Ultra Triathlon Italy

From September 4 to November 25, the “Ultra Triathlon Italy” will take place, featuring triathlon courses up to 30 times the distance of an Ironman and running courses up to 7,000 kilometers.

The shortest triathlon course was the Double Iron.

The swim took place at the “I Borghi di Lugana” outdoor pool. Then, cyclists had to complete 7.6-kilometer loops; the road was full of potholes, and on an Ironman-distance course, they had to climb about 1,000 meters in elevation. The run took place on a 1.1-kilometer loop, which

Musculoskeletal (Mal)adaptations in Response to a > 30 000-km Running Challenge

Ultra-endurance sports are increasingly popular, yet the long-term physiological consequences of sustained extreme training loads remain poorly understood. In particular, the effects of prolonged ultra-endurance exercise on skeletal muscle structure, function and molecular remodelling are largely unknown. This case study examined a highly experienced ultra-endurance athlete who completed a world-record attempt to run 30 300 km, with extensive phenotyping focusing on skeletal muscle adaptations and recovery. A 49-year-old male athlete (172 cm, 65 kg) ran ~70 km daily for 15 months. Musculoskeletal, cardiac and visceral ultrasonography, leg muscle strength and power measurements were performed before and after the challenge. Muscle biopsies (n = 4) from vastus lateralis were obtained immediately after completion and during 17 months of recovery to assess myosin heavy chain (MHC) composition, mitochondrial electron transport chain (ETC) complexes and proteins involved in mitochondrial turnover, autophagy and inflammation. Body composition, haematological and biochemical markers, and gut microbiota composition were monitored longitudinally. The athlete ran 30 300 km over 444 days, maintaining a daily distance of ~70 km despite substantial musculoskeletal discomfort, including a tibial stress reaction mid-challenge, which resolved gradually with continued running. Body mass decreased by ~3 kg, primarily reflecting fat loss (~83%), accompanied by reductions in muscle thickness, maximal strength and power. Circulating creatine kinase (3-15-fold), oxidative stress markers (~50%) and GDF8 (~10%-50%) were sustainedly increased, whereas IGF-I decreased (~10%-40%), suggesting a reduced anabolic environment during the challenge. Muscle biopsy analyses revealed a progressive recovery of mitochondrial function during the 17 months following the challenge, as evidenced by a progressive increase in ETC protein abundance and the expression of regulators of mitochondrial dynamics and quality control (MFN2, PARKIN, DRP1). In contrast, markers of autophagy, apoptosis and inflammation were decreased during the 17-months post-challenge (LC3A/B-I by ~50%, CASP3 by ~60% and NF-κBSer536 by ~20%). Muscle fibre composition showed extreme predominance of slow fibres (nearly 100% MHC-I), which persisted during recovery. Most molecular and functional alterations gradually resolved within 10-17 months. Gut microbiota diversity increased during the challenge, with enrichment of Bifidobacterium during running and Akkermansia during recovery. Sustaining daily ultrarunning for more than 1 year induces substantial skeletal muscle remodelling, including reduced muscle size, impaired contractile function and mitochondrial maladaptations, despite largely preserved endocrine and haematological stability. These findings highlight skeletal muscle as a primary physiological system challenged during extreme endurance exercise and demonstrate that recovery from such perturbations may require more than one year.

Generalized anxiety disorder is associated with self-reported injury history among Brazilian ultramarathoners

Injuries among ultramarathoners are influenced by training load, recovery characteristics, anthropometric, and biomechanical characteristics. Beyond these contributors, there is increasing interest in understanding how psychological and behavioural factors may influence injury frequency and severity. Our purpose was to identify the prevalence of injuries among Brazilian ultramarathoners and the individual, training, and psychological variables associated with a higher risk of injuries. This is a cross-sectional, web-based research design that sampled Brazilian ultramarathoners of both sexes. Data was collected through an online survey during April and June 2025. The questionnaire collected information about: sex, age, body weight and height, training parameters, injury occurrence, general anxiety disorder (GAD), and exercise addiction. Ultramarathoners were classified for the GAD and exercise addiction, using specific cut-off points. An independent t-test and logistic regression model were used for the total sample and both sexes, adopting 95% of confidence interval (CI). The study included 495 ultramarathoners (44.5 ± 9.9 years). Injury prevalence was 27.7%. For the total sample, BMI (OR = 1.08; 95%CI = 1.00 to 1.13), GAD low (OR = 1.62; 95%CI = 1.00 to 2.64), and GAD severe (OR = 3.26; 95%CI = 1.32 to 8.03) increased the injury risk. For women, age and GAD severe (OR = 15.92; 95%CI = 2.47 to 102.31) were significantly associated with injury, while for men, an association was observed for GAD low (OR = 1.76; 95%CI = 1.03 to 3.02). Age, BMI, and generalized anxiety disorder were significantly associated with injury risk, with women classified as having severe symptoms showing greater vulnerability.

Gotthard Marathon

The first Gotthard Marathon took place on August 22. After the start at the Göschenen train station, runners first had to climb 1,266 meters in elevation to the Gotthard Pass, and then descended 1,383 meters to Airolo and Ambri-Piotta.

ORTA 10in10

From August 5 to 14, ORTA 10in10 took place once again—that is, 10 marathons in 10 days, with 4x10 km runs along Lake Orta every day.

With temperatures reaching 39.5 degrees and 10 days of nonstop sunshine, the challenge was to keep going.

Double Iron Estonia

The ULTRA TRIATHLON ESTONIA took place.

With very cool temperatures in the far north, the swim took place in a small indoor pool in Vinni, followed by a bike course with heavy traffic in and around Vinni, and finally a few laps around the high school.

Diabetes Mellitus and Long-Distance Running: A Systematic Review

Athletes with diabetes increasingly participate in endurance running, benefiting from physiological adaptations and technological advances like continuous glucose monitoring (CGM) for glycemic control. So far, no comprehensive review summarizing the current knowledge has been performed. To identify the prevalence of long-distance runners with diabetes, their performance, methods used for blood glucose monitoring and glycemic control. PubMed, Medline Ovid, Scopus, SPORTDiscus, Cochrane databases, CINAHL, and Web of Science were systematically searched until April 2024 using key terms related to long-distance running and diabetes. An updated search applying the identical strategy was conducted on May 3rd, 2026, to capture subsequently published literature. This study included original research articles, case reports, and case studies published in English or German in peer-reviewed journals, utilizing both quantitative and qualitative methodologies. Eligibility criteria encompassed runners with a confirmed diagnosis of diabetes mellitus, irrespective of type, who participated in endurance events of at least half-marathon distance, including half-marathons, marathons, ultra-marathons, and other ultra-endurance competitions. Patients with prediabetic state, gestational diabetes, or after pancreatic islet-cell transplantation were excluded. For quality assessment, we used the Joanna Briggs Institute of Analytical Cross-Sectional Studies or the Joanna Briggs Institute of Analytical Case Report critical appraisal tool. A total of 656 studies were identified, with 22 meeting the inclusion criteria, comprising 99 runners with diabetes (99.0% Type 1, 1.0% Type 2 diabetes mellitus). Among them, 50.0% used CGM, 27.2% had an insulin pump, 63.6% administered insulin via multiple daily injections, and the method of insulin application was not specified in 7.0% of runners. The weighted mean HbA1c was 7.4% (95% CI 6.9–8.1). Time-in-range varied by race distance: 40–100% for half-marathoners, 51.6% for marathoners, and 47–73% for ultra-marathoners. No cases of symptomatic hypoglycemia were observed during the races. However, asymptomatic late-onset hypoglycemia (occurring 6–15 h post-exercise) was reported in 27 runners. The most common insulin adjustment strategy before competitive races was a 50–80% reduction of basal insulin. Despite limited research, evidence suggests that with proper preparation and multidisciplinary support, athletes with diabetes can safely participate in endurance events, including ultra-marathons, while maintaining stable glycemic control.

Nationality patterns of the fastest marathon runners across age groups in the Berlin marathon

While the dominance of elite East African marathoners is well-established, little is known about the nationality distribution of the fastest age group marathoners. This study examined how the nationality distribution of the fastest marathon runners varies across age groups and sexes in the ‘Berlin Marathon’. We analysed race data from 825,886 finishers (627,962 men and 197,807 women) of the ‘Berlin Marathon’ from 1999 to 2024. Finishers were grouped by five-year age brackets, sex and nationality. We examined performance across five analytical layers: (1) all runners, (2) top 100, (3) top 30, (4) top 10 and (5) the single fastest runner per country and age group. Linear regression models were applied to both the entire dataset and the subset of the top 100 finishers per age group to assess the predictive value of age and nationality on finish time. Most finishers were from Germany, with the USA becoming the second-most represented country after 2017. In younger age groups (20-39 years), the fastest average times for both sexes were achieved by runners from Kenya and Ethiopia. In middle-aged (40-49 years) and older groups (50 + years), top performances shifted toward runners from Germany, the United States, Japan, and Switzerland. In regression models, age group and nationality explained only 4.1% of the variance in male finish times and 2.9% in females across the full dataset. However, for the top 100 runners, explanatory power rose significantly to 52.8% for men and 48.6% for women. The nationality distribution of the fastest age group marathoners shifts with age in the ‘Berlin Marathon’: East African nations dominate at younger ages, while Western Europe and East Asian countries lead among older runners. These results emphasize the global expansion of competitive master running and the role of cultural and demographic factors in shaping endurance performance across the lifespan.

Performance, physiology, and determinants of success in IRONMAN® 70.3: A systematic review

IRONMAN® 70.3 events represent a rapidly expanding endurance discipline characterized by distinct physiological demands, performance determinants, and race-specific risk profiles. Despite their global popularity, no systematic review has synthesized evidence exclusively focused on this distance. To consolidate current knowledge on performance predictors, physiological responses, training characteristics, nutritional strategies, environmental influences, and medical considerations in IRONMAN® 70.3 triathletes, and to identify gaps requiring further investigation. A systematic search of PubMed, Scopus, SciELO, EBSCO and Google Scholar was conducted up to 25th November 2025. Search terms were developed according to PRISMA guidelines and included variations of ‘Ironman 70.3’, ‘half triathlon’ and ‘middle-distance triathlon’. Eligible studies reporting physiological, anthropometric, nutritional, environmental, medical, or performance-related outcomes specific to IRONMAN® 70.3. Risk of bias was assessed using the Newcastle–Ottawa Scale, the Cochrane RoB tool, and the NIH Quality Assessment Tool, according to study design. A total of 86 studies were included, predominantly observational in design, with sample sizes ranging from 1 to 852,721 participants, mostly trained male triathletes aged 25–39 years. Participation has increased across age groups, with pronounced growth among female and masters triathletes. Peak performance in professional male triathletes is reached at approximately age 28, and in female triathletes at age 32. Across large datasets, cycling appeared to be the strongest predictor of overall race time, accounting for the largest proportion of performance variance. Physiologically, competition was associated with transient reductions in immune function, reversible muscle damage, and shifts in hydration and electrolyte balance, while higher intracellular water and efficient fat oxidation were associated with better outcomes. Evidence specific to IRONMAN® 70.3 is limited by small sample sizes, heterogeneous designs, male-dominated cohorts, and insufficient sex-specific analyses. Future research should distinguish recreational from elite triathletes, incorporate balanced sex representation, and apply standardized physiological and environmental monitoring to refine targeted recommendations for performance, health, and safety.