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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).
- Analysis of over 1 million race records shows runners from East African countries as the fastest in 50-km ultra-marathonsPublication . Weiss, Katja; Valero, David; Villiger, Elias; Thuany, Mabliny; Forte, Pedro; Gajda, Robert; Scheer, Volker; Sreckovic, Sreten; Cuk, Ivan; Nikolaidis, Pantelis Theo; Andrade, Marilia Santos; Knechtle, BeatThe 50-km ultra-marathon is a popular race distance, slightly longer than the classic marathon distance. However, little is known about the country of affiliation and age of the fastest 50-km ultra-marathon runners and where the fastest races are typically held. Therefore, this study aimed to investigate a large dataset of race records for the 50-km distance race to identify the country of affiliation and the age of the fastest runners as well as the locations of the fastest races. A total of 1,398,845 50-km race records (men, n = 1,026,546; women, n = 372,299) were analyzed using both descriptive statistics and advanced regression techniques. This study revealed significant trends in the performance of 50-km ultra-marathoners. The fastest 50-km runners came from African countries, while the fastest races were found to occur in Europe and the Middle East. Runners from Ethiopia, Lesotho, Malawi, and Kenya were the fastest in this race distance. The fastest 50-km racecourses, providing ideal conditions for faster race times, are in Europe (Luxembourg, Belarus, and Lithuania) and the Middle East (Qatar and Jordan). Surprisingly, the fastest ultra-marathoners in the 50-km distance were found to fall into the age group of 20–24 years, challenging the conventional belief that peak ultra-marathon performance comes in older age groups. These findings contribute to a better understanding of the performance models in 50-km ultra-marathons and can serve as valuable insights for runners, coaches, and race organizers in optimizing training strategies and racecourse selection.
- Associations Between Hydration, Sodium Intake, and Body Mass in Ultra-Endurance Trail Runners Under Ecological Race Conditions: A Cross-Sectional Field StudyPublication . Amorim, Rafael Mendes; Guilherme, Larissa Quintão; Filgueiras, Mariana de Santis; Saborosa, Guilherme Pereira; Pires, Gabrielle Ferreira; Neumann, Nathan de Oliveira; Scheer, Volker; Leite, Luciano Bernardes; Forte, Pedro; Malheiro, Alexandra; Quaresma, Marcus Vinicius Lucio dos Santos; Souza, Helton de Sá; Kravchychyn, Ana Claudia PelissariHydration and electrolyte strategies are critical in mountain ultra-endurance events, yet field-based evidence from trail races remains limited. This study examined the relationship between fluid intake, sodium consumption, and body mass changes in trail runners competing under real environmental conditions. Methods: A cross-sectional field study was conducted during La Misi & oacute;n Brasil 2024. Athletes of both sexes competing in the endurance race (35 km; EG: n = 15; age = 37.0 [29.5-46.0] years; 12 men and 3 women) and the ultra-endurance race (80 km; UEG: n = 13; age = 42.0 [37.0-46.0] years; 11 men and 2 women) were included in the study. Pre- and post-race body mass were assessed, and in-race fluid and food intake were collected using an adapted 24-h dietary recall. Water and sodium intake were expressed as total (L and mg, respectively) and per-hour (mL/h and mg/h, respectively) values. Environmental temperature and humidity were obtained from a local weather station. Group comparisons were performed using the Mann-Whitney U test, and associations were examined with Spearman's correlation (p < 0.05). Results: EG (n = 15) and UEG (n = 13) showed similar absolute and relative body mass changes (2.6% to -3.0%; p > 0.05). EG runners presented greater weight loss rate (-270 vs. -115 g/h; p = 0.002), while UEG consumed higher total water (7.11 vs. 4.14 L; p = 0.008) and sodium (5789 vs. 2857 mg; p = 0.003). Water intake per hour was higher in EG (626 vs. 427 mL/h; p = 0.017). Body Mass Index was negatively correlated with hourly weight loss (r = -0.605; p < 0.001). Water and sodium intake per hour were positively correlated (r = 0.607; p < 0.001), though neither predicted hourly weight loss. Conclusions: Hydration responses may differ according to environmental stress and pacing demands. Changes in body mass may not necessarily reflect hydration adequacy, suggesting a possible multifactorial nature of hydroelectrolyte balance during mountain endurance events.
- Case Report: Case study of 100 consecutive IRONMAN®-distance triathlons—impact of race splits and sleep on the performance of an elite athletePublication . Knechtle, Beat; Leite , Luciano Bernardes; Forte, Pedro; Andrade, Marilia Santos; Cuk, Ivan; Nikolaidis, Pantelis Theo; Scheer, Volker; Weiss, Katja; Rosemann, ThomasLong-distance triathletes such as IRONMAN (R) and ultra-triathletes competing in longer race distances continue to extend ultra-endurance limits. While the performance of 60 IRONMAN (R)-distance triathlons in 60 days was the longest described to date, we analysed in the present case study the impact of split disciplines and recovery in one athlete completing 100 IRONMAN (R)-distance triathlons in 100 days. To date, this is the longest self-paced world record attempt for most daily IRONMAN (R)-distance triathlons.To assess the influence of each activity's duration on the total time, the cross-correlation function was calculated for swimming, cycling, running, and sleeping times. The autocorrelation function, which measures the correlation of a time series with itself at different lags, was also employed using NumPy.The moving average for swimming slightly increased in the middle of the period, stabilizing at similar to 1.43 h. Cycling displayed notable fluctuations between similar to 5.5 and 7h, with a downward trend toward the end. The moving average for running remains high, between 5.8 and 7.2 h, showing consistency over the 100 days. The moving average for total time hovered at similar to 15 h, with peaks at the beginning, and slightly declined in the final days. The cross-correlation between swimming time and total time showed relatively low values. Cycling demonstrated a stronger correlation with total time. Running also exhibited a high correlation with total time. The cross-correlation between sleep time and swimming time presented low values. In cycling, the correlation was stronger. For running, a moderate correlation was observed. The correlation with total time was also high. The autocorrelation for swimming showed high values at short lags with a gradual decrease over time. For cycling, the autocorrelation also began strong, decreasing moderately as lags increased. Running displayed high autocorrelation at short lags, indicating a daily dependency in performance, with a gradual decay over time. The total time autocorrelation was high and remained relatively elevated with increasing lags, showing consistent dependency on cumulative efforts across all activities. In a triathlete completing 100 IRONMAN (R)-distance triathlons in 100 days, cycling and running split times have a higher influence on overall times than swimming. Swimming performance is not influenced by sleep quality, whereas cycling performance is. Swimming times slowed faster over days than cycling and running times. Any athlete intending to break this record should focus on cycling and running training in the pre-event preparation.
- Elderly female ultra-marathoners reduced the gap to male ultra-marathoners in Swiss running racesPublication . Knechtle, Beat; Witthoft, Anja; Valero, David; Thuany, Mabliny; Nikolaidis, Pantelis Theo; Scheer, Volker; Forte, Pedro; Weiss, KatjaRecent studies showed that female runners reduced the performance gap to male runners in endurance running with increasing age and race distance. However, the investigated samples were generally small. To investigate this further, the present study examined sex differences by age across various race distances (5, 10 km, half-marathon, marathon, and ultra-marathon) using a large dataset of over 1,100,000 race records from Switzerland over two decades (1999-2019). The study explored performance and participation disparities between male and female runners by employing diverse methods, such as descriptive statistics, histograms, scatter and line plots, correlations, and a predictive machine learning model. The results showed that female runners were more prevalent in shorter races (5, 10 km, half-marathon) and outnumbered male runners in 5 km races. However, as the race distance increased, the male-to-female ratio declined. Notably, the performance gap between sexes reduced with age until 70 years, after which it varied depending on the race distance. Among participants over 75 years old, ultra-marathon running exhibited the smallest sex difference in performance. Elderly female ultra-marathoners (75 years and older) displayed a performance difference of less than 4% compared to male ultra-marathoners, which may be attributed to the presence of highly selected outstanding female performers.
- 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.
- The role of sleep on physical and cognitive performance of ultra-endurance athletes: a systematic reviewPublication . Guilherme, Larissa Quintão; Rodrigues, Bruno; Rosa, Carla; Leite, Luciano; Scheer, Volker; Forte, Pedro; Hermsdorff, Helen; Kravchychyn, Ana Claudia Pelissari; Souza, Helton de SáSleep is an important factor for recovery and performance in endurance sports, yet its role in ultra-endurance events remains unclear due to extreme physical and cognitive demands and disrupted sleep patterns. This systematic review aimed to analyze the role of sleep in physical and cognitive performance in ultra-endurance athletes. This systematic review followed PRISMA guidelines. A comprehensive search was conducted in May 2025 across PubMed/Medline, Embase, SPORTDiscus, and Web of Science. Two researchers independently screened, selected, extracted, and assessed data quality using the JBI tools (PROSPERO ID: CRD420251042220). Of 424 articles, 16 met inclusion criteria, totaling data from 1389 athletes. Regarding physical performance, better outcomes were associated with no or less sleep during competition (TST), extended sleep the night before, and increased time in light sleep. In contrast, longer wake time, lower sleep quality, greater sleepiness during competition, and higher sleep efficiency were linked to poorer performance. Cognitive performance was positively associated with pre-race sleep quality and mid-race naps. Conversely, greater accumulated sleep before testing was linked to worse cognitive outcomes. Sleep, particularly total sleep time (TST), plays an important role in ultra-endurance performance, although this relationship may be non-linear and influenced by race context and individual strategies. Pre-race and intra-race sleep strategies such as napping and extended sleep may benefit performance. Further rigorous and longitudinal studies are needed to clarify sleep’s impact on performance and recovery in ultra-endurance contexts.
- 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-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.
- The fastest 24-hour ultramarathoners are from Eastern EuropePublication . Knechtle, Beat; Valero, David; Villiger, Elias; Scheer, Volker; Weiss, Katja; Forte, Pedro; Thuany, Mabliny; Vancini, Rodrigo Luiz; Lira, Claudio A.B. de; Nikolaidis, Pantelis Theo; Ouerghi, Nejmeddine; Rosemann, ThomasUltramarathon running is of increasing popularity, where the time-limited 24-hour run is one of the most popular events. Although we have a high scientific knowledge about different topics for this specific race format, we do not know where the best 24-hour runners originate from and where the fastest races are held. The purpose of the present study was to investigate the origin of these runners and the fastest race locations. A machine learning model based on the XG Boost algorithm was built to predict running speed based on the athlete´s age, gender, country of origin and the country where the race takes place. Model explainability tools were used to investigate how each independent variable would influence the predicted running speed. A sample of 171,358 race records from 63,514 unique runners from 73 countries participating in 24-hour races held in 57 countries between 1807 and 2022 was analyzed. Most of the athletes originated from the USA, France, Germany, Great Britain, Italy, Japan, Russia, Australia, Austria, and Canada. Tunisian athletes achieved the fastest average running speed, followed by runners from Russia, Latvia, Lithuania, Island, Croatia, Slovenia, and Israel. Regarding the country of the event, the ranking looks quite similar to the participation by the athlete, suggesting a high correlation between the country of origin and the country of the event. The fastest 24-hour races are recorded in Israel, Romania, Korea, the Netherlands, Russia, and Taiwan. On average, men were 0.4 km/h faster than women, and the fastest runners belonged to age groups 35–39, 40–44, and 45–49 years. In summary, the 24-hour race format is spread over the world, and the fastest athletes mainly originate from Eastern Europe, while the fastest races were organized in European and Asian countries.