Participation and performance trends in 161km ultra-marathons in terms of nationality – a retrospective data analysis of worldwide participation from 1998-2011

This study investigated the nationalities of finishers, the annual number of finishers participating in a specific region and the performance of athletes regarding their nationality of all 161km ultra-marathons held worldwide from 1998 to 2011. The associations between nationality and performance and changes in performance across years in 36,425 finishers were analysed using correlation and linear regression analyses. Participation increased significantly for athletes originating from North America, Europe and Australia (P<0.01). Most runners originated from the USA (84%). The share of US-American athletes decreased significantly from 89.6% (1998) to 75.9% (2011) (P<0.01), while the share of European finishers increased significantly from 1.6% (1998) to 14.5% (2011) (P<0.01). The share of finishers competing in races held in the USA decreased significantly from 92.1% (1998) to 80.7% (2011) (P<0.01), while the share of finishers competing in European races increased significantly from 0% (1998) to 12.8% (2011) (P<0.01). The share of US-American athletes in the annual top ten decreased significantly from 76% (1998) to 52% (2011) (P<0.01), while the share of European athletes in the annual top ten increased significantly from 1% (1998) to 18% (2011) (P<0.01). Top ten US-American athletes achieved the fastest race times ever in women and men. Top ten European runners improved their performance to a higher extent than US-American athletes. These findings indicate that (i) ultra-marathoners originating from the USA dominated 161km ultra-marathons in participation and performance, (ii) 161km ultra-marathons were becoming more popular in Europe, and (iii) European athletes increasingly tended to compete in European races rather than to compete in the USA and improved their performance across years

Atrophy of the brachialis muscle after a displaced clavicle fracture in an Ironman triathlete: case report

Clavicle fractures are frequent injuries in athletes and midshaft clavicle fractures in particular are well-known injuries in Ironman triathletes. In 2000, Auzou et al. described the mechanism leading to an isolated truncular paralysis of the musculocutaneous nerve after a shoulder trauma. It is well-known that nerve palsies can lead to an atrophy of the associated muscle if they persist for months or even longer. In this case report we describe a new case of an Ironman triathlete suffering from a persistent isolated atrophy of the brachialis muscle. The atrophy occurred following a displaced midshaft clavicle fracture acquiring while falling off his bike after hitting a duck during a competition

An increased fluid intake leads to feet swelling in 100-km ultra-marathoners - an observational field study

BACKGROUND: An association between fluid intake and changes in volumes of the upper and lower limb has been described in 100-km ultra-marathoners. The purpose of the present study was (i) to investigate the association between fluid intake and a potential development of peripheral oedemas leading to an increase of the feet volume in 100-km ultra-marathoners and (ii) to evaluate a possible association between the changes in plasma sodium concentration ([Na+]) and changes in feet volume. METHODS: In seventy-six 100-km ultra-marathoners, body mass, plasma [Na+], haematocrit and urine specific gravity were determined pre- and post-race. Fluid intake and the changes of volume of the feet were measured where the changes of volume of the feet were estimated using plethysmography. RESULTS: Body mass decreased by 1.8 kg (2.4%) (p 0.05). Plasma volume and urine specific gravity increased (p < 0.0001). Fluid intake was positively related to the change in the volume of the feet (r = 0.54, p < 0.0001) and negatively to post-race plasma [Na+] (r = -0.28, p = 0.0142). Running speed was negatively related to both fluid intake (r = -0.33, p = 0.0036) and the change in feet volume (r = -0.23, p = 0.0236). The change in the volume of the feet was negatively related to the change in plasma [Na+] (r = -0.26, p = 0.0227). The change in body mass was negatively related to both post-race plasma [Na+] (r = -0.28, p = 0.0129) and running speed (r = -0.34, p = 0.0028). CONCLUSIONS: An increase in feet volume after a 100-km ultra-marathon was due to an increased fluid intake

The effects of course length on freestyle swimming speed in elite female and male swimmers - a comparison of swimmers at national and international level

Freestyle swimming performance over 50 m, 100 m, 200 m, 400 m, 800 m and 1,500 m was compared on short (25 m) and long (50 m) course for 92,196 national swimmers (i.e. annual high score list Switzerland) and 1,104 international swimmers (i.e. finalists FINA World Championships) from 2000 to 2012. National and international swimmers of both sexes were on average 2.0 ± 0.6% faster on short than on long course. Sex-related differences in swimming speed were greater on short than on long course for international and national swimmers from 50 m to 800 m. Freestyle swimming performance improved across years for international swimmers in both short- and long-course whereas only male national swimmers were able to improve on short and long course events except for short course events on 800 m and 1,500 m. Performance in national women competing in short and long course events showed only improvements on 50 m, 100 m and 1,500 m across years. The sex-related differences in freestyle swimming performance showed no change for international swimmers. For national swimmers, the sex-related differences in freestyle swimming performance increased over time in long course from 50 m to 800 m, but decreased for 1,500 m. In conclusion, elite female and male freestyle swimmers at national and international level were about 2% faster on 25 m compared to 50 m course. During the 2000-2012 period, international as well as national swimmers (i.e. for national level predominantly men) improved freestyle swimming performance in both long and short course. More vigorous and optimized training programs focused on muscular force production in combination with efficient swimming skills might close the performance gap between elite swimmers at national level and FINA finalists. Further research especially including effects of anthropometric, biomechanical, and physiological factors is required to fully understand the effects of course length on freestyle swimming performance, and to determine whether course length has similar effects on other swim styles

33 Ironman triathlons in 33 days-a case study

This case report presents the performance of an athlete who completed for the first time in history the total distance of 33 Ironman triathlons within 33 consecutive days. The athlete finished the total distance of 7,458 km (i.e. 125 km swimming, 5,940 km cycling and 1,393 km running) within a total time of 410 h and a mean time of 12 h 27 min per Ironman distance. During the 33 days, the athlete became slower in swimming (r(2) = 0.27, p = 0.0019), transition time 1 (r(2) = 0.66, p < 0.001), and transition time 2 (r(2) = 0.48, p < 0.0001). However, in cycling (r(2) = 0.07, p = 0.13), running (r(2) = 0.04, p = 0.25) and overall race time (r(2) = 0.10, p = 0.069), the athlete was able to maintain his performance during the 33 days. The coefficients of variation (CV) for the split times in swimming, cycling, running and overall race times were very low (i.e. 2.7%, 3.2%, 4.7%, and 2.7%, respectively) whereas the CV for transition times 1 and 2 were considerably higher (i.e. 25.5% and 55.5%, respectively). During the 33 days, body mass decreased from 83.0 kg to 80.5 kg (r(2) = 0.55, p < 0.0001). Plasma [Na(+)] remained within the reference range, creatine kinase, blood glucose and liver enzymes were minimally elevated above the reference range after four of five stages where blood analyses were performed. This case report shows that this athlete finished 33 Ironman triathlons within 33 consecutive days with minor variations over time (i.e. even pacing) in both split times and overall race times. This performance was most probably due to the high experience of the athlete, his pacing strategy and the stable environmental conditions

Oral transmucosal fentanyl citrate analgesia in prehospital trauma care: an observational cohort study.

BACKGROUND Pain is one of the major prehospital symptoms in trauma patients and requires prompt management. Recent studies have reported insufficient analgesia after prehospital treatment in up to 43% of trauma patients, leaving significant room for improvement. Good evidence exists for prehospital use of oral transmucosal fentanyl citrate (OTFC) in the military setting. We hypothesized that the use of OTFC for trauma patients in remote and challenging environment is feasible, efficient, safe, and might be an alternative to nasal and intravenous applications. METHODS This observational cohort study examined 177 patients who were treated with oral transmucosal fentanyl citrate by EMS providers in three ski and bike resorts in Switzerland. All EMS providers had previously been trained in administration of the drug and handling of potential adverse events. RESULTS OTFC caused a statistically significant and clinically relevant decrease in the level of pain by a median of 3 (IQR 2 to 4) in NRS units (P < 0.0001). Multiple linear regression analysis showed a significant absolute reduction in pain, with no differences in all age groups and between genders. No major adverse events were observed. CONCLUSIONS Prehospital administration of OTFC is safe, easy, and efficient for extrication and transport across all age groups, gender, and types of injuries in alpine environments. Side effects were few and mild. This could provide a valuable alternative in trauma patients with severe pain, without the delay of inserting an intravenous line, especially in remote areas, where fast action and easy administration are important

Participation and Performance Trends in Triple Iron Ultra-triathlon - a Cross-sectional and Longitudinal Data Analysis

PURPOSE: The aims of the present study were to investigate (i) the changes in participation and performance and (ii) the gender difference in Triple Iron ultra-triathlon (11.4 km swimming, 540 km cycling and 126.6 km running) across years from 1988 to 2011. METHODS: For the cross-sectional data analysis, the association between with overall race times and split times was investigated using simple linear regression analyses and analysis of variance. For the longitudinal data analysis, the changes in race times for the five men and women with the highest number of participations were analysed using simple linear regression analyses. RESULTS: During the studied period, the number of finishers were 824 (71.4%) for men and 80 (78.4%) for women. Participation increased for men (r(2)=0.27, P<0.01) while it remained stable for women (8%). Total race times were 2,146 ± 127.3 min for men and 2,615 ± 327.2 min for women (P<0.001). Total race time decreased for men (r(2)=0.17; P=0.043), while it increased for women (r(2)=0.49; P=0.001) across years. The gender difference in overall race time for winners increased from 10% in 1992 to 42% in 2011 (r(2)=0.63; P<0.001). The longitudinal analysis of the five women and five men with the highest number of participations showed that performance decreased in one female (r(2)=0.45; P=0.01). The four other women as well as all five men showed no change in overall race times across years. CONCLUSIONS: Participation increased and performance improved for male Triple Iron ultra-triathletes while participation remained unchanged and performance decreased for females between 1988 and 2011. The reasons for the increase of the gap between female and male Triple Iron ultra-triathletes need further investigations

Age of peak swim speed and sex difference in performance in medley and freestyle swimming – A comparison between 200 m and 400 m in Swiss elite swimmers

The aims of the present study were to examine (i) the age of peak swim speed and (ii) the sex difference in peak swim times in 200m and 400m medley versus freestyle. Swim times and ages of 5,524 swimmers (2,785 males and 2,739 females) from the Swiss high score list from 2006 to 2010 were analyzed using one-way analysis of variance (ANOVA). The age of peak swim speed was younger for females (~20-21 years) compared to males (~22-25 years) for both distances and both swimming styles. The sex differences in peak swim times for age group 10-39 years were 9.7% (SD=3.4) and 7.1% (SD=5.1) for 200m and 400m individual medley, and 10.1% (SD=5.0) and 6.1% (SD=4.0) for 200m and 400m freestyle, respectively. The sex differences were neither different between the two distances nor between the two disciplines (p > .05). There were no differences within each sex (i.e. females to females, and males to males) in the age of reaching peak swim speed in 200m and 400m individual medley and freestyle. However, females reached the peak swim speed at a younger age than males. The sex differences in peak swim times were similar for 200m than for 400m for both swim styles. To summarize, the present findings suggest no difference in the age of peak swim times in 200m and 400m individual medley and freestyle. However, females reached peak swim times earlier than males, which might be dependent on a different development of the genders in puberty and the related physiological and anthropometric factors. Sex differences in peak swim times were similar for 200m than for 400m for both swim styles

Will women soon outperform men in open-water ultra-distance swimming in the 'Maratona del Golfo Capri-Napoli'?

This study investigated the change in sex differences across years in ultra-distance swimming performances at the 36-km 'Maratona del Golfo Capri-Napoli' race held from 1954 to 2013. Changes in swimming performance of 662 men and 228 women over the 59-year period were investigated using linear, non-linear and hierarchical regression analyses. Race times of the annual fastest swimmers decreased linearly for women from 731 min to 391 min (r (2)  = 0.60, p < 0.0001) and for men from 600 min to 373 min (r (2)  = 0.30, p < 0.0001). Race times of the annual top three swimmers decreased linearly between 1963 and 2013 for women from 736.8 ± 78.4 min to 396.6 ± 4.5 min (r (2)  = 0.58, p < 0.0001) and for men from 627.1 ± 34.5 min to 374.1 ± 0.3 min (r (2)  = 0.42, p < 0.0001). The sex difference in performance for the annual fastest decreased linearly from 39.2% (1955) to 4.7% (2013) (r (2)  = 0.33, p < 0.0001). For the annual three fastest competitors, the sex difference in performance decreased linearly from 38.2 ± 14.0% (1963) to 6.0 ± 1.0% (2013) (r (2)  = 0.43, p < 0.0001). In conclusion, ultra-distance swimmers improved their performance at the 'Maratona del Golfo Capri-Napoli' over the last ~60 years and the fastest women reduced the gap with the fastest men linearly from ~40% to ~5-6%. The linear change in both race times and sex differences may suggest that women will be able to achieve men's performance or even to outperform men in the near future in an open-water ultra-distance swimming event such as the 'Maratona del Golfo Capri-Napoli'