To answer this difficult question, we have checked historical records and considered the following marathons and achievements:

  • World-record (WR) performances.
  • Olympic Games and World Athletics Championships marathons: first 5 places.
  • World Marathon Majors Series, comprising Boston, Chicago, New York, London, Berlin and Tokyo: first 3 positions.

Although the Majors Series only started per se in 2006 we have considered all available results.

Marathon comparison: Kenya vs. Ethiopia



For Kenya, 5 different runners have broken the WR, all of them in the Berlin Marathon: Paul Tergat (2003), Patrick Musyoki (2011), Wilson Kipsang (2013), Dennis Kimetto (2014) and Eliud Kipchoge (2018).

For Ethiopia, Abebe Bikila did it twice, to win the gold medal in the Olympics of Rome 1960 and Tokyo 1964, while Haile Gebrselassie did it consecutively in the Berlin Marathons of 2007 and 2008. Additionally, Belayneh Dinsamo broke the WR in Rotterdam in 1988.

Both countries have broken the WR 5 times: TIE


Kenya has won two Olympic gold medals: Samuel Wanjiru in Beijing 2008 and Eliud Kipchoge in Rio 2016. There also 3 silvers, 2 bronzes and a 5th place.

As mentioned previously, Ethiopia won the Olympics of Rome 1960 and Tokyo 1964 with Abebe Bikila. In 1968 Ethiopia got a third consecutive victory with Mamo Wolde in Mexico 1968. Ethiopia´s latest victory was with Gezahegne Abera in Sydney 2000. Additionally, they have 1 silver, 2 bronzes and a 4th place.

Although both countries have been very successful at Olympic level: Ethiopia WINS in this section.


Kenya has won the title in 5 occasions, with Ethiopia winning it only in 2. In total numbers Kenya added 3 silvers, 1 bronze and 1 5th place, while Ethiopia added 5 silvers, 3 bronzes and 3 4th places.

Considering only victories, Kenya is ahead, although Ethiopia compensates considering its results globally. We consider it a TIE.


It is in this section that there is the biggest difference of them all.

Kenya has won 94 Majors since its first victory in 1983, with a total of 253 podium positions. And the impressive numbers don´t finish here. Since 1987 a Kenyan athlete has won at least one of the Marathon Majors every year. Furthermore, in 2007, 2014 and 2017, Kenya won 5 of the 6 annual Majors. In the 40 years going from 1981 to 2020 there has been 206 Major Marathons: Kenya has won a 45.6% of them.  His best athlete in this section has been Eliud Kipchoge, winning by himself a total of 7 Majors, and breaking the WR in Berlin 2018.

Ethiopia has won a “mere” total of 24 Majors. The best athlete in these events has been Haile Gebrselassie, winner of 4 consecutive editions of the Berlin Marathon between 2006 and 2009, breaking twice the WR.

Winner in this section: Kenya WINS.



Despite the Olympic advantage of Ethiopia, and because of the massive difference in the World Marathon Majors section, KENYA would be the WINNER of this marathon duel in male category. 

Some of the best marathon runners from Kenya



Kenya has broken the WR in 4 occasions: Tegla Loroupe did it twice (1998 and 1999), Catherine Ndereba (2001) and Brigid Kosgei (2019).

No Ethiopian woman has broken the WR yet.

Kenya WINS clearly this section.


Women´s marathon only entered the Olympics in Los Angeles 1984. Both countries have won one Olympic title: Tiki Gelana did so for Ethiopia in London 2012 while Jemima Sumgong did the same for Kenya in Rio 2016.

Kenya also got 3 silver medals (Catherine Ndereba in 2004 and 2008, and Priscah Jeptoo in 2012) for 0 of Ethiopia. They have similar 3rd and 4th places, with Kenya having a 5th place.

Although tied in victories, due to the number of top 5 positions, Kenya WINS.


Kenya has won 5 titles. Catherine Ndereba (2003 and 2007) and Edna Kiplagat (2011 and 2013) did it twice, while Ruth Chepngetich won the last title in 2019.

Ethiopia has won only 1 world title: Mare Dibaba in 2015.

Additionally, Kenya could count also with 4 silver medals against 0 for Ethiopia-

Kenya WINS clearly this section also.


Not as markedly as with the men but there are also important differences in this section.

Kenya has won 53 Majors since its first victory in 1994 and occupied the podium 144 times. The country has had many top athletes over the years: Mary Keitany has 7 victories until now, the same number of triumphs than Eliud Kipchoge. We could also highlight Catherine Ndereba with 6 victories and Joyce Chepchumba with 5. Kenya has won a 25.7% of the Marathon Majors from 1981, but considering only the last 25 years, from 1995 to 2020, the percentage of Kenyan victories is 38.4% (as there were no many Kenyan women participating previously).

Meanwhile Ethiopia has won 35 Majors in women, for a total of 99 podium positions. The best athletes in these events are Aberu Kebede, with 4 victories, and Fatuma Roba with 3. It looks that Ethiopian women has been less consistent in these Majors over the years.

Winner in this section: Kenya WINS.


With more difference than in the men´s marathon, Kenyan women rules over her neighbours from Ethiopia, dominating in every marathon section.

KENYA would be the WINNER of this marathon duel in female category.

Some of the best marathon runners from Ethiopia


Despite the highest population of Ethiopia when compared to Kenya, and the big names of some well-known Ethiopian athletes, Kenya wins in the comparison at both, men and women levels.

Some Ethiopian figures such as Abebe Bikila and Mamo Wolde competed in a time where many athletes uniquely focused on Olympic events, taking place every 4 years.

Additionally, more recent runners such as Haile Gebreselassie or Kenenisa Bekele, or even Eliud Kipchoge, only moved to the marathon distance later in his careers, at 29, 32 and 28 years old, after impressive careers in shorter distances.

The most important duel in sight should be the Olympics of Tokyo 2021, although nobody knows if an unexpected rival decides to take the crown and start writing a new chapter of this history.

See you soon.


Kenyan runners Geoffrey Mutai and Dennis Kimetto at the Berlin Marathon 2012

For quite some time runners from Kenya and Ethiopia have shone in athletics at international level, especially in long-distance running events, such as the marathon.

From Olympics to World Championships their success has been unquestionable. But, is there anything that makes them stand out from their opponents?

With this post we start a special about Kenyan and Ethiopian runners. In this one we will explore the different factors that could give them that “advantage”.



Most successful athletes come from ethnic subgroups within their respective countries. The Arsi, in Ethiopia, and the Kalenjin, in Kenya.

Mitochondrial DNA (mtDNA) is uniquely maternally inherited and allows to determine the ancestry lines by studying specific sections of the chromosomes called haplogroups.

Investigating the genetic ancestry of the elite East African runners no genetic differences were found that could explain their success. Kenyan and Ethiopian populations were not genetically isolated in East Africa during evolution. The typically Eurasian haplogroups M and R were present at a frequency of 10% in Kenya compared with 45% in Ethiopia.

Regarding some performance-enhancing genes appear two candidates:

  • The angiotensin-converting enzyme (ACE), with two alleles:
    • L – associated with endurance performance and altitude tolerance
    • D – associated with power performance
  • The alpha-actinin-3 (ACTN3) gene, associated with physical performance.

However, no differences were observed between elite runners and the general population. Thus, it looks that genetics would not be the reason behind Kenyan and Ethiopian runners’ success.


Maximal Oxygen Uptake (VO2max)

It has been postulated that extensive walking and running from an early age could enhance VO2max. 86% of Kenyan and 68% of Ethiopian international-level runners run to school as children, with distances up to 20 kilometres.

Comparing VO2max from Kenyan with Scandinavian or German elite runners at sea level no differences were observed. Once again it looks that VO2max would be unable to explain these runners’ success.


Running efficiency

The Kenyans are characterized by long, slender legs that are typical of central and southern African tribes. The Ethiopians, in contrast, have physical characteristics from northern Africa with some European and Middle Eastern physical traits:  more light-skinned, shorter and with a greater thigh circumference than Kenyans.

Kenyan runners could benefit from these differences by being more “mechanically efficient”.

Maybe running efficiency is a contributing factor for these runners, especially Kenyans.


Blood composition and skeletal muscle fibres composition

No differences were observed when comparing these characteristics between elite runners of these nationalities and other ethnic backgrounds.


Traditional diets

Traditional Kenyan diet is composed of 10% protein, 13% fat, and 77% carbohydrate, a composition consistent with recommendations for endurance-sport athletes. Carbohydrate comes from vegetables, fruit, rice, unrefined sugar and a traditional maize dish, ugali, with very high glycaemic index. Also, they use a traditional tea, called chai, immediately after training and with their meals. Its high glycaemic index helps to recover glycogen stores.

Traditional Ethiopian diet is composed of 13% protein, 23% fat, and 64% carbohydrate. The carbohydrates come from vegetables, fruit, rice, bread, pasta, and unrefined sugar.

These diets do not appear to be very different from the training diets of most of their competitors. It doesn´t look that they would give Kenyan any distinctive competitive advantage.


Living and training at altitude

Most of the successful runners from Kenyan and Ethiopia were raised at an elevation of approximately 2000 to 2500 metres in Eastern Africa. They “live high” and “train high”. Other nationalities´ athletes do training periods at altitude but seem unable to do it consistently for long periods without breaking down.

So chronic altitude residence and moderate-volume/high-intensity altitude training could contribute somehow to their exceptional performances? Although it doesn´t explain why other countries such as Nepal or Bolivia don’t produce also so many great runners.


Motivation to achieve economic success

Kenya and Ethiopia still show high levels of unemployment and people living below the World Health Organization poverty line. Success in distance running is a way of economical and societal progress for them and their families. Economic success was the primary reason for training and competition for a third of Kenya´s elite runners.

Thus, motivation could join the reasons behind Kenyan and Ethiopian success.


In summary, Kenyan and Ethiopian distance-running success appears to be the result of a series of favourable characteristics:

  • exceptional biomechanical and metabolic economy/efficiency,
  • chronic exposure to altitude in combination with moderate-volume/high-intensity training (live high + train high),
  • and a strong psychological motivation for economic and social advancement.



Kenyan and Ethiopian Distance Runners: What Makes Them so Good? Wilber RL & Pitsiladis YP. International Journal of Sports Physiology and Performance, (2012), 7(2), 92-102.

A runner at the EVERY ONE race in Ethiopia (Photo by Great Ethiopian Run)

Book: CON LOS PIES SOBRE EL ASFALTO (Itziar Matamoros, 2019, 240 pages)

The story of Ramiro Matamoros, known as the “king of popular races”.

As added to the title itself, we have a biography of the runner Ramiro Matamoros, written by his own daughter Itziar, journalist and writer.

It is a very easy to read book, written from a close distance. It surely contributes that his own daughter writes it. Hence the number of funny anecdotes that populate its pages. On the other hand, the fast and direct style contributes to making it a “quick” book that can be read almost in one go. In addition, it is structured in 42 kilometres/chapters in a nod to the marathon distance.

Summarizing, the book tells us who Ramiro Matamoros is. For whom is not familiar with his name, he was one of the best Spanish runners for more than two decades: from the late 70s until well into the 90s. His multiple victories gave him the nickname of “king of popular races”.

For Spanish runners around 50 years old, his name was a constant in the media. However, for those of us who are a little younger and who did not get to compete in “their time”, this book brings us closer to one of the most interesting characters in the Spanish running world. As in so many places, “the running boom” changed running from an activity for a minority to a “mass sport”.

Ramiro Matamoros was born in a small village in Ávila, Navarrevisca, in 1957. We follow his footsteps as a child until he moves to Madrid for working reasons. He started running by chance, and without counting on the means of other athletes who were exclusively dedicated to running, he began to compete with great success, while combining his work as a snack’s deliveryman for a well-known brand. Hence comes another of his nicknames as “king of the potato chips.”

Throughout the book we follow his sporting and family steps, accompanied by his inseparable wife Begoña, and numerous family and friends throughout the country and beyond.

Among his most outstanding achievements he won the San Silvestre Vallecana Popular in its first edition, in 1978, competing the next day in the San Silvestre for elite athletes, where he finished among the top 20. He won this race on 6 other occasions, the last time in 1994.

In the marathon distance, he won the 1985 Valencia Marathon in debut in the distance, and the 1986 Madrid Popular Marathon (he was also second in 1994). In turn, he participated also in the Chicago and New York marathons.

However, injuries impeded him greater successes. These in combination with long working hours, without following adequate food and rest, that other athletes without such demanding work requirements could afford, possibly deprived us of who could have been one of the best Spanish athletes in history. To have an idea his best times were:

  • 000: 29’11’’,
  • half marathon: 1h03’49’’,
  • marathon 2h16’56’’ (when the Spanish national record was 2h11’10’’)

He had a highly competitive level, although after his injury he left, suddenly and without warning, to stop being part of the group of the best.

The book introduces us to other well-known and successful athletes and friends of him, such as Fabián Roncero or Abel Antón, among many others. They give also some valuable opinions.

Once the injuries separated him from racing, he found his motivation, once again unexpectedly, in two projects linked to athletics: the Athletic Club of Alcobendas (later on San Sebastián de los Reyes)/Clínica Menorca, and the group Correr en Rosa (Run in Pink), to bring sports practice closer to breast and ovarian cancer patients.

In short, a highly recommended book to understand how amateur athletics and life was, and in which many runners of a certain age can see themselves reflected. And not least, also the portrait of a mythical figure in the Spanish popular scene: Ramiro Matamoros, the “king of popular races” and the “king of potato chips”.

We finish with one of the last sentences of the book:

“He doesn’t know if he has been a good athlete, but what he sure did achieve was being a person who lived true to his personality. Not thinking about what they will say, but looking at all costs for his happiness and of those around him”.

To find more information about the book and the author:


Photo by Chander R (Unsplash)

Haematuria is defined as the presence of blood, or red blood cells, in the urine.

It may be classified as:

  • macroscopic, if it is visible to the naked age.
  • microscopic, it is only visible in a urine analysis (reactive strips or under a microscope).

And alternatively, according to its origin in:

  • glomerular, when it originates in the kidneys. The glomeruli are a network of blood vessels that filter blood, removing excess fluid and waste through to make urine.
  • non-glomerular, when it originates in the urinary system.

There are many causes of haematuria. Among them we could highlight urinary tract infections, kidney stones, tumours (kidney or bladder), traumas and associated with exercise. In this post we will focus only in the sports-related haematuria.

Sports-related haematuria is a common phenomenon, usually microscopic and transient, that appears after the exercise and mostly related to the intensity of the exercise. Only a 2-3% of haematuria cases is macroscopic.

Although the origin is not always clear, sports haematuria is usually related to a direct trauma, release of haemolysing factors, non-steroidal anti-inflammatory drug use and dehydration, among others.

In contact sports (boxing, rugby, cycling, skiing, football, hockey) traumas are frequent. In rugby for example haematuria affected 24.4% of the players. Trauma to the kidneys is the most frequent one (75-80% of urological traumas), followed by urethral and bladder injuries.

In non-contact sports (swimming, rowing or running) haematuria is mainly caused by physiological changes during the effort. Catecholamines are secreted by exercise to divert blood from the kidneys to the muscles. This may cause hypoxic damage to the kidneys and increase the permeability of glomeruli, releasing red cells to the filtrated urine.

As mentioned previously, among the factors contributing to haematuria exercise intensity is key: significantly higher levels of haematuria were found in athletes sprinting at high intensity over others running at lower intensity or simply cycling.

If haematuria persists for longer than 48 h, especially if it is visible and despite sport effort, medical advice should be seeked. Usually a computed tomography scan is prescribed to discard any underlying condition, usually urinary tract abnormalities.

Keep healthy and look always for medical advice if you find any sign of blood in your urine.



Haematuria in Sport: A Review.

Akiboye RD, Sharma DM.

Eur Urol Focus. 2019;5(5):912‐916. doi:10.1016/j.euf.2018.02.008

Urine sample with presence of red blood cells
Photo by Giorgio Trovato (Unsplash)


Drafting Bekele vs. Kipchoge

We are highlighting the main findings of a recent article that has examined the drafting strategy of Kenenisa Bekele in the Berlin 2019 marathon, where he run the second fastest marathon time ever in 2.01.41. Using a simulation model his drafting positions behind the pacers were studied, and how they affected his drag resistance and aerodynamic power.

Drafting has been widely used in sports, at least until the Covid-19 outbreak. Using a “sheltered” position athletes try to get an advantage from going behind one or several pace-setters.

This strategy was key in the heavily publicised Ineos 1:59 challenge, that got Eliud Kipchoge under the 2 hours barrier in Vienna last October. In Kipchoge´s successful, although unrecognised attempt, five pacers formed an inverted arrowhead in front of him, with two additional runners behind.

As for Bekele he used 3 pacers for the first 25 kilometres (not so many runners in the world would have been capable of keeping his pace for longer). His splits were 1.01.05 for the first half and 1.00.36 for the second. They were positioned side-by-side along a frontal axis. Bekele did not maintain a fixed position behind this pacers’ line. Three positions were identified and compared using a computational model with Bekele running alone.

Therefore, the article compared among four conditions (see first figure accompanying the post):

  1. Bekele running alone
  2. Bekele behind one of the lateral pacers
  3. Bekele between two pacers
  4. Bekele behind the central pacer

Briefly, the study showed (see second figure) that Bekele benefited from using pacers. Running alone Bekele had to “fight” against an aerodynamic power of 44 watts. Meanwhile running accompanied the aerodynamic power ranged between 27 and 19 watts. This decrease in “force opposition” could result in an aerodynamic power gain of 57%.

The best aerodynamic, offering the maximum reduction of air resistance, was achieved when Bekele run just behind the central pacer (d), although it was very similar to running between the two lead runners (c).

These aerodynamic improvements lead to a maximum gain of only 2.84% on the total mechanical power. Although air resistance is key in the power output of sports such as cycling (80–90%), its impact is considerably lower in running.

Despite the limitations of the study, simplified in terms of runner anthropometric differences, body kinetics and other external factors (weather conditions, running shoes, course, etc) this relatively small improvement in aerodynamics may hold the key in breaking the world marathon record in a future attempt.



Numerical Investigation of the Impact of Kenenisa Bekele’s Cooperative Drafting Strategy on Its Running Power During the 2019 Berlin Marathon

Polidori G, Legrand F, Bogard F, Madaci F, Beaumont F

J Biomech. 2020 Jun 23; 107:109854. doi: 10.1016/j.jbiomech.2020.109854.

Bekele´s different drafting aerodynamics


Informative panel Olympic women marathon final Barcelona 1992

In 1986 Barcelona finally won the bid for the Summer Olympics of 1992, after having tried unsuccessfully to host them in 1924, 1936 and 1972. Luckily these were the first Games unaffected by boycotts since 1972. They were also the first after the end of the Cold War and the dissolution of the Soviet Union, whose states participated under the Unified Team flag, topping the medal rankings.

Meanwhile Germany was participating again as a unified country and South Africa was back after a long hiatus because of the apartheid regime. The old Yugoslavia didn´t participate in team sports because of the Balkans ongoing conflict, although its individual athletes could compete.

In women athletics Algerian athlete Hassiba Boulmerka, frequently criticized by Muslim groups in her country, won the 1500 metres after being forced to move to Europe to train. Also, worth to mention the 10000 metres final with the duel between Elana Meyer (South Africa) and Derartu Tulu (Ethiopia).

Valentina Mikhailovna Yegorova was born in Cheboksary, Russia, although he competed in Barcelona under the Unified Team flag. From a young age she run, focusing soon in the marathon distance. Her first medal in an international event was at the 1990 European Athletics Championships, where she won the silver, only beaten by Rosa Mota.

The marathon of Barcelona 1992 used a point-to-point course, starting in the coastal city of Mataró and following a flat road through the coastline until kilometre 25. Afterwards it entered Barcelona, where course still had to get to Montjuic and the Olympic Stadium, located at 147 metres above sea level. This altitude difference was saved in the last 7 kilometres, making it one of the toughest Olympic marathon courses in record.

As for the women marathon it was scheduled for August 1st at 18.30. Temperature was 27°C with a light sea breeze. 47 runners were present, with Lisa Ondieki (previously Martin) from Australia and Lorraine Moller from New Zealand participating in the Olympic marathon for the third time, after being only celebrated in Los Angeles 1984 and Seoul 1988.

Because of the steep ascent of the final section runners didn´t start very fast. The 10k was crossed in 36.27, with Ondieki, Katrin Dörre-Heinig (Germany) and Manuela Machado (Portugal) at the front line. By the 20k (1.14.09) Ondieki was still leading ahead of a big group of runners. Abruptly she decreased her pace, followed by a series of leadership changes while runners abandoned the coastline.

The 30k was crossed by Yegorova first in 1.48.49, almost one minute ahead of teammate Madina Biktagirova and Japanese Yuko Arimori. The next section from 30 to 35k was downhill, with Arimori taking advantage to move into second place and close the distance with Yegorova (2.06.36) to 12s. Moller had moved into third, a further 18s behind. It was time for the last, but hardest effort: the ascension to Montjuic and the finish line.

But it was clear that nothing has been decide yet. In the ramps Arimori caught Yegorova and they continued running side by side. By the 40k (2.24.54) they were only 1s apart. Moller, far behind, was out of the fight for victory.

Just entering the stadium Yegorova attacked for a last time, with Arimori unable to figth back. And so, it was the victory for Yegorova in 2.32.41, only 8s of Arimori. It was the closest victory in the short history of women Olympic marathon. Moller closed the medal positions in 2.33.59.

And the Olympic marathon wasn´t over for Russian Yegorova and Japanese Arimori. They came head to head once again four years later, in Atlanta 1996. And we will tell you everything here.

Thanks for reading us, and don´t forget to follow us.



“The Olympic Marathon”, DE Martin & RWH Gynn. Human Kinetics, 2000.

Valentina Yegorova crossing the finish line
Cobi, official pet of Barcelona 1992


The Female Athlete Triad (FAT)

The term Female Athlete Triad, or FAT, was coined in 1992 by the American College of Sport Medicine (ACSM) for a condition seen in female athletes and women including three factors:

  • menstrual dysfunction
  • low energy availability, with or without eating disorders
  • decreased bone mineral density (BMD) and/or osteoporosis

Among the risk factors for FAT we have:

  • participation in sports where appearance is important (gymnastics, ballet, figure skating, diving or body building)
  • participation in endurance sports (distance running, triathlon, swimming, cycling, wrestling or boxing)
  • pressure to lose weight to improve performance
  • competitive personality traits
  • lack of non-sports social relations
  • training while injured, sick or excessively tired.

We are going to focus this post in the three factors affected by FAT, how often they appear and what strategies can be followed to counteract them.


Menstrual dysfunction

The loss of menstruation, or amenorrhea, can be:

  • Primary: when the woman has not experienced her first menstrual period by age 15 although other secondary characteristics have developed.
  • Secondary: when missing three consecutive periods.

In disciplines such as ballet or running the prevalence of secondary amenorrhea can be 69%, compared to a 2-5% range in the general population.  Leptin is a substance associated with fat mass, and its deficiency involved in the amenorrhea of athletes with FAT.

Menstrual dysfunction may lead to infertility, while the low levels of oestrogens can cause endothelial dysfunction, resulting in cardiovascular disease. On top of this, amenorrhoeic athletes have 2-4 times greater risk for stress fracture than controls.


Low energy availability

Irregular eating is frequent among athletes, affecting between 16% to 47% of female elite athletes. Prevalence varies with the sport discipline, age and intensity although levels, are much higher than in the general population (0.5-10% prevalence).

  • The irregular eating of the female athlete doesn´t need to reach the level of a clinical eating disorder, such as anorexia or bulimia, for the FAT to appear. Simply they often lack the appetite necessary to compensate for the energy expenditure from an intense exercise regimen.

Additionally, many female athletes are pressurised to maintain low body weight from coaches, often with poor guidance on healthy dieting and regardless of the method used to attain it.

Low energy availability may have serious effects due to a deficiency in essential amino acids and fatty acids, key in maintaining the body´s ability to build bone, maintain muscle mass, repair damaged tissues and recover from injury. Furthermore, it also has psychological effects, such as depression, low self-esteem and diverse anxiety disorders.


Decreased bone mineral density (BMD) / Osteoporosis

Bone problems are typically the first signs of FAT. The disease is characterized by deterioration of bones tissue, resulting in bone fragility and increased risk of fracture, especially stress fractures.

The prevalence of low BMD in female athletes ranges from 22% to 50%, with osteoporosis affecting up to 13% of them in some studies. This compares to the 12% and 2.3% prevalence in normal population, respectively. Decreased BMD and osteoporosis affect aged woman after menopause, and not healthy athletes at much younger ages.

Healthy athletes tend to higher levels of BMD because of the beneficial effects that physical activity has on it. Nevertheless, when amenorrhea is present their levels of BMD are smaller due to changes in the hormone levels that disrupt bone remodelling and accelerate bone resorption. Thus, menstrual irregularities in young female athletes may counteract the positive effects of physical activity on the bones.



The number of athletes suffering simultaneously the 3 aspects of the triad is quite low. Prevalence is around 4.3% of female athletes, not very far from the 3.4% among healthy controls. Despite this, not all components must be present to suffer negative effects on health.

Women with the triad also have decreased immune function and impaired skeletal muscle oxidative metabolism (worse use of energy sources by the muscles) leading to a decrease of physical performance.



The best approach to the FAT is early detection and prevention. Any female athlete with signs of any of the three components of the triad should be referred to a healthcare professional team, including a sports physician, a nutritionist and a phycologist/psychiatrist. Support from the coaching team and family is important during the rehabilitation process.

The main goal of any treatment is restoring the menstrual cycles and increase the levels of BMD. To do so a change of diet and exercise levels is prescribed to increase overall energy availability. Any improvement is not immediate, and sometimes may not be enough to fully restore bone health.



  • Female athlete triad is a complex syndrome impacting athlete´s wellbeing, at physical and psychological levels.
  • It usually begins with a disturbance of energy balance, and progress towards menstrual and osteoporosis problems.
  • Prevention and education are key factors to avoid the FAT and help maintaining sport practice as a health source.



The Female Athlete Triad

Nazem TG, Ackerman KE

Sports Health. 2012 Jul; 4(4): 302–311. doi: 10.1177/1941738112439685

Photo by Morgan Sarkissian (Unsplash)


The COVID-19 global pandemic is creating new challenges for many nations around the world. Until a successful vaccine is developed many governments have followed lockdown policies, challenging at physical and mental level.

Forced isolation alters daily routines. The reduction in daily energy expenditure, altered sleep and a decrease in the levels of physical activity are only some of the factors that may trigger adverse health effects. Physical inactivity by itself accounts for 6% of global deaths (only behind hypertension, tobacco and hyperglycaemia as risk factor).

There is a cyclical relationship between these factors and the metabolic equilibrium. During periods of inactivity, even of short duration, there are:

  • decrease in the synthesis of skeletal muscle proteins, causing loss of muscle mass
  • increase of insulin resistance, causing dysregulation of glucose metabolism, weight gain and increase of body fat
  • impaired immune defence and higher risk of infections

It results difficult to maintain energy balance, even in normal conditions, in many industrialised countries. This is evident because of the levels of obesity worldwide. With access to public spaces very limited many organisms and individuals have tried online to maintain us motivated and reasonably in good physical shape.

Ten minutes seem the minimum exercise time necessary to ensure cardiometabolic protection, with High-Intensity Interval Training, or HIIT, as an interesting alternative, with very short (30s-4 min) repetitions of intense activity bouts. Some individuals with pre-existing conditions could dose exercise bouts during the day.

To keep muscle mass resistance-type exercise has powerful stimulatory effects on the synthesis of muscle proteins, even with low loads. Using body weight or resistance bands could also be an alternative. Dietary protein supplementation could complement these exercises, although taking into consideration the reduction in energy requirements.

Timing of meals has also diverse physiological effects. Human metabolism is more active in the morning hours, and eating should follow, whenever possible, the circadian rhythm to improve glycaemic and weight control. During isolation, feeding patterns could be adjusted by reducing the “eating window” to a shorter span, trying to reduce food intake specially during late evening hours.

With isolation we are less exposed to daylight. It alters our circadian rhythm, and consequently sleep quality. There is an association between poor sleep quality and obesity. Therefore, optimising our sleep pattern could become a key factor in maintaining our metabolic health.

Thus, keeping a minimum level of physical activity, together with good dietary habits at appropriate times and a reasonable sleep pattern could be steps in the right direction to keep us healthy during these hard times.


Together we will overcome it!



The Challenge of Maintaining Metabolic Health During a Global Pandemic

King AJ, Burke LM, Halson SL, Hawley JA

Sports Med. 2020 May 24;1-9. doi: 10.1007/s40279-020-01295-8.

Photo by Carabo Spain (Pixabay)


Photo by Jeremy Perkins (Unsplash)

Philosophy and running may look as very different activities, but below the surface they share a common ground. Based on a recent article we will explain it in more detail.

Firstly, philosophers and runners dream about getting “somewhere”. Achieving the desired goal becomes a demanding process that may take years.


“The meaning of life is not offered to anyone. Everyone has to acquire and create it”

Antoine de Saint-Exupery

Behind every story of sport success there is a lot of work in physical training, but also at a mental level.

Let´s think of a runner getting to the magical kilometre 35 in a marathon. Something overcomes the fatigue and withdrawing thoughts pushing him forward to overcome retreat. Let´s call it “inner strength”.

On a similar way, philosophers are often only appreciated long after death, despite a long work process searching for answers. Their “inner will” doesn´t allow them to abandon their goals.

Sports and philosophy remove us from the issues of daily life, contributing to promote our personality. Additionally, long-distance running also provides a lot of time for thinking about life.


“The only reality for man is life and his goals”

Friedrich Nietzsche

Sports practice involves at a certain level a search for body perfection, where will, courage, and perseverance are important.

Runners undergo a transformation process as they get to know themselves better. Only a person aware of his abilities and limitations can set goals and follow the path to their realization. Having a goal motivates us to work.

The goal can be constantly modified while improving and enhancing the capabilities. It is important that it is achievable and within reach. Otherwise, it could have a demotivating effect.

Additionally, the goal doesn´t have to be uniquely connected with improving the body. A social or psychological motivational background may also be considered.


“Physical activity in its original psychophysical meaning is the fulfilment of human freedom” Hans Lenk

Achieving sporting success is the result of hard work and commitment.

A sense of freedom is achieved by overcoming our personal weaknesses, and/or winning against the opponents or the challenge ahead of us, whether the distance, environment or weather conditions.

Sport has been recognised as a great economic and social tool for development. Additionally, there are countless scientific publications recognising the benefits of physical activity towards health-promoting lifestyles.

Longer lifespans in good psychophysical conditions contribute also to the development of civilization.


“Sport is intimate, even spiritual, reaching the peak of human existence, giving room to discover the self”

Howard Slusher

The human body is not always prepared for what an athlete can do. It needs first to master its abilities. Thanks to training, the body gains new capabilities.

Proper practice will cause progress and avoid injuries. It is a transformative process, usually not exempt of internal conflicts while trying to reconcile work and family life.

Too little training load will not provide physiological effects, and too much can only do harm.


“The best way to face the long distance is to accept its hardship”

Ian Walker

Running is the simplest form of physical activity. It can be practiced anywhere and by anyone. As a psychosocial therapy allows us to break away from everyday reality. It offers relaxation and oblivion from our worries.

Within limits running increases fitness and health, offering the opportunity to compete with ourselves and overcome our weaknesses.

During the difficult moments of a marathon run we must remind ourselves that although feeling bad, we will soon feel better again.



Philosophy of marathon runs

Fajdek P.

Health Promotion & Physical Activity 2020, 10, 1: 1-6.

Photo by Juan Ruminpunu (Unsplash)

THE MARATHON BEYOND THE IRON CURTAIN (a flash story based on a true event)


Napping in the car had done him well. Norbert feels now relaxed, and ready with his shirt and race number for the race. The numerous people on the streets, ensures an animated course through Munich city centre.

Integrated into the course, Norbert finds himself, as he was hoping, at the head of the race. His mind is a whirlwind of sensations while descending the tunnel that gives access to the Olympic stadium. The finish line of the marathon is only a short distance ahead.

Coming out of the tunnel´s darkness, and as his eyes adjust to the evening light which fills the stands with an orange hue, he hears the clamour of the crowd. They are cheering: An athlete in the German shirt is headed for victory! Inside the Olympiastadiom´s track, and not feeling any fatigue, he knows that glory is within his reach.

It is only when approaching the finish line that his most immediate pursuer, the US athlete Shorter, makes his entrance into the stadium, receiving the boo from the dedicated German public, who is clearly sweeping for home.

Thus, without even needing to sprint, Norbert crosses first the finish line. Dodging the track judges, and with no time for celebrations, he unexpectedly continues running, heading again towards the tunnel.

Running only the last kilometre of the marathon, and surprisingly deceiving public and judges, he has managed to feel the taste of victory. Nevertheless, Frank Shorter from the United States is the true winner of the 1972 Munich Olympic marathon in 2h12m19s.

However, for East German student Norbert Sudhaus, his short-lived joke has also secured him a place in the annals of Olympic history.