Health and Exercise-Related Medical Issues among 1,212 Ultramarathon Runners: Baseline Findings from the Ultrarunners Longitudinal TRAcking (ULTRA) Study
Regular exercise is associated with substantial health benefits; however, little is known about the health impact of extreme levels of exercise. This study examined the prevalence of chronic diseases, health-care utilization, and risk factors for exercise-related injuries among ultramarathon runners. Retrospective, self-reported enrollment data from an ongoing longitudinal observational study of 1,212 active ultramarathon runners were analyzed. The most prevalent chronic medical conditions were allergies/hay fever (25.1%) and exercise-induced asthma (13.0%), but there was a low prevalence of serious medical issues including cancers (4.5%), coronary artery disease (0.7%), seizure disorders (0.7%), diabetes (0.7%), and human immunodeficiency virus (HIV) infection (0.2%). In the year preceding enrollment, most (64.6%) reported an exercise-related injury that resulted in lost training days (median of 14 days), but little nonattendance of work or school due to illness, injury, or exercise-related medical conditions (medians of 0 days for each). The knee was the most common area of exercise-related injury. Prior year incidence of stress fractures was 5.5% with most (44.5%) involving the foot. Ultramarathon runners who sustained exercise-related injuries were younger (p<0.001) and less experienced (p<0.01) than those without injury. Stress fractures were more common (p<0.01) among women than men. We conclude that, compared with the general population, ultramarathon runners appear healthier and report fewer missed work or school days due to illness or injury. Ultramarathon runners have a higher prevalence of asthma and allergies than the general population, and the prevalence of serious medical issues was nontrivial and should be recognized by those providing medical care to these individuals. Ultramarathon runners, compared with shorter distance runners, have a similar annual incidence of exercise-related injuries but higher proportion of stress fractures involving the foot, and it is the younger and less experienced ultramarathoners who appear most at risk for injury.
References
[1]
Hoffman MD, Ong JC, Wang G (2010) Historical analysis of participation in 161 km ultramarathons in North America. Int J Hist Sport 27: 1877–1891.
[2]
Anonymous (2013) Ultrarunning 2012 - The year in review. UltraRunning March 2013: 25–41.
[3]
Bruso JR, Hoffman MD, Rogers IR, Lee L, Towle G, et al. (2010) Rhabdomyolysis and hyponatremia: a cluster of five cases at the 161-km 2009 Western States Endurance Run. Wilderness Environ Med 21: 303–308.
[4]
Graham SM, McKinley M, Chris CC, Westbury T, Baker JS, et al. (2012) Injury occurrence and mood states during a desert ultramarathon. Clin J Sport Med 22: 462–466.
[5]
Hoffman MD, Fogard K (2011) Factors related to successful completion of a 161-km ultramarathon. Int J Sports Physiol Perform 6: 25–37.
[6]
Holtzhausen LM, Noakes TD, Kroning B, de Klerk M, Roberts M, et al. (1994) Clinical and biochemical characteristics of collapsed ultra-marathon runners. Med Sci Sports Exerc 26: 1095–1101.
[7]
Khodaee M, Ansari M (2012) Common ultramarathon injuries and illnesses: race day management. Curr Sports Med Rep 11: 290–297.
[8]
Krabak BJ, Waite B, Lipman G (2013) Injury and illnesses prevention for ultramarathoners. Curr Sports Med Rep 12: 183–189.
[9]
Krabak BJ, Waite B, Schiff MA (2011) Study of injury and illness rates in multiday ultramarathon runners. Med Sci Sports Exerc 43: 2314–2320.
[10]
Sandell R, Pascoe MD, Noakes TD (1988) Factors associated with collapse during and after ultramarathon footraces: a preliminary study. Phys Sportsmed 16: 86–94.
[11]
Scheer BV, Murray A (2011) Al Andalus Ultra Trail: an observation of medical interventions during a 219-km, 5-day ultramarathon stage race. Clin J Sport Med 21: 444–446.
[12]
Hoffman MD, Fogard K (2012) Demographic characteristics of 161-km ultramarathon runners. Res Sports Med 20: 59–69.
[13]
Hoffman MD, Krishnan E (2013) Exercise habits of ultramarathon runners: baseline findings from the ULTRA Study. J Strength Cond Res [Epub ahead of print]
[14]
Hoffman MD, Chen L, Krishnan E (2013) Body mass index and its correlates in 1,212 ultramarathon runners: baseline findings from the ULTRA Study. J Phys Act Health [in press]
[15]
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, et al. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62: 593–602.
[16]
Thorpe KE, Howard DH, Galactionova K (2007) Differences in disease prevalence as a source of the U.S.-European health care spending gap. Health Aff (Millwood) 26: w678–686.
[17]
U.S. Department of Health and Human Services (2012) Vital and Health Statistics, Series 10, Number 256. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2011. HyattsvilleMD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. 218 p.
[18]
Eijkemans M, Mommers M, Draaisma JM, Thijs C, Prins MH (2012) Physical activity and asthma: a systematic review and meta-analysis. PLoS One 7(12): e50775 doi:10.1371/journal.pone.0050775.
[19]
Elers J, Pedersen L, Backer V (2011) Asthma in elite athletes. Expert Rev Respir Med 5: 343–351.
[20]
Robson-Ansley P, Howatson G, Tallent J, Mitcheson K, Walshe I, et al. (2012) Prevalence of allergy and upper respiratory tract symptoms in runners of the London marathon. Med Sci Sports Exerc 44: 999–1004.
[21]
Thompson W, Nequin N (1983) Ultrarunners–Who are they? Ultrarunning 3: 22–23.
[22]
Rauch TM, Tharion WJ, Strowman SR, Shukitt BL (1988) Psychological factors associated with performance in the ultramarathon. J Sports Med Phys Fitness 28: 237–246.
[23]
Bovens AM, Janssen GM, Vermeer HG, Hoeberigs JH, Janssen MP, et al. (1989) Occurrence of running injuries in adults following a supervised training program. Int J Sports Med 10 Suppl 3S186–190.
[24]
Lysholm J, Wiklander J (1987) Injuries in runners. Am J Sports Med 15: 168–171.
[25]
Macera CA, Pate RR, Powell KE, Jackson KL, Kendrick JS, et al. (1989) Predicting lower-extremity injuries among habitual runners. Arch Intern Med 149: 2565–2568.
[26]
Walter SD, Hart LE, McIntosh JM, Sutton JR (1989) The Ontario cohort study of running-related injuries. Arch Intern Med 149: 2561–2564.
[27]
van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, et al. (2007) Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med 41: 469–480.
[28]
Millet GY, Hoffman MD, Morin MB (2012) Sacrificing economy to improve running performance – a reality in the ultramarathon? J Appl Physiol 113: 507–509.
[29]
Brubaker CE, James SL (1974) Injuries to runners. J Sports Med 2: 189–198.
[30]
James SL, Bates BT, Osternig LR (1978) Injuries to runners. Am J Sports Med 6: 40–50.
[31]
Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, et al. (1987) Stress fractures in athletes. A study of 320 cases. Am J Sports Med 15: 46–58.
[32]
McBryde AM Jr (1985) Stress fractures in runners. Clin Sports Med 4: 737–752.
[33]
Bennell KL, Malcolm SA, Thomas SA, Wark JD, Brukner PD (1996) The incidence and distribution of stress fractures in competitive track and field athletes. A twelve-month prospective study. Am J Sports Med 24: 211–217.
[34]
Brukner P, Bradshaw C, Khan KM, White S, Crossley K (1996) Stress fractures: a review of 180 cases. Clin J Sport Med 6: 85–89.
[35]
Hoffman MD, Hew-Butler T, Stuempfle KJ (2013) Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners. Med Sci Sports Exerc 45: 784–791.
[36]
Frizzell RT, Lang GH, Lowance DC, Lathan SR (1986) Hyponatremia and ultramarathon running. JAMA 255: 772–774.
[37]
Lang G (1984) Medical findings in the Western States 100 Mile. Ultrarunning 3: 14–18.
