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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/m$^{2}$) 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.

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.

OBJECTIVES Swimming is one of the most popular forms of physical activity. Pool water is cleaned with chlorine, which - in combination with compounds contained in water - could form chloramines and trichloromethane in the swimmer's lungs. The aim of the present study was to examine the effect of swimming training in an indoor pool on the composition of swimmers' respiratory phase metabolomics, and develop a system to provide basic information about its impact on the swimmer's airway mucosa metabolism, which could help to assess the risk of secondary respiratory tract diseases i.e. sport results, condition, and health including lung acute and chronic diseases). DESIGN A group of competitive swimmers participated in the study and samples of their respiratory phase before training, immediately after training, and 2 h after training were assessed. METHODS Sixteen male national and international-level competitive swimmers participated in this study. Respiratory phase analysis of the indoor swimming pool swimmers was performed. Gas chromatography combined with mass spectrometry (GCMS) was used in the measurements. All collected data were transferred to numerical analysis for trends of tracking and mapping. The breathing phase was collected on special porous material and analyzed using GCMS headspace. RESULTS The obtained samples of exhaled air were composed of significantly different metabolomics when compared before, during and after exercise training. This suggests that exposition to indoor chlorine causes changes in the airway mucosa. CONCLUSION This phenomenon may be explained by occurrence of a chlorine-initiated bio-reaction in the swimmers' lungs. The obtained results indicate that chromatographic exhaled gas analysis is a sensitive method of pulmonary metabolomic changes assessment. Presented analysis of swimmers exhaled air indicates, that indoor swimming may be responsible for airway irritation caused by volatile chlorine compounds and their influence on lung me

Background: Ice swimming for 1 mile and 1 km is a new discipline in open-water swimming since 2009. This study examined female and male performances in swimming 1 mile (‘Ice Mile’) and 1 km (‘1 km Ice event’) in water of 5 °C or colder between 2009 and 2015 with the hypothesis that women would be faster than men. Methods: Between 2009 and 2015, 113 men and 38 women completed one ‘Ice Mile’ and 26 men and 13 completed one ‘1 km Ice event’ in water colder than +5 °C following the rules of International Ice Swimming Association (IISA). Differences in performance between women and men were determined. Sex difference (%) was calculated using the equation ([time for women] – [time for men]/[time for men] × 100). For ‘Ice Mile’, a mixed-effects regression model with interaction analyses was used to investigate the influence of sex and environmental conditions on swimming speed. The association between water temperature and swimming speed was assessed using Pearson correlation analyses. Results: For ‘Ice Mile’ and ‘1 km Ice event’, the best men were faster than the best women. In ‘Ice Mile’, calendar year, number of attempts, water temperature and wind chill showed no association with swimming speed for both women and men. For both women and men, water temperature was not correlated to swimming speed in both ‘Ice Mile’ and ‘1 km Ice event’. Conclusions: In water colder than 5 °C, men were faster than women in ‘Ice Mile’ and ‘1 km Ice event’. Water temperature showed no correlation to swimming speed.

BACKGROUND Exercise-associated hyponatremia (EAH), rhabdomyolysis and renal failure appear to be a unique problem in ultra-endurance racers. METHODS We investigated the combined occurrence of EAH and rhabdomyolysis in seven different ultra-endurance races and disciplines (i.e. multi-stage mountain biking, 24-h mountain biking, 24-h ultra-running and 100-km ultra-running). RESULTS Two (15.4%) ultra-runners (man and woman) from hyponatremic ultra-athletes (n = 13) and four (4%) ultra-runners (four men) from the normonatremic group (n = 100) showed rhabdomyolysis following elevated blood creatine kinase (CK) levels > 10,000 U/L without the development of renal failure and the necessity of a medical treatment. Post-race creatine kinase, plasma and urine creatinine significantly increased, while plasma [Na(+)] and creatine clearance decreased in hyponatremic and normonatremic athletes, respectively. The percentage increase of CK was higher in the hyponatremic compared to the normonatremic group (P < 0.05). Post-race CK levels were higher in ultra-runners compared to mountain bikers (P < 0.01), in faster normonatremic (P < 0.05) and older and more experienced hyponatremic ultra-athletes (P < 0.05). In all finishers, pre-race plasma [K(+)] was related to post-race CK (P < 0.05). CONCLUSIONS Hyponatremic ultra-athletes tended to develop exercise-induced rhabdomyolysis more frequently than normonatremic ultra-athletes. Ultra-runners tended to develop rhabdomyolysis more frequently than mountain bikers. We found no association between post-race plasma [Na(+)] and CK concentration in both hypo- and normonatremic ultra-athletes.

BACKGROUND This study investigated changes in normalised running speed as a proxy for effort distribution over segments in male elite and age group 100 km ultra-marathoners with the assumption that older runners would slow down more than younger runners. METHODS The annual ten fastest finishers (i.e. elite and age group runners) competing between 2000 and 2009 in the '100 km Lauf Biel' were identified. Normalised average running speed (i.e. relative to segment 1 of the race corrected for gradient) was analysed as a proxy for pacing in elite and age group finishers. For each year, the ratio of the running speed from the final to the first segment for each age cohort was determined. These ratios were combined across years with the assumption that there were no 'extreme' wind events etc. which may have impacted the final relative to the first segment across years. The ratios between the age cohorts were compared using one-way ANOVA and Tukey's post-hoc test. The ratios between elite and age group runners were investigated using one-way ANOVA with Dunnett's multiple comparison post-hoc tests. The trend across age groups was investigated using simple regression analysis with age as the dependent variable. RESULTS Normalised average running speed was different between age group 18-24 years and age groups 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59 and 65-69 years. Regression analysis showed no trend across age groups (r(2) = 0.003, p > 0.05). CONCLUSION To summarize, (i) athletes in age group 18-24 years were slower than athletes in most other age groups and (ii) there was no trend of slowing down for older athletes.

BACKGROUND: To assess the prevalence of exercise-associated hyponatremia (EAH) in two 24-hour mountain bike (MTB) (R1,R2), one 24-hour running (R3) and one multi-stage MTB (R4) races held in the Czech Republic in a cluster of four cross-sectional studies. METHODS: In 27 ultra-mountain bikers (ultra-MTBers), 12 ultra-runners, and 14 multi-stage MTBers, fluid intake, changes (Δ) in body mass, hematocrit, plasma volume, plasma [Na+], plasma [K+], plasma osmolality, urine [Na+], urine [K+], urine specific gravity, urine osmolality, K+/Na+ ratio in urine, transtubular potassium gradient and glomerular filtration rate were measured and calculated. The use of non-steroidal anti-inflammatory drugs and symptoms of EAH were recorded using post-race questionnaires. RESULTS: Of the 53 finishers, three (5.7%) developed post-race EAH, thereof one (3.7%) ultra-MTBer, one (8.3%) ultra-runner and one (7.1%) multi-stage MTBer. Plasma [Na+] decreased significantly (p < 0.001) only in R4. Urine osmolality (R1, R3, R4 p < 0.001; R2 p < 0.05) and glomerular filtration rate (p < 0.001) increased, and body mass decreased in all races (p < 0.05). Δ body mass was inversely related to the number of kilometers achieved (p < 0.001) in R2 where better ultra-MTBers tended to lose more weight. Δ body mass (p < 0.001) and %Δ body mass (p = 0.05) were positively related to lower post-race plasma [Na+] in R3 that was associated with increased loss in body mass. Fluid intake was positively related to race performance in R1 and R2 (R1: p = 0.04; R2: p = 0.01) where ultra-MTBers in R1 and R2 who drank more finished ahead of those who drank less. Post-race plasma [Na+] was negatively associated with race performance in ultra-MTBers in R2 (p < 0.05), similarly ultra-runners in R3 (p < 0.05) where finishers with more kilometres had lower post-race plasma [Na+]. CONCLUSIONS: The prevalence of EAH in the Czech Republic was no higher compared to existing reports on ultra-endurance athletes in other countries.

Background: Recent findings showed that elite Ironman triathletes competing in ‘Ironman Hawaii’ improved both split and overall race times. The present study investigated whether elite athletes also improved in transition time (i.e. time needed between disciplines for changing clothes and equipment). Methods: Changes in split times, overall race times and transition times (i.e. expressed in absolute and relative terms) in the annual fastest competing in ‘Ironman Hawaii’ were investigated using linear, non-linear and multi-level regression analyses. To detect a potential difference in transition times between different race distances, we compared transition times in ‘Ironman Hawaii’ to transition times in the World Championships ‘Ironman 70.3’ covering the half distance of the Ironman distance triathlon. Results: In ‘Ironman Hawaii’, transition times remained unchanged for the annual fastest women but increased linearly for the annual fastest men. For the annual ten fastest, transition times increased linearly for women and men in both absolute and relative terms. The sex difference in transition times remained unchanged for the annual fastest, but decreased linearly for the annual ten fastest. In ‘Ironman 70.3’, transition times remained unchanged for the annual fastest. For the annual ten fastest, transition times decreased linearly for both women and men in absolute and relative terms. The sex difference in transition times remained unchanged for both the annual fastest and the annual ten fastest. Transition times were faster in ‘Ironman 70.3’ for women in 2011 and for men in 2006, 2007, and 2010-2013. In relative terms, transition times were faster in ‘Ironman 70.3’compared to ‘Ironman Hawaii’ during 2006-2013. The sex difference in transition times remained unchanged. Conclusions: In ‘Ironman Hawaii’, transition times increased for both women and men whereas the sex difference decreased. In ‘Ironman 70.3’, transition times decreased for both women and men wherea

BACKGROUND: Recent studies found that the athlete's age of the best ultra-marathon performance was higher than the athlete's age of the best marathon performance and it seemed that the athlete's age of peak ultra-marathon performance increased in distance-limited races with rising distance. METHODS: We investigated the athlete's age of peak ultra-marathon performance in the fastest finishers in time-limited ultra-marathons from 6 hrs to 10 d. Running performance and athlete's age of the fastest women and men competing in 6 hrs, 12 hrs, 24 hrs, 48 hrs, 72 hrs, 144 hrs (6 d) and 240 hrs (10 d) were analysed for races held between 1975 and 2012 using analysis of variance and multi-level regression analysis. RESULTS: The athlete's ages of the ten fastest women ever in 6 hrs, 12 hrs, 24 hrs, 48 hrs, 72 hrs, 6 d and 10 d were 41 ± 9, 41 ± 6, 42 ± 5, 46 ± 5, 44 ± 6, 42 ± 4, and 37 ± 4 yrs, respectively. The athlete's age of the ten fastest women was different between 48 hrs and 10 d. For men, the athlete's ages were 35 ± 6, 37 ± 9, 39 ± 8, 44 ± 7, 48 ± 3, 48 ± 8 and 48 ± 6 yrs, respectively. The athlete's age of the ten fastest men in 6 hrs and 12 hrs was lower than the athlete's age of the ten fastest men in 72 hrs, 6 d and 10 d, respectively. CONCLUSION: The athlete's age of peak ultra-marathon performance did not increase with rising race duration in the best ultra-marathoners. For the fastest women ever in time-limited races, the athlete's age was lowest in 10 d (~37 yrs) and highest in 48 hrs (~46 yrs). For men, the athlete's age of the fastest ever in 6 hrs (~35 yrs) and 12 hrs (~37 yrs) was lower than the athlete's age of the ten fastest in 72 hrs (~48 yrs), 6 d (~48 yrs) and 10 d (~48 yrs). The differences in the athlete's age of peak performance between female and male ultra-marathoners for the different race durations need further investigations.

BACKGROUND: The aim of the present study was to investigate participation and performance trends regarding the nationality of successful solo swimmers in the 'English Channel Swim'. METHODS: The nationality and swim times for all swimmers who successfully crossed the 33.8-km 'English Channel' from 1875 to 2013 were analysed. RESULTS: Between 1875 and 2013, the number of successful female (571, 31.4%) and male (1,246, 68.6%) solo swimmers increased exponentially; especially for female British and American swimmers and male British, US-American and Australian swimmers. Most of the swimmers were crossing the 'English Channel' from England to France and most of the competitors were from Great Britain, the United States of America, Australia and Ireland. For women, athletes from the United States of America, Australia and Great Britain achieved the fastest swim times. For men, the fastest swim times were achieved by athletes from the United States of America, Great Britain and Australia. Swim times of the annual fastest women from Great Britain and the United States of America decreased across years. For men, swim times decreased across years in the annual fastest swimmers from Australia, Great Britain, Ireland, South Africa and the United States of America. Men were swimming faster from England to France than from France to England compared to women. Swim times became faster across years for both women and men for both directions. CONCLUSIONS: Between 1875 and 2013, the most representative nations in the 'English Channel Swim' were Great Britain, the United States of America, Australia and Ireland. The fastest swim times were achieved by athletes from the United States of America, Australia and Great Britain.

BACKGROUND: The aims of the study were (i) to investigate the relationship between elite marathon race times and age in 1-year intervals by using the world single age records in marathon running from 5 to 93 years and (ii) to evaluate the sex difference in elite marathon running performance with advancing age. METHODS: World single age records in marathon running in 1-year intervals for women and men were analysed regarding changes across age for both men and women using linear and non-linear regression analyses for each age for women and men. RESULTS: The relationship between elite marathon race time and age was non-linear (i.e. polynomial regression 4(th) degree) for women and men. The curve was U-shaped where performance improved from 5 to ~20 years. From 5 years to ~15 years, boys and girls performed very similar. Between ~20 and ~35 years, performance was quite linear, but started to decrease at the age of ~35 years in a curvilinear manner with increasing age in both women and men. The sex difference increased non-linearly (i.e. polynomial regression 7(th) degree) from 5 to ~20 years, remained unchanged at ~20 min from ~20 to ~50 years and increased thereafter. The sex difference was lowest (7.5%, 10.5 min) at the age of 49 years. CONCLUSION: Elite marathon race times improved from 5 to ~20 years, remained linear between ~20 and ~35 years, and started to increase at the age of ~35 years in a curvilinear manner with increasing age in both women and men. The sex difference in elite marathon race time increased non-linearly and was lowest at the age of ~49 years. KEYWORDS: Boys; Girls; Master runner; Performance; Running; Sex difference

Background This study investigated swimming speeds and sex differences of finalists competing at the Olympic Games (i.e. 624 female and 672 male athletes) and FINA World Championships (i.e. 990 women and 1008 men) between 1992 and 2013. Methods Linear, non-linear and multi-level regression models were used to investigate changes in swimming speeds and sex differences for champions and finalists. Results Regarding finalists in FINA World Championships and Olympic Games, swimming speed increased linearly in both women and men in all disciplines and race distances. Male world champions' swimming speed remained stable in 200 m butterfly, 400 m, 800 m and 1,500 m freestyle. Considering women, swimming speed remained unchanged in 50 m and 400 m freestyle. In the Olympic Games, swimming speed of male champions remained unchanged in 200 m breaststroke, 50 m, 400 m, 800 m and 1,500 m freestyle. Female Olympic champions' swimming speed remained stable in 100 m and 200 m backstroke, 100 m butterfly, 200 m individual medley, 50 m and 200 m freestyle. Evaluating sex differences between finalists in FINA World Championships, results showed a linear decrease in 100 m breaststroke and 200 m butterfly and a non-linear increase in 100 m backstroke. In finals at the Olympic Games, the sex difference decreased linearly for 100 m backstroke, 400 m and 800 m freestyle. However, a linear increase for 200 m butterfly can be reported. Considering Olympic and world champions, the sex difference remained stable in all disciplines and race distances. Conclusion Swimming speed of the finalists at the Olympic Games and FINA World Championships increased linearly. The top annual female swimmers increased swimming speed rather at longer race distances (i.e. 800 m and 1,500 m freestyle, 200 m butterfly, and 400 m individual medley), whereas the top annual male swimmers increased it rather at shorter race distances (i.e. 100 m and 200 m freestyle, 100 m butterfly, and 100 m breaststroke). Sex differ

Background Existing literature showed improved swimming performances for swimmers wearing wetsuits competing under standardized conditions in races held in pools on short to middle distances. Data about the influence of wetsuits on swimming performances in long and ultra-long open-water swimming races are missing. It is unknown whether the benefit of wearing wetsuits is comparable in men and women. The aim of this study was to investigate the influence of wearing a wetsuit on open-water swimming performances at the 26.4 km 'Marathon Swim in Lake Zurich' in Lake Zurich, Switzerland, and the 3.8 km Lake Ontario Swim Team-Race (LOST-Race) in Lake Ontario, Canada. Methods Race times of the fastest female and male swimmers competing with and without wetsuit were compared using multi-level regression analyses and analysis of variance. Results In the 'Marathon Swim' in Lake Zurich, wearing a wetsuit had no effect on race time regarding the gender where athletes wearing a wetsuit were not faster than athletes without wetsuit. However, the ten fastest men wearing a wetsuit (410.6 +/- 26.7 min) were faster (32.7%, p < 0.01) than the ten fastest women without wetsuit (544.9 +/- 81.3 min). In the 'LOST-Race', the top ten men wearing a wetsuit (51.7 +/- 2.5 min) were faster (13.2%, p < 0.01) than the top ten women wearing a wetsuit (58.5 +/- 3.2 min). Additionally, the top ten men without wetsuit (52.1 +/- 2.4 min) were faster (19.6%, p < 0.01) than the top ten women without wetsuit (62.3 +/- 2.5 min). The top ten women wearing a wetsuit (58.5 +/- 3.2 min) were faster (6.5%, p < 0.01) than top ten women wearing a wetsuit (62.3 +/- 25 min). Conclusions These results suggest that wearing a wetsuit had a positive influence on swimming speed for both women and men but the benefit of the use of wetsuits seemed to depend on additional factors (i.e. race distance). Women seemed to benefit more from wearing wetsuits than men in longer open-water ultra-distance swimming races.

Background The purpose of this study was to examine the sex and age-related differences in performance in a draft-legal ultra-cycling event. Methods Age-related changes in performance across years were investigated in the 24-hour draft-legal cycling event held in Schotz, Switzerland, between 2000 and 2011 using multi-level regression analyses including age, repeated participation and environmental temperatures as co-variables. Results For all finishers, the age of peak cycling performance decreased significantly (Ss = -0.273, p = 0.036) from 38 +/- 10 to 35 +/- 6 years in females but remained unchanged (Ss = -0.035, p = 0.906) at 41.0 +/- 10.3 years in males. For the annual fastest females and males, the age of peak cycling performance remained unchanged at 37.3 +/- 8.5 and 38.3 +/- 5.4 years, respectively. For all female and male finishers, males improved significantly (Ss = 7.010, p = 0.006) the cycling distance from 497.8 +/- 219.6 km to 546.7 +/- 205.0 km whereas females (Ss = -0.085, p = 0.987) showed an unchanged performance of 593.7 +/- 132.3 km. The mean cycling distance achieved by the male winners of 960.5 +/- 51.9 km was significantly (p < 0.001) greater than the distance covered by the female winners with 769.7 +/- 65.7 km but was not different between the sexes (p > 0.05). The sex difference in performance for the annual winners of 19.7 +/- 7.8% remained unchanged across years (p > 0.05). The achieved cycling distance decreased in a curvilinear manner with advancing age. There was a significant age effect (F = 28.4, p < 0.0001) for cycling performance where the fastest cyclists were in age group 35-39 years. Conclusion In this 24-h cycling draft-legal event, performance in females remained unchanged while their age of peak cycling performance decreased and performance in males improved while their age of peak cycling performance remained unchanged. The annual fastest females and males were 37.3 +/- 8.5 and 38.3 +/- 5.4 years old, respectively. The sex d

BACKGROUND: Age and peak performance in ultra-endurance athletes have been mainly investigated in long-distance runners and triathletes, but not for long-distance swimmers. The present study investigated the age and swimming performance of elite ultra-distance swimmers competing in the 5-, 10- and 25-km Fédération Internationale de Natation (FINA) World Cup swimming events. METHODS: The associations of age and swimming speed in elite male and female swimmers competing in World Cup events of 5-, 10- and 25-km events from 2000 to 2012 were analysed using single and multi-level regression analyses. RESULTS: During the studied period, the swimming speed of the annual top ten women decreased significantly from 4.94 ± 0.20 to 4.77 ± 0.09 km/h in 5 km and from 4.60 ± 0.04 to 4.44 ± 0.08 km/h in 25 km, while it significantly increased from 4.57 ± 0.01 to 5.75 ± 0.01 km/h in 10 km. For the annual top ten men, peak swimming speed decreased significantly from 5.42 ± 0.04 to 5.39 ± 0.02 km/h in 5 km, while it remained unchanged at 5.03 ± 0.32 km/h in 10 km and at 4.94 ± 0.35 km/h in 25 km. The age of peak swimming speed for the annual top ten women remained stable at 22.5 ± 1.2 years in 5 km, at 23.4 ± 0.9 years in 10 km and at 23.8 ± 0.9 years in 25 km. For the annual top ten men, the age of peak swimming speed increased from 23.7 ± 2.8 to 28.0 ± 5.1 years in 10 km but remained stable at 24.8 ± 1.0 years in 5 km and at 27.2 ± 1.1 years in 25 km. CONCLUSION: Female long-distance swimmers competing in FINA World Cup races between 2000 and 2012 improved in 10 km but impaired in 5 and 25 km, whereas men only impaired in 5 km. The age of peak performance was younger in women (approximately 23 years) compared to men (about 25-27 years).

BACKGROUND: This study examined participation and performance trends in 'Ironman Hawaii' regarding the nationality of the finishers. METHODS: Associations between nationalities and race times of 39,706 finishers originating from 124 countries in the 'Ironman Hawaii' from 1985 to 2012 were analyzed using single and multi-level regression analysis. RESULTS: Most of the finishers originated from the United States of America (47.5%) followed by athletes from Germany (11.7%), Japan (7.9%), Australia (6.7%), Canada (5.2%), Switzerland (2.9%), France (2.3%), Great Britain (2.0%), New Zealand (1.9%), and Austria (1.5%). German women showed the fastest increase in finishers (r2=0.83, p<0.0001), followed by Australia (r2=0.78, p<0.0001), Canada (r2=0.78, p<0.0001) and the USA (r2=0.69, p<0.0001). Japanese women showed no change in the number of finishers (r2=0.01, p>0.05). For men, athletes from France showed the steepest increase (r2=0.85, p<0.0001), followed by Austria (r2=0.68, p<0.0001), Australia (r2=0.67, p<0.0001), Brazil (r2=0.60, p<0.0001), Great Britain (r2=0.46, p<0.0001), Germany (r2=0.26, p<0.0001), the United States of America (r2=0.21, p=0.013) and Switzerland (r2=0.14, p=0.0044). The number of Japanese men decreased (r2=0.35, p=0.0009). The number of men from Canada (r2=0.02, p>0.05) and New Zealand (r2=0.02, p>0.05) remained unchanged. Regarding female performance, the largest improvements were achieved by Japanese women (17.3%). The fastest race times in 2012 were achieved by US-American women. Women from Japan, Canada, Germany, Australia, and the United States of America improved race times. For men, the largest improvements were achieved by athletes originating from Brazil (20.9%) whereas the fastest race times in 2012 were achieved by athletes from Germany. Race times for athletes originating from Brazil, Austria, Great Britain, Switzerland, Germany, Australia, Canada, Japan, New Zealand and France decreased. Race times in athletes originating from Austra

BACKGROUND: The present study investigated the changes in swimming speeds and sex differences for elite male and female swimmers competing in 5 km, 10 km and 25 km open-water FINA World Cup races held between 2000 and 2012. METHODS: The changes in swimming speeds and sex differences across years were analysed using linear, non-linear, and multi-level regression analyses for the annual fastest and the annual ten fastest competitors. RESULTS: For the annual fastest, swimming speed remained stable for men and women in 5 km (5.50 ± 0.21 and 5.08 ± 0.19 km/h, respectively), in 10 km (5.38 ± 0.21 and 5.05 ± 0.26 km/h, respectively) and in 25 km (5.03 ± 0.32 and 4.58 ± 0.27 km/h, respectively). In the annual ten fastest, swimming speed remained constant in 5 km in women (5.02 ± 0.19 km/h) but decreased significantly and linearly in men from 5.42 ± 0.03 km/h to 5.39 ± 0.02 km/h. In 10 km, swimming speed increased significantly and linearly in women from 4.75 ± 0.01 km/h to 5.74 ± 0.01 km/h but remained stable in men at 5.36 ± 0.21 km/h. In 25 km, swimming speed decreased significantly and linearly in women from 4.60 ± 0.06 km/h to 4.44 ± 0.08 km/h but remained unchanged at 4.93 ± 0.34 km/h in men. For the annual fastest, the sex difference in swimming speed remained unchanged in 5 km (7.6 ± 3.0%), 10 km (6.1 ± 2.5%) and 25 km (9.0 ± 3.7%). For the annual ten fastest, the sex difference remained stable in 5 km at 7.6 ± 0.6%, decreased significantly and linearly in 10 km from 7.7 ± 0.7% to 1.2 ± 0.3% and increased significantly and linearly from 4.7 ± 1.4% to 9.6 ± 1.5% in 25 km. CONCLUSIONS: To summarize, elite female open-water ultra-distance swimmers improved in 10 km but impaired in 25 km leading to a linear decrease in sex difference in 10 km and a linear increase in sex difference in 25 km. The linear changes in sex differences suggest that women will improve in the near future in 10 km, but not in 25 km.

BACKGROUND: The effects of running and cycling on changes in hydration status and body composition during a 24-hour race have been described previously, but data for 24-hour ultra-mountain bikers are missing. The present study investigated changes in foot volume, body composition, and hydration status in male and female 24-hour ultra-mountain bikers. METHODS: We compared in 49 (37 men and 12 women) 24-hour ultra-mountain bikers (ultra-MTBers) changes (Delta) in body mass (BM). Fat mass (FM), percent body fat (%BF) and skeletal muscle mass (SM) were estimated using anthropometric methods. Changes in total body water (TBW), extracellular fluid (ECF) and intracellular fluid (ICF) were determined using bioelectrical impedance and changes in foot volume using plethysmography. Haematocrit, plasma [Na+], plasma urea, plasma osmolality, urine urea, urine specific gravity and urine osmolality were measured in a subgroup of 25 ultra-MTBers (16 men and 9 women). RESULTS: In male 24-hour ultra-MTBers, BM (P < 0.001), FM (P < 0.001), %BF (P < 0.001) and ECF (P < 0.05) decreased whereas SM and TBW did not change (P > 0.05). A significant correlation was found between post-race BM and post-race FM (r = 0.63, P < 0.001). In female ultra-MTBers, BM (P < 0.05), %BF (P < 0.05) and FM (P < 0.001) decreased, whereas SM, ECF and TBW remained stable (P > 0.05). Absolute ranking in the race was related to Delta%BM (P < 0.001) and Delta%FM in men (P < 0.001) and to Delta%BM (P < 0.05) in women. In male ultra-MTBers, increased post-race plasma urea (P < 0.001) was negatively related to absolute ranking in the race, Delta%BM, post-race FM and Delta%ECF (P < 0.05). Foot volume remained stable in both sexes (P > 0.05). CONCLUSIONS: Male and female 24-hour ultra-MTBers experienced a significant loss in BM and FM, whereas SM remained stable. Body weight changes and increases in plasma urea do not reflect a change in body hydration status. No oedema of the lower limbs occurred.

BACKGROUND: Osteoarthritis is an increasing burden in an ageing population. Sports, especially when leading to an overstress of joints, is under suspicion to provoke or at least accelerate the genesis of osteoarthritis. We present the radiologic findings of a 49-years old ultra-endurance athlete with 35 years of training and competing, whose joints of the lower limbs were examined using three different types of magnetic resonance imaging, including a microscopic magnetic resonance imaging coil. To date no case report exists where an ultra-endurance athlete was examined such detailed regarding overuse-injuries of his joints. CASE PRESENTATION: A 49 years old, white, male ultra-endurance athlete reporting no pain during training and racing and with no significant injuries of the lower limbs in his medical history was investigated regarding signs of chronic damage or overuse injuries of the joints of his lower limbs. CONCLUSION: Despite the age of nearly 50 years and a training history of over 35 years, the athlete showed no signs of chronic damage or overuse injuries in the joints of his lower limbs. This leads to the conclusion that extensive sports and training does not compulsory lead to damages of the musculoskeletal system. This is a very important finding for all endurance-athletes as well as for their physicians.

BACKGROUND: This study examined the changes in participation, performance and age of East African runners competing in half-marathons and marathons held in Switzerland between 2000 and 2010. METHODS: Race times, sex, age and origin of East African versus Non-African finishers of half-marathon and marathon finishers were analyzed. RESULTS: Across time, the number of Kenyan and Ethiopian finishers remained stable (P > 0.05) while the number of Non-African finishers increased for both women and men in both half-marathons and marathons (P < 0.05). In half-marathons, the top ten African women (71 ± 1.4 min) and top three (62.3 ± 0.6 min) and top ten (62.8 ± 0.4 min) African men were faster than their Non-African counterparts (P < 0.05). In marathons, however, there was no difference in race times between the top three African men (130.0 ± 0.0 min) and women (151.7 ± 2.5 min) compared to Non-African men (129.0 ± 1.0 min) and women (150.7 ± 1.2 min) (P > 0.05). In half-marathons and marathons was no difference in age between the best Non-African and the best African runners (P > 0.05). CONCLUSIONS: During the last decade in Switzerland, the participation of Kenyan and Ethiopian runners in half- and full- marathons remained stable. In marathons there was no difference in age and performance between the top African and the top Non-African runners. Regarding half-marathons, the top African runners were faster but not younger than the top Non-African runners. Future insight should be gained by comparing the present results with participation, performance and age trends for East African runners competing in marathons held in larger countries.

BACKGROUND: Sex-related differences in performance and in age of peak performance have been reported for freestyle swimming. However, little is known about the sex-related differences in other swimming styles. The aim of the present study was to compare performance and age of peak performance for elite men and women swimmers in breaststroke versus freestyle. METHODS: Race results were analyzed for swimmers at national ranked in the Swiss high score list (during 2006 through 2010) and for international swimmers who qualified for the finals of the FINA World Swimming Championships (during 2003 through 2011). RESULTS: The sex-related difference in swimming speed was significantly greater for freestyle than for breaststroke over 50 m, 100 m, and 200 m race distances for Swiss swimmers, but not for FINA finalists. The sex-related difference for both freestyle and breaststroke swimming speeds decreased significantly with increasing swimming distance for both groups. Race distance did not affect the age of peak performance by women in breaststroke, but age of peak performance was four years older for FINA women than for Swiss women. Men achieved peak swimming performance in breaststroke at younger ages for longer race distances, and the age of peak swimming performance was six years older for FINA men than for Swiss men. In freestyle swimming, race distance did not affect the age of peak swimming performance for Swiss women, but the age of peak swimming performance decreased with increasing race distance for Swiss men and for both sexes at the FINA World Championships. CONCLUSIONS: Results of the present study indicate that (i) sex-related differences in swimming speed were greater for freestyle than for breaststroke for swimmers at national level, but not for swimmers at international level, and (ii) both female and male swimmers achieved peak swimming speeds at younger ages in breaststroke than in freestyle. Further studies are required to better understand differences b

BACKGROUND: Participation and performance trends have been investigated in a single stage Ironman triathlon such as the 'Ironman Hawaii,' but not for a multi-stage ultra-triathlon such as the 'Ultraman Hawaii' covering a total distance of 515 km. The aims of this study were to analyze (1) changes in participation and performance, (2) sex-related differences in overall and split time performances, and (3) the age of peak performance in Ultraman Hawaii. METHODS: Age and race times including split times for 98 women and 570 men who successfully finished Ultraman Hawaii (day 1 with 10-km swimming and 145-km cycling, day 2 with 276-km cycling, and day 3 with 84-km running) between 1983 and 2012 were analyzed. Changes in variables over time of annual winners and annual top three women and men were investigated using simple linear regression analyses. RESULTS: The number of female finishers increased (r2 = 0.26, p < 0.01), while the number of male finishers remained stable (r2 = 0.03, p > 0.05). Overall race times decreased for both female (r2 = 0.28, p < 0.01) and male (r2 = 0.14, p < 0.05) winners and for both the annual top three women (r2 = 0.36, p < 0.01) and men (r2 = 0.14, p = 0.02). The sex difference in performance decreased over time from 24.3% to 11.5% (r2 = 0.39, p < 0.01). For the split disciplines, the time performance in cycling on day 1 (r2 = 0.20, p < 0.01) and day 2 decreased significantly for men (r2 = 0.41, p < 0.01) but for women only on day 2 (r2 = 0.45, p < 0.01). Split times showed no changes in swimming and running. The age of the annual winners increased from 28 to 47 years for men (r2 = 0.35, p < 0.01) while it remained stable at 32 +/- 6 years for women (r2 < 0.01, p > 0.05). The age of the annual top three finishers increased from 33 +/- 6 years to 48 +/- 3 years for men (p < 0.01) and from 29 +/- 7 years to 49 +/- 2 years for women (p < 0.01). CONCLUSIONS: Both the annual top three women and men improved performance in Ultraman Hawaii during t

BACKGROUND: The present study examined the sex difference in swimming (7.8 km), cycling (360 km), running (84 km), and overall race times for Double Iron ultra-triathletes. METHODS: Sex differences in split times and overall race times of 1,591 men and 155 women finishing a Double Iron ultra-triathlon between 1985 and 2012 were analyzed. RESULTS: The annual number of finishes increased linearly for women and exponentially for men. Men achieved race times of 1,716 ± 243 min compared to 1,834 ± 261 min for women and were 118 ± 18 min (6.9%) faster (p < 0.01). Men finished swimming within 156 ± 63 min compared to women with 163 ± 31 min and were 8 ± 32 min (5.1 ± 5.0%) faster (p < 0.01). For cycling, men (852 ± 196 min) were 71 ± 70 min (8.3 ± 3.5%) faster than women (923 ± 126 min) (p < 0.01). Men completed the run split within 710 ± 145 min compared to 739 ± 150 min for women and were 30 ± 5 min (4.2 ± 3.4%) faster (p = 0.03). The annual three fastest men improved race time from 1,650 ± 114 min in 1985 to 1,339 ± 33 min in 2012 (p < 0.01). Overall race time for women remained unchanged at 1,593 ± 173 min with an unchanged sex difference of 27.1 ± 8.6%. In swimming, the split times for the annual three fastest women (148 ± 14 min) and men (127 ± 20 min) remained unchanged with an unchanged sex difference of 26.8 ± 13.5%. In cycling, the annual three fastest men improved the split time from 826 ± 60 min to 666 ± 18 min (p = 0.02). For women, the split time in cycling remained unchanged at 844 ± 54 min with an unchanged sex difference of 25.2 ± 7.3%. In running, the annual fastest three men improved split times from 649 ± 77 min to 532 ± 16 min (p < 0.01). For women, however, the split times remained unchanged at 657 ± 70 min with a stable sex difference of 32.4 ± 12.5%. CONCLUSIONS: To summarize, the present findings showed that men were faster than women in Double Iron ultra-triathlon, men improved overall race times, cycling and running split times, and the sex diffe

BACKGROUND: Autoimmune thyroid diseases including Graves' disease and Hashimoto's thyroiditis are caused by immune response to self-thyroid antigens. The rare situation of hyperthyroidism with Graves' disease in twins has been reported in a very few case reports in literature. CASE PRESENTATION: We present monozygotic female twins developing consecutively Graves' disease within five years. One year before the diagnosis of Graves' disease was established in the first twin, the mother developed a toxic thyroid nodule with hyperthyroidism leading to hemi thyroidectomy. Both the mother and the twins were cigarette smokers. The twins were treated with carbamizole and this therapy led to normalization of thyroid stimulating hormone and thyroxine. CONCLUSION: This case report supports the hypothesis that a genetic factor as well as an environmental factor (cigarette smoking) might be of great importance in the aetiology of Graves' disease.

Background The aims of the present study were, firstly, to investigate in a cross-sectional analysis the age of peak Ironman performance within one calendar year in all qualifiers for Ironman Hawaii and Ironman Hawaii; secondly, to determine in a longitudinal analysis on a qualifier for Ironman Hawaii whether the age of peak Ironman performance and Ironman performance itself change across years; and thirdly, to determine the gender difference in performance. Methods In a cross-sectional analysis, the age of the top ten finishers for all qualifier races for Ironman Hawaii and Ironman Hawaii was determined in 2010. For a longitudinal analysis, the age and the performance of the annual top ten female and male finishers in a qualifier for Ironman Hawaii was determined in Ironman Switzerland between 1995 and 2010. Results In 19 of the 20 analyzed triathlons held in 2010, there was no difference in the age of peak Ironman performance between women and men (p > 0.05). The only difference in the age of peak Ironman performance between genders was in ‘Ironman Canada’ where men were older than women (p = 0.023). For all 20 races, the age of peak Ironman performance was 32.2 ± 1.5 years for men and 33.0 ± 1.6 years for women (p > 0.05). In Ironman Switzerland, there was no difference in the age of peak Ironman performance between genders for top ten women and men from 1995 to 2010 (F = 0.06, p = 0.8). The mean age of top ten women and men was 31.4 ± 1.7 and 31.5 ± 1.7 years (Cohen's d = 0.06), respectively. The gender difference in performance in the three disciplines and for overall race time decreased significantly across years. Men and women improved overall race times by approximately 1.2 and 4.2 min/year, respectively. Conclusions Women and men peak at a similar age of 32–33 years in an Ironman triathlon with no gender difference. In a qualifier for Ironman Hawaii, the age of peak Ironman performance remained unchanged across years. In contrast, gender differences in perf

BACKGROUND: The aims of the present study were to examine (a) participation and performance trends and (b) the age of peak running performance in master athletes competing in 24-h ultra-marathons held worldwide between 1998 and 2011. METHODS: Changes in both running speed and the age of peak running speed in 24-h master ultra-marathoners (39,664 finishers, including 8,013 women and 31,651 men) were analyzed. RESULTS: The number of 24-h ultra-marathoners increased for both women and men across years (P < 0.01). The age of the annual fastest woman decreased from 48 years in 1998 to 35 years in 2011. The age of peaking running speed remained unchanged across time at 42.5 ± 5.2 years for the annual fastest men (P > 0.05). The age of the annual top ten women decreased from 42.6 ± 5.9 years (1998) to 40.1 ± 7.0 years (2011) (P < 0.01). For the annual top ten men, the age of peak running speed remained unchanged at 42 ± 2 years (P > 0.05). Running speed remained unchanged over time at 11.4 ± 0.4 km h-1 for the annual fastest men and 10.0 ± 0.2 km/h for the annual fastest women, respectively (P > 0.05). For the annual ten fastest women, running speed increased over time by 3.2% from 9.3 ± 0.3 to 9.6 ± 0.3 km/h (P < 0.01). Running speed of the annual top ten men remained unchanged at 10.8 ± 0.3 km/h (P > 0.05). Women in age groups 25-29 (r2 = 0.61, P < 0.01), 30-34 (r2 = 0.48, P < 0.01), 35-39 (r2 = 0.42, P = 0.01), 40-44 (r2 = 0.46, P < 0.01), 55-59 (r2 = 0.41, P = 0.03), and 60-64 (r2 = 0.57, P < 0.01) improved running speed; while women in age groups 45-49 and 50-54 maintained running speed (P > 0.05). Men improved running speed in age groups 25-29 (r2 = 0.48, P = 0.02), 45-49 (r2 = 0.34, P = 0.03), 50-54 (r2 = 0.50, P < 0.01), 55-59 (r2 = 0.70, P < 0.01), and 60-64 (r2 = 0.44, P = 0.03); while runners in age groups 30-34, 35-39, and 40-44 maintained running speed (P > 0.05). CONCLUSIONS: Female and male age group runners improved running speed. Runners aged >40 years ach

Background The aim of the present study was to compare the trends in participation, performance and age of finishers in ‘Badwater’ and ‘Spartathlon’ as two of the toughest ultramarathons in the world of more than 200 km of distance. Methods Running speed and age of male and female finishers in Badwater and Spartathlon were analyzed from 2000 to 2012. Age of peak performance and sex difference in running speed were investigated during the studied period. Results The number of female and male finishes increased in Badwater and Spartathlon. Women accounted on average for 21.5% ± 6.9% in Badwater and 10.8% ± 2.3% in Spartathlon. There was a significant increase in female participation in Badwater from 18.4% to 19.1% (p < 0.01) and in Spartathlon from 11.9% to 12.5% (p = 0.02). In men, the age of finishers was higher in Badwater (46.5 ± 9.3 years) compared to Spartathlon (44.8 ± 8.2 years) (p < 0.01). The age of female finishers of both races was similar with 43.0 ± 7.5 years in Badwater and 44.5 ± 7.8 years in Spartathlon (p > 0.05). Over the years, the age of the annual five fastest men decreased in Badwater from 42.4 ± 4.2 to 39.8 ± 5.7 years (p < 0.05). For women, the age remained unchanged at 42.3 ± 3.8 years in Badwater (p > 0.05). In Spartathlon, the age was unchanged at 39.7 ± 2.4 years for men and 44.6 ± 3.2 years for women (p > 0.05). In Badwater, women and men became faster over the years. The running speed increased from 7.9 ± 0.7 to 8.7 ± 0.6 km/h (p < 0.01) in men and from 5.4 ± 1.1 to 6.6 ± 0.5 km/h (p < 0.01) in women. The sex difference in running speed remained unchanged at 19.8% ± 4.8% (p > 0.05). In Spartathlon, the running speed was stable over time at 10.8 ± 0.7 km/h for men and 8.7 ± 0.5 km/h for women (p > 0.05). The sex difference remained unchanged at 19.6% ± 2.5% (p > 0.05). Conclusions These results suggest that for both Badwater and Spartathlon, (a) female participation increased, (b) the fastest finishers were approximately 40 to 45 years, a

BACKGROUND: In recent years, there was an increased interest in investigating the gender difference in performance and the age of peak performance in ultra-endurance performances such as ultra-triathlon, ultra-running, and ultra-swimming, but not in ultra-cycling. The aim of the present study was to analyze the gender difference in ultra-cycling performance and the age of peak ultra-cycling performance in the 720-km 'Swiss Cycling Marathon', the largest European qualifier for the 'Race Across America'. METHODS: Changes in the cycling speed and age of 985 finishers including 38 women and 947 men competing in the Swiss Cycling Marathon from 2001 to 2012 covering a distance of 720 km with a change of altitude of 4,993 m were analyzed using linear regression. RESULTS: The gender difference in performance was 13.6% for the fastest cyclists ever, 13.9% ± 0.5% for the three fastest cyclists ever and 19.1% ± 3.7% for the ten fastest cyclists ever. The gender difference in performance for the annual top three women and men decreased from 35.0% ± 9.5% in 2001 to 20.4% ± 7.7% in 2012 (r2 = 0.72, p = 0.01). The annual top three women improved cycling speed from 20.3 ± 3.1 km h-1 in 2003 to 24.8 ± 2.4 km h-1 in 2012 (r2 = 0.79, p < 0.01). The cycling speed of the annual top three men remained unchanged at 30.2 ± 0.6 km h-1 (p > 0.05). The age of peak performance for the ten fastest finishers ever was 35.9 ± 9.6 years for men and 38.7 ± 7.8 years for women, respectively (p = 0.47). CONCLUSIONS: The gender difference in ultra-cycling performance decreased over the 2001 to 2012 period in the 720-km Swiss Cycling Marathon for the annual top three cyclists and reached approximately 14%. Both women and men achieved peak performance at the age of approximately 36 to 39 years. Women might close the gender gap in ultra-endurance cycling in longer cycling distances. Future studies need to investigate the gender difference in performance in the Race Across America, the longest nonstop and