The Sustainability of Endurance Sports

A conversation Am and I had the other day sparked this blog topic. I had questioned at what point does a good thing cease to be a good thing. We spoke specifically of all the benefits that training for a sprint triathlon(or any aerobic activity) could provide: increased muscle strength, improved cardiovascular function, decreased risk of heart disease, diabetes and stroke, increased bone density, positive mood, and a pletheora of other benefits. We wondered whether the risk/reward ratio worsened as the distance(and training time allotted) increased up to an Ironman distance.


Are Ultra-Endurance Athletes Healthy?


The definition of healthy, as defined by those handy online dictionaries, is:
1) Appearing vigorous and youthful
2) Freedom from injury, imperfection, or impairment
3) Absence of illness
4) Good mental health
5) Active and high energy
6) Vitality.


Appearing vigorous or youthful?
Maybe at the start of the race after a couple weeks taper but typically, these athletes are day in/day out limping around after a hard workout, definitely not bestowing the virtues of vigor or appearing youthful. Emaciated athletes fill the pages of Ironman and Ultra-running magazines as much as do their model counter-parts fill the beauty magazines. And just as those models are not healthy by this definition, neither are these athletes.

Chrissie Wellington After a Bike Crash

When is thin, too thin?

Typical Ultra-runner

In addition to the emaciated looks of these ultra-athletes, the noticable wrinkles should be a clue of premature aging. All those hours in the sun not only causes those wrinkles but can also cause skin cancer. The researchers of an article in a 2006 issue of Archives of Dermatology found that the runners had a more suspicious moles and other skin abnormalities suggestive of an increased risk of skin cancer than non-runners.

TAKE HOME: Don't worry about your body weight but rather focus on a well-rounded body type that fits you as an individual and don't forget the sunscreen.


Freedom from Injury, Imperfection, or Impairment:
A 2007 American Family Physician article cites: patellofemoral pain syndrome, Iliotibial band friction syndrome, medial tibial stress syndrome(shin splints), Achilles tendinopathy, plantar fascitiis, and stress fracture as the most common acute injuries that can be sustained by endurance athletes.

Kujala et al. found athletes from all types of competitive sports are at slightly increased risk of requiring hospital care because of osteoarthritis of the hip, knee, or ankle. Egermann et al. found that with increased number of weekly training hours with triathletes, the risk of muscle-tendon injuries increased and that 62.1% of all participants in their retrospective survey sustained either a muscle-tendon or ligament-capsule injury. This was corroborated with an American Journal of Sports Medicine study on Ironman triathletes which found 91% of all athletes sustained at least one soft tissue overuse injury during the previous year's training.
To make matters worse, Burns et al. has found that the most significant predictor of injury during the triathlon season was a previous injury. Vetter and Symonds agreed, findings 50% of all college athletes report chronic injury and was correlated with training intensity. So it appears injuries beget more injuries.

Interestingly, a study looking at Olympic distance versus Ironman distance triathletes found that while the number of overuse injuries in the two groups were fairly similar, the recurrence rate of injury and time away from the sport were greater in the Ironman group. The researchers stressed the importance of understanding "cumulative stress" which often occurs when an athlete is prevented from doing one aspect of training so they increase the load of another discipline. They state that this can actually increase both their risk of injury recurrence as well as time to full rehabilitation.

TAKE-HOME: Injuries need to be avoided rather than treated. If we can listen to our bodies we are sure to find a way to determine when we are about to cross that line into over-training and subsequent injury. If you're injured already, take the extra time to heal then work on the physical impairments that lead to the breakdown in the first place.


Absence of Illness:
It has been shown that while moderate levels of activity can boost the immune system, over-training and ultra-races can lower resistance to disease due to the release of cortisol and its subsequent suppresion of the immune system. While this reduction in immunity is only short-lived, chronic overtraining can, and often does, lead to chronic illness in this population. Again, not healthy by this definition.

TAKE HOME: Take time after races to fully recover. An extra day of rest may not seem like much of a benefit to you but your body takes a lot longer to recover than you think. At first sign of getting sick, cut back on your training intensity and durations.


Good mental health
Another concern for endurance sports is pyschological. Motivation is a huge determinant in successful longevity of participation. Too much(or inappropriate) motivation may lead to over-training and physical and mental burnout. Too little motivation may lead to under-training, poor results and potentially mental burnout.

Perception of self can also impact endurance sport participation. People who train hard and do not see the improvements that they expect, are probably more likely to discontinue participation than those that continue to progress(or maintain) performance times or placements.

A study of mental exhaustion with college athletes, found that with increased training intensity and durations came increases in both physical and mental exhaustion.

However, if you love training and you do it for the love of the sport and not due to extrinsic goals or rewards, studies have shown that this can actually be a benefit to mental health. So for this one, it depends on the person.
TAKE HOME: Evaluate the reasons for doing the activities that you do and make sure they're the right reasons.

Active and high energy
A healthy person is one that has energy throughout the hours awake- not just during their training. As mentioned above, it is pretty common to see ultra-distance athletes hobbling around exhausted due to their training regime. If your training is limiting all other aspects of your life, are you really healthy?

TAKE HOME: Leave something in the bank so you can play with your kids or go for a spontaneous hike once you're done your workout.


Vitality
This one is definitely interesting. Terramoto found that elite endurance athletes do survive longer than the general population which they attribute to lower cardiovascular disease mortality. However, there also have been studies looking at low bone density in female endurance athletes which one of the most accurate predictors of mortality in the elderly. Additionally, cyclists have a similar problem with osteoporosis due to the limited weight bearing they do during training.

Hackney states that the cardiovascular protective effects comes at the expense of "spermatogenesis" problems. It is surmised that there is a shift in the hypothalamic-pituitary-testicular regulatory axis which results in reduced testosterone which has a cardiovascular protective effect but also makes reproduction a little tricky. So while these athletes are at less risk of death themselves, they are also at less risk of continuing the circle of life.

TAKE-HOME: If you're a female athlete or primarily a cyclist, make sure you're doing some resistance training to develop and maintain your bone density. If you're young and thinking of having kids, maybe hold off on the extreme ends of the endurance activity to ensure your swimmers can at least keep up with the rest of you.

SOCIOECONOMIC RESTRICTIONS
Let's be honest. Ultra events are very expensive. Just registering for an Ironman is more than a lot of people make in a week, no less getting yourself and your bike there, staying the requisite three-day minimum, the bike, the access to a pool etc. Additionally, with the rise in attendence of these events, there has come an equal rise in cost. This can certainly be a limited to participation in ultra-events.


In addition to financial restrictions on participation of ultra-events, societal restrictions are a huge impact. Family, friends and jobs all can impact participation due to the sheer amount of hours per week that these events require. An average marathoner may run 60-80 miles a week(6-12 hours/week),while an ultramarathoner may do a weekend long-run in the range of six hours. Ultra-cyclists and triathletes often dedicate 5-8 hours on the weekends to those long century rides.


So with the potential health risks associated with ultra-distance training, these socioecomonic restrictions also can impede on an individual's ability to sustain ultra-distance training and competition year in and year out.

TAKE-HOME: If you have a great support group of friends and family that all can train together and you choose to spend your money racing rather than boozing, you're golden. Otherwise evaluate your situation.

Summary:
While I love the challenge and appeal of these ultra-long races that challenge one's mind and body, the costs associated(both physically, psychologically and socioeconomically) need to be considered when training for and competing in these events. Use of sunscreen, being aware of early signs of overtraining and injury, allowing for full recovery after strenuous workouts and ensuring that I am addressing and caring for all aspects of my life, not just the sport, are necessary for allowing for ultras to be sustainable in my life.


Train less, train smart, eat well, love what you do and who you're with.







References:

Nottin S, Doucende G, Schuster I, Tanguy S, Dauzat M, Obert P. Alteration in left ventricular strains and torsional mechanics after ultralong duration exercise in athletes. Circ Cardiovasc Imaging. 2009 Jul;2(4):323-30.


Egermnnn M, Brocai D, Lill CA, Schmitt H. Analysis of injuries in long-distance triathletes. Int J Sports Med. 2003. 24(4).


Scott JM, Esch BT, Shave R, Warburton DE, Gaze D, George K. Cardiovascular consequences of completing a 160-km ultramarathon. Med Sci Sports Exerc. 2009 Jan;41(1):26-34.


Braam L, Knapen M, Geusens P, Brouns F, Vermeer C. Factors Affecting Bone Loss in Female Endurance Athletes: A two year follow-up study.


Kujala, UM, Sarna S, Kaprio J, Koskenvuo M, Karjalainen J. Heart attacks and lower-limb function in master endurance athletes. Med. Sci. Sports Exerc., Vol. 31, No. 7, pp. 1041-1046, 1999.


Burns J, Keenan AM, Redmond AC. Factors associated with triathlon-related overuse injuries. J Orthop Sports Phys Ther. 2003 Apr;33(4):177-84.

Vleck VE, Bentley DJ, Millet GP, Cochrane T. Triathlon event distance specialization: training and injury effects. J Strength Cond Res. 2010 Jan;24(1):30-6.


Vetter RE, Symonds ML. Correlations between injury, training intensity, and physical and mental exhaustion among college athletes. J Strength Cond Res. 2010 Mar;24(3):587-96.

Hackney AC. Effects of endurance exercise on the reproductive system of men: the "exercise-hypogonadal male condition." J Endocrinol Invest. 2008 Oct;31(10):932-8.


O'Toole ML, Hiller WDB, Smith RA, Sisk TD. Overuse injuries in ultraendurance triathletes. Am J Sports Med July 1989 vol. 17 no. 4 514-518

Kujala U M, Kaprio J , Sarno S. Osteoarthritis of weight bearing joints of lower limbs in former elite male athletes. BMJ 1994;308:819

Cosca DD, Navazio F. Common Problems in Endurance Athletes.American Family Physician 2007. 76(2)


Teramoto M, Bungum TJ. Mortality and Longevity of Elite Athletes. Journal of Science and Medicine in Sport. 2010. 13(4).