180 km), running (42 km), and overall race time for elite female and male Ironman triathletes competing in Ironman Switzerland, a qualifier for the Ironman world championship, known as the Ironman Hawaii.Methods: The age of the annual top ten overall swimmers, cyclists, runners, and annual overall finishers for both male and female elite triathletes and their corresponding split and overall race times at the Ironman Switzerland were analyzed between 1995 and 2011.Results: The mean age of the elite Ironman triathletes was 33 ± 3 years for men and 34 ± 4 years for women. For women, the age of peak performance was not significantly different between the three disciplines (P > 0.05), while for men, the best swimmers (29 ± 3 years) were significantly (P < 0.05) younger than the best runners (35 ± 5 years). During the study period, the age of peak performance remained unchanged for men at 31 ± 3 years (P > 0.05), but increased for women from 30 ± 4 years in 1995 to 36 ± 5 years in 2011 (P < 0.01).Conclusion: Although both women and men improved their overall race times during the 1995–2011 period, the age of peak performance was similar between women and men in the three disciplines and in overall race time. Future studies need to examine the change in age of peak performance across years in the Ironman Hawaii world championship event.Keywords: gender difference, swimming, cycling, running, ultraendurance

Abstract Backstroke has been thoroughly investigated in the context of sports science. However, we have no knowledge about the nationalities of the fastest age group backstroke swimmers. Therefore, the present study intended to investigate the nationalities of the fastest backstroke swimmers. For all World Masters Championships held between 1986 and 2024, the year of competition, the first and last name, the age, and the age group, and both the stroke and the distance were recorded for each swimmer. Descriptive data were presented using mean, standard deviation, maximum and minimum values, and confidence intervals. The top ten race times for each swimming distance and sex were identified for descriptive purposes. Nationalities were then grouped into six categories: the top five nationalities with the most appearances in the backstroke swimming top ten times by distance each year and one group consisting of all other nationalities. The Kruskal–Wallis test compared nationality differences, followed by Bonferroni-adjusted pairwise comparisons to identify specific distinctions. Between 1986 and 2024, most age group backstroke swimmers (39.6%) competed in the 50 m event (11,964, 6206 women, and 5,758 men), followed by the 100 m event (32.3%, n = 9764, 5157 women, and 4607 men), and the 200 m event (28.1%, n = 8483, 4511 women, and 3,972 men). Germany had the highest number of top ten female swimmers in the 50 m backstroke distance. Brazil had the highest number of top ten male swimmers in the same distance. The USA had the highest number of female and male swimmers among the top ten in the 100 m and 200 m backstroke distances. Germany and Great Britain were the only countries with swimmers in the top ten for all female backstroke distances. Brazil, the USA, Italy, and Germany were the countries that had swimmers in the top ten for all male backstroke distances. In summary, the fastest backstroke age group swimmers originated from Germany, Brazil, USA, Great Britain, and Italy, where differences between the sexes and race distances exist.

Purpose The IRONMAN® triathlon is an endurance multisport discipline of high popularity. Professional IRONMAN® triathletes need to qualify for the IRONMAN® World Championships and, therefore, would benefit from identifying the fastest race courses. Our purpose was to identify the fastest races held for professional IRONMAN® triathletes competing from 2002 to 2022. Methods This was an observational study, sampling 7,078 race records (380 different events in 55 different event locations) of professional IRONMAN® triathletes of both sexes (4,235 males and 2,843 females). We downloaded information about sex, nationality, both split (swimming, cycling, and running) and overall race times, the event location, and the year. Information about race course characteristics, water temperatures, and air temperatures was obtained. Descriptive statistics were calculated for each event location, and factorial ANOVA tests were used to explore the statistical significance of the results. A confidence interval of 95% was adopted. Results The fastest overall IRONMAN® average race times were achieved during the IRONMAN® Tallinn, IRONMAN® Switzerland held in Thun, and IRONMAN® Des Moines. A lake for the swim split characterized the first five courses, while the bike split featured rolling or hilly terrain. For the run split, most of the courses were characterized as flat. For environmental characteristics, lower water and air temperatures also added time to the average finish time. Conclusions Understanding the fastest race courses and their characteristics would assist professional IRONMAN® triathletes in selecting races that offer the optimal conditions for their competition. Fast IRONMAN® race courses typically feature a lakeside swim course, a rolling or hilly bike course, and a flat run course.

Self-modeling (SM) and self-control (SC) feedback can be presented as two solutions for learning improvement. Therefore, the aim of the present study was to investigate the effects of SM and SC feedback on 100-m freestyle performance of professional swimmers and waterpolo players. 25 elite male swimmers and waterpolo players, were randomly assigned to four groups: swimmer group with SM, swimmer group with SM and SC feedback, waterpolo players group with SM, and waterpolo players group with SM and SC feedback. 100-m freestyle times and performance were recorded. SM and SC feedback for the participants were utilized at the acquisition stage. The device used included a Lenovo B570 laptop and an Exilim ZR200 canon camcorder. SM and SC feedback presented to the swimmers and waterpolo players led to improved speed and results, and the effect of presenting SM with SC feedback to swimmers had better results. In conclusion, the present study indicates that SC modeling of watching video is a suitable method for professional swimmers. Water polo trainers can also use SM and SC feedback to enhance their players' swimming technique.

Christoph Alexander Rüst,1 Beat Knechtle,1,2 Patrizia Knechtle,2 Thomas Rosemann11Institute of General Practice and for Health Services Research, University of Zurich, Zurich, 2Gesundheitszentrum St Gallen, St Gallen, SwitzerlandBackground: Of the anthropometry and training variables used to predict race performance in a 24-hour ultrarun, the personal best marathon time is the strongest predictor in recreational male 24-hour ultramarathoners. This finding raises the question of whether similarities exist between male recreational 24-hour ultramarathoners and male recreational marathoners.Methods: The association between age, anthropometric variables (ie, body mass, body height, body mass index, percent body fat, skeletal muscle mass, limb circumference, and skinfold thickness at the pectoral, mid axillary, triceps, subscapular, abdominal, suprailiac, front thigh, and medial calf sites), previous experience and training characteristics (ie, volume, speed, and personal best time), and race time for 79 male recreational 24-hour ultramarathoners and 126 male recreational marathoners was investigated using bivariate and multivariate analysis.Results: The 24-hour ultramarathoners were older (P < 0.05), had a lower circumference at both the upper arm (P < 0.05) and thigh (P < 0.01), and a lower skinfold thickness at the pectoral, axillary, and suprailiac sites (P < 0.05) compared with the marathoners. During training, the 24-hour ultramarathoners were running for more hours per week (P < 0.001) and completed more kilometers (P < 0.001), but were running slower (P < 0.01) compared with the marathoners. In the 24-hour ultramarathoners, neither anthropometric nor training variables were associated with kilometers completed in the race (P > 0.05). In the marathoners, percent body fat (P < 0.001) and running speed during training (P < 0.0001) were related to marathon race times.Conclusion: In summary, differences in anthropometric and training predictor variables do exist between male recreational 24-hour ultramarathoners and male recreational marathoners for race performance.Keywords: endurance, performance, athlete, body fat, skinfold thickness

Katrin Sigg,1 Beat Knechtle,1,2 Christoph Alexander Rüst,1 Patrizia Knechtle,2 Romuald Lepers,3 Thomas Rosemann11Institute of General Practice and Health Services Research, University of Zurich, Zurich; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, FranceBackground: A recent study showed that European triathletes performed faster in Double Iron ultratriathlons than North American athletes. The present study analyzed triathletes participating in Double Iron ultratriathlons to determine the origin of the fastest Double Iron ultratriathletes, focusing on European countries.Methods: Participation and performance trends of finishers in Double Iron ultratriathlons from 1985–2011 of the different countries were investigated. Additionally, the performance trends of the top three women and men overall from 2001–2011 were analyzed.Results: A total of 1490 finishers originated from 24 different European countries and the United States. The number of European triathletes increased for both women (r2 = 0.56; P < 0.01) and men (r2 = 0.63; P < 0.01). The number of the North American triathletes increased for women (r2 = 0.25; P < 0.01), but not for men (r2 = 0.02; P > 0.05). Hungarian triathletes showed a significant improvement in both overall race times and in cycling split times, Swiss triathletes improved both their swim and run times, and French triathletes improved their swim times.Conclusion: Men and women triathletes from Central European countries such as France, Germany, Switzerland, and Hungary improved Double Iron ultratriathlon overall race times and split times during the 26-year period. The reasons might be the social and economic factors required to be able to participate in such an expensive and lavish race. Also, a favorable climate may provide the ideal conditions for successful training. Future studies need to investigate the motivational aspects of European ultraendurance athletes.Keywords: triathlon, ultraendurance, swimming, cycling, running

Beat Knechtle,1,2 Sabrina Baumgartner,1 Patrizia Knechtle,2 Christoph Alexander Rüst,1 Thomas Rosemann,1 Raúl Bescós31Institute of General Practice and Health Services Research, University of Zurich, Zurich; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3National Institute of Physical Education, Barcelona, SpainBackground: Changes in single skinfold thickness and body fat have been investigated in ultraswimmers and ultracyclists, but not in ultrarunners. The present study investigated the changes in single skinfold thickness during a 100 km ultramarathon.Methods: Firstly, we investigated associations between prerace preparation and prerace body composition and, secondly, changes in single skinfold thickness during a 100 km ultramarathon in 219 male ultramarathoners. Changes in fat mass and skeletal muscle were estimated using anthropometric methods.Results: Kilometers run weekly prerace and running speed during training were negatively associated with all skinfold thicknesses (P < 0.05) except for the front thigh skinfold. During the race, skinfold thickness at the pectoral (−0.1%), suprailiac (−1.8%), and calf (−0.8%) sites decreased (P < 0.05). The subjects lost 1.9 ± 1.4 kg of body mass (P < 0.001), 0.7 ± 1.0 kg of estimated skeletal muscle mass (P < 0.001), and 0.2 ± 1.3 kg of estimated fat mass (P < 0.05). The decrease in body mass was positively related to the decrease in both estimated skeletal muscle mass (r = 0.21, P = 0.0017) and estimated fat mass (r = 0.41, P < 0.0001).Conclusion: Firstly, prerace fat mass and prerace skinfold thickness were associated with both volume and speed in running training. Secondly, during the ultramarathon, skinfold thickness decreased at the pectoral, suprailiac, and calf sites, but not at the thigh site. Percent decreases in skinfold thickness for ultrarunners was lower than the percent decreases in skinfold thickness reported for ultraswimmers and ultracyclists.Keywords: endurance, athlete, fat mass, muscle mass, adipose subcutaneous tissue

Background: Recent studies have shown that personal best marathon time is a strong predictor of race time in male ultramarathoners. We aimed to determine variables predictive of marathon race time in recreational male marathoners by using the same characteristics of anthropometry and training as used for ultramarathoners.Methods: Anthropometric and training characteristics of 126 recreational male marathoners were bivariately and multivariately related to marathon race times.Results: After multivariate regression, running speed of the training units (β=-0.52, P

Christoph Alexander Rüst1, Beat Knechtle1,2, Patrizia Knechtle2, Ursula Barandun1, Romuald Lepers3, Thomas Rosemann11Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3INSERM U887, University of Burgundy, Faculty of Sport Sciences, Dijon, FranceAbstract: The aim of this study was to investigate predictor variables of anthropometry, training, and previous experience in order to predict a half marathon race time for future novice recreational male half marathoners. Eighty-four male finishers in the ‘Half Marathon Basel’ completed the race distance within (mean and standard deviation, SD) 103.9 (16.5) min, running at a speed of 12.7 (1.9) km/h. After multivariate analysis of the anthropometric characteristics, body mass index (r = 0.56), suprailiacal (r = 0.36) and medial calf skin fold (r = 0.53) were related to race time. For the variables of training and previous experience, speed in running of the training sessions (r = –0.54) were associated with race time. After multivariate analysis of both the significant anthropometric and training variables, body mass index (P = 0.0150) and speed in running during training (P = 0.0045) were related to race time. Race time in a half marathon might be partially predicted by the following equation (r2 = 0.44): Race time (min) = 72.91 + 3.045 * (body mass index, kg/m2) –3.884 * (speed in running during training, km/h) for recreational male runners. To conclude, variables of both anthropometry and training were related to half marathon race time in recreational male half marathoners and cannot be reduced to one single predictor variable.Keywords: anthropometry, body fat, skin-folds, training, endurance

Romuald Lepers1, Beat Knechtle2,3, Patrizia Knechtle2, Thomas Rosemann2 1INSERM U887, Faculty of Sport Sciences, University of Burgundy, Dijon, France; 2Institute of General Practice and Health Services Research, University of Zurich, Switzerland; 3Gesundheitszentrum St Gallen, St Gallen, Switzerland Abstract: Despite increased interest in ultra-endurance events, little research has examined ultra-triathlon performance. The aims of this study were: (i) to compare swimming, cycling, running, and overall performances in three ultra-distance triathlons, double Ironman distance triathlon (2IMT) (7.6 km swimming, 360 km cycling, and 84.4 km running), triple Ironman distance triathlon (3IMT) (11.4 km, 540 km, and 126.6 km), and deca Ironman distance triathlon (10IMT) (38 km, 1800 km, and 420 km) and (ii) to examine the relationships between the 2IMT, 3IMT, and 10IMT performances to create predicted equations of the 10IMT performances. Race results from 1985 through 2009 were examined to identify triathletes who performed the three considered ultra-distances. In total, 73 triathletes (68 men and 5 women) were identified. The contribution of swimming to overall ultra-triathlon performance was lower than for cycling and running. Running performance was more important to overall performance for 2IMT and 3IMT compared with 10IMT. The 2IMT and 3IMT performances were significantly correlated with 10IMT performances for swimming and cycling, but not for running. 10IMT total time performance might be predicted by the following equation: 10IMT race time (minutes) = 5885 + 3.69 × 3IMT race time (minutes). This analysis of human performance during ultra-distance triathlons represents a unique data set in the field of ultra-endurance events. Additional studies are required to determine the physiological and psychological factors associated with ultra-triathlon performance. Keywords: triathlon, swimming, cycling, running, ultra-endurance

Christoph Alexander Rüst1, Beat Knechtle1,2, Patrizia Knechtle2, Thomas Rosemann1, Romuald Lepers31Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3INSERM U887, University of Burgundy, Faculty of Sport Sciences, Dijon, FranceBackground: The purpose of this study was to define predictor variables for recreational male Ironman triathletes, using age and basic measurements of anthropometry, training, and previous performance to establish an equation for the prediction of an Ironman race time for future recreational male Ironman triathletes.Methods: Age and anthropometry, training, and previous experience variables were related to Ironman race time using bivariate and multivariate analysis.Results: A total of 184 recreational male triathletes, of mean age 40.9 ± 8.4 years, height 1.80 ± 0.06 m, and weight 76.3 ± 8.4 kg completed the Ironman within 691 ± 83 minutes. They spent 13.9 ± 5.0 hours per week in training, covering 6.3 ± 3.1 km of swimming, 194.4 ± 76.6 km of cycling, and 45.0 ± 15.9 km of running. In total, 149 triathletes had completed at least one marathon, and 150 athletes had finished at least one Olympic distance triathlon. They had a personal best time of 130.4 ± 44.2 minutes in an Olympic distance triathlon and of 193.9 ± 31.9 minutes in marathon running. In total, 126 finishers had completed both an Olympic distance triathlon and a marathon. After multivariate analysis, both a personal best time in a marathon (P < 0.0001) and in an Olympic distance triathlon (P < 0.0001) were the best variables related to Ironman race time. Ironman race time (minutes) might be partially predicted by the following equation: (r2 = 0.65, standard error of estimate = 56.8) = 152.1 + 1.332 × (personal best time in a marathon, minutes) + 1.964 × (personal best time in an Olympic distance triathlon, minutes).Conclusion: These results suggest that, in contrast with anthropometric and training characteristics, both the personal best time in an Olympic distance triathlon and in a marathon predict Ironman race time in recreational male Ironman triathletes.Keywords: body fat, swimming, cycling, running, triathlon

BackgroundTriathletes are pushing their limits in multi-stage Ironman-distance triathlons. In the present case study, we investigated the pacing during 20, 40, and 60 Ironman-distance triathlons in 20, 40, and 60 days, respectively, of one professional IRONMAN® triathlete.Case studyEvent 1 (20 Ironman-distance triathlons in 20 days), Event 2 (40 Ironman-distance triathlons in 40 days), and Event 3 (60 Ironman-distance triathlons in 60 days) were analyzed by discipline (swimming, cycling, running, and overall event time), by Deca intervals (10 days of consecutive Ironman-distance triathlons) and additional data (sleep duration, body mass, heart rate in cycling and running). To test differences between Events and Deca intervals within the same discipline, T-tests (2 groups) or one-way ANOVAs (3 or more groups) were used.ResultsSwimming splits were fastest in Event 1, (ii) cycling and running splits were fastest in both Event 2 and 3, (iii) overall speed was fastest in Event 3, (iv) sleep duration increased during Event 2 but decreased in Event 3, (v) body mass decreased in Event 2, but increased in Event 3 and (vi) heart rate during cycling was similar in both Event 2 and 3. In contrast, heart rate during running was greater in Event 3.ConclusionIn a professional IRONMAN® triathlete finishing 20, 40, and 60 Ironman-distance triathlons in 20, 40, and 60 days, respectively, split performances and both anthropometrical and physiological changes such as body mass and heart rate differed depending upon the duration of the events.

ObjectiveThis study aims to evaluate and predict the long-term effectiveness of five lifestyle interventions for individuals with eating disorders using machine learning techniques.MethodsThis study, conducted at Dr. Irandoust’s Health Center at Qazvin from August 2021 to August 2023, aimed to evaluate the effects of five lifestyle interventions on individuals with eating disorders, initially diagnosed using The Eating Disorder Diagnostic Scale (EDDS). The interventions were: (1) Counseling, exercise, and dietary regime, (2) Aerobic exercises with dietary regime, (3) Walking and dietary regime, (4) Exercise with a flexible diet, and (5) Exercises through online programs and applications. Out of 955 enrolled participants, 706 completed the study, which measured Body Fat Percentage (BFP), Waist-Hip Ratio (WHR), Fasting Blood Sugar (FBS), Low-Density Lipoprotein (LDL) Cholesterol, Total Cholesterol (CHO), Weight, and Triglycerides (TG) at baseline, during, and at the end of the intervention. Random Forest and Gradient Boosting Regressors, following feature engineering, were used to analyze the data, focusing on the interventions’ long-term effectiveness on health outcomes related to eating disorders.ResultsFeature engineering with Random Forest and Gradient Boosting Regressors, respectively, reached an accuracy of 85 and 89%, then 89 and 90% after dataset balancing. The interventions were ranked based on predicted effectiveness: counseling with exercise and dietary regime, aerobic exercises with dietary regime, walking with dietary regime, exercise with a flexible diet, and exercises through online programs.ConclusionThe results show that Machine Learning (ML) models effectively predicted the long-term effectiveness of lifestyle interventions. The current study suggests a significant potential for tailored health strategies. This emphasizes the most effective interventions for individuals with eating disorders. According to the results, it can also be suggested to expand demographics and geographic locations of participants, longer study duration, exploring advanced machine learning techniques, and including psychological and social adherence factors. Ultimately, these results can guide healthcare providers and policymakers in creating targeted lifestyle intervention strategies, emphasizing personalized health plans, and leveraging machine learning for predictive healthcare solutions.

The present study aimed to compare V̇O2max (absolute, adjusted to total body mass, and adjusted to lean mass) in recreational runners and sedentary women < and > 50 yr and verify the effect of aging and physical activity level on the three types of V̇O2 max expression. The study included 147 women:85 runners (45.7 ± 14.1 yr) and 62 sedentary controls (48.8 ± 9.8 yr). They were subjected to cardiopulmonary exercise testing for V̇O2 max measurement and a body composition test by dual-emission X-ray absorptiometry system. V̇O2max were expressed as absolute values (L/min), relative to total body mass values (mL/kg/min), and relative to lean mass values (mL/kgLM/min). The two-way analysis of variance revealed a significant interaction [F(2,131) = 4.43, p

Abstract Background Ultra-endurance events are gaining popularity in multiple exercise disciplines, including cycling. With increasing numbers of ultra-cycling events, aspects influencing participation and performance are of interest to the cycling community. Main body The aim of this narrative review was, therefore, to assess the types of races offered, the characteristics of the cyclists, the fluid and energy balance during the race, the body mass changes after the race, and the parameters that may enhance performance based on existing literature. A literature search was conducted in PubMed, Scopus, and Google Scholar using the search terms ‘ultracycling’, ‘ultra cycling’, ‘ultra-cycling’, ‘ultra-endurance biking’, ‘ultra-bikers’ and ‘prolonged cycling’. The search yielded 948 results, of which 111 were relevant for this review. The studies were classified according to their research focus and the results were summarized. The results demonstrated changes in physiological parameters, immunological and oxidative processes, as well as in fluid and energy balance. While the individual race with the most published studies was the Race Across America, most races were conducted in Europe, and a trend for an increase in European participants in international races was observed. Performance seems to be affected by characteristics such as age and sex but not by anthropometric parameters such as skin fold thickness. The optimum age for the top performance was around 40 years. Most participants in ultra-cycling events were male, but the number of female athletes has been increasing over the past years. Female athletes are understudied due to their later entry and less prominent participation in ultra-cycling races. A post-race energy deficit after ultra-cycling events was observed. Conclusion Future studies need to investigate the causes for the observed optimum race age around 40 years of age as well as the optimum nutritional supply to close the observed energy gap under consideration of the individual race lengths and conditions. Another research gap to be filled by future studies is the development of strategies to tackle inflammatory processes during the race that may persist in the post-race period.

Abstract The 50-km ultra-marathon is a popular race distance, slightly longer than the classic marathon distance. However, little is known about the country of affiliation and age of the fastest 50-km ultra-marathon runners and where the fastest races are typically held. Therefore, this study aimed to investigate a large dataset of race records for the 50-km distance race to identify the country of affiliation and the age of the fastest runners as well as the locations of the fastest races. A total of 1,398,845 50-km race records (men, n = 1,026,546; women, n = 372,299) were analyzed using both descriptive statistics and advanced regression techniques. This study revealed significant trends in the performance of 50-km ultra-marathoners. The fastest 50-km runners came from African countries, while the fastest races were found to occur in Europe and the Middle East. Runners from Ethiopia, Lesotho, Malawi, and Kenya were the fastest in this race distance. The fastest 50-km racecourses, providing ideal conditions for faster race times, are in Europe (Luxembourg, Belarus, and Lithuania) and the Middle East (Qatar and Jordan). Surprisingly, the fastest ultra-marathoners in the 50-km distance were found to fall into the age group of 20–24 years, challenging the conventional belief that peak ultra-marathon performance comes in older age groups. These findings contribute to a better understanding of the performance models in 50-km ultra-marathons and can serve as valuable insights for runners, coaches, and race organizers in optimizing training strategies and racecourse selection.

Participation in marathons has dramatically increased over the last few years. Marathon running has many proven beneficial effects, especially on cardiovascular health and fitness. Most research has focused on physiologic and pathophysiologic adaptations in connection with endurance exercise. Nevertheless, marathon running also has a major impact on psychological aspects and positively influences mental health, which has only recently attracted research interest. The present narrative review aimed to review the personality traits of marathon runners with an emphasis on recent literature. Marathon runners show a distinct personality and highly characteristic personality traits needed to successfully finish such a demanding race, i.e., a strong sense of vigor, self-sufficiency, and intelligence as well as low scores in anger, fatigue, tension, and depression. Furthermore, personality differences are detectable between runners of different sexes, ages, and performance level groups. This has significant clinical implications for athletes, coaches and competition organizers, as these groups show different patterns of personality traits. Future studies should focus on changes in cognition and mood states pre-, during, and post-endurance events, as well as during training periods. Large-scale studies comparing personality differences by sex, age, and performance are also important for better clinical guidance.

Abstract This study evaluated the acute effect of the exergame Kinect Sports® beach volleyball on state anxiety level in adult women. Thirty healthy adult women (age: 21 [4] years, body mass: 54.70 [19.50] kg, height: 1.61 ± 0.05 m, and body mass index: 21.87 [5.76] kg/m2, data are expressed as median [interquartile range] and as the mean ± standard deviation) were assigned to play an exergame of beach volleyball in singleplayer mode session (intervention session) for ~ 30 min using the Xbox 360 Kinect® or remained seated (control session). State anxiety was evaluated before and after the intervention and control sessions through the State-Trait Anxiety Inventory. State anxiety obtained in both sessions (exergame and control) was classified as intermediate before (median: 36.00 [IQR: 4.75] and mean = 38.73 ± 7.23, respectively) and after (mean: 34.86 ± 6.81 and mean: 37.66 ± 8.44, respectively). Friedman test found no time significant effect on state anxiety of the sessions (χ2 [3] = 6.45, p-value = 0.092, Kendall’s W = 0.07 “trivial”). In conclusion, the present study showed that there were no significant differences in the state anxiety level after an acute session of the exergame beach volleyball.

Mateus Guilherme Calixto Assis,1 José Geraldo Gomes Barbosa Junior,2 Aldo Seffrin,2 Vinícius Ribeiro dos Anjos Souza,2 Lavínia Vivan,2 Mila Alves Matos Rodrigues,3 Claudio André Barbosa de Lira,3 Rodrigo Luiz Vancini,4 Beat Knechtle,5 Katja Weiss,5 Marilia Santos Andrade6 1Department of Orthopedics and Traumatology, Federal University of São Paulo, São Paulo, Brazil; 2Postgraduate Program in Translation Medicine, Federal University of São Paulo, São Paulo, Brazil; 3Human and Exercise Physiology Division, Federal University of Goiás, Goiás, Brazil; 4Center for Physical Education and Sports, Federal University of Espírito Santo, Espírito Santo, Brazil; 5Institute of Primary Care, University of Zurich, Zurich, Switzerland; 6Department of Physiology, Federal University of São Paulo, São Paulo, BrazilCorrespondence: Beat Knechtle, Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, St. Gallen, 9001, Switzerland, Tel +41 (0) 71 226 93 00, Fax +41 (0) 71 226 93 01, Email beat.knechtle@hispeed.chPurpose: Endurance sports performance is influenced by several factors, including maximal oxygen uptake (⩒O2max), the percentage of ⩒O2max that can be sustained in endurance events, running economy, and body composition. Traditionally, ⩒O2max can be measured as an absolute value, adjusted for body mass, reflecting the athlete’s central capacity (maximal cardiac output), or adjusted for lean mass (LM), reflecting the athlete’s peripheral capacity (muscular oxidative capacity). The present study aims to evaluate absolute, total body mass, and lower limb LM-adjusted ⩒O2max, ventilatory thresholds (VT), respiratory compensation points (RCP), and body composition during two training periods separated by 8 months.Patients and Methods: Thirteen competitive amateur triathletes [seven men (40.7± 13.7 years old, 76.3± 8.3kg, and 173.9± 4.8cm) and six women (43.5± 6.9 years old, 55.0± 2.7kg, 164.9± 5.2cm)] were evaluated for body composition with dual-energy X-ray absorptiometry and ⩒O2max, VT, RPC, and maximal aerobic speed (MAS) with a cardiorespiratory maximal treadmill test.Results: The absolute ⩒O2max (p = 0.003, d = 1.05), body mass–adjusted ⩒O2max (p < 0.001, d = 1.2859), and MAS (p = 0.047, d = 0.6139) values differed significantly across evaluation periods. Lower limb LM–adjusted ⩒O2max (p = 0.083, d = − 0.0418), %⩒O2max at VT (p = 0.541, d = − 0.1746), speed at VT (p = 0.337, d = − 0.2774), % ⩒O2max at RCP (p = 0.776, d = 0.0806), and speed at RCP (p = 0.436, d = 0.2234) showed no difference.Conclusion: The sensitivities of ⩒O2max adjusted for body mass and ⩒O2max adjusted for LM to detect changes in physical training state differ. Furthermore, decreases in physical fitness level, as evaluated by ⩒O2max values, are not accompanied by changes in VT.Keywords: amateur triathletes, skeletal muscle oxidative capacity, triathlon, performance

Abstract This study investigated the combined effects of 12 weeks of high-intensity interval training (HIIT) and spirulina supplementation on adipokine levels, insulin resistance, anthropometric indices, and cardiorespiratory fitness in 44 obese males (aged 25–40 years). The participants were randomly assigned to one of four groups: control (CG), supplement (SG), training (TG), or training plus supplement (TSG). The intervention involved daily administration of either spirulina or a placebo and HIIT three times a week for the training groups. Anthropometric indices, HOMA-IR, VO2peak, and circulating adipokines (asprosin and lipocalin2, omentin-1, irisin, and spexin) were measured before and after the 12-week intervention. Post-intervention analysis indicated differences between the CG and the three interventional groups for body weight, fat-free mass (FFM), percent body fat (%BF), HOMA-IR, and adipokine levels (p

Little is known about the prevalent nationalities among the best-placed athletes participating in “Ironman Hawaii.” Moreover, the age at which athletes achieve their best performances remains unclear. The present study aimed to compare the prevalent nationalities among the athletes, their respective placement among the top five, and the performance difference between the different age groups in ‘Ironman Hawaii’ from 2003 to 2019. A total of 30 354 amateur triathletes were selected from the Obsessed Triathlete (OBSTRI) website. A “TOP 5” division filter was applied for further analysis, resulting in 1 851 athletes being included in this study. Among the male runners, Americans participated the most in Ironman events (39%), followed by Germans (10%). Among female runners, Americans participated the most (54%), followed by Australian runners (8%). Male Americans also featured most among the top five (30%), followed by Germans (16%). Female Americans were the most prevalent among the top five (47%), followed by Australian Americans (10%). There were no significant performance differences (p ​> ​0.05) between the 25–29 and 40–44 age groups for either sex. The 45–49 age group presented significantly worse performance than the 35–39 age group for both sexes (p ​

This study aimed to investigate the effects of swimming in cold water on the release of FGF21 from various tissues and its impact on fat metabolism. Twenty Wistar rats were randomly divided into three groups: untrained (C), trained in thermo-neutral water (TN, 30 °C) and trained in cold water (TC, 15 °C). The training groups swam intervals (2–3 min) until exhaustion, 1 min rest, three days a week for six weeks, with 3–6% bodyweight load. The mRNA expression of variables was determined in white fat tissue (WAT), and FGF21 protein was also measured in the liver, brown fat tissue (BAT), serum, and muscle. The experimental protocols resulted in lower body weight gain, associated with reduced WAT volume; the most remarkable improvement was observed in the TC group. Swimming significantly increased FGF21 protein levels in WAT, BAT, and muscle tissues compared to the C group; substantial increases were in the TC group. Changes in FGF21 were highly correlated with the activation of genes involved in fat metabolisms, such as CPT1, CD36, and HSL, and with glycerol in WAT. The findings indicate a positive correlation between swimming in cold water and the activation of genes involved in fat metabolism, possibly through FGF21 production, which was highly correlated with fat-burning genes.

The use of data-driven technologies such as Artificial Intelligence (AI) and Machine Learning (ML) is growing in healthcare. However, the proliferation of healthcare AI tools has outpaced regulatory frameworks, accountability measures, and governance standards to ensure safe, effective, and equitable use. To address these gaps and tackle a common challenge faced by healthcare delivery organizations, a case-based workshop was organized, and a framework was developed to evaluate the potential impact of implementing an AI solution on health equity. The Health Equity Across the AI Lifecycle (HEAAL) is co-designed with extensive engagement of clinical, operational, technical, and regulatory leaders across healthcare delivery organizations and ecosystem partners in the US. It assesses 5 equity assessment domains-accountability, fairness, fitness for purpose, reliability and validity, and transparency-across the span of eight key decision points in the AI adoption lifecycle. It is a process-oriented framework containing 37 step-by-step procedures for evaluating an existing AI solution and 34 procedures for evaluating a new AI solution in total. Within each procedure, it identifies relevant key stakeholders and data sources used to conduct the procedure. HEAAL guides how healthcare delivery organizations may mitigate the potential risk of AI solutions worsening health inequities. It also informs how much resources and support are required to assess the potential impact of AI solutions on health inequities.

Abstract Background and rationale The literature shows that the prevalence of dietary supplements is high and guidance by a nutritionist or specialized professional is low in professional triathletes. It is reasonable to assume that in recreational triathletes, the prevalence of dietary supplements will also be high and that a significant portion of the sampled population will use supplements without any guidance from a qualified professional. The present study investigated dietary supplement use among Brazilian male recreational triathletes. Methods A total of 724 Brazilian male recreational triathletes (age: 38.00 [10.00] years and body mass index: 24.16 [3.02] kg/m2) took part in this study. All participants answered an online questionnaire containing questions about their demographic characteristics and the nutritional aspects of their diet. Results The results showed that ~ 90% (n = 653) of the interviewed participants reported using at least one dietary supplement. Surprisingly, ~ 25% did not receive supplement advice from a professional nutritionist. Conclusion The prevalence of dietary supplements in male recreational triathletes was high, and a substantial part of the sample did not receive professional recommendations. This situation is worrisome because dietary supplements should be prescribed by a professional nutritionist. Practical implications Our results suggest the need for an appropriate attitude and guidance by health professionals who deal with this population, especially nutritionists, to promote safe practices.

Abstract Purpose To compare the academic performance of undergraduate students in physical education who studied exercise physiology before and after studying human physiology and investigate students’ perceptions of human physiology and exercise physiology courses. Methods This study included 311 undergraduate students pursuing a bachelor’s degree in physical education. Participants were divided into two groups: those who had previously attended and completed the human physiology course (group 1, n = 212, 68.2%) and those who had not previously attended or had attended but failed the human physiology course (group 2, n = 99, 31.8%). The prevalence ratio (PR) and 95% confidence interval (95% CI) were calculated using a Poisson regression model with a robust variance estimator. The second aim comprised 67 students with bachelor’s degrees in physical education who completed an electronic questionnaire about their perceptions of human physiology and exercise physiology curriculum. Results Compared with those who attended human physiology and passed, those who had not previously attended or had attended but failed the human physiology course have a higher PR of 2.37 (95% CI, 1.68–3.34) for failing exercise physiology. Regarding the students’ perceptions of human physiology and exercise physiology courses, most students reported that they were challenging (58.2% and 64.2%, respectively), but they also recognized the importance of these courses for professional practice (59.7% and 85.1%, respectively). Conclusion Human physiology should be considered a prerequisite for an undergraduate course leading to a bachelor’s degree in physical education. Furthermore, students considered human physiology and exercise physiology courses important yet challenging. Therefore, continuous student assessment is vital for improving the teaching–learning process.

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI’s Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model’s ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model’s potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Pantelis T Nikolaidis,1,2 Beat Knechtle3,4 1School of Health and Caring Sciences, University of West Attica, Egaleo, Greece; 2Exercise Physiology Laboratory, Nikaia, Greece; 3Institute of Primary Care, University of Zurich, Zurich, Switzerland; 4Medbase St. Gallen am Vadianplatz, St. Gallen, SwitzerlandCorrespondence: Pantelis T Nikolaidis, School of Health and Caring Sciences, University of West Attica, Ag. Spyridonos, Egaleo, 12243, Greece, Tel +30 6977820298, Email pademil@hotmail.comAim: Although it has been previously observed that sedentary behavior (SB) was not related to training duration in marathon runners, little information existed about the relationship of SB with training, anthropometric and physiological characteristics in this population. This study aimed to investigate the prevalence of SB and its correlation with performance parameters (such as body fat percentage, maximal oxygen uptake and weekly training volume) as well as its variation by sex and day (ie, weekdays versus weekend) in recreational marathon runners.Methods: A total of 151 finishers (women, n = 29; men, n = 122; age 43.1 (8.7) years, mean (standard deviation)) in the Athens marathon 2017 performed a series of anthropometric and physiological tests, and completed the Multi-context sitting time questionnaire.Results: SB did not correlate with anthropometric and physiological characteristics and no difference in these characteristics was shown between low and high sedentary participants (p > 0.05). SB did not differ between women and men (p > 0.05), but differed between working and non-working days (p < 0.05).Conclusion: In contrast to previous findings on the general population indicating an association of a high SB with a low cardiorespiratory and muscular fitness, our finding of no correlation between SB and physical fitness in marathon runners suggested that endurance exercise might offset the negative effects of SB.Keywords: body fat, endurance exercise, long distance running, maximal oxygen uptake, moderate exercise intensity, physical inactivity

This study aimed to investigate the trends of finishers in the São Silvestre race in Brazil, taking into account sex, age, and performance levels. A total of 31 ​775 runners (women, n ​= ​13 ​847; men, n ​= ​17 ​928), aged (45.2 ​± ​16.8) years, finishers in the São Silvestre race between 2007 and 2021, were considered in the present analysis. Data (event year, date of birth, sex, and race times) were downloaded from the official race website. The man-Whitney U test, Spearman correlation, and robust regression model were computed. Participation increased over time for both sexes. Regarding age groups, “31–40 years” (women) and “> 60 years” (men) were those with the highest number of finishers. We found a decrease in performance across the years (β ​= ​2.45; p ​

Abstract Background Although several studies have shown that the Coronavirus Disease 2019 (COVID-19) lockdown has had negative impacts on mental health and eating behaviors among the general population and athletes, few studies have examined the long-term effects on elite and sub-elite athletes. The present study aimed to investigate the long-term impact of COVID-19 lockdown on mental health and eating behaviors in elite versus sub-elite athletes two years into the pandemic. A cross-sectional comparative study was conducted between March and April 2022, involving athletes from 14 countries, using a convenient non-probabilistic and snowball sampling method. A total of 1420 athletes (24.5 ± 7.9 years old, 569 elites, 35% women, and 851 sub-elites, 45% women) completed an online survey-based questionnaire. The questionnaire included a sociodemographic survey, information about the COVID-19 pandemic, the Depression, Anxiety and Stress Scale—21 Items (DASS-21) for mental health assessment, and the Rapid Eating Assessment for Participants (REAP-S) for assessing eating behavior. Results The results showed that compared to sub-elite athletes, elite athletes had lower scores on the DASS-21 (p = .001) and its subscales of depression (p = .003), anxiety (p = .007), and stress (p

Abstract Complications such as diabetes and preeclampsia can occur during pregnancy. Moderate-intensity exercise can prevent such complications by releasing placentokines and exerkines, such as apelin, adiponectin, leptin, irisin, and chemerin. Exercise and apelin increase thermogenesis and glucose uptake in pregnancy by activating AMPK, PI3K, PGC-1α, AKT1, UCP3, and sarcolipin. Exercise increases apelin levels to reduce preeclampsia symptoms by increasing eNOS, NO, placental growth factor (PlGF), and VEGF and decreasing levels of fms-like tyrosine kinase 1 (sFlt-1), soluble endoglin (sEng), and oxidative stress. A negative relationship has been reported between plasma leptin and VO2peak/kg and VO2peak in women with gestational diabetes. In active women, decreases in leptin levels reduce the risk of preeclampsia by ~ 40%. Higher adiponectin levels are associated with greater physical activity and lead to increased insulin sensitivity. Increased adiponectin levels in preeclampsia and exercise counteract inflammatory and atherogenic activities while also having vascular protective effects. Exercise increases irisin levels that correlate negatively with fasting glucose, insulin concentration, and glycosylated hemoglobin levels. Irisin augments mRNA expression levels of UCP1 and cell death-inducing DNA fragmentation factor-like effector A (cidea) to cause browning of adipose tissue, increased thermogenesis, and increased energy consumption. Irisin concentrations in mothers with preeclampsia in the third trimester negatively correlate with systolic and diastolic blood pressure. Expression levels of chemerin, IL-6, and TNF-α are increased in gestational diabetes, and the increases in chemerin in late pregnancy positively correlate with the ratio of sFlt-1 to PlGF as a marker of preeclampsia. The effects of physical exercise on placentokines and exerkines in women at various stages of pregnancy remain poorly understood.

Background: For Ironman® triathlon, it has been reported that most of the fnishers and the fastest women and men in Ironman® Hawaii originated from the United States of America (USA). We have, however, no knowledge of where the fastest race courses in the Ironman® 70.3 triathlon took place. We aim to analyse where the Ironman® 70.3 races were held and where the fastest split and overall race times were achieved. Methods: The athletes’ sex, age group, country of origin, and split times for swimming, running, cycling, and transitioning were obtained from the official Ironman® website. To investigate the locations of the fastest Ironman® 70.3 competitions between 2004 and 2020, a full sample of 852,721 qualifying records throughout 197 different event locations was processed. These race records were aggregated by location, and each location’s split and full finish times were calculated. Data analysis was performed first for the full sample (all race records), and then for an elite sub-sample consisting of the top 100 males and top 100 females records in each location. Results: For the full sample, the fastest overall race times were achieved in Ironman® 70.3 Zell am See (Austria). For the top 100 athletes sub-sample, the Ironman® 70.3 European Championship Elsinore and Ironman® 70.3 World Championship were the fastest courses. Conclusion: These results are useful for athletes’ strategic planning and inform event organisers about the strengths of different courses, aiding in the optimisation and promotion of future Ironman® 70.3 races worldwide. Keywords: endurance, performance, half-distance Ironman®, multi-sport, running.

Background Restorative justice interventions can help address the harm created by gun violence, although few restorative justice programs focus solely on survivors or loved ones of victims of gun violence. Our aim was to assess how gun violence impacts those injured by firearms through qualitative analysis of their lived experiences.Methods From August 2022 to October 2023, we operated a program entitled Prescriptions for Repair in Durham, North Carolina, USA, which was supported by community groups, public government, and academia. Through a series of structured listening sessions using a restorative justice framework, trained community-based facilitators helped 30 participants (11 survivors of gun violence and 19 loved ones of victims of gun violence) tell their stories through a non-judgmental narrative process. We conducted a qualitative thematic analysis of the listening sessions from 19 participants to define the major lessons learned from survivors of gun violence. We summarized participant responses into individual-level and community-level views on how to ‘make things as right as possible’.Results The lived experiences of gun violence survivors and their loved ones confirmed the inherent value of structured listening programs, how poverty, race and racism impact gun violence, and the need to focus resources on children and youth.Conclusions Listening to the survivors of gun violence through restorative justice programs can help address the personal and community harm resulting from gun violence.Level of evidence Level IV, prospective observational study.

IntroductionOur study examined 16,611 records of professional triathletes from 163 Ironman® 70.3 races across 97 countries (2004-2020). The aim was to identify the most predictive discipline—swim, bike, or run—for overall race time.MethodsWe used correlation matrices to compare the dependent variable “finish time” with independent variables “swim time,” “bike time,” and “run time.” This analysis was conducted separately for male and female athletes. Additionally, univariate and multiple linear regression models assessed the strength of these associations.ResultsThe results indicated that “bike time” had the strongest correlation with finish time (0.85), followed by “run time” (0.75 for females, 0.82 for males) and “swim time” (0.46 for females, 0.63 for males). Regression models confirmed “bike time” as the strongest predictor of overall race time (R² = 0.8), with “run time” and “swim time” being less predictive.DiscussionThe study concludes that in Ironman 70.3 races, “bike time” is the most significant predictor of overall race performance for both sexes, suggesting a focus on cycling in training and competition strategies. It also highlights a smaller performance gap between genders in swimming than in cycling or running.

Abstract Few studies were developed to understand the relationship between running characteristics and motivation. The purpose of this study was to assess the relationship between running event history, running experience, and best race performances in recreational distance runners. We used a web survey to obtain information regarding running experience, racing history, and periodization training routines/exercise habits, including weekly volumes and daily mileage and duration across periods and conditions. Associations between variables were conducted with the Chi-square test (χ2; nominal scale) and Wilcoxon test. Multiple linear regression analysis and multivariate linear regression were performed. Concerning the participants’ motive for exercising, a significant difference was identified between the race distance subgroups (p

We examined the effect of amount of muscle mass involved in moderate-intensity continuous physical exercise on executive function. To this end, fifty-five participants completed two acute physical exercise sessions on an airbike ergometer using the upper and lower limbs simultaneously and only the upper limbs, and a resting control session in a randomized order. The physical exercise session lasted 30 min and was performed at moderate intensity (between 64 %–76 % of maximal heart rate evaluated in graded maximal exercise testing). Participants took the Stroop test (congruent and incongruent trials) before and after the sessions to assess executive performance. For the congruent trial, both physical exercise interventions improved executive function performance (pre vs. post, p-value = 0.002 and 0.003 for physical exercise with upper limbs and physical exercise with upper and lower limbs, respectively). Furthermore, executive function performance was higher after the physical exercise interventions than after the control session (p-value = 0.002 and 0.004 for physical exercise with upper limbs and physical exercise with upper and lower limbs, respectively). For the incongruent trial, both physical exercise interventions also improved executive function performance (pre vs. post, p-value < 0.001 for physical exercise with upper limbs and physical exercise with upper and lower limbs, respectively). owever, there were no significant differences after both physical exercise interventions and resting control session (p-value = 0.175). Executive function (congruent trial) was positively impacted by acute aerobic physical exercise regardless of the amount of muscle mass involved (upper limbs or upper plus lower limbs). Therefore, we recommend aerobic physical exercise with less or more muscle mass involved to improve cognitive function.

Abstract Pacing during cycling and running in an IRONMAN triathlon has been investigated in only one study with elite IRONMAN triathletes. We have, however, no knowledge of how professional triathletes pace during an IRONMAN World Championship. To investigate the split-by-split speed, pacing strategies and pacing variability in professional female and male IRONMAN World Championship participants in the fastest IRONMAN World Championship ever in IRONMAN Hawaii 2022. For both cycling and running, 25 specific split times were recorded in each discipline. The best 30 men and 30 women overall were chosen from the official IRONMAN website database for further analysis. They were divided into three performance groups: Top 10, 11–20th place, and 21st–30th place. Mean speed, individual linear regressions with the corresponding correlation coefficients, and coefficient of variation were calculated to assess split-by-split speed, pacing strategies, and pacing variability, respectively. In both men’s and women’s cycling and running segments, the top ten participants exhibited faster split times compared to the slower performance groups. Notably, no discernible differences existed between the 11–20th and 21st–30th place in men’s cycling and women’s running times. Conversely, in men’s running and women’s cycling segments, those in the 11–20th place displayed quicker times than those in the 21st–30th place. In the cycling segment across all groups, men demonstrated a more negative pacing pattern (indicating an increase in speed), whereas women exhibited more consistent pacing. In the running segment, the top 10 men and all women’s groups showcased relatively similar slightly positive pacing profiles. However, men ranking 11–20th and 21st–30th displayed more pronounced positive pacing strategies, implying a more significant decline in speed over time. In terms of cycling, the variability in pacing remained relatively consistent across the three performance groups. Conversely, during the running segment, the top ten male triathletes and those in the 11–20th place displayed lower pacing variability than their counterparts in the 21st–30th position place and all women’s groups. In summary, performance and pacing were examined in professional male and female IRONMAN World Championship participants during IRONMAN Hawaii 2022. Top performers showed faster cycling and running split times, with differences in pacing strategies between sexes. The pacing was more consistent in cycling, while running pacing varied more, particularly among male triathletes in different performance groups.

Abstract Background The sex difference in the three split disciplines (swimming, cycling, and running) and overall race times in triathlon races has mainly been investigated for the Olympic distance and IRONMAN® triathlon formats, but not for the half IRONMAN® distance, i.e., the IRONMAN® 70.3. The aim of the present study was to investigate the sex differences in IRONMAN® 70.3 by age group in 5-year intervals for the split disciplines of this race. Data from 823,459 records (625,393 males and 198,066 females) of all age group finishers (in 5-year intervals) competing in all official IRONMAN® 70.3 races held worldwide between 2004 and 2020 were analyzed, and sex differences by age group and split disciplines were evaluated. Results Males were faster than females in all split disciplines and all age groups. The sex difference was lower in swimming than in cycling and running and less pronounced for triathletes between 20 and 50 years of age. After the age of 60 years, females were able to reduce the sex difference to males in swimming and cycling, but not in running, where the reduction in the sex difference started after the age of 70 years. The lowest sex difference was in the age group 75 + years for swimming and cycling and in the age group 30–34 years for running. Across age groups, the sex difference was U-shaped in swimming and running, with an increase after 18–24 years in swimming and after 40–44 years in running. In contrast, the sex difference decreased continuously with the increasing age for cycling. Conclusions In conclusion, the study found that the sex difference in performance decreases with age in the IRONMAN® 70.3 race distance. However, females did not outperform males at older ages. Notably, sex differences were observed across different disciplines, with swimming displaying lower differences compared to cycling and running. These findings underscore the complex interplay between age, sex, and performance in endurance sports, emphasizing the need for additional research to understand the factors influencing these differences.

Abstract Recent studies showed that female runners reduced the performance gap to male runners in endurance running with increasing age and race distance. However, the investigated samples were generally small. To investigate this further, the present study examined sex differences by age across various race distances (5, 10 km, half-marathon, marathon, and ultra-marathon) using a large dataset of over 1,100,000 race records from Switzerland over two decades (1999–2019). The study explored performance and participation disparities between male and female runners by employing diverse methods, such as descriptive statistics, histograms, scatter and line plots, correlations, and a predictive machine learning model. The results showed that female runners were more prevalent in shorter races (5, 10 km, half-marathon) and outnumbered male runners in 5 km races. However, as the race distance increased, the male-to-female ratio declined. Notably, the performance gap between sexes reduced with age until 70 years, after which it varied depending on the race distance. Among participants over 75 years old, ultra-marathon running exhibited the smallest sex difference in performance. Elderly female ultra-marathoners (75 years and older) displayed a performance difference of less than 4% compared to male ultra-marathoners, which may be attributed to the presence of highly selected outstanding female performers.

Many of today’s recreational runners have changed their diet from omnivorous to vegetarian or vegan for reasons like better sport performance, animal ethics, positive health, eco-aspects, or male infertility. Others have constructed the flexitarian diet due to current trends in sustainable eating. The aim of this investigation was to analyze the dietary habits and race day strategies of recreational endurance runners following current sustainable dietary trends. Recreational endurance runners (18+ years) were invited to complete the standardized online survey on socio-demography/anthropometry, motivations, running/racing history, food frequency, and race day dietary strategy. Chi-squared tests and Wilcoxon tests were used for the statistical analysis. In total, 289 participants submitted the survey; 146 subjects following flexitarian (n = 34), vegetarian (n = 50), or vegan (n = 62) diets were included in the final sample. Significant differences were found across the diet types: BMI (p = 0.018), fruit/vegetable consumption (p < 0.001), and the dietary motive of performance (p = 0.045). The findings suggest that the flexitarian diet may be appropriate for health- and environmentally conscious populations living in a meat-centered society and lacking social support to eat completely vegetarian/vegan. Following a plant-based diet is perceived as easy for health-conscious, athletic populations, and the vegan diet does not require a particularly effortful/complex race day strategy for endurance runners.

Abstract Background An association between fluid intake and limb swelling has been described for 100-km ultra-marathoners. We investigated a potential development of peripheral oedemata in Ironman triathletes competing over 3.8 km swimming, 180 km cycling and 42.2 km running. Methods In 15 male Ironman triathletes, fluid intake, changes in body mass, fat mass, skeletal muscle mass, limb volumes and skinfold thickness were measured. Changes in renal function, parameters of skeletal muscle damage, hematologic parameters and osmolality in both serum and urine were determined. Skinfold thicknesses at hands and feet were measured using LIPOMETER® and changes of limb volumes were measured using plethysmography. Results The athletes consumed a total of 8.6 ± 4.4 L of fluids, equal to 0.79 ± 0.43 L/h. Body mass, skeletal muscle mass and the volume of the lower leg decreased (p p >0.05). The decrease in skeletal muscle mass was associated with the decrease in body mass (p p >0.05). Haemoglobin, haematocrit and serum sodium remained unchanged (p >0.05). Osmolality in serum and urine increased (p +]) (r = −0.52, p r = −0.60, p Conclusions In these Ironman triathletes, ad libitum fluid intake maintained plasma [Na+] and plasma osmolality and led to no peripheral oedemata. The volume of the lower leg decreased and the decrease was unrelated to fluid intake. Future studies may investigate ultra-triathletes competing in a Triple Iron triathlon over 11.4 km swimming, 540 km cycling and 126.6 km running to find an association between fluid intake and the development of peripheral oedemata.