Does a multi-stage ultra-endurance run cause de- or hyper hydration?
We investigated the changes in body mass and parameters of both renal function and fluid metabolism in a case study in a female ultra-endurance runner during the longest multi-stage mountain ultra-marathon in Europe, the ‘Swiss Jura Marathon' in 2008. The female ultra-runner performed the 7 stages with a total distance of 175 km, a total ascent of 5,000 m, and a total descent of 8,000 m within 23:11 h: min, finishing as second female runner. By the end of the race, body mass decreased by 0.3 kg, fat mass by 1.2 kg and skeletal muscle mass by 0.7 kg. Haemoglobin and haematocrit decreased by 4.5% and 7.5 %, respectively, and plasma volume increased by 10 %. Serum osmolality decreased by 3.3%. Parameters of myocellular damage increased substantially (CK + 630 %, LDH + 178 % and GOT + 181 %). Creatinine continuously increased in plasma (+ 23 %) and urine (+ 47 %). Creatinine clearance (- 18.7 %), glomerular filtration rate (- 19.4 %) and serum albumin (- 10.6 %) decreased. Urinary specific gravity decreased after each stage and was increased before each stage. Urinary osmolality decreased after each stage and was increased before each stage. The average daily fluid intake from stage 1 to stage 7 (during performance and rest) was 4.9 l per day. Total body water increased by 1.2 l by the end of the race. The potassium-to-sodium ratio in urine was increased after each stage. We assume that the increase in total body water was due to an increased activity in the renin-angiotensin-aldosterone-system as evidenced by the change in urinary electrolytes after the stages and an increased activity of vasopressin as evidenced by increase of urinary osmolality before the stages.
Armstrong L.E., Maresh C.M., Castellani J.W., et al. Urinary indices of hydration status. Int J Sport Nutr 1994; 4:265-279. https://doi.org/10.1123/ijsn.4.3.265
Ball S.D., Swan P., Desimone R. Accuracy of anthropometry compared to dual energy x-ray absorptiometry. A new generalizable equation for women. Res Q Exerc Sport 2004; 75:248-258. https://doi.org/10.1080/02701367.2004.10609158
Bircher S., Enggist A., Jehle T., Knechtle B. Effects of an extreme endurance race on energy balance and body composition - a case report. J Sports Sci Med 2006; 5:154-162.
Bisson D.L., Dunster G.D., O'Hare J.P., Hampton D., Apenney M.D. Renal sodium retention does not occur during the luteal phase of the menstrual cycle in normal women. Br J Obstet Gynaecol 1992; 99:247-252. https://doi.org/10.1111/j.1471-0528.1992.tb14507.x
Dill D.B., Costill D.L. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J Appl Physiol 1974; 37:247-248.
Cheuvront S.N., Montain S.J., Sawka M.N. Fluid replacement and performance during the marathon. Sports Med 2007; 37:353-357. https://doi.org/10.2165/00007256-200737040-00020
Cockcroft D.W., Gault M.H. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16:31–41. https://doi.org/10.1159/000180580
Fellmann N., Sagnol M., Bedu M., et al. Enzymatic and hormonal responses following a 24 h endurance run and a 10 h triathlon race. Eur J Appl Physiol 1988; 57:545-553. https://doi.org/10.1007/BF00418460
Fellmann N., Bedu M., Giry J., et al. Hormonal, fluid, and electrolyte changes during a 72-h recovery from a 24-h endurance run. Int J Sports Med 1989; 10:406-412. https://doi.org/10.1055/s-2007-1024934
Fellmann N., Ritz P., Ribeyre J., Beaufrère B., Delaître M., Coudert J. Intracellular hyperhydration induced by a 7-day endurance race. Eur J Appl Physiol 1999; 80:353-359. https://doi.org/10.1007/s004210050603
Freund B.J., Claybaugh J.R., Dice M.S., Hashiro G.M. Hormonal and vascular fluid responses to maximal exercise in trained and untrained males. J Appl Physiol 1987; 63:669-675.
Fridén J. Changes in human skeletal muscle induced by long-term eccentric exercise. Cell Tissue Res 1984; 236:365-372. https://doi.org/10.1007/BF00214240
Gastmann U., Dimeo F., Huonker M., et al. Ultra-triathlon-related blood-chemical and endocrinological responses in nine athletes. J Sports Med Phys Fitness 1998; 38:18-23.
Höchli D., Schneiter T., Ferretti G., et al. Loss of muscle oxidative capacity after an extreme endurance run: The Paris-Dakar Foot-Race. Int J Sports Med 1995; 16:343-346. https://doi.org/10.1055/s-2007-973017
Kaminsky L.A., Paul G.L. Fluid intake during an ultramarathon running race: relationship to plasma volume and serum sodium and potassium. J Sports Med Phys Fitness 1991; 31:417-419.
Kao W.F., Shyu C.J., Yang X.W., et al. Athletic performance and serial weight changes during 12- and 24-hour ultra-marathons. Clin J Sport Med 2008; 18:155-158. https://doi.org/10.1097/JSM.0b013e31815cdd37
Kavouras S.A. Assessing hydration status. Curr Opin Clin Nutr Metab Care 2002; 5:519-524. https://doi.org/10.1097/00075197-200209000-00010
Kim H.J., Lee Y.H., Kim C.K. Biomarkers of muscle and cartilage damage and inflammation during a 200 km run. Eur J Appl Physiol 2007; 99:443-447. https://doi.org/10.1007/s00421-006-0362-y
Knechtle B., Kohler G. Running 338 kilometres within five days has no effect on body mass and body fat but reduces skeletal muscle mass – the Isarrun 2006. J Sports Sci Med 2007; 6:401-407.
Knechtle B., Duff B., Schulze I., Kohler G. The effects of running 1,200 km within 17 days on body composition in a female ultrarunner-Deutschlandlauf 2007. Res Sports Med 2008a; 16:167-188.
Knechtle B., Duff B., Schulze I., Kohler G. A multi-stage ultra-endurance run over 1,200 km leads to a continuous accumulation of total body water. J Sports Sci Med 2008b; 7:357-364.
Knechtle B., Knechtle P., Schück R., Andonie J.L., Kohler G. Effects of a Deca Iron Triathlon on body composition – a case study. Int J Sports Med 2008c; 29:343-351.
Knechtle B., Salas O.F., Andonie J.L., Kohler G. Effect of a multistage ultra-endurance triathlon on body composition: World Challenge Deca Iron Triathlon 2006. Br J Sports Med 2008d; 42:121-125.
Knechtle B., Wirth A., Knechtle P., Rosemann T. Increase of total body water in face of a decrease of body mass during non-stop running 100 km – formation of oedema? Research Quarterly for Exercise and Sport, 2009, in press.
Kuipers H., Janssen G.M.E., Bosman F., Frederik P.M., Geurten P. Structural and ultrastructural changes in skeletal muscle associted with long-distance training and running. Int J Sports Med 1989;10: S156-S159.
Lee R.C., Wang Z., Heo M., Ross R., Janssen I., Heymsfield S.B. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr 2000; 72:796-803.
Lehmann M., Huonker M., Dimeo F. Serum amino acid concentrations in nine athletes before and after the 1993 Colmar Ultra Triathlon. Int J Sports Med 1995; 16:155-159. https://doi.org/10.1055/s-2007-972984
Levey A.S., Bosch J.P., Lewis J.B., Greene T., Rogers N., Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130:461-470. https://doi.org/10.7326/0003-4819-130-6-199903160-00002
Maughan R.J., Whiting P.H., Davidson R.J. Estimation of plasma volume changes during marathon running. Br J Sports Med 1985; 19:138-141. https://doi.org/10.1136/bjsm.19.3.138
Melin B., Eclache J.P., Geelen G., et al. Plasma AVP, neurophysin, rennin activity, and aldosterone during submaximal exercise performed until exhaustion in trained and untrained men. Eur J Appl Physiol 1980 ;44 :141-151. https://doi.org/10.1007/BF00421092
Mischler I., Boirie Y., Gachon P., et al. Human albumin synthesis is increased by an ultra-endurance trial. Med Sci Sports Exerc 2003; 35:75-81. https://doi.org/10.1097/00005768-200301000-00013
Milledge J.S., Bryson E.I., Catley D.M., et al. Sodium balance, fluid homeostasis and the renin-aldosterone system during the prolonged exercise of hill walking. Clin Sci (Lond) 1982; 62:595-604. https://doi.org/10.1042/cs0620595
Neumayr G., Pfister R., Hoertnagl H., Mitterbauer G., Prokop W., Joannidis M. Renal function and plasma volume following ultramarathon cycling. Int J Sports Med 2005; 26:2-8. https://doi.org/10.1055/s-2004-815717
Pastene J., Germain M., Allevard A.M., Gharib C., Lacour J.R. Water balance during and after marathon running. Eur J Appl Physiol 1996;73: 49-55. https://doi.org/10.1007/BF00262808
Raschka C., Plath M., Cerull R., Bernhard W., Jung K., Leitzmann C. The body muscle compartment and its relationship to food absorption and blood chemistry during an extreme endurance performance. Z Ernahrungswiss 1991; 30:276-288. https://doi.org/10.1007/BF01651957
Raschka C., Plath M. Body fat compartment and its relationship to food intake and clinical chemical parameters during extreme endurance performance. Schweiz Z Sportmed 1992; 40:13-25.
Shireffs S.M. Markers of hydration status. Eur J Clin Nutr 2003;57: S6-S9.
Skenderi K.P., Kavouras S.A., Anastasiou C.A., Yiannakouris N., Matalas A.L. Exertional rhabdomyolysis during a 246-km continuous running race. Med Sci Sports Exerc 2006; 38:1054-1057. https://doi.org/10.1249/01.mss.0000222831.35897.5f
Speedy D.B., Noakes T.D., Rogers I.R., et al. Hyponatremia in ultradistance triathletes. Med Sci Sports Exerc 1999; 31:809-815. https://doi.org/10.1097/00005768-199906000-00008
Speedy D.B., Faris J.G., Hamlin M., et al. Hyponatremia and weight changes in an ultradistance triathlon. Clin J Sport Med 1997; 7:180-184. https://doi.org/10.1097/00042752-199707000-00005
Szmuilowicz E.D., Adler G.K., Williams J.S., et al. Relationship between aldosterone and progesterone in the human menstrual cycle. J Clin Endocrinol Metab 2006; 91:3981-3987. https://doi.org/10.1210/jc.2006-1154
Wade C.E., Dressendorfer R.H., O'Brien J.C., Claybaugh J.R. Renal function, aldosterone, and vasopressin excretion following repeated long-distance running. J Appl Physiol 1981; 50:709-712.
Whiting P.H., Maughan R.J., Miller J.D. Dehydration and serum biochemical changes in marathon runners. Eur J Appl Physiol 1984; 52:183-187. https://doi.org/10.1007/BF00433390