Strenuous exercise induces significant increases in cardiac biomarkers. However, it is still unclear whether this is caused by cardiomyocyte necrosis or secondary mechanisms such as ischemia, cardiac energy deficiency, increased inflammation, or renal dysfunction. Therefore, we investigated cardiac biomarkers (high-sensitive cardiac troponin T (hs-cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (h-FABP)), inflammation markers (high-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10, tumor necrosis factor-α), and renal function (cystatin C) in 102 healthy men age 42 ± 9 yr before and 0, 24, and 72 h after a marathon. Kinetics of hs-cTnT revealed a peak immediately after the race (V3) that decreased rapidly to pretest values within 72 h (V5) (median (interquartile range) = 31.07 (19.25-46.86) ng·L(-1) at V3 and 3.61 (3.20-6.70) ng·L(-1) at V5, P < 0.001). NT-proBNP and h-FABP kinetics showed a similar pattern (NT-proBNP = 92.6 (56.9-149.7) ng·L(-1) at V3 and 34.9 (21.7-54.5) ng·L(-1) at V5; h-FABP = 44.99 (32.19-64.42) μg·L(-1) at V3 and 7.66 (5.64-10.60) μg·L(-1) at V5; always P < 0.001). Proinflammatory markers, such as IL-6 and hs-CRP, and renal dysfunction were significantly augmented immediately after the race (before the race compared with maximum after the race: IL-6 = 15.5-fold, hs-CRP = 28-fold, cystatin C = 1.22-fold, all P < 0.001). These increases were not related to the increase of hs-cTnT. Similarly, training history, finishing time, and exercise intensity were not associated with changes of hs-cTnT. Cardiac biomarkers were increased immediately after a marathon race. Interestingly, values returned to normal levels within 72 h. These kinetics with a sharp peak indicate that cardiac necrosis during marathon running seems very unlikely but may be explained by altered myocyte metabolism.

Strenuous exercise significantly increases the incidence of upper respiratory tract illness (URTI) caused by transient immune dysfunction. Naturally occurring polyphenolic compounds present in food such as nonalcoholic beer (NAB) have strong antioxidant, antipathogenic, and anti-inflammatory properties.The objective of this study was to determine whether ingestion of NAB polyphenols for 3 wk before and 2 wk after a marathon would attenuate postrace inflammation and decrease URTI incidence. Healthy male runners (N = 277, age = 42 ± 9 yr) were randomly assigned to 1-1.5 L · d(-1) of NAB or placebo (PL) beverage (double-blind design) for 3 wk before and 2 wk after the Munich Marathon. Blood samples were collected 4 and 1 wk before the race and immediately and 24 and 72 h after the race and analyzed for inflammation measures (interleukin-6 and total blood leukocyte counts). URTI rates, assessed by the Wisconsin Upper Respiratory Symptom Survey, were compared between groups during the 2-wk period after the race. Change in interleukin-6 was significantly reduced in NAB compared with PL immediately after the race (median (interquartile range) = 23.9 (15.9-38.7) vs 31.6 (18.5-53.3) ng · L(-1), P = 0.03). Total blood leukocyte counts were also reduced in NAB versus PL by approximately 20% immediately and 24 h after the race (P = 0.02). Incidence of URTI was 3.25-fold lower (95% confidence interval = 1.38-7.66) (P = 0.007) in NAB compared with PL during the 2-wk postmarathon period. Consumption of 1-1.5 L · d(-1) of NAB for 3 wk before and 2 wk after marathon competition reduces postrace inflammation and URTI incidence.

Various tests are available to assess athletes for factors associated with their susceptibility and risk of anterior cruciate ligament (ACL) injury or reinjury; however, it is unclear which tests are clinically meaningful and what should be considered when using them. Therefore, the aim of this scoping review was to screen and summarize testing and to derive evidence-based recommendations for clinicians, practitioners and future research. Five databases were searched to identify studies addressing musculoskeletal morphology or functional-performance-related screening tests with a clear conceptual link or an evidence-based relationship to ACL (re)injury. A quality rating was carried out using the National Institutes of Health (NIH) Study-Quality Assessment Tool. Six different categories of common screening tests were identified: balance and postural control, gait- and running-related tests, joint laxity, joint morphology and anthropometrics, jump tests and strength tests. Predicting future injury in a complex, dynamic system based on a single screening test is methodologically challenging, which is also reflected in the highly controversial findings in the literature regarding potential associations between specific screening tests and the occurrence of ACL injuries and reinjuries. Nonetheless, various screening tests can provide clinically relevant information on ACL-(re)injury-related factors and help to provide tailored preventive measures. A selection of corresponding evidence-based recommendations is derived and presented in this scoping review.

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.