Incidence of Hyponatremia During a Continuous 246-km Ultramarathon Running Race

Incidence of Hyponatremia During a Continuous 246-km Ultramarathon Running Race

The purpose of this observational study was to examine the incidence of exercise-associated hyponatremia (EAH) in a 246-km continuous ultra-marathon.

Adam D. Seal, Costas A. Anastasiou, Katerina P. Skenderi, Marcos Echegaray, Nikos Yiannakouris, Yiannis E. Tsekouras, Antonia L. Matalas, Mary Yannakoulia, Fani Pechlivani and Stavros A. Kavouras

Methods: Over 2 years, 63 male finishers of the annual Spartathlon ultra-marathon foot race from Athens to Sparta, Greece were included in the data analysis. A blood sample was drawn from an antecubital vein the day before the race as well as within 15min post-race and analyzed for sodium concentration. During the second year of data collection, blood was also drawn at the 93-km checkpoint (n = 29). Height and weight were measured pre and post-race.
Results: Mean race time of all subjects was 33 ± 3 h with a range of 23.5 and 36.0 h. Of the 63 finishers recruited, nine began the race with values indicative of mild hyponatremia. Seven runners were classified as hyponatremic at the 93-km checkpoint, three of whomhad sodium levels of severe hyponatremia. After the race, 41 total finishers (65%) developed either mild (n = 27, 43%) or severe hyponatremia (n = 14, 22%).
Mean change in bodyweight percentage and serum sodium from pre-race to post-race was −3.6 ± 2.7% (−2.5 ± 1.9 kg) and −6.6 ± 5.6 mmol·L−1, respectively. Pre-race serum sodium level was not a significant predictor of post-race serum sodium levels (b = 0.08, R2 = 0.07, P = 0.698), however, there was a significant negative association between change in bodyweight percentage and post-race serum sodium concentration (b = −0.79, R2 = 0.29, P = 0.011).

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Described as the world's most grueling race, the Spartathlon runs over rough tracks and muddy paths (often it rains during the race), crosses vineyards and olive groves, climbs steep hillsides and, most challenging of all, takes the runners on the 1,200 meter ascent and descent of Mount Parthenio in the dead of night.
This is the mountain, covered with rocks and bushes, on which it is said Pheidippides met the god Pan.

Spartathlon is the event that brings this deed to attention today by drawing a legend out of the depths of history. The idea for its creation is belongs to John Foden, a British RAF Wing Commander. As a lover of Greece and student of ancient Greek history, Foden stopped his reading of Herodotus' narration regarding Pheidippides, puzzled and wondering if a modern man could cover the distance from Athens to Sparta, i.e. 250 kms, within 36 hours.


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