Table 4 Cardiopulmonary physiology
Study | Participants | Measures | Design | Evidence quality | Major findings |
|---|---|---|---|---|---|
Picco et al.[39] | 28 athletes (11 females and 17 males) who completed either a 70 km or 55 km mountain ultramarathon Age 38 ± 9 years | ECHO: EF, GLS, RVFWS, ventricular torsion and volume | Cohort study | Low | Whole cohort: Significant post-race decreases in EF (62.7 ± 6.1% to 57.2 ± 8.7%, p = 0.008), GLS, RVWS, LA volume and LV end diastolic dimensions. Post-race increases in RA area and RV diastolic dimensions. Females: only reduced LV dimension (p = 0.05) and increased RV diameter (p = 0.012) were significant |
Picco et al.[40] | 24 athletes (5 females aged 38 ± 4 years, and 19 males aged 42 ± 12 years) who completed a 55 km mountain ultramarathon | ECHO, serum lactate and CPK | Cohort study | Low | Females had lower incidence of ECHO features of exercise induced cardiac fatigue for the right ventricle (p = 0.3) and the left ventricle (p < 0.001) Females had significantly lower serum lactate post-race (2.63 mmol/L vs 4.37 mmol/L, p = 0.018). No difference in CPK |
Cote et al.[41] | 25 athletes (8 females aged 45.9 ± 10.2 years, and 17 males aged 44.8 ± 6.6 years) who completed either a 100 km or 160 km ultramarathon | ECHO | Cohort study | Low | No significant sex differences in the cardiac response to an ultramarathon |
Tiller et al.[42] | 16 athletes (8 females and 8 performance-matched males) who completed either the UTMB or CCC races in 2018 or 2019. Average age 38.4 ± 7.6 years. Average finish time (hh:mm) 30:52 ± 10:42 | Vital signs, ECG, anthropometry Serum electrolytes, Hb concentration, Hct, and biomarkers Pulmonary function tests. Resting lung diffusing capacity, transthoracic ultrasound | Cohort study | Low | Females and males exhibited significant pre- to post-race increases in BNP (25.8 ± 14.6 vs. 140.9 ± 102.7 pg/mL, p = 0.007; and 26.6 ± 17.5 vs. 96.4 ± 51.9 pg/mL; p = 0.002, respectively) and CK-MB (3.3 ± 2.4 vs. 74.6 ± 49.6 IU/L, p = 0.005; and 7.2 ± 3.9 vs. 108.8 ± 37.4 IU/L; p = 0.002, respectively), while males only exhibited significant pre- to post-race increases in Cr (1.06 ± 0.19 vs. 1.23 ± 0.24 mg/dL; p = 0.028). Females exhibited significant pre- to post-race decreases in FVC (p = 0.008, d = 0.79), PEF (p = 0.039, d = 0.92), IC (p = 0.004, d = 1.46), FeNO (p = 0.031, d = 0.66), and PIMAX (p = 0.028, d = 0.47), while males exhibited significant pre- to post-race decreases in PEF (p = 0.048. d = 0.25), IC (p = 0.005, d = 0.79), FeNO (p = 0.038, d = 0.97), DLCO (p = 0.004, d = 0.83), DLNO (p = 0.002, d = 0.88), and VC (p = 0.002, d = 1.22) Both males and females exhibited significant pre- to post-increases in lung comet tails (p = 0.006, d = 2.41; and p = 0.048, d = 0.96, respectively). Pooled effect size was greater in males (d = 0.86) than in females (d = 0.63) |
Martinez-Navarro et al.[43] | 32 athletes (13 females and 19 males) who completed a 107 km mountain ultramarathon | Spirometry, peak expiratory flow rate (PEF) | Cohort study | Low | No significant sex differences in spirometry changes during and post ultramarathon aside from significantly greater decline in FEV1/FVC in females (16.1% vs 3.5%, p = 0.019) |