Recovery after Running an “Everesting” Mountain Ultramarathon

rkers of muscle microdamage and systemic in ammation do not adequately explain the reduced performance observed over a prolonged recovery after running a mountain ultra- marathon. This case study aimed to determine whether the reduced performance after the Everesting mountain ultramarathon can be further assessed by considering cardiorespiratory and metabolic alterations determined via repeated incremental and continuous running tests. A single runner (age: 24 years, BM: 70 kg, BMI: 22, Vo 2peak: 74 mL min 1 kg 1 ) was observed over a preparatory period of two months with a one-month recovery period. The Everesting consisted of nine ascents and descents of 9349 vertical metres completed in 18:22 (h:min). During the rst phase of the recovery, enhanced peak creatine kinase (800%) and C-reactive protein (44%) levels explained the decreased performance. In contrast, decreased performance during the second, longer phase was associated with a decreased lactate threshold and Vo 2(21% and 17%, respectively), as well as an increased energetic cost of running (15%) and higher endogenous carbohydrate oxidation rates (87%), lactate concentrations (170%) and respiratory muscle fatigue sensations that remained elevated for up to one month. These alterations may represent characteristics that can explain the second phase of the recovery process after Everesting. Keywords: relative running intensity; energetic cost; lactate threshold; carbohydrate oxidation rate; respiratory fatigue 1. Introduction Everesting ultramarathon running events evolved from the general

carbohydrate oxidation rates (87%), lactate concentrations (170%) and respiratory muscle fatigue sensations that remained elevated for up to one month. These alterations may represent characteristics that can explain the second phase of the recovery process after Everesting. Keywords: relative running intensity; energetic cost; lactate threshold; carbohydrate oxidation rate; respiratory fatigue 1. Introduction Everesting ultramarathon running events evolved from the general category of moun- tain ultramarathons (MUM) and ultramarathons. This running event consists of several uphill and downhill runs that reach or even exceed the cumulative terrestrial altitude of Mount Everest (8864 m). The altitude, the steepness, the nature of the routes (dry land, ice and rocks) and thus a high proportion of eccentric work and different, even extreme environmental conditions are the main differences compared to other ultramarathons. The decreased performance during these runs is a result of accumulated fatigue. Ultrama- rathons last several hours to days and are interrupted by rest breaks that are as short as possible. Decreased performance has been associated with an increased energy cost (Cr) during this event [1,2], muscle microdamage due to mechanical stress [3,4], oxidative stress [5,6], neuromuscular fatigue [7,8], systemic in ammation [9,10], respiratory muscle fatigue [11] and an imbalance between the effects of the anabolic hormone testosterone and the catabolic hormone cortisol [12]. The changes during an ultramarathon persist after these events in the recovery phase but eventually revert to their resting values. This phenomenon could be related to the return of an athlete's ultra-endurance performance to pre-competition levels. The most dramatic changes occur in the rst few days after an ultra- endurance competition. The typical blood markers for muscle microdamage, represented by creatine phosphokinase (CPK), and for systemic in ammation, represented by C-reactive protein (CRP), have been associated with a signi cant decrease in performance. Notably, Life2023,13, 1946.

Life2023,13, 1946 2 of 15 the aforementioned changes reach peak blood concentration about1–2 daysafter the ultra- marathon and then decrease toward the resting values within the next 3–5 days [13]. In contrast, performance tests used to assess recovery after ultramarathons showed a sustained decline in performance even after a longer period. Sherman et al. [14] reported decreased isokinetic torque during knee extension after as many as seven days. Similarly, Chambers et al. [15] found that vertical jump height decreased for 18 days. Warhol et al. [4] reported that muscle biopsies showed incomplete regeneration 12 weeks after an ultra- marathon. Although these parameters and the corresponding performance tests do not represent extreme endurance performance, they suggest that a return to pre-competition performance may take longer than ten days [4,13,16]. The aforementioned dramatic decrease in performance could be associated with an early dramatic increase in the blood markers of muscle damage and systemic in ammation. Despite these phenomena disappearing within days, the performance remained reduced. Hypothetically, the recuperation of performance during the recovery period after an ultra- marathon could represent two phases re ecting the typical behaviour of a dynamic system after the termination of an impulse [17]. We hypothesised that the same two phases may also occur after Everesting. The rst phase could be related to the early dramatic decrease in performance. The second phase follows the rst phase and could be a longer process asso- ciated with slow recovery from microdamage in exercising muscles [4]. These phenomena cannot be detected by blood markers measured during resting because they already reach their resting values typical for a period before the ultramarathon, with the exception of the values obtained via muscle biopsy [4]. Therefore, they may be associated with other factors. One of these could be the decrease in running ef ciency, as may be evidenced by increased energetic costs. Other markers should also be identi ed and selected to potentially assess changes in cardiorespiratory function through an increase in heart rate and ventilation and changes in metabolism through an altered selection between carbohydrates and fats as fuels. However, these alterations require

of these could be the decrease in running ef ciency, as may be evidenced by increased energetic costs. Other markers should also be identi ed and selected to potentially assess changes in cardiorespiratory function through an increase in heart rate and ventilation and changes in metabolism through an altered selection between carbohydrates and fats as fuels. However, these alterations require adequate exercise, perhaps in an ultrama- rathon, where they manifest themselves in an organism that has not yet fully recovered. Therefore, we hypothesise that uctuations in the potential parameters to be selected and tested in advance will be greater after Everesting than during the preparatory period and will disappear in conjunction with the increased performance during the second recovery phase, lasting one month or longer. Testing this hypothesis requires an incremental testing protocol and a continuous running test instead of resting measurements. A continuous running test needs initial, runner-speci c calibration according to intensity and duration to ascertain possible differences in uenced by training and those caused by Everesting and recovery. These tests should be repeated several times during the experimental procedure before Everesting (preparatory period) and after Everesting (recovery period). Managing a complex experiment needs careful planning, which can enable standardization of test- ing conditions, but also needs to be exible to disable interferences with training in the preparatory period and with recovery time course during the recovery period. To achieve these standards effectively, a case study research design was selected. 2. Case Report 2.1. Participant and Ethical Approval A single male subject was used in this study, an amateur ultramarathon runner (age: 24 years; BM: 70 kg; BMI: 22; Vo 2peak= 74 (ml min 1 kg 1 )). The runner had ve years of experience in endurance running. In the last two years, the subject specialised in Everesting. Preparation for the competition season started in November, but special preparation for Everesting started only two months before the event. At the time of the experiment, the runner was healthy and had no injuries. The subject gave his written informed consent, and the experimental procedure was approved by the Faculty

In the last two years, the subject specialised in Everesting. Preparation for the competition season started in November, but special preparation for Everesting started only two months before the event. At the time of the experiment, the runner was healthy and had no injuries. The subject gave his written informed consent, and the experimental procedure was approved by the Faculty of Sport Ethics Committee (FS8:2021).

Life2023,13, 1946 3 of 15 2.2. Experimental Design and Protocol The preparatory period for the Everesting trial consisted of two months of regular training. The additional month after Everesting represented a recovery period. The runner participated in the following tests: resting haematological venous blood measurements, a body composition test, an incremental test and a submaximal continuous running test (CRT), all on the treadmill. These tests were repeated according to the schedule shown in Table. Table 1.Testing schedule during the experimental period. Testing Day 58 54 47 27 25 18 2 0 1 3 5 8 10 12 19 25 30 Incremental test X X X TRIAL X X Continuous running test Xw Xc Xc Xw Xc Xw Xc Xw Hematological analyses X X X X X X Body composition X X X X X X X X X X—realised test; Xw—water beverage; Xc—carbohydrate beverage. Training in the last two months before Everesting consisted of two one-month meso- cycles. The training characteristics were designed by the runner. The rst of the two mesocycles consisted of ve 6-day microcycles of equal length. The rst day consisted of a continuous 30–40 km run at 3.5–3.8 m s 1 (LSD) (Figure). The fourth day consisted of a similar but shorter continuous 20–30 km run at about 4.6–4.8 m s 1 (LSD) (Figure). The second day of the microcycle consisted of 2 km runs repeated ve times at a speed of about 5.1–5.3 m s 1 (close to Vo 2peakintensity), with ve minutes of recovery in between (repeated distances) (Figure). The third and sixth days were recovery days.Life 2023, 13, x FOR PEER REVIEW 4 of 16 Figure 1. Training characteristics during the preparatory period for Evereting consisted of LSD— long, slow distance and repeated distances. 2.3. Measurements 2.3.1. Haematological Measurements Haematological tests were performed in the morning (fasted). Two venous blood samples of 5 and 3.5 mL were collected in SST II Advance BD Vacutainers and centrifuged at 1700 RPM for 10 min. Analyses were performed using Beckmann Coulter AU 680 (Beckmann, Boston, MA, USA) and Abbott Architect i1000 (Abbott, Abbott Park, IL, USA)

distances. 2.3. Measurements 2.3.1. Haematological Measurements Haematological tests were performed in the morning (fasted). Two venous blood samples of 5 and 3.5 mL were collected in SST II Advance BD Vacutainers and centrifuged at 1700 RPM for 10 min. Analyses were performed using Beckmann Coulter AU 680 (Beckmann, Boston, MA, USA) and Abbott Architect i1000 (Abbott, Abbott Park, IL, USA) devices. The third sample of 3 mL was collected in a BD Vacutainer K2E (Becton Dickinson, Franklin Lakes, NJ, USA) with EDTA. The haemogram was obtained using a Sysmex XN-1000 analyser. The tests were repeated six times according to a specifi c scheme (Table 1). 2.3.2. Body Composition Body composition was analysed using an InBody720 Body Composition Analyser (Seoul, Republic of Korea) in the morning (fasted). The test was repeated nine times according to a specific scheme (Table 1). 2.3.3. Incremental Testing Protocol The incremental test was repeated five times according to a specific schedule (Table 1). This test consisted of 4-min runs on a Pulsar treadmill (HP Cosmos, Nußdorf, Germany). The running speed was increased by 2 km·h −1 from an initial 2.2 m·s −1 (8 km·h −1 ). This exercise was interrupted for 0.5 min for blood sampling until the subject could no longer maintain his running speed due to fatigue. Continued breath-by-breath gas exchange was analysed using a Vmax Spectra (SensorMedics, Orange City, FL, USA). At every exercise stage, the blood lactate concentration [LA] was measured from a hyperaemic earlobe capillary blood sample (5 µL) using the Lactate Pro 2 analyser (Arkray, Kyoto, Japan). 2.3.4. Continuous Running Test (CRT) A continuous 120-min submaximal running test (CRT) at 3.9 m·s −1 (14 km·h −1 ) was performed eight times: four times with a carbohydrate drink (CHO, Xc) and four times with water (WAT, Xw), according to a specific schedule (Table 1). The velocity was selected to correspond with the Lactate Threshold [18,19] determined during the first test, which Figure 1. Training characteristics during the preparatory period for Evereting consisted of LSD—long, slow distance and repeated distances. The rst day consisted additionally of light stretching and general strength exercises.

four times with water (WAT, Xw), according to a specific schedule (Table 1). The velocity was selected to correspond with the Lactate Threshold [18,19] determined during the first test, which Figure 1. Training characteristics during the preparatory period for Evereting consisted of LSD—long, slow distance and repeated distances. The rst day consisted additionally of light stretching and general strength exercises. The fth training day consisted of about 20 km of fartlek and Nordic walking in the mountains. The fartlek training started with a steady run of light to moderate intensity, followed by two repetitions of about one kilometre of high–intensity running on slightly sloping terrain, and continued with a two–kilometre run with very steep descents. The rst half of the training ended with about three-kilometres of very steep Nordic walking. The second half of the training starts with a fast run of four-kilometres downhill, followed by two repetitions of runs of one kilometre uphill. The fartlek ends with a four–kilometre steep descent to the starting place. The rst two microcycles of the second mesocycle

Life2023,13, 1946 4 of 15 were a continuation of the microcycles in the rst mesocycle. The four other microcycles represented tapering in which the running volume was linearly reduced to the last 60% of the training volume in the rst mesocycle (Figure). The total training volume in both mesocycles was 750 km. 2.3. Measurements 2.3.1. Haematological Measurements Haematological tests were performed in the morning (fasted). Two venous blood samples of 5 and 3.5 mL were collected in SST II Advance BD Vacutainers and centrifuged at 1700 RPM for 10 min. Analyses were performed using Beckmann Coulter AU 680 (Beckmann, Boston, MA, USA) and Abbott Architect i1000 (Abbott, Abbott Park, IL, USA) devices. The third sample of 3 mL was collected in a BD Vacutainer K2E (Becton Dickinson, Franklin Lakes, NJ, USA) with EDTA. The haemogram was obtained using a Sysmex XN- 1000 analyser. The tests were repeated six times according to a speci c scheme (Table). 2.3.2. Body Composition Body composition was analysed using an InBody720 Body Composition Analyser (Seoul, Republic of Korea) in the morning (fasted). The test was repeated nine times according to a speci c scheme (Table). 2.3.3. Incremental Testing Protocol The incremental test was repeated ve times according to a speci c schedule (Table). This test consisted of 4-min runs on a Pulsar treadmill (HP Cosmos, Nußdorf, Germany). The running speed was increased by 2 km h 1 from an initial 2.2 m s 1 (8 km h 1 ). This exercise was interrupted for 0.5 min for blood sampling until the subject could no longer maintain his running speed due to fatigue. Continued breath-by-breath gas exchange was analysed using a Vmax Spectra (SensorMedics, Orange City, FL, USA). At every exercise stage, the blood lactate concentration [LA] was measured from a hyperaemic earlobe capillary blood sample (5 L) using the Lactate Pro 2 analyser (Arkray, Kyoto, Japan). 2.3.4. Continuous Running Test (CRT) A continuous 120-min submaximal running test (CRT) at 3.9 m s 1 (14 km h 1 ) was performed eight times: four times with a carbohydrate drink (CHO, Xc) and four times with water

[LA] was measured from a hyperaemic earlobe capillary blood sample (5 L) using the Lactate Pro 2 analyser (Arkray, Kyoto, Japan). 2.3.4. Continuous Running Test (CRT) A continuous 120-min submaximal running test (CRT) at 3.9 m s 1 (14 km h 1 ) was performed eight times: four times with a carbohydrate drink (CHO, Xc) and four times with water (WAT, Xw), according to a speci c schedule (Table). The velocity was selected to correspond with the Lactate Threshold [18,19] determined during the rst test, which was classi ed as “somewhat heavy” according to the Borg scale [20]. A 25-min rest period before the test was followed by a 10-min warm-up run of 2.2 m s 1 (8 km h 1 ), followed by a two-hour run brie y interrupted for measurement purposes (Figure). The runner arrived at the laboratory having consumed a diet of foods naturally low in 13 C for three days. The runner also avoided strenuous endurance training during this time. About 25 min before the start, Capsolin cream (Laboratorio Farmaceutico SIT, Mede, Italy) was applied to the skin of the earlobe to in uence hyperaemia. Respiratory gases were also collected at rest in a comfortable sitting position using a Vmax Spectre metabolic cart (Sensor Medics, Yorba Linda, CA, USA). In addition, two vacutainers (20 mL each) were lled with exhaled air to determine the 13 C/ 12 C ratio of exhaled air at rest. A micro-sample of 95 L capillary blood from a hyperaemic earlobe was collected to measure blood gas, acid–base, electrolyte, lactate [LA], and glucose [GLU] concentrations using an ABL800FLEX analyser (Radiometer, København, Denmark). The runner ingested a 6 mL kg 1 bolus of a 15% sugarcane solution (CHO) (Mascavo, Brusque, Brazil) 20 min before the start of the test. The sugarcane consisted of 87% sucrose, 2% glucose and 2% fructose with a high natural abundance of 13 C (d 13CVPDB= 9.8‰). Breath analysis to determine the 13 C/ 12 C ratio was performed using a Europa Scienti c 20–20 isotope ratio mass spectrometer with an ANCA- TG trace gas separation module (Europa Scienti

before the start of the test. The sugarcane consisted of 87% sucrose, 2% glucose and 2% fructose with a high natural abundance of 13 C (d 13CVPDB= 9.8‰). Breath analysis to determine the 13 C/ 12 C ratio was performed using a Europa Scienti c 20–20 isotope ratio mass spectrometer with an ANCA- TG trace gas separation module (Europa Scienti c, Cheshire, UK). The test run began with a 10-min warm-up at 2.8 m s 1 (Figure), which continued at 3.9 m s 1 (14 km h 1 ) until

Life2023,13, 1946 5 of 15 the rst interruption for approximately 20–30 s at 25 min to remove the breathing mask and put on a mask adapted for isotope breath sampling. The runner continued to run until the 27th minute. Breath sampling was performed in the last three minutes. Then, the run was interrupted for about 1 min to collect blood samples, consume the drink (this time, 2 mL kg 1 ) and put the breathing mask back on (Figure the second interruption, this time between the 45th and 50th minutes (and again in the interval between the 55th and 60th minutes) to remove and put on the breathing mask to collect breath for the isotope measurement (Figure). The third repetition of the procedure occurred between the 75th and 80th minutes and again in the interval between the 85th and 90th minutes. The fourth and nal repetition was performed between the 105th and 110th minutes and again in the interval between the 115th and 120th minutes (Figure). The last blood samples were taken immediately after the end of the run.Life 2023, 13, x FOR PEER REVIEW 5 of 16 was classified as “somewhat heavy” according to the Borg scale [20]. A 25-min rest period before the test was followed by a 10-min warm-up run of 2.2 m·s −1 (8 km·h −1 ), followed by a two-hour run briefly interrupted for measurement purposes (Figure 2). The runner arrived at the laboratory having consumed a diet of foods naturally low in 13 C for three days. The runner also avoided strenuous endurance training during this time. About 25 min before the start, Capsolin cream (Laboratorio Farmaceutico SIT, Mede, Italy) was applied to the skin of the earlobe to influence hyperaemia. Respiratory gases were also collected at rest in a comfortable sitting position usi ng a Vmax Spectre metabolic cart (Sensor Medics, Yorba Linda, CA, USA). In addition, two vacutainers (20 mL each) were filled with exhaled air to determine the 13 C/ 12 C ratio of exhaled air at rest. A micro-sample of 95 µL capillary blood from a hyperaemic earlobe was collected

The study investigates recovery metrics after an ultramarathon event.