19 July 2013

Core strength training and mountain ultramarathon running

I have horrible soreness today in what feels to be almost all major muscles in my body. This is following taking two so called functional toning/core training classes on two consecutive days this week. I know that there is a debate whether strength and core training really is beneficial for ultramarathon runners and the stride and running economy. Nevertheless, I think that some basic core strength is necessary in a race like Tor des Géants where there will be some really technical parts with climbing up and downhill in difficult terrain.

Not surprisingly, there are no really good studies performed, at least not yet to my knowledge, evaluating the benefits of core strength for mountain ultramarathon and the closest study I found was the one by Sato & Mokha published in J Strength Cond Res 2009; 23: 133-40 “Does core strength training influence running kinetics, lower-extremity stability, and 5000-M performance in runners?” and this is as the title indicating looking at benefits in 5000 meter runners. In contrast to several other studies of strength training in runners, they however saw a clear benefit in improved running times in the 14 healthy volunteers randomized to the core training group after 6-weeks.  Most studies performed on general resistance strength training in runners  appears to be of short duration, but still indicates that there might be benefits after this limited time period (reviewed in Yamamoto et al. The effects of resistance training on endurance distance running performance among highly trained runners: a systematic review. J Strength Cond Res. 2008; 22: 2036-44).

There are neither no good studies comparing various types of strength training programs for running, but in healthy males there are indications that high-resistance circuit training as in the functional toning classes I attended gives equal effect as traditional strength training in most aspects (Alcaraz et al. Similarity in adaptations to high-resistance circuit vs. traditional strength training in resistance-trained men. J Strength Cond Res. 2011; 25:2519-27) and that plyometric (“jump”) training might be particularly beneficial (Berryman et al. Effect of plyometric vs. dynamic weight training on the energy cost of running. J Strength Cond Res. 2010; 24: 1818-25). I still vividly remember the worst DOMS of my life I have had as a young athlete competing in Military Pentathlon and that was after an indoor plyometric strength class. I know that there are other studies arguing for other modes of strength training, but none has really looked at ultramarathon performance anyway. A very inspiring ultramarathon running colleague of mine just started a new blog (In Swedish, but with instruction movies) about strength training called “Lift a Rock” and, as strength training always will be a complement to running for a runner I will follow the exercises she recommends with interest and see if there are elements I can incorporate into my training routine. I think that the severe delayed onset muscle soreness (DOMS) I am feeling now is a sign that I really need to add some strength training until the start of TDG. A good thing is that I am soon going on a short vacation and will then also be able to add some swimming to my training.

17 July 2013

The poster to sign after finishing Tor des Géants (TDG) 2013

At the Tor des Géants facebook page the poster the finishers will sign after having completed the race was just posted. It looks great. Inspiring for the training the remaining 52 days before the race - I really want my name on that poster :-)

Less fatigue after TDG's 200 miles than UTMB's 100 miles

It is not all running races which have a scientific article published about it. I read with great interest the recent article from Grégoire P. Millet’s group at Institute of Sport Sciences at University of Lausanne in Switzerland where they have studied a group of runners in Tor des Géants (TDG). The lead author is Jonas Saugy and the article entitled “Alterations of Neuromuscular Function after the World’s Most Challenging Mountain Ultra-Marathon” is published in PLoS ONE 2013; 8: e65596. The article gained great interest in media when it came out a couple of weeks ago and it has been referred to in for instance Science, Runner’s World and National Geographic.

In the study, 25 male runners took part and of them 15 (60%) completed TDG. These runners were compared with a control group of 8 healthy males who did not run but experienced a similar level of sleep deprivation during the race. The results were also compared with those in a similar study conducted by Millet’s group at UTBM (Millet GY et al. Neuromuscular consequences of an extreme mountain ultra-marathon. PLoS ONE 2011; 6: e17059).

Not surprisingly, maximal voluntary contraction (MVC), central activation ratio (CAR) in both knee extensors (KE) and plantar flexors (PF) became statistically significantly reduced during TDG. Markers of neuromuscular fatigue (NMF) such as 100 Hz doublet (PS100) and peak twitch measured by electromyography (EMG) were also altered in TDG runners, but not in sleep derived controls. Blood concentrations of creatine kinase (CK), lactate dehydrogenease (LDH), C-Reactive Protein (CRP) and myoglobin were also higher during and after TDG in runners, but no elevation was seen in sleep derived controls. So far the findings were as expected, but, surprisingly, the degree of neuromuscular fatigue, muscle damage and inflammation was less in TDG runners compared with UTMB runners. Sauguy and colleagues speculate that this might be due to an anticipatory pacing strategy during the first part of the race and fatigue combined with a high level of sleep deprivation during the second part of the race leading to a slower speed during the whole course. The speed decrease relative to UTMB in the TDG runners tested was -23.1% (5.5±2.8 vs 7.2±1.3 km/h average equivalent-flat speed considering TDG to have an equivalent flat distance of 545 km and UTMB 262 km). Paradoxically, an extreme ultramarathon such as TDG thus seems to induce relative muscle preservation. So, from a pure muscle perspective it might be more exerting to run shorter than longer. When I completed La Boucle at Trail Verbier St Bernard last summer I talked to some UTMB completers who said that the faster pace and elevation change over a shorter distance made this race almost tougher supporting this notion. This weekend Emelie Forsberg completed the 65 km Ice Trail Tarentaise Val d´Isère Skyrunning Event and wrote on her Swedish blog that this was the toughest course she had run despite the relatively short distance. It will be interesting to see what I say in September after hopefully having completed TDG.

14 July 2013

Inspiring stories from Tor des Géants and the summits around Aosta Valley

In preparation for Tor des Géants I have looked for other blogs about the event to learn from past experiences, but most importantly to be inspired and find motivation to continue to push myself through the sometimes quite tedious and painful training. There are numerous good stories, recollections and race reports of this adventure and below are just some of the ones in English that I have found through a brief search. They are listed in no particular order or ranking and I do apologize for other good stories that I certainly have missed to list here. Note that some of the blogs contains several parts and in that case only the first is linked here.


13 July 2013

Blueberries and endurance running

Less than 60 days left to Sunday September 8 and the start of Tor des Géants in Courmayeur. From having wished that the there would be more time until then, I am now wishing that time would pass more quickly. A very good sign that I am starting to get as prepared as I could be I guess. I am still in a period where I focus a lot on getting distance in my legs and I have started to feel very strong. The problems I have had with my Achilles tendons and my left ankle have all subsided despite my ramping up the weekly milage even further. It is soon time for a short vacation in Southern Italy and I will then start to focus on adding more quality to my training and starting to gain speed and further up/downhill running technique.

I am writing this on a flight on my way to Chicago – I think my seventh business trip overseas to the US during the past year. Back home in Sweden there has been a lovely July weatherwise and there is plenty of wild blueberries in the forests. Blueberries are and have since my childhood always been my favorite berries. I simply love blueberry pie, blueberry ice cream or just simply milk or yoghurt and blueberries. I therefore became doubly happy when stumbled across some studies showing that the blueberry fruit exhibit antioxidant and anti-inflammatory properties and can facilitate recovery from exercise-induced muscle damage (EIMD). Although blueberries are low in vitamin C and E they contain the broadest range of anthocyanin and polyphenolic antioxidant compounds among common berryfruits (Wu X et al. Lipophilic and hydrophilic antioxidant capacities of common foods in the United States. J Agri Food Chem 2004, 52: 4026).  

In a study from New Zeeland ten healthy females in underwent a randomized cross-over study where they consumed a blueberry smoothie or placebo of a similar antioxidant capacity 5 and 10 hours prior to and then immediately, 12 and 36 hours after EIMD induced by 300 strenuous eccentric contractions of the quadriceps (McLeay et al. Effect of New Zealand blueberry consumption on recovery from eccentric exercise-induced muscle damage. J Int Soc Sport Nutr 2012, 9: 19). A significant (p < 0.001) decrease in isometric, concentric and eccentric torque was observed 12 hours following exercise in both treatment groups. During the 60 hour recovery period, a significant (p = 0.047) interaction effect was seen for peak isometric tension suggesting a faster rate of recovery in the blueberry intervention group. There was a faster rate of decrease in oxidative stress observed in the blueberry group, however, it was not significant (p < 0.05) until 36 hours post-exercise and interestingly coincided with a gradual increase in plasma antioxidant capacity. The ingestion of the blueberry beverage had no effect on perceived muscle soreness or pain.

Another interesting study was performed in the US were twenty-five well-trained subjects were randomized into two groups receiving either 250 g of blueberries per day for 6 weeks and 375 g given 1 h prior to 2.5 h of running at 72% maximal oxygen consumption (n = 13) or receiving control (McAnulty LS et al. Effect of blueberry ingestion on natural killer cell counts, oxidative stress, and inflammation prior to and after 2.5 h of running- Appl Physiol Nutr Metab. 2011; 36: 976-84). Markers of oxidative stress (F2-isoprostanes) and nucleic acid oxidation (5-OHMU) were significantly less increased in the blueberry group and plasma IL-10 and NK cell counts were significantly greater in the blueberry group. Changes in all other studies markers did not differ. The authors claim that the study indicates that daily blueberry consumption for 6 weeks increases NK cell counts, and acute ingestion reduces oxidative stress and increases anti-inflammatory cytokines. It is as the study by McLeay a small study, but interesting as it really evaluates the response after a strenuous running trial. There are clear indications that the effects of blueberries are direct and not indirect effect of other vitamins (Sánchez-Moreno et al. Effect of a blueberry nutritional supplement on macronutrients, food group intake, and plasma vitamin E and vitamin C in US athletes. Int J Food Sci Nutr. 2008; 59 :327).

01 July 2013

IL-1Ra as a performance enhancing drug? New doping for ultramarathon and endurance activities

This weekend the 100th edition of Tour de France started in Porto-Vecchio, Corsica. I have followed the race for many years each summer and I was completely thrilled by the repeated victories of Lance Armstrong.  Needless to say, the revelation that he all these years deviously had used prohibited substances to enhance his performance was a huge disappointment and I regard it as a very dark moment for not only this race but for all endurance sport competitions – if he could get away with this for so many years how many else have done so and are continuing to do so? I am a positive person and strongly believe that most athletes are honest and I think for instance runners like Kilian Jornet and Emelie Forsberg, who by the way placed first and second in the Mont Blanc Marathon this weekend, certainly do not use prohibited substances to enhance their performance. Kilian is clearly a physical phenomenon and his training is clearly in line with his performances as described for instance in articles in New York Times and Runners World.

Looking at the advancements in performance enhancing drugs I think we are moving  away from traditional blood doping through auto-transfusions with the athlete’s own blood or by stimulating production of the oxygen-bearing red blood cells through erythropoietin (EPO). To speculate, I think the future probably lies more on the cellular level with a focus on regeneration of tissues and repairing damages induced by muscular stress. A key component in regeneration is the immune system as it has become clear during the past few years that it is not only involved in protecting us against outside threats like bacteria, viruses and parasites, but also becomes activated by damage induced by for instance strenuous physical activity. The immune system is heavily involved in delayed onset muscle soreness (DOMS)/muscle fever – the question is how it is involved in the development and resolution of DOMS (see for instance review articles by Gleeson M. J Appl Physiol 2007; 103: 693–699; Walsh NP et al. Exerc Immunol Rev. 2011; 17: 6-63 and Paulsen G, et al. Exerc Immunol Rev. 2012; 18: 42-97). Interestingly, the role of muscles has been revised by new research showing that they act as a secretory organ important for the general health and well-being and playing an important part in the immune regulation of the body through anti-inflammatory effects (Pedersen BK & Febbraio MA. Nat Rev Endocrinol. 2012; 8: 457-65 and Petersen AM & Pedersen BK. J Appl Physiol 2005; 98: 1154-1162).

Key mediator of the immune system in response to stress and injuries through the so called inflammasome is the signal-molecule cytokine interleukin-1 and its receptor (reviewed in for instance Rathinam VA et al.  Nat Immunol. 2012; 13: 333-2 and Dinarello CA et al. Nat Rev Drug Discov. 2012; 11: 633-52). I will here not go into the details of IL-1 and its importance for a multitude of clinical disorders, but briefly highlight some of the evidence for the emerging role for this cytokine in exercise induced damage. One of the effects of IL-1 is to induce fever through its role as a pyrogen and already in 1983 it was shown that exercise could let to production of an endogenous pyrogen later shown to be IL-1 (Cannon & Kluger  Science. 1983; 220: 617-9; Cannon et al Am J Physiol. 1989 257:R451-5).

Following systemic release of IL-1 in the body after strenuous exercise there is also a concomitant increase in the receptor IL-1Ra, which act as an endogenous self-control of the IL-1 response and limits inflammation – it is known that genetic deficiency of IL-1ra is the cause of several severe fever disorders so this is an adequate and physiological response. Interestingly, it has been shown that variation in the gene for IL-1Ra (VNTR IL-1RN polymorphism) is associated with athlete status (Cauci et al. BMC Med Genet. 2010; 11: 299). In a large Italian study of Italian they found a dose-effect relationship with the 1/2 IL-1RN genotype being 2-fold more frequent in professional than in recreational athletes and 3-fold more frequent in professional athletes than in non-athletes. How this is occurring is unclear, but one hypothesis would be that the 1/2IL-1RN genotype could favor muscle repair in athletes through higher circulating or local levels of IL-1Ra.

However, a recent study indicate that the circulating levels of IL-1Ra is actually not higher in endurance trained athletes compared with recreationally active men, but this small study only evaluated the effect after a short moderate exercise so more studies are clearly needed (Scott JP et al. Eur J Appl Physiol. 2013; 113: 1871-82). The hypothesis that IL-1Ra is involved in muscle repair after exercise would implicate that recombinant IL-1Ra might be beneficial after strenuous exercise in the recovery process and in healing of for instance DOMS. Recombinant IL-1Ra is available as the drug Anakinra (Kineret®) and this might thus be an interesting compound to test whether it would be performance-enhancing or not, as it might well be during a prolonged competition such as Tour de France where rapid recovery between stages is paramount. One major risk with this would of course be the immune suppressant effects of the drug, but as it is widely used and already indicated for rheumatoid arthritis it can certainly be tested in clinical trials. Looking at a website for clinical trials, www.clinicaltrials.gov,  I can see that there currently is one trial evaluating Anakinra in exercise ongoing done by a group led by Prof Donath in Zürich, but this trial is focusing only on the effects after a one-hour bout of exercise not likely to induce moderate or severe muscle damage (NCT01771445). In line with the hypothesis that IL-1Ra might be beneficial for DOMS is reports that indicate that new exercise, generating more IL-1Ra, is beneficial through the so called Repeated Bout Effect (RBE) (reviewed in for instance Assumpção Cde ScientificWorldJournal. 2013; 2013: 189149). The role of IL-1Ra and related substances in the immune system following exercise is really fascinating and I think we will learn and hear a lot more about this in the coming few years.