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- 24-Hour Ultra-Marathon Running: A Narrative Review of Performance Factors and Physiological ImpactsPublication . Knechtle, Beat; Braschler, Lorin; Weiss, Katja; Scheer, Volker; Duric, Sasa; Leite , Luciano Bernardes; Forte, Pedro; Nikolaidis, Pantelis T.; Chlíbková, Daniela; Rosemann, ThomasThe 24-hour ultra-marathon is a specific race format with a long tradition and high popularity. To date, no comprehensive review has systematically summarized the scientific literature on 24-hour ultra-marathon running. We performed a comprehensive search in the PubMed and Scopus databases, covering studies published until the end of 2025. The participation of runners and finishers in 24-hours has increased in the past decades. Most participants in 24-hours are age group or master runners older than 35 years. 24-hour ultra-runners typically cover distances exceeding 100 km per event, with an average distance ranging from similar to 150-160 km, while the top performers can achieve over 200 km. Men achieve greater distances than women. The best performance is achieved at 40-50 years. The most important predictive variables in 24-hours are training, nutrition, previous experience, and pacing; anthropometric characteristics seemed of no predictive value. During 24-hours, athletes ingest mainly carbohydrates and experience an energy deficit, but rarely exercise-associated hyponatremia. A 24-hour run leads to decrease in body mass, which can be due to dehydration, a loss of skeletal muscle mass, and/or a loss of fat mass. A 24-hour run has effects on the cardiovascular system (i.e., decrease in blood pressure, changes in cardiac biomarkers, and changes in electrocardiogram and echocardiographic findings), the kidneys (i.e. reversible impairment of kidney function), the digestive system (i.e., gastrointestinal discomfort, reversible increase in liver enzymes), the immune system (i.e., increase in immune markers) and the hematological system (i.e., decrease in red blood cells, increase in white blood cells). All negative effects are resolved within 2-3 days. In summary, 24-hour ultra-marathon runners are master athletes with extensive experience, optimal training preparation, and optimal nutrition to complete a 24-hour run successfully. The adverse effects on the heart, kidneys, immune system, and digestive tract generally resolve within a few days after the event. Future studies need to investigate nutrition after the race to enhance recovery and the impact of training and competing in this specific race format on the locomotor system (i.e. skeleton, muscles, tendons, joints).
- Athletes’ origin trends in participation and performance of master runners in the New York City marathon (1999–2024): a sex- and age-group analysisPublication . Duric, Sasa; Villiger, Elias; Andrade, Marilia Santos; Leite, Luciano Bernardes; Forte, Pedro; Chlíbková, Daniela; Nikolaidis, Pantelis Theo; Weiss, Katja; Rosemann, Thomas; Knechtle, BeatIt is well known that the fastest elite marathon runners come from East African countries such as Ethiopia and Kenya. However, to date, there is no information available on the origin of the fastest age group (master) marathoners. This study aimed to determine the countries of origin of the fastest age group marathoners who have participated in the 'New York City Marathon' over the past several decades. Race data from 1,009,839 runners (626,183 male and 383,656 female finishers) who completed the 'New York City Marathon' between 1999 and 2024 were analyzed. Participants were categorized into five-year age groups: <20, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, and 75 + years. The data were stratified by sex (male and female) and country of origin. The dataset was organized into five performance-based subgroups: (i) the entire dataset, including all finishers by age group and nationality; (ii) the top 100 finishers per age group; (iii) the top 30 finishers per age group; (iv) the top 10 finishers per age group; and (v) the top individual from each country within each age group. Regression analyses were conducted to explore demographic predictors of marathon performance. Participation generally increased over the study period, with temporary declines during the COVID-19 pandemic; male participation consistently outnumbered female participation, the 40-44 years age group was the most represented for both sexes, and participation was lowest in the youngest (< 20 years) and oldest (75 + years) age groups. Crucially, analyses focusing on the fastest age-group marathoners revealed clear nationality-based performance patterns. In younger adult age groups (20-39 years), the fastest average race times were predominantly achieved by female and male runners from Kenya and Ethiopia. The < 20 years age category showed comparatively stronger performances from European runners, including those from Poland, Switzerland and Italy. In the 50 years and older age groups, the best average times were increasingly recorded by runners from the United States of America, Japan, Germany and Switzerland. This shift highlights a regional transition in peak marathon performance with increasing age, from East African to European, North American, and East Asian dominance.
- The Norseman Xtreme Triathlon: A narrative review of current scientific evidence on performance, physiology, and health risksPublication . Knechtle, Beat; Andrade, Marilia Santos; Leite, Luciano Bernardes; Forte, Pedro; Nikolaidis, Pantelis Theo; Chlibkova, Daniela; Weiss, Katja; Rosemann, Thomas; Duric, SasaThe 'Norseman Xtreme Triathlon', held annually in Norway, is considered one of the world's most challenging triathlons, surpassing the traditional IRONMAN (R)-distance in terms of difficulty. This narrative review aims to summarize the current scientific evidence to support athletes and coaches in preparation for this event.MethodsWe conducted a narrative review to summarize the current scientific literature on the 'Norseman Xtreme Triathlon'. A structured search was conducted in two major databases-PubMed and Scopus-using free-text terms related to 'Norseman Xtreme Triathlon'. The search included articles published up to the end of November 2025, without language restrictions. After removing duplicates and unrelated articles based on title and abstract screening, 16 relevant publications were included for analysis.ResultsOver the years, the number of female and male finishers increased, the men-to-women ratio decreased, and both split and overall race times decreased. Most athletes competing in the 'Norseman Xtreme Triathlon' came from Norway, and Norwegian athletes achieved the most podiums. The race affects different organ systems and biomarkers, with increased values of WBC, CK, NT-proBNP, CRP and AST returning to pre-race levels within hours or days. Due to the cold environment, athletes appeared to be at risk of developing hypothermia and swimming-induced pulmonary edema (SIPE) during swimming and both exercise-induced bronchoconstriction (EIB) and exercise-induced arterial hypoxemia (EIAH) after the race.ConclusionsParticular care is needed in preparing for the cold water and general cold environment during cycling and running. The specific nutritional demands, the aspects of pre-race preparation (e.g. training, experience), post-race recovery trajectories, hormonal profiles, or psychological responses of the 'Norseman Xtreme Triathlon' remain underexplored and represent an important area for future research.
- Pacing of the first and only female finisher in the world's longest triathlon: The 2024 Triple Deca ultra triathlonPublication . Duric, Sasa; Andrade, Marilia Santos; Leite, Luciano Bernardes; Forte, Pedro; Nikolaidis, Pantelis Theo; Cuk, Ivan; Weiss, Katja; Rosemann, Thomas; Knechtle, BeatPacing in triathlon has been analyzed for distances up to 60 long-distance triathlons in 60 days in men. However, no study has examined pacing in a female ultra-endurance triathlete in a multi-day triathlon exceeding 10 days. Thus, this case study analyzes the pacing of the first and only woman to complete 30 long-distance triathlons in 30 days. Methods: Lap times for swimming, cycling, and running, including transitions, were collected from race results. The athlete tracked each discipline daily using a Fenix 7 Sapphire Solar, recording average and maximum heart rates and energy expenditure. The coefficient of variation and second-order polynomial regression were calculated for average pace, split, and total times. Repeated measures ANOVA tested interactions in pace performance across 10-day phases and intra-discipline daily pacing variations. Multivariate regression examined physiological parameters' impact on pacing. Results: The female triathlete maintained a relatively even pacing strategy throughout the race, with a decrease in cycling speed and an increase in running speed. Cycling showed the strongest and significant correlation with total race time (r = 0.810; p < 0.001), while running (r = 0.347; p = 0.119) and swimming (r = -0.312; p = 0.165) displayed non-significant associations. The pace varied within the disciplines, with cycling becoming slower and running faster in the last quarter of the race. Energy expenditure, maximum and average heart rate were significant predictors for cycling (R-2 = 0.538; p < 0.001), while only average heart rate was the best predictor for running performance (R-2 = 0.450; p < 0.001). Conclusions: Tactical considerations most likely influenced pacing, particularly in cycling and running. Future research should further explore pacing strategies in ultra-endurance events.
- Resilience against exercise-related coronary atherosclerosis: A case study in a master athlete participating in 500 marathonsPublication . Knechtle, Beat; Duric, Sasa; Scheer, Volker; Nikolaidis, Pantelis T.; Chlíbková, Daniela; Leite, Luciano Bernardes; Cuk, Ivan; Forte, Pedro; Wilhelm, Matthias; Weiss, Katja; Rosemann, ThomasBackground and purpose Lifelong endurance exercise is generally associated with cardiovascular health benefits. However, recent studies suggest that prolonged high-volume training may contribute to coronary atherosclerosis, even in athletes with low traditional cardiovascular risk. This case report aims to explore the cardiovascular status of a master endurance athlete with an exceptionally high lifetime training volume, in light of recent concerns raised in the literature. Methods We present the case of a 60-year-old recreational male marathon runner with no history of cardiovascular disease, who completed over 500 marathons between the ages of 30 and 60 years, covering similar to 127 000-km running. In 2024 alone, he completed 60 marathons. Cardiovascular evaluation included clinical risk assessment and coronary computed tomography angiography (CTCA). Results The runner was asymptomatic, had a low ESC-SCORE2 (3.3%), a favorable lipid profile, and normal levels of high-sensitivity C-reactive protein and lipoprotein (a). CTCA revealed no evidence of calcified, mixed, or non-calcified coronary plaques. Conclusions This case highlights that some master athletes may demonstrate resilience to coronary atherosclerosis despite decades of high training volume. In low-risk individuals, prolonged endurance training alone may not necessarily lead to coronary artery disease, emphasizing the need for individualized cardiovascular screening strategies.
- Sex differences in performance and pacing in the greatest Quintuple Iron ultra-triathlon race in history: The IUTA World Championship 2024 in FrancePublication . Knechtle, Beat; Leite , Luciano Bernardes; Duric, Sasa; Cuk, Ivan; Andrade, Marilia Santos; Scheer, Volker; Nikolaidis, Pantelis Theo; Weiss, Katja; Rosemann, Thomas; Forte, PedroPacing in ultra-triathlon has been investigated by analyzing lap times from Double to Deca Iron ultra-triathlon for World Cup races but not for a World Championship. The present study aimed to investigate pacing in ultra-triathletes competing in the fastest and largest World Championship in Quintuple Iron ultra-triathlon ever held in history. A total of 11 female and 24 male finishers who completed the 2024 Quintuple Ultra Triathlon World Championship in Colmar, France, were analyzed. Independent t-tests assessed sex-based performance variations with effect sizes (Cohen's d). A two-way ANOVA evaluated the effects of sex and performance quartiles on cycling and running, with eta squared (eta(2)) used to measure effect sizes. Overall, men were slower in swimming and cycling and faster in running and overall race time. The variability in lap times was similar in cycling for both women and men but higher in running for women. There was a significant interaction between sex and performance quartiles in cycling but not running. For cycling, the variability in performance was higher in men compared to women; for running, it was similar for both women and men. The finding that women outperformed men in swimming and cycling, likely due to the elite nature of the World Championship, which featured a highly selected and committed female cohort with a high completion rate. While both sexes showed consistent pacing in cycling, women exhibited greater variability in running, possibly due to more frequent breaks.
- Sex- and nationality-based participation and performance trends in the Swissman Xtreme Triathlon (2019–2025)Publication . Leite, Luciano Bernardes; Forte, Pedro; Andrade, Marilia Santos; Duric, Sasa; Nikolaidis, Pantelis T.; Thuany, Mabliny; Weiss, Katja; Rosemann, Thomas; Knechtle, BeatBackground Participation and performance trends are well investigated for the IRONMAN triathlon. For Xtreme Triathlons (XTri World Tour) races, only one study has examined participation and performance trends for the ‘Norseman Xtreme Triathlon’ in Norway, but not for other XTri World Tour events. Therefore, the aim of the present study was to investigate participation and performance trends in the ‘Swissman Xtreme Triathlon’ as part of the XTri World Tour. Methods Finisher data from all ‘Swissman Xtreme Triathlon’ editions (2019–2025) were analyzed. DNS, DNF, missing information, and implausible finishing times were excluded. Participation patterns were described by sex and nationality. Sex differences in race time were evaluated using Mann–Whitney U tests. Differences among the ten most represented nationalities were tested using Welch’s ANOVA with Dunnett’s T3 post-hoc comparisons. Temporal changes in performance were assessed with quantile regression at the 0.25, 0.50, and 0.75 quantiles (p < 0.05). Results A total of 1,032 finishers were included, of whom 13.5% were women. Switzerland had the highest participation (n = 431). Performance was similar across most nationalities, with slower times observed only among athletes from the United States compared with Switzerland (p = 0.01), Germany (p = 0.02), and Norway (p = 0.03). No sex-based differences were found in any edition (overall p = 0.4922; r = −0.02). Quantile regression revealed clear temporal changes in performance. At the median (0.50), race time increased by 715 s·year ⁻ ¹ (95% CI: 434–997; p < 0.0001), and a similar rise occurred at the 0.75 quantile (β = 727 s·year ⁻ ¹; 95% CI: 498–955; p < 0.0001). In contrast, the 0.25 quantile showed a smaller and non-significant increase (β = 345 s·year ⁻ ¹; p = 0.0626), indicating that intermediate and slower athletes were primarily responsible for the overall temporal decline. Sex-specific analyses confirmed this pattern: significant increases at the median and 0.75 quantiles for men, and a significant increase only at the median quantile for women. Conclusions Swiss athletes formed the largest portion of competitors in ‘Swissman Xtreme Triathlon’, while performance was comparable across most nationalities. Women and men performed similarly throughout all editions. Race times increased across years, particularly among intermediate and slower finishers. These findings provide an updated overview of participation and performance trends in this major XTri World Tour event. Future studies need to investigate more races of the XTri World Tour.
- Sex-based performance analysis in Olympic triathlon: swimming, cycling, and running at Paris 2024Publication . Leite, Luciano Bernardes; Coelho, Bruno de Cássio; Forte, Pedro; Nikolaidis, Pantelis Theo; Duric, Sasa; Andrade, Marilia Santos; Cuk, Ivan; Weiss, Katja; Rosemann, Thomas; Knechtle, BeatThis study aimed to analyze sex differences in performance across the disciplines of the Olympic triathlon at the 2024 Paris Olympic Games. Performance times in swimming, cycling, running and transitions (T1 and T2) were compared between male (n = 50) and female (n = 51) athletes. Data were extracted from the official Olympic website and analyzed using the Mann-Whitney U test with effect size (Cohen's d). Quantile regression was applied to examine the relationship between total race time and performance in each discipline of the Olympic triathlon. Male athletes outperformed females across all segments, including swimming, cycling, running, and transitions (p < 0.001). Cycling accounted for the largest proportion of total race time in both sexes (49.4% for females, 48.2% for males), while the contribution of running was slightly higher in males (29.8%) than in females (29.5%). Quantile regression revealed that cycling was the most influential predictor of total time among males, whereas running had greater impact among females, particularly in slower athletes (q = 0.75). Swimming was a consistent but less prominent predictor in both sexes, especially among faster athletes (q = 0.25). Transitions had limited influence in males but showed significant associations with performance among females at specific quantiles, notably in T2. These findings underscore the need for sex-specific training strategies, emphasizing running development in female triathletes and cycling optimization in males, while also considering the role of transitions, especially in draft-legal events.
- Sex-specific differences in performance and pacing in the world’s longest triathlon in historyPublication . Knechtle, Beat; Leite , Luciano Bernardes; Forte, Pedro; Andrade, Marilia Santos; Nikolaidis, Pantelis Theo; Scheer, Volker; Duric, Sasa; Cuk, Ivan; Rosemann, ThomasSex differences in performance and pacing in triathlon have been studied for IRONMAN triathlons (3.8 km swimming, 180 km cycling and 42.195 km of running) and ultra-triathlons (i.e. Double-, Triple-, Quintuple- and Deca Iron ultra-triathlons) corresponding to 2x, 3x, 5x and 10x the IRONMAN triathlon distance. However, no study has to date investigated the sex difference in performance and pacing in the longest triathlon held in history, the Triple Deca Iron ultra-triathlon covering 114 km of swimming, 5,400 km of cycling and 1,266 km of running. A total of 14 triathletes (10 men and four women) competed in the 2024 Triple Deca Ultra Triathlon in Desenzano del Garda, with four men and three women officially finishing the race within the time limit. The data were analyzed to investigate performance differences across disciplines (i.e. swimming, cycling, and running), pacing strategies and sex differences. Variability was assessed using each discipline's coefficient of variation (CV). The relation-ships between CV and overall rankings were examined using linear regression analysis. Men were faster in swimming (12.4%), cycling (24.8%) and running (8.5%). Cycling showed the greatest pacing variability, while running exhibited steadier pacing, with more consistent athletes performing better overall, reflecting the unique endurance challenges of this segment. Overall, men were faster than women in all split disciplines, with the highest sex difference in cycling and the smallest in running. The analysis revealed significant differences in both cycling and running times among athletes. The variability in cycling times indicates diverse pacing strategies and endurance levels, while the running times further highlight the individual performance dynamics of the athletes. The results illustrate how variability in pacing affects cumulative performance and final rankings.
- Women in the triathlon—the differences between female and male triathletes: a narrative reviewPublication . Loosli, Michèle; Nikolaidis, Pantelis Theo; Scheer, Volker; Wilhelm, Matthias; Forte, Pedro; Andrade, Marilia Santos; Rosemann, Thomas; Duric, Sasa; Cuk, Ivan; Knechtle, BeatTriathlon events have gained popularity in recent years. With the increasing participation of women, aspects that influence performance and physiology, as well as differences between women and men, are of interest to athletes and coaches. A review of the existing literature concerning differences between women and men in triathlon is lacking. Therefore, this narrative review aimed to compare female and male triathletes in terms of participation, performance, and the different influences on performance (e.g., physiology, age, pacing, motivation). A literature search was conducted in PubMed and Scopus using the search terms "female triathletes", "women in triathlon", "triathlon AND gender difference", and "triathlon AND sex difference". 662 articles were found using this search strategy, of which 147 were relevant for this review. All distances from sprint to ultra-triathlon (e.g., x-times IRONMAN (R) distance) were analyzed. Results: The results showed that the participation of female triathletes, especially female master triathletes increased over time. An improvement in the performance of female and older triathletes was observed at the different distances in the last decades. Sex differences in performance varied across distances and in the three disciplines. Female triathletes showed a significantly lower VO2max and higher lactate thresholds compared to men. They also had a higher body fat percentage and lower body mass. The age for peak performance in the IRONMAN (R) triathlons is achieved between 25 and 39 years for both women and men. Strong predictors of IRONMAN (R) race performance in both female and male triathletes include achieving a personal best time in a marathon and a previous best time in triathlon races. Further studies need to balance the representation of female and male athletes in study cohorts to ensure that findings are relevant to both sexes. Another research gap that should be addressed by future studies is the effect of menstruation and female hormones, the presence of premenstrual syndrome, and the impact of pregnancy and childbirth on the triathlon performance to better understand the differences with men and to account for hormonal fluctuations in training.