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It is known that microtrauma exists in the thigh muscles after long-distance running such as the half-marathon. Moreover, training characteristics of long-distance runners may influence the specificity of the distribution of muscle fiber types in the thigh and affect muscle responses to lipid metabolism. However, the specific changes in microtrauma and intramuscular lipid in thigh muscles after a half-marathon are unknown. A cohort of 20 healthy recreational marathon runners was recruited to complete a half-marathon. MRI T2 mapping and 6-echo q-Dixon sequences were employed at baseline (P1), 2-3 h after running (P2), and 1 day after running (P3). Inflammatory markers (the T2 values) and intramuscular fat fraction (the proton density fat fraction, PDFF) were measured in thigh muscles to detect microtrauma and intramuscular lipid changes, respectively. One-way analysis of variance showed significant time effects for T2 values and PDFF. Post hoc analysis of the 14 datasets collected at three time points revealed significantly higher T2 values in all thigh muscles after running (all p < 0.05). Significant differences in T2 values persisted for all thigh muscles at P3 compared to P1 (all p < 0.05). The PDFF of the vastus lateralis and vastus medialis was significantly decreased at P2 compared to P1 (p < 0.05). No significant differences in PDFF were observed for the thigh muscles at P3 compared to P1. The manifestations of inflammation edema and intramuscular lipid investigated through MRI may offer valuable insights for recreational marathon runners regarding the lower limb movement characteristics during half-marathon running.

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OBJECTIVE: The aim of this study was to determine the incidence and nature (severity and type by organ system and specific diagnosis) of all medical encounters (MEs), including serious/life-threatening MEs (SLMEs) during a South African road marathon. METHODS: This descriptive study was a retrospective analysis of data collected over 6 years at the Cape Town Marathon from 2014 to 2019, which included 40 446 starters. All MEs were collected and described as per the consensus statement for mass community-based sporting events. Incidences (I; per 1000 starters; 95% CI) are described for all MEs, SLMEs, and by organ system and specific diagnosis. RESULTS: The incidence of all MEs was 8.7 (95% CI: 7.8-9.6) per 1000 starters. The largest contributor to all MEs, by organ system affected, was cardiovascular-related, with an incidence of 1.8 (95% CI: 1.4-2.2), where exercise-associated postural hypotension was the most common specific diagnosis (I = 1.3; 95% CI: 1.0-1.7). The incidence of all SLMEs was 1.0 (95% CI: 0.7-1.4) making up 11.7% (41/350) of all MEs. The incidence of SLMEs by organ system was highest in the cardiovascular system (I = 0.4; 95% CI: 0.3-0.7), with acute coronary syndrome (ACS) (I = 0.2; 95% CI: 0.1-0.4) the most common specific diagnosis. There were no sudden cardiac deaths (SCD) nor sudden cardiac arrests (SCA). CONCLUSION: There was a high proportion of cardiovascular-related medical encounters, as well as SLMEs. We recommend that event organizers and race medical directors investigate prevention strategies to mitigate against risk of SLMEs, specifically acute cardiovascular SLMEs.

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INTRODUCTION: Exertional rhabdomyolysis (ER) is the breakdown of muscle cells that occurs after intensive physical activity. Although a cautious and gradual return to physical activity (RTPA) is recommended after an episode of ER, physical sequelae are reported long afterwards. CASE REPORT: We present the case of a 31-year-old untrained amateur runner with no prior medical history who developed heat stroke, ER, and acute kidney failure on the occasion of a half-marathon. Three months later, whereas the patient was symptom-free and CK levels were normal, an MRI revealed typical signs of rhabdomyolysis, which normalized thereafter. DISCUSSION: Given that clinical and biological data inform RTPA decisions, the delay between clinical biological and MRI normalization may cause an RTPA to be initiated prior to full muscle recovery, which could account for the symptoms' prolonged persistence. In sportspeople who have recovered and their CK blood levels are returned to normal, MRI data could defer the RTPA if MRI abnormalities persist or, conversely, give it the green light.

In the event of exertional rhabdomyolysis following a race, the presence of muscular lesions on MRI, even if the patient feels healed and creatine kinase levels have returned to normal, should postpone the return to physical activity.

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PURPOSE: Hematopoietic stem cell (HSC) transplant is one of the curative methods for some patients with hematological malignancies. Granulocyte colony-stimulating factor (G-CSF) is the most common drug used to mobilize CD34+ cells, generally found in small numbers. Recent evidence showed that exercise causes transient mobilization in HSC. However, the type and intensity of exercise have not been fully revealed. We aimed to detect a significant increase in stem cell levels following 60 minutes of running at a personalized running pace. MATERIALS/METHODS: Eighteen runners, 48.2±1.9 years with peak oxygen consumption of 46.2±1.4 ml/kg/min, were enrolled in the study. The cardiopulmonary exercise test was performed to determine the individual running pace, and the participants ran 60-min on a treadmill at an intensity close to their ventilatory threshold (VT). The blood sampling for HSC count was performed before, immediately after, at the 1st, 4th and 24th hour after the 60-min running. RESULTS: The CD34+ HSCs were 13.9±2.3cells/µl before and significantly increased immediately after to 19.5±3.6cells/µl (p < 0.05). The consecutive HSC counts were 15.3±2.2, 19.5±4.8 and 15.1±3.4cells/µl at the 1st, 4th, and 24th hour, respectively. CONCLUSION: The individual data showed that some runners had higher HSC levels than the transplantation limit before and after the 60-min running trail, which was maintained for 24 hours. Pre-running high CD34+ HSCs may reflect an adaptive response to regular exercise, with a 60-min run near the VT further elevating HSCs. Individualized exercise may be a valuable tool to mobilize the CD34+ HSCs in peripheral blood for donors.

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The concept of the "central governor" in exercise physiology suggests the brain plays a key role in regulating exercise performance by continuously monitoring physiological and psychological factors. In this case report, we monitored, for the first time, a marathon runner using a metabolic portable system and an EEG wireless device during an entire marathon to understand the influence of brain activity on performance, particularly the phenomenon known as "hitting the wall". The results showed significant early modification in brain activity between the 10th and 15th kilometers, while the RPE remained low and cardiorespiratory responses were in a steady state. Thereafter, EEG responses decreased after kilometer 15, increased briefly between kilometers 20 and 25, then continued at a slower pace. After kilometer 30, both speed and respiration values dropped, along with the respiratory exchange ratio, indicating a shift from carbohydrate to fat metabolism, reflecting glycogen depletion. The runner concluded the race with a lower speed, higher RPE (above 15/20 on the Borg RPE scale), and reduced brain activity, suggesting mental exhaustion. The findings suggest that training strategies focused on recognizing and responding to brain signals could allow runners to optimize performance and pacing strategies, preventing premature exhaustion and improving overall race outcomes.

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Intensive physical activity (PA) can lead to proteinuria and, consequently, serum protein profiles in athletes. Therefore, the aim of this study was to investigate the effects of acute aronia juice consumption before a simulated half-marathon race on serum protein profiles in recreational runners. The pilot study was designed as a single-blind, placebo-controlled, crossover study, with 10 male participants who consumed aronia juice (containing 1.3 g polyphenols) or placebo before the race. The blood levels of total proteins, albumin, the non-albumin fractions gamma, beta, alpha2 and alpha1, as well as renal function parameters, were determined before and 15 min, 1 h and 24 h after the race. The significant changes in urea, creatinine and uric acid levels were noticed at selected time points in both groups. In the placebo group, a significant decrease in total proteins (p < 0.05) was observed 24 h after the race, along with an increase in gamma fraction abundance (p < 0.05). In addition, urea and uric acid levels returned to baseline only in the aronia group 24 h after the race. Thus, according to the results obtained, acute aronia juice supplementation before intensive PA could influence the transient change in renal function and PA-induced protein loss in recreational runners.

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Marathon runners, subjected to intense training regimens and prolonged, exhaustive exercises, often experience a compromised immune response. Probiotic supplementation has emerged as a potential remedy to mitigate the impact of prolonged exercise on athletes. Consequently, this study sought to assess the influence of probiotic supplementation on monocyte functionality both before and after the official marathon race. Twenty-seven runners were randomly and double-blindly assigned to two groups: placebo (n 13) and probiotic (PRO) (n 14). Over 30 d, both groups received supplements - placebo sachets containing maltodextrin (5 g/d) and PRO sachets containing 1 × 1010 colony-forming unit Lactobacillus acidophilus and 1 × 1010 colony-forming unit Bifidobacterium bifidum subsp. lactis. Blood samples were collected, and immunological assays, including phagocytosis, hydrogen peroxide production, cytokine levels and monocyte immunophenotyping, were conducted at four different intervals: baseline (start of supplementation/30 d pre-marathon), 24 h-before (1 d pre-marathon), 1 h-after (1 h post-marathon) and 5 d-after (5 d post-marathon). Monocyte populations remained consistent throughout the study. A notable increase in phagocytosis was observed in the PRO group after 30 d of supplementation. Upon lipopolysaccharide stimulation, both PRO and placebo groups exhibited decreased IL-8 production. However, after the marathon race, IL-15 stimulation demonstrated increased levels of 5 d-after, while IL-1-ß, IL-8, IL-10, IL-15 and TNF-α varied across different intervals, specifically within the PRO group. Probiotic supplementation notably enhanced the phagocytic capacity of monocytes. However, these effects were not sustained post-marathon.

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INTRODUCTION AND IMPORTANCE: Embolization of an arteriovenous malformation (AVM) via the anterior inferior cerebellar artery (AICA) is difficult. The "pressure cooker" technique in the AICA via a marathon microcatheter can be effective. CASE STUDY: A 43-year-old man with a cerebellar hematoma involving the brainstem. Angiography revealed an AVM supplied by the right AICA. Embolizing the AVM by casting an Onyx-18 liquid embolic system assisted by the "pressure cooker" technique was planned. An Apollo microcatheter was used for Onyx casting, and a Marathon microcatheter was used to establish a coiling plug to prevent Onyx reflux. The AVM was obliterated. Postoperatively, burr hole drainage of the cerebellar hematoma was performed. Postoperative computed tomography showed that the cerebellar hematoma and hydrocephalus had resolved. Magnetic resonance imaging revealed that there was no new serious infarction from damage to the cerebellum or brainstem. The patient recovered well. CLINICAL DISCUSSION: During Onyx casting, the drawback is that reflux can occlude normal vessels. The "pressure cooker" technique was useful for preventing Onyx reflux and for driving the Onyx to penetrate the AVM. However, it was difficult to use this technique in slim AICA; the Marathon microcatheter had a thinner tip than other microcatheters, and it can be used to establish the "pressure cooker" technique. This technique provides more solutions for AVMs in transarterial embolization through small feeding arteries. CONCLUSION: In a selective case, it was feasible to use the "pressure cooker" technique in the AICA via a Marathon microcatheter to embolize the AVM.

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[This corrects the article DOI: 10.3389/fphys.2024.1340513.].

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Many of today's recreational runners have changed their diet from omnivorous to vegetarian or vegan for reasons like better sport performance, animal ethics, positive health, eco-aspects, or male infertility. Others have constructed the flexitarian diet due to current trends in sustainable eating. The aim of this investigation was to analyze the dietary habits and race day strategies of recreational endurance runners following current sustainable dietary trends. Recreational endurance runners (18+ years) were invited to complete the standardized online survey on socio-demography/anthropometry, motivations, running/racing history, food frequency, and race day dietary strategy. Chi-squared tests and Wilcoxon tests were used for the statistical analysis. In total, 289 participants submitted the survey; 146 subjects following flexitarian (n = 34), vegetarian (n = 50), or vegan (n = 62) diets were included in the final sample. Significant differences were found across the diet types: BMI (p = 0.018), fruit/vegetable consumption (p < 0.001), and the dietary motive of performance (p = 0.045). The findings suggest that the flexitarian diet may be appropriate for health- and environmentally conscious populations living in a meat-centered society and lacking social support to eat completely vegetarian/vegan. Following a plant-based diet is perceived as easy for health-conscious, athletic populations, and the vegan diet does not require a particularly effortful/complex race day strategy for endurance runners.

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OBJECTIVES: We aimed to identify the major determinants of cardiac troponin changes response to exercise among non-elite runners participating in the Beijing 2022 marathon, with a particular focus on the associations with the cardiac function assessed by tissue Doppler echocardiography and speckle tracking. DESIGN: A prospective study. METHODS: A total of 33 non-elite participants in the 2022 Beijing Marathon were included in the study. Echocardiographic assessment and blood sample collection were conducted before, immediately after, and two weeks after the marathon. Blood samples were analyzed using the same Abbot high-sensitivity cTnI STAT assay. Echocardiography included tissue Doppler and speckle tracking echocardiography. RESULTS: Following the marathon, significant increases were observed in cardiac biomarkers, with hs-cTnI elevating from 3.1 [2.3-6.7] to 49.6 [32.5-76.9] ng/L (P < 0.0001). Over 72 % of participants had post-race hs-TnI levels surpassing the 99th percentile upper reference limit. There was a notable correlation between pre-marathon hs-cTnI levels (ß coefficient, 0.56 [0.05, 1.07]; P = 0.042), weekly average training (ß coefficient, -1.15 [-1.95, -0.35]; P = 0.009), and hs-cTnI rise post-marathon. Echocardiography revealed significant post-race cardiac function changes, including decreased E/A ratio (P < 0.0001), GWI (P < 0.0001), and GCW (P < 0.0001), with LVEF (ß coefficients, 0.112 [0.01, 0.21]; P = 0.042) and RV GLS (ß coefficients, 0.124 [0.01, 0.23]; P = 0.035) changes significantly associated with hs-TnI alterations. All echocardiographic and laboratory indicators reverted to baseline levels within two weeks. CONCLUSIONS: Baseline hs-cTnI levels and weekly average training influence exercise-induced hs-cTnI elevation in non-elite runners. Echocardiography revealed post-race changes in cardiac function, with LVEF and RV GLS significantly associated with hs-TnI alterations. These findings contribute to understanding the cardiac response to exercise and could guide training and recovery strategies.

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INTRODUCTION AND IMPORTANCE: The twig-like middle cerebral artery (MCA) is rare and has a plexiform network of small vessels that replaces the MCA trunk, with a prevalence ranging from 0.11 %-1.17 %. It can be associated with an aneurysm. A Marathon microcatheter may be an alternative for coiling procedures. However, this technique has rarely been reported. PRESENTATION OF CASE: A 63-year-old man suffered from headaches. The neurological examination results were unremarkable. Angiography revealed a twig-like MCA with an unruptured aneurysm. Due to stenosis of the aneurysm neck, a Marathon microcatheter was used to successfully reach the aneurysm, and coiling was completed with Chinese Visee coils. Postoperatively, the patient recovered uneventfully. Due to the lack of ischemic changes in the right hemisphere, the patient was kept under follow-up observation. At the 8-month follow-up by telephone, the patient was healthy. CLINICAL DISCUSSION: Aneurysms in the twig-like MCA may have stenosis of the aneurysm neck, and routine microcatheters used to deliver coils are often too thick to catheterize the aneurysm neck. The Marathon microcatheter has a distal inner diameter (ID) of 0.013, and as an alternative for coiling procedures, it may be soft enough to thin enough to go into the aneurysm. However, it can be used in the delivery of certain coils. CONCLUSION: Aneurysms in the twig-like MCA are difficult to catheterize with the routine microcatheters used to deliver coils. A Marathon microcatheter may be used to perform the coiling procedure. However, only certain coils that match the Marathon microcatheter can be chosen.

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Recent improvements in elite running performances across all distances have been largely attributed to the introduction of advanced footwear technology (AFT), which features a curved and stiff plate working synergistically with a new generation of midsole foams demonstrating enhanced resilience and compliance. These recent improvements appear to be considerably more pronounced in women's events, highlighted by improvements in road racing world records by an average of 3.7% (range: 2.6%-5.2%) compared to mean progressions of 1.5% (range: 1.3%-1.9%) in the same men's events. Although there is a growing body of research investigating the mechanisms underpinning running performance enhancements derived from AFT, there remains no explanation for potential sex-based differences in their benefits. We overview the currently available evidence and highlight why the recent direction of AFT research provides a barrier to progress by focusing primarily on male athletes. We subsequently provide our perspective on why women may be benefiting from the new generation of shoes more than men, suggest potential mechanisms leading to hypotheses that need to be further investigated in upcoming studies, and finally propose that factors outside of footwear innovation may have concurrently driven the recently observed performance evolutions.

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Background: When marathon runners break the 2-h barrier at the finishing line, it attracts global attention. This study is aimed to conduct a bibliometric analysis of publications in the field of marathon running, analyze relevant research contributors, and visualize the historical trends of marathon performance research over the past 15 years. Methods: On 8 December 2023, we extracted high-quality publication data from the Web of Science Core Collection spanning from 1 January 2009 to 30 November 2023. We conducted bibliometric analysis and research history visualization using the R language packages biblioshiny, VOSviewer, and CiteSpace. Results: A total of 1,057 studies were published by 3,947 authors from 1,566 institutions across 63 countries/regions. USA has the highest publication and citation volume, while, the University of Zurich being the most prolific research institution. Keywords analysis revealed several hotspots in marathon research over the past 3 years: (1) physiology of the elite marathon runners, (2) elite marathon training intensity and pacing strategies, (3) nutritional strategies for elite marathon runners, (4) age and sex differences in marathon performance, (5) recovery of inflammatory response and muscle damage. Conclusion: This study presents the first comprehensive bibliometric analysis of marathon performance research over the past 15 years. It unveils the key contributors to marathon performance research, visually represents the historical developments in the field, and highlights the recent topical frontiers. The findings of this study will guide future research by identifying potential hotspots and frontiers.

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Background: Marathon running poses unique cardiovascular challenges, sometimes leading to syncopal episodes. We present a case series of athletes who experienced pre-/syncope during the Zurich Marathon 2023, accompanied by elevated cardiac biomarkers. Case summary: Eight athletes (2 females, 6 males) aged 21-35 years, with pre-/syncope and various additional diverse symptoms such as dizziness and palpitations during the (half-)marathon, were admitted to two emergency departments in Zurich, Switzerland. Clinical evaluations included electrocardiogram, echocardiography, telemetry, coronary computed tomography (CT) scans, and cardiac biomarker assessments. High-sensitive troponin T (hs-cTnT) was elevated in all cases at initial assessment and returned to normal at follow-up. All athletes who received CT scans had normal coronary and brain CT results. None of the eight athletes had underlying cardiovascular disease. Renal function normalized post-admission, and neurological symptoms resolved within hours. Creatinine levels indicated transient acute kidney injury. A common feature was inexperience in running, inadequate race preparation, particularly regarding fluid, electrolyte, and carbohydrate intake, along with pacing issues and lack of coping strategies with heat. Discussion: From a clinician perspective, the case series highlights the challenge in the management of patients with a pre-/syncopal event during strenuous exercise and elevated cardiac biomarkers. Diverse initial symptoms prompted tailored investigations. Adequate training, medical assessments, and awareness of syncope triggers are essential for marathon participants. Caution and pacing strategies are crucial, especially among novices in competitive running. This information is pertinent given the growing popularity of marathon events and prompts a standardized diagnostic approach after these events.

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BACKGROUND: A typical training plan is a mix of many training sessions with different intensities and durations to achieve a specific goal, like running a marathon in a certain time. Scientific publications provide little specific information to aid in writing a comprehensive training plan. This review aims to systematically and quantitatively analyse the last 12 weeks before a marathon as recommended in 92 sub-elite training plans. METHODS: We retrieved 92 marathon training plans and linked their running training sessions to five intensity zones. Subsequently, each training plan was grouped based on the total running volume in peak week into high (> 90 km/week), middle (65-90 km/week), and low (< 65 km/week) training volume plan categories. RESULTS: In the final 12 weeks before a race, recommended weekly running volume averaged 108 km, 59 km, and 43 km for high, middle, and low distance marathon training plans. The intensity distribution of these plans followed a pyramidal training structure with 15-67-10-5-3%, 14-63-18-2-3%, and 12-67-17-2-2% in zones 1, 2, 3, 4, and 5, for high, middle, and low volume training plans, respectively. CONCLUSIONS: By quantitatively analysing 92 recommended marathon training plans, we can specify typical recommendations for the last 12 weeks before a marathon race. Whilst this approach has obvious limitations such as no evidence for the effectiveness of the training plans investigated, it is arguably a useful strategy to narrow the gap between science and practice.

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Participation in marathons has dramatically increased over the last few years. Marathon running has many proven beneficial effects, especially on cardiovascular health and fitness. Most research has focused on physiologic and pathophysiologic adaptations in connection with endurance exercise. Nevertheless, marathon running also has a major impact on psychological aspects and positively influences mental health, which has only recently attracted research interest. The present narrative review aimed to review the personality traits of marathon runners with an emphasis on recent literature. Marathon runners show a distinct personality and highly characteristic personality traits needed to successfully finish such a demanding race, i.e., a strong sense of vigor, self-sufficiency, and intelligence as well as low scores in anger, fatigue, tension, and depression. Furthermore, personality differences are detectable between runners of different sexes, ages, and performance level groups. This has significant clinical implications for athletes, coaches and competition organizers, as these groups show different patterns of personality traits. Future studies should focus on changes in cognition and mood states pre-, during, and post-endurance events, as well as during training periods. Large-scale studies comparing personality differences by sex, age, and performance are also important for better clinical guidance. See also the graphical abstract(Fig. 1).

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A 56-year-old healthy woman presented with subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm and was treated with internal trapping of the affected site including the aneurysm. She suffered rebleeding due to recanalization of the aneurysm 5 days after the first treatment. Because of the close proximity of the coil mass to the posterior inferior cerebellar artery (PICA) origin at first treatment, additional coil embolization by tight packing of the coil mass was planned. However, navigation of the microcatheter into the coil mass was challenging due to the tightly packed coil mass. Thus, a Marathon microcatheter, which has narrower outer diameter and is designed for liquid embolization, was used and successfully placed into the coil mass in an anterograde fashion. Thereafter, the DAC was advanced just proximal to the coil mass to reduce the kickback of the microcatheter during deployment of the coils and avoid the coil mass expansion toward the PICA origin, resulting in complete obliteration of the aneurysm with PICA preservation. Follow-up angiography performed 6 months after the second treatment showed complete obliteration of the aneurysm. The patient's course was uneventful after 1 year following the second treatment, with a modified Rankin Scale score of 1. Therefore, coil embolization through the tightly packed coil mass using a Marathon microcatheter is feasible. A low-profile DAC is also useful for enabling physicians to push the coil deployed through the flexible Marathon microcatheter.