This study compared metabolite shifts induced by training for, participation in, and recovery from a marathon race competition among athletes divided into three groups based on fitness (relative maximum oxygen uptake (VO₂max)) and performance levels (net running time). Plasma samples from 76 male runners participating in the Munich Marathon were analyzed for metabolite shifts using a targeted metabolomics panel. For the entire cohort of runners, pronounced increases were measured immediately after the race for plasma concentrations of acylcarnitines (AC), the ratio (palmitoylcarnitine + stearoylcarnitine)/free carnitine that is used as a proxy for the activity of the mitochondrial enzyme carnitine palmitoyltransferase, and arginine-related metabolites, with decreases in most amino acids (AA) and phospholipids. Plasma levels of AA and phospholipids were strongly increased 24 and 72 h post-race. Post-race plasma concentrations of AC and arginine-related metabolites were higher in the low compared to top performers, indicating an accumulation of fatty acids and a reliance on protein catabolism to provide energy after the marathon event. This study showed that marathon race competition is associated with an extensive and prolonged perturbation in plasma metabolite concentrations with a strong AC signature that is greater in the slower, less aerobically fit runners. Furthermore, changes in the arginine-related metabolites were observed.

Patients with chronic kidney disease (CKD) on hemodialysis (HD) experience treatment-related immobility and physical deconditioning, which is responsible for an increased risk of frailty and a high burden of multi-morbidity. Exercise has been shown to counteract this vicious cycle; however, its effectiveness has only been investigated in small cohorts. Therefore, the objective of the Dialysis Training Therapy (DiaTT) trial will be to assess the effects of a 12-month intradialytic exercise program on physical functioning, frailty and health economics in a large cohort of HD patients in a real-world setting. DiaTT will be a prospective, cluster-randomized (1:1), controlled, multi-center, interventional clinical trial across 28 dialysis units, aiming at the recruitment of >1100 CKD patients on HD. The intervention group will receive 12 months’ intradialytic exercise (combined aerobic and resistance training), whereas the usual care group will not receive intervention. The primary endpoint will be a change on the sit-to-stand test (STS60) result between baseline and 12 months. Secondary endpoints will include physical functioning, frailty, quality of life, 3-point MACE, hospitalizations, survival, quality of HD, health literacy and health care costs. By including almost as many patients as previously investigated in smaller trials, DiaTT will be the largest randomized, controlled trial assessing frailty, quality of life and mortality in the field of nephrology.

Introduction Prolonged strenuous exercise training may result in structural, functional and electrical cardiac remodelling, as well as vascular and myocardial injuries. However, the extent to which high-volume, intense exercise is associated with arrhythmias, myocardial fibrosis, coronary heart disease and pathological alterations of the vasculature remains unknown. In addition, there is no clear consensus on the clinical significance of these exercise-induced changes. Previous studies typically used cross-sectional designs and examined exercise-induced cardiovascular changes in small cohorts of athletes for up to 3–7 days of recovery. Long-term longitudinal studies investigating cardiovascular changes induced by prolonged strenuous exercise in large cohorts of athletes are needed to improve scientific understanding in this area. Methods and analysis In this prospective observational monocenter study, 277 participants of the Beer, Marathon, Genetics, Inflammation and the Cardiovascular System (Be-MaGIC) study (ClinicalTrials.gov: NCT00933218) will be invited to participate in this 10-year follow-up study. A minimum target sample size of 130 participants will be included in the study. Participating athletes will be examined via the following: anthropometry, resting electrocardiography and echocardiography, blood sampling, retinal vessel diameters, carotid sonography and cardiopulmonary exercise testing, including exercise electrocardiography. Discussion This longitudinal study will provide comprehensive data on physiological changes in the cardiovascular system and the development of pathologies after a 10-year period of prolonged and strenuous endurance exercise. Since the participants will have engaged in a wide range of training loads and competitive race events, this study will provide useful risk factor determinants and training load cut-off values. The primary endpoint is the association between the exercise-induced increase in cardiac troponin during the Munich marathon 2009 and the decline in right ventricular ejection fraction over the next 10 years. Trial registration number NCT04166903.

Objectives: Physical activity is associated with positive health effects and improved cognitive function in children. However, these data are primarily based on cross-sectional studies. We investigated changes in cognitive function, physical fitness and physical activity in children following a school-based intervention. Methods: The ‘fit4future’ study is a prospective, interventional, long-term study conducted in Germany to evaluate the impact of a comprehensive school-based health promotion programme in children. The aims of the programme have been to increase the amount of physical activity, to support a healthy diet and to improve attention and concentration performance as well as coping strategies. Schools received equipment to support physical activity, for example, action cards, brochures as well as online materials containing information regarding physical activity, nutrition, cognitive function and stress management. Teachers were trained in six workshops to enable them to promote a systematic health promotion process at schools. Parents received brochures about healthy lifestyles with practical advice for everyday family life. Additional information was provided on the programme’s homepage. At the beginning of the second and the end of the third grade, children completed a differential performance test (Concentrated Task) for the assessment of concentration and attention in which they had to cross predetermined pictorial symbols on preprinted test sheets (average marked signs). Changes in the average marked signs were investigated and compared with age-specific and sex-specific norms. Physical fitness and activity were assessed using a six-item fitness test and questionnaire. Results: A total of 839 children (mean age 7.5±0.6 years, 48% girls) from 32 schools participated in this study. Over 2 years, average marked signs increased from 91.6±20.7 to 138.0±27.6 (p<0.001) (n=553 children, mean age 7.5±0.6 years, 51% girls). This improvement was greater than expected compared with the age-specific and sex-specific norms. The children showed significant improvements in all fitness test items and a significant increase in physical activity (p<0.001). Age, baseline average marked signs and changes in the jump-and-reach test were associated with changes in cognitive function (regression coefficient β=0.95, SE=0.23, p<0.001). Conclusion: A school-based health promotion programme improved cognitive function, physical activity and physical fitness beyond the age-related improvements expected over 2 years in a large cohort of primary school children. Trial registration number: German Clinical Trials Register (DRKS-ID: DRKS00020894, Date of registration: 2020-02-26).