The Impact of the COVID-19 Pandemic on Endurance and Ultra-Endurance Running

ckground and objectives: The COVID-19 outbreak has become a major health and economic crisis. The World Health Organization declared it a pandemic in March 2020, and many sporting events were canceled.Materials and Methods: We examined the effects of the COVID-19 pandemic on endurance and ultra-endurance running (UER) and analyzed nishes and events during the COVID-19 pandemic (observation period March 2020–October 2020) to the same time period pre- COVID-19 outbreak (March 2019–October 2019).Results:Endurance nishes decreased during the pandemic (459,029 to 42,656 (male: 277,493 to 25,582; female 181,536 to 17,074; allp< 0.001). Similarly, the numbers of endurance events decreased (213 vs. 61 events;p< 0.001). Average marathon nishing times decreased during the pandemic in men (5:18:03 0:16:34 vs. 4:43:08 0:25:08 h:min:s (p= 0.006)) and women (5:39:32 0:19:29 vs. 5:14:29 0:26:36 h:min:s (p= 0.02)). In UER, nishes decreased signi cantly (580,289 to 110,055;p< 0.001) as did events (5839 to 1791; p< 0.001). Popular event locations in United States, France, UK, and Germany decreased signi cantly (p< 0.05). All distance and time-limited UER events saw signi

men (5:18:03 0:16:34 vs. 4:43:08 0:25:08 h:min:s (p= 0.006)) and women (5:39:32 0:19:29 vs. 5:14:29 0:26:36 h:min:s (p= 0.02)). In UER, nishes decreased signi cantly (580,289 to 110,055;p< 0.001) as did events (5839 to 1791; p< 0.001). Popular event locations in United States, France, UK, and Germany decreased signi cantly (p< 0.05). All distance and time-limited UER events saw signi cant decreases (p< 0.05).Conclusions: The COVID-19 pandemic has had a signi cant effect on endurance and UER, and it is unlikely that running activities return to pre-pandemic levels any time soon. Mitigation strategies and safety protocols should be established. Keywords:COVID-19; endurance running; marathon; ultra-endurance; running; sport industry 1. Introduction The coronavirus (COVID-19) pandemic, due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a major health and economic crisis around the world during 2020 [1]. First reports of a new viral pneumonia appeared in December 2019 in Wuhan, China, and by January 2020, the World Health Organization (WHO) reported of the spread of a new type of Coronavirus—COVID-19 [2]. The virus rapidly expanded throughout the world, and in March 2020, the WHO declared it a pandemic [2]. Countries around the world implemented travel restrictions, closed borders, and imposed local and national lockdowns of varying degrees to reduce the spread of the virus and manage health care resources [1]. These measures also included the cancelation of mass gathering and sporting events in order to reduce and control the spread of the virus, as particularly mass gatherings and sporting events on a large scale present unique challenges to public health authorities and governments [3]. Undoubtedly, this has had adverse effects on the economy, with tourism and sport tourism being important economic sectors and likely some of the sectors most severely impacted due to lockdowns, travel restrictions, and closed borders [1,4]. The Medicina2021,57, 52.

Medicina2021,57, 52 2 of 8 extent to which this has affected endurance and ultra-endurance running (UER) events and nishing numbers is not known. The most prominent cancelations or (postponements) of sporting events due to the COVID-19 pandemic are the Olympic Games in Tokyo 2020 and Union of European Football Associations (UEFA) Euro 2020 Football Championships [3]. However, similarly, all other professional and amateur sports, including football, basketball, golf, athletics, triathlon etc. were initially canceled or postponed, with some professional sports (e.g., football, basketball, golf) being allowed to resume sometime later despite ongoing lockdowns or restrictions of movements under strict public health protocols [5,6]. Endurance running events in 2020 were no exception, with cancelation or postpone- ments of big city marathons such as those in Berlin, Paris, Boston, New York, and London due to safety concerns [7]. Some events were hosted as virtual competitions, whereas others such as the Tokyo marathon 2020 were only open to elite runners [7]. This has had important economic effects on the host city, as most of these big marathons attract around 50,000 participants. For the New York City Marathon, it was estimated that, in 2014, the economic impact of the race was approximately 415 million US dollars [8]. Thus, cancelation of any of these mass gathering events will likely have an important effect on the sporting industry and the local economy. However, not only mass gathering events and prominent races were canceled due to the COVID-19 pandemic but also many smaller and local endurance events, with an impact on the local economy and the sporting community that is still not fully understood, and its effects are dif cult to estimate. Similarly, cancelation of ultra-endurance running (UER) events occurred, such as the Ultra Trail du Mont-Blanc ® 2020, one of the most well-known UER event worldwide that usually attracts over 7000 participants from all around the world and with race distances of up to 170 km [9]. Other iconic races, such as the Comrades marathon in South Africa, the oldest ultramarathon, as well as the oldest 100 km race (Bieler Lauftage), the Spartathlon, a 246 km

® 2020, one of the most well-known UER event worldwide that usually attracts over 7000 participants from all around the world and with race distances of up to 170 km [9]. Other iconic races, such as the Comrades marathon in South Africa, the oldest ultramarathon, as well as the oldest 100 km race (Bieler Lauftage), the Spartathlon, a 246 km race in Greece, and many more UER were canceled or held virtually in 2020 [10,11]. The Two Oceans Marathon, a prominent race in South Africa, was also canceled in 2020, a race that attracted over 34,000 participants in 2019 [4]. Many of these events were canceled at short notice with considerable loss to the stakeholders, and in the case of the Two Oceans Marathons, the estimated loss of revenue was thought to be in the region of 2 million dollars [4]. However, considering endurance and UER events as a whole, the vast majority of races are smaller events (e.g., the Al Andalus Ultra Trail in Spain or the Isle of Wight Ultra Challenge in the UK) with fewer participant and less revenue at individual races; nevertheless, they represent an integral part of the sporting community and the wider sporting tourism branch. Running is an important sporting activity and one of the most popular sports world- wide that has seen an important increase in participation in endurance and UER events over the last few decades [12,13]. Therefore, it is worth a closer examination of the effects from the COVID-19 pandemic on this sporting sector. The main aim of this study, therefore, was to explore the impact of the COVID-19 pandemic on the number of endurance and UER events and nisher numbers as well as a secondary aim to explore the age and the nishing marathon times during the rst few months of the COVID-19 pandemic (March 2020–October 2020) and compare them to the same time period pre-COVID-19 pandemic (March 2019–October 2019) to evaluate the effect COVID-19 has had so far on the endurance and UER event sector. Our hypothesis was that nishes and events in endurance and UER would decrease signi

and the nishing marathon times during the rst few months of the COVID-19 pandemic (March 2020–October 2020) and compare them to the same time period pre-COVID-19 pandemic (March 2019–October 2019) to evaluate the effect COVID-19 has had so far on the endurance and UER event sector. Our hypothesis was that nishes and events in endurance and UER would decrease signi cantly during the COVID-19 pandemic. 2. Materials and Methods Marathons (distance 42.195 km) were classi ed as endurance running events, while UER events included running distances over marathon distance, timed-events over 6 h duration, and multi-day and multi-stage events on all running surfaces [14].

Medicina2021,57, 52 3 of 8 2.1. Ethical Procedures This study was approved by the Institutional Review Board of Kanton St. Gallen, Switzerland, with a waiver of the requirement for informed consent of the participant as the study involved the analysis of publicly available data (EKSG 01-06-2010). The study was conducted in accordance with the recognized ethical standards according to the Declaration of Helsinki (2013). 2.2. Data Sampling Data on marathon results were obtained through the publicly available database, accessible through the website (http://www.marathonguide.com/results/). This database represents the largest marathon database in the world. Data on UER events were obtained from a publicly available database, accessible through the website of the Deutsche Ultra- marathon Vereinigung (DUV) at:. The DUV contains the largest dataset on UER worldwide and has been frequently evaluated within the scienti c literature [10,15,16]. Data on race events, race location, race distance, nishing numbers, race time, sex, and nationality were, when available and accessible, analyzed for the time period since the declaration of the COVID-19 pandemic by the WHO in March 2020 [2] until the end of data sampling in October 2020 COVID-19 pandemic period (March 2020–October 2020) and compared to the same time period in the prior year, called the pre-pandemic period (March 2019–October 2019). In total, 1,192,029 nishes in 7478 events were examined. 2.3. Data Analysis Kolmogorov–Smirnov test was applied to test for normality. Descriptive analysis was performed and presented as mean and relative (%) frequency and change. Mean marathon nishing times and age were also presented with standard deviations (SD). An independentt-test was used to test the differences between groups and Mann–Whitney test for not normally distributed data (pre-pandemic vs. pandemic). Statistical signi cance was set at 5% (p< 0.05). All analyses were carried out using the Python programming language (Python Software Foundation,), Google Colab notebook, and the Statistical Software for the Social Sciences (IBM SPSS v26. Chicago, IL, USA). 3. Results Data and results for endurance (marathon) running are available in Table. The number of marathon nishes according to sexes with monthly breakdowns and percentage change during the COVID-19 pandemic was compared to the

using the Python programming language (Python Software Foundation,), Google Colab notebook, and the Statistical Software for the Social Sciences (IBM SPSS v26. Chicago, IL, USA). 3. Results Data and results for endurance (marathon) running are available in Table. The number of marathon nishes according to sexes with monthly breakdowns and percentage change during the COVID-19 pandemic was compared to the pre-pandemic period and is shown in Table. Monthly breakdowns were used to demonstrate the evolution of the pandemic, as at different time points, different lockdown restrictions applied throughout the world. A 10.8-fold drop could be observed in total nishes pre- to pandemic times, with almost no nishes during April/May 2020. Table 1. Data on number of marathon nishes according to sexes with monthly breakdowns and percentage change during the time period of the start of the COVID pandemic (March 2020) until the end of the observation period (October 2020) and comparison to the same time period pre-COVID in 2019 (March–October 2019). March April May June July August September October Total Marathon nishes 2019 45,593 100,898 66,159 28,176 15,633 11,512 26,996 164,062 459,029 Marathon nishes 2020 32,549 8 0 199 293 1872 4676 3059 42,656 * Change (%) 28.6 100.0 100.0 99.3 98.1 83.7 82.7 98.1 90.7 Male nishes 2019 27,812 58,521 41,680 17,187 10,161 8058 17,277 96,797 277,493 Male nishes 2020 19,204 4 0 137 170 1179 2899 1988 25,582 * Change (%) 31.0 100.0 100.0 99.2 98.3 85.4 83.2 97.9 93.0 Female nishes 2019 17,781 42,377 24,479 10,989 5472 3454 9719 67,265 181,536 Female nishes 2020 13,345 4 0 62 123 693 1777 1071 17,074 * Change (%) 24.9 100.0 100.0 99.4 97.8 79.9 81.7 98.4 92.8 *p< 0.001.

Medicina2021,57, 52 4 of 8 The number of endurance events dropped signi cantly pre-pandemic to the COVID- 19 pandemic period from 213 to 61 races in the database (p< 0.001), an approximately 3.5-fold drop. Most events were held in United States (pre-pandemic vs. pandemic 61.6% vs. 72.7%), United Kingdom (10.7% vs. 11.4%), and Canada (10.0% vs. 4.5%), and the majority of nishes originated from the United States (pre-pandemic vs. pandemic 72.0% vs. 93.5%). The ratio between nishes per event dropped from 2.155 pre-pandemic to 700 nishers/event during the COVID-19 pandemic (p< 0.001), suggesting that events were smaller during the pandemic, as less nishes were observed. The average age of nishers pre-pandemic was 47.8 2.0 years and, during the pandemic, was 43.6 4.3 years (p= 0.02), with female nishers pre-pandemic 46.0 2.08 years compared to 42.6 2.3 years during the pandemic (p= 0.01) and for male nishers 48.9 2.1 years and 43.6 4.3 years (p= 0.02), respectively. Average marathon nishing times for men pre-pandemic were 5:18:03 0:16:34 h:min:s compared to 4:43:08 0:25:08 h:min:s (p= 0.006) pandemic period and for women 5:39:32 0:19:29 h:min:sec compared to 5:14:29 0:26:36 h:min:s (p= 0.02), respectively. Data for UER nishes, event distances, and event locations are shown in Tables–4. Data for UER event nishes, ultra events, and nishes per event with monthly breakdowns and percentage change during the COVID pandemic compared to the pre-pandemic period are shown in Table. Table 2. Data for ultra-endurance event nishes, ultra events, and nishes per event with monthly breakdowns and percentage change during the time period of the start of the COVID pandemic (March 2020) until the end of the observation period (October 2020) and comparison to the same time period pre-COVID in 2019 (March–October 2019). March April May June July August September October Total Finishes Ultra 201956,741 96,709 74,678 107,273 58,196 54,627 62,147 69,927 580,289 Finishes Ultra 202021,310 680 1262 3031 10,124 20,978 27,860 24,810 110,055 * Change (%) 62.4 99.3 98.3 97.2 82.6 61.6 55.2 64.5 81.0 Ultra events 2019 577 643 775 883 648 707 799 807 5839 Ultra events 2020 205 21 49 92 175 360

July August September October Total Finishes Ultra 201956,741 96,709 74,678 107,273 58,196 54,627 62,147 69,927 580,289 Finishes Ultra 202021,310 680 1262 3031 10,124 20,978 27,860 24,810 110,055 * Change (%) 62.4 99.3 98.3 97.2 82.6 61.6 55.2 64.5 81.0 Ultra events 2019 577 643 775 883 648 707 799 807 5839 Ultra events 2020 205 21 49 92 175 360 447 442 1791 * Change (%) 64.5 96.7 93.7 89.6 73.0 49.1 44.1 45.2 69.3 Finishes/event 2019 98.3 150.4 96.4 121.5 89.8 77.3 77.8 86.7 99.8 Finishes/event 2020 104.0 32.4 25.8 32.9 57.9 58.3 62.3 56.1 53.7 # Change (%) 5.7 78.5 73.3 72.9 35.6 24.6 19.9 35.2 46.2 *p< 0.001, # p< 0.05. Table 3. Data for ultra-endurance event nishes in distance-limited events (50 km, 100 km, and 100 miles) and time-limited events (6 h, 12 h, and 24 h) with monthly breakdowns and percentage change during the time period of the start of the COVID pandemic (March 2020) until the end of the observation period (October 2020) and comparison to the same time period pre-COVID in 2019 (March–October 2019). Finishes March April May June July August September October Total 50 km 2019 19,289 36,907 17,831 14,433 10,126 10,206 6554 15,424 130,770 50 km 2020 5626 32 126 390 974 3588 4921 5189 20,846 † Change (%) 70.8 99.9 99.3 97.3 90.4 64.8 24.9 66.4 84.1 100 km 2019 6690 5013 2848 8915 5097 3112 7819 9059 48,553 100 km 2020 250 19 205 149 467 992 3782 1240 7104 # Change (%) 96.3 99.6 92.8 98.3 90.8 68.1 51.6 86.3 85.4 100 miles 2019 1364 604 1521 3113 1103 3092 2484 3257 16,538 100 miles 2020 129 0 41 34 604 289 1340 1048 3485 † Change (%) 90.5 100.0 97.3 98.9 45.2 90.7 46.1 67.8 78.9 6 h 2019 4902 4175 3621 2206 2587 1617 8292 3043 30,443 6 h 2020 2374 0 0 282 460 717 936 2917 7686 † Change (%) 51.6 100.0 100.0 87.2 82.2 55.7 88.7 4.1 74.8 12 h 2019 1329 3825 3477 3673 3406 1586 484 3919 21,699 12 h 2020

90.5 100.0 97.3 98.9 45.2 90.7 46.1 67.8 78.9 6 h 2019 4902 4175 3621 2206 2587 1617 8292 3043 30,443 6 h 2020 2374 0 0 282 460 717 936 2917 7686 † Change (%) 51.6 100.0 100.0 87.2 82.2 55.7 88.7 4.1 74.8 12 h 2019 1329 3825 3477 3673 3406 1586 484 3919 21,699 12 h 2020 143 0 84 246 761 646 1334 1717 4931 † Change (%) 89.2 100.0 97.6 93.3 77.7 59.3 175.6 56.2 77.3 24 h 2019 1753 905 6617 4940 466 3645 865 1910 21,101 24 h 2020 243 0 162 24 1677 1043 1540 895 5584 † Change (%) 86.1 100.0 97.6 99.5 259.9 71.4 78.0 53.1 73.5 # p< 0.001, † p< 0.05.

Medicina2021,57, 52 5 of 8 Table 4. Event location (country) of ultra-endurance running events pre- COVID-19 (March 2019-Ocotber 2019) compared with monthly numbers and total numbers and percentage change to the observation period during the COVID-19 pandemic (March 2020–October 2020) with listings of the top three event locations (pre-COVD-19: USA, FRA (France), and GBR (Great Britain); COVID-19 pandemic: USA, GER (Germany), and UK (United Kingdom)), with percentage of all event locations during that particular month). Further analysis of the location with the greatest change during the observation period is included (TPE: China Tapei). Ultra Event Location March April May June July August September October Total 2019 USA (%) 183 (31.7) 214 (33.3) 210 (27.1) 199 (22.5) 161 (24.8) 216 (30.6) 217 (27.2) 266 (33.0) 1666 (28.5) 2020 USA (%) 84 (41.0) 0 (0.0) 13 (26.5) 29 (31.5) 58 (33.1) 80 (22.2) 126 (28.2) 173 (39.1) 563 (31.4) * Change (%) 54.1 100.0 93.8 85.4 64.0 63.0 41.9 35.0 66.2 2019 FRA (%) 30 (5.2) 67 (10.4) 65 (8.4) 103 (11.7) 68 (10.5) 35 (5.0) 43 (5.4) 58 (7.2) 469 (8.0) 2020 FRA (%) 15 (7.3) 0 (0.0) 0 (0.0) 0 (0.0) 4 (2.3) 33 (9.2) 25 (5.6) 21 (4.8) 98 (5.5) # Change (%) 99.8 N/A N/A N/A 99.6 99.9 99.9 99.9 100.0 2019 UK (%) 44 (7.6) 28 (4.4) 64 (8.3) 63 (7.1) 50 (7.7) 54 (7.6) 86 (10.8) 32 (4.0) 421 (7.2) 2020 UK (%) 11 (5.4) 0 (0.0) 0 (0.0) 1 (1.1) 3 (1.7) 17 (4.7) 31 (7.0) 36 (8.1) 99 (5.5) * Change (%) 99.8 N/A N/A 98.4 99.3 99.9 100.0 99.9 100.0 2019 GER (%) 30 (5.2) 23 (3.6) 30 (3.9) 50 (5.7) 27 (4.3) 58 (8.2) 37 (4.6) 23 (2.9) 278 (4.8) 2020 GER (%) 5 (2.4) 0 (0.0) 4 (8.2) 11 (12.0) 13 (7.4) 30 (8.3) 29 (6.5) 27 (6.1) 119 (6.6) # Change (%) 83.3 100.0 86.7 78.0 51.9 48.3 21.6 17.4 57.2 2019 TPE (%) 20 (3.5) 24 (3.7) 13 (1.7) 20 (2.3) 12 (1.9) 18 (2.5) 15 (1.9) 16 (2.0) 138 (2.4) 2020 TPE (%) 10 (4.9) 19 (90.5) 17

(%) 5 (2.4) 0 (0.0) 4 (8.2) 11 (12.0) 13 (7.4) 30 (8.3) 29 (6.5) 27 (6.1) 119 (6.6) # Change (%) 83.3 100.0 86.7 78.0 51.9 48.3 21.6 17.4 57.2 2019 TPE (%) 20 (3.5) 24 (3.7) 13 (1.7) 20 (2.3) 12 (1.9) 18 (2.5) 15 (1.9) 16 (2.0) 138 (2.4) 2020 TPE (%) 10 (4.9) 19 (90.5) 17 (34.7) 12 (13.0) 12 (6.9) 19 (5.3) 14 (3.1) 6 (1.4) 109 (6.1) # Change (%) 50.0 20.8 30.8 40.0 0.0 5.6 6.7 62.5 21.0 *p< 0.001, # p< 0.05. A 5.3-fold decrease in UER nishes can be observed during the COVID-19 pandemic, and a 3.3-fold decrease in UER events. Finishes per events also decreased from 99.8 to 53.7 nishes/event, a 1.9-fold decrease, demonstrating that events were smaller with fewer nishes. The 50 km distance remained the most popular UER distance, and data for UER event nishes in distance-limited events (50 km, 100 km, and 100 miles) and time-limited events (6 h, 12 h, and 24 h) with monthly breakdowns and percentage change during the COVID pandemic compared to pre-pandemic period are shown in Table. UER event locations (countries) during the COVID-19 pandemic are compared monthly to the pre-pandemic period and shown in Table. The three top event locations pre- pandemic were USA, France, and United Kingdom and during the COVID-19 pandemic were USA, Germany, and United Kingdom. For further comparison and illustration, the UER events of China Tapei are shown, as this location showed, in contrast to others, a relative increase during the COVID-19 pandemic, especially in April 2020 with over 90% of events hosted in this location. Additionally, UER event numbers and performances from 2018 (6708 vs. 609,847) increased to 2019 (7468 vs. 671,738), increases of 11.3% and 10.1%, respectively. 4. Discussion Running is one of the most popular sports worldwide, with endurance and UER showing important increases in participation and nishes over the last few decades [13,14]. Since the onset of the COVID-19 pandemic in March 2020 [2], many sporting events were canceled or postponed, but the impact of the pandemic on endurance and UER has not

This study examines the effects of the COVID-19 pandemic on endurance and ultra-endurance running.