The Tour Divide (TD) is a 4385 km ultra-endurance bicycle race that follows the continental divide from Canada to Mexico. In this case study, we performed a comprehensive molecular and physiological profile before and after the completion of the TD. Assessments were performed 35 days before the start (Pre-TD) and ∼36 h after the finish (Post-TD). Total energy expenditure was assessed during the first 9 days by doubly labelled water (2 H2 18 O), abdominal and leg tissue volumes via MRI, and graded exercise tests to quantify fitness and substrate preference. Vastus lateralis muscle biopsies were taken to measure mitochondrial function via respirometry, and vascular function was assessed using Doppler ultrasound. The 47-year-old male subject took 16 days 7 h 45 min to complete the route. He rode an average of 16.8 h/day. Neither maximal O2 uptake nor maximal power output changed pre- to post-TD. Measurement of total energy expenditure and dietary recall records suggested maintenance of energy balance, which was supported by the lack of change in body weight. The subject lost both appendicular and trunk fat mass and gained leg lean mass pre- to post-TD. Skeletal muscle mitochondrial and vascular endothelial function decreased pre- to post-TD. Overall, exercise performance was maintained despite reductions in muscle mitochondrial and vascular endothelial function post-TD, suggesting a metabolic reserve in our highly trained athlete.

A non-linear heart rate variability (HRV) index based on fractal correlation properties called alpha1 of Detrended Fluctuation Analysis (DFA-alpha1), has been shown to change with endurance exercise intensity. Its unique advantage is that it provides information about current absolute exercise intensity without prior lactate or gas exchange testing. Therefore, real-time assessment of this metric during field conditions using a wearable monitoring device could directly provide a valuable exercise intensity distribution without prior laboratory testing for different applied field settings in endurance sports. Until of late no mobile based product could display DFA-alpha1 in real-time using off the shelf consumer products. Recently an app designed for iOS and Android devices, HRV Logger, was updated to assess DFA-alpha1 in real-time. This brief research report illustrates the potential merits of real-time monitoring of this metric for the purposes of aerobic threshold (AT) estimation and exercise intensity demarcation between low (zone 1) and moderate (zone 2) in a former Olympic triathlete. In a single-case feasibility study, three practically relevant scenarios were successfully evaluated in cycling, (1) estimation of a HRV threshold (HRVT) as an adequate proxy for AT using Kubios HRV software via a typical cycling stage test, (2) estimation of the HRVT during real-time monitoring using a cycling 6 min stage test, (3) a simulated 1 h training ride with enforcement of low intensity boundaries and real-time HRVT confirmation. This single-case field evaluation illustrates the potential of an easy-to-use and low cost real-time estimation of the aerobic threshold and exercise intensity distribution using fractal correlation properties of HRV. Furthermore, this approach may enhance the translation of science into endurance sports practice for future real-world settings.

The Pacific Crest Trail (PCT) is a 4265-km hiking trail that extends from the US-Mexican border to the US-Canadian border through the mountain ranges of western North America. Individuals who hike the entire length of the trail in one season (4-6 months) perform long daily exercise durations while exposed to extreme environmental temperatures, high altitudes, intense solar radiation, and the consumption of calorie-rich, nutrient-poor diets. This case study reports changes in arterial function and body composition in a subject before and after a 112-day long-distance hike of the PCT. Brachial artery flow-mediated dilation, a measure of vascular endothelial function, decreased from: 6.97% to 5.00%. Carotid-femoral pulse wave velocity, a measure of aortic stiffness, increased from 5.39 to 5.76 m/s. Dual-energy x-ray absorptiometry scans detected no major changes in total-body bone mineral density, fat mass, or lean mass, although there were minor, unfavorable changes in some subregions of the body. It is important for individuals completing a long-distance hike to be aware of the potential deleterious changes associated with large volumes of exercise and consuming a high-calorie, low-quality diet.

Despite the established benefits of regular physical activity in cardiovascular disease prevention, coronary events in the context of atherosclerotic coronary artery disease are the most common cause of exercise-related sudden death. A paradoxical development of an increased coronary calcification burden is likely associated with endurance training even in the absence of any of the traditional cardiovascular risk factors. In this case report, we present a 50-year-old male long-distance runner with excessive subclinical myocardial ischemia.

BACKGROUND: The cardinal symptoms of auto-immune myasthenia gravis are fatigue and weakness. Endurance events such as marathon running would seem incompatible with this chronic disease. Many patients stop sport altogether. There is limited literature of patients with auto-immune myasthenia gravis undergoing regular endurance exercise.
METHODS: We report the case of a 36-year-old female who began long-distance running whilst experiencing initial symptoms of myasthenia gravis. She was diagnosed with auto-immune myasthenia gravis and whilst advised to stop all sport, her way of fighting and living with this chronic and unpredictable disease was to continue running to maintain a healthy body and mind. Despite suffering from ocular, bulbar and localized limb fatigability, she managed to complete multiple marathons and achieve disease stability with cholinesterase inhibitors.
CONCLUSIONS: Marathon and half-marathon running lead to distinct changes in mediators of inflammation in an exercise-dose-dependent manner. Despite symptoms of weakness and fatigue in certain muscles in myasthenia gravis, physical exertion remains possible and may not worsen symptoms as demonstrated in this case and recent studies. The immunomodulatory role of exercise could be considered in this case however this hypothesis remains to be confirmed in future studies with quantitative data.