ULTRA-ENDURANCE: NUTRITION AND HYDRATION

For a race to be considered ultra-endurance it must last more than 4 hours, although sometimes they are only considered if lasting beyond 6 hours. These races can last for days, or even weeks, with energy requirements as high as 7000 kilocalories per day.  A negative energy balance can lead to energy depletion, with a decrease of the levels of body fat and skeletal muscle mass, with sport anaemia, gastrointestinal discomfort and hypohydration also being noted as key factors in the performance.

Inadequate nutrition might impair performance, with energy deficit affecting finish times in many ultra-endurance events. For a 24 hours race the decrease of body mass reported was 1.7%, a combination of fat mass, skeletal muscle mass and fluid loss, especially located in the lower trunk.

Carbohydrates are usually the main source of energy, with an average of 68% in ultra-endurance events, although their contribution can be modified, especially in cold conditions, like in an 800k Antarctic race, where fat can be contributing a 60% to the energy expenditure and carbohydrates only a 25%. The consumption can go to 90g of carbohydrates per hour of exercise for ultra-endurance athletes, compared with the 60g/h of endurance athletes.

The first carbo-loading protocol, aimed to load the body glycogen stores (liver and muscles), was developed in the 1960s. It consisted of a 3-4 days “depletion phase”, with high-intensity exercise and low carbohydrates intake, and a 3-4 days “loading phase”, with low-intensity exercise and high-carbohydrates diet. This classic protocol was later modified to a 6-days period, with progressive increase in the carbohydrates intake accompanied by a decrease in physical activity. This shorter protocol avoided fatigue in the stressful depletion phase. The most recent approach favours the combination of a resting period rest of up to three days with a high carbohydrates diet.

In ultra-endurance sports fat is a reliable source of energy. The “fat-adaptation” diets are aimed to increase the oxidation of fatty acids and attenuate glycogen depletion, in what is known as “ketogenic adaptation”. They provide 60-70% of energy from fat, and only a 15-20% from carbohydrates, and are followed for the last 5-10 days before the race. As intensity in these competitions is always sub-maximal the high levels of at would not be detrimental.

Amino acids are the building blocks of proteins, and it is still unclear if their consumption has any effect on skeletal muscle damage. On the other side, the intake of more than 2g of protein per kilogram of weight per day didn´t have any influence on physical performance.

It is clear that maintaining hydration levels is important to keep aerobic performance. Hypohydration decreases performance, increasing body temperature, heart rate, and the use of carbohydrates as fuel source. Common recommendations for proper hydration, trying to avoid losses over 2% of body mass, are usually suitable for shorter periods of exercise but sometimes inappropriate for ultra-endurance activities, often resulting in hyperhydration.

Previous recommendations disqualifying “thirst” as a stimulus “to drink” originated in conditions where hypohydration would develop rapidly, usually in high sweating rates and high intensity exercise. Nowadays the concept of “drinking to thirst” is adequate for ultra-endurance activities, even in hot conditions. Several studies have reported that this level of drinking doesn´t affect negatively performance in comparison with higher volumes of liquid uptake.

Excessive fluid intake (overload), or hyperhydration, may be associated with an increase in body mass, total body water, and a decrease in plasma sodium concentrations, a condition called hyponatraemia, which can develop serious complications. The hyponatraemia is common among endurance athletes, with more prevalence in female and slower athletes, and although is present in ultra-running and ultra-swimmimg, is usually absent in ultra-cycling, probably because cyclists can drink from their bottles as they wish. Excessive sodium intake is unnecessary, and potentially harmful.

Proper nutrition will delay fatigue and hydration will support body functions, maintaining exercise performance during ultra-endurance events, and by extension in your life.

 

Bibliography:

Nutrition in Ultra-Endurance: State of the Art.

Nikolaidis PT, Veniamakis E, Rosemann T, Knechtle B.

Nutrients. 2018 Dec 16; 10(12). doi: 10.3390/nu10121995.

 

Considerations for ultra-endurance activities: part 1- nutrition.

Costa RJS, Hoffman MD, Stellingwerff T.

Res Sports Med. 2018 Jul 28:1-16, doi: 10.1080/15438627.2018.1502188

 

Considerations for ultra-endurance activities: part 2 – hydration.

Hoffman MD, Stellingwerff T, Costa RJS.

Res Sports Med. 2018 Jul 28:1-13, doi: 10.1080/15438627.2018.1502189

MADEIRA ISLAND (PORTUGAL)

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Funchal view

Madeira is an archipelago located 600 miles south from Europe and 300 miles from the African coast and an autonomous region of Portugal. With a volcanic origin, Madeira Island is the main one in the group, allocating the region capital Funchal, well communicated by air with other European cities, or reachable by a short flight from Portugal.

The island is 57k in length against a 22k width, rich in vegetation and fresh water, offering high-contrast areas, from its highest point in Pico Ruivo to the coast. It contains over 3000 kilometers of “levadas” or irrigation ditches, built since the XVI century to transport water from the North of the island to the south, with many hiking routes following their course. A paradise for outdoor travellers, as together with the multiple hiking opportunities, weather conditions are ideal all-year round.

View of a typical farming landscape
CR7 bust in Funchal airport

For a long weekend trip (Friday to Monday) we decided to book accommodation in Funchal, with plenty of choices for every budget, and rent a car. Although there are many companies offering tours, a car offers freedom and saves time, allowing to cover more ground. A premium insured rental for 3 days was less than 100€ (Europcar).

Old Funchal church
Old Funchal main street

The first evening is used to visit the old quarters in Funchal. The city occupies a band along the coast, and is strongly focused on tourism, with countless restaurants and hotels. It is the first opportunity to taste a traditional dinner, with “espetada”, a cow meat skewer, fried corn and passion fruit dessert, and also a glass of “poncha”, typical alcoholic drink from the islands.

Meat "espetada"
Bolo do caco
Start point of hiking route from Pico Arieiro to Pico Ruivo
Trout farm in Ribeiro Frio

Saturday is time to go the distance. Although not very big, the complicated roads don´t allow high driving speeds. The first stop is in the Pico do Arieiro, 1818 meters high, a great viewpoint of the surrounding mountains. A popular hiking route goes to Pico Ruivo, the highest in the island, in a round trip of 6-7 hours for a 12k walk. The views are surely worthy, although it would take most of the day. As we are trying to visit other spots we continue our route.

Descending the mountain and crossing the clouds offer some eerie views of the forest as we get to Ribeiro Frio, starting point of many hiking routes following the “levadas”, and where we also visit a trout farm. Continuing towards the north coast we get to Santana, a small village with some traditional Madeiran houses that make for a short stop.

Trail running route
Traditional houses in Santana

Heading back to Funchal there is still time to visit the Botanical Gardens overlooking the city, and spend the sunset in the spectacular lookout of Cabo Girão, a cliff 580 metres high.

Funchal botanical garden
View towards sea from cliff of Cabo Girão

Sunday afternoon, after the marathon, we head towards Porto Moniz, one hour drive from Funchal. On the north coast it is famous because of its natural pools, although the rain, that appeared as we crossed the island,  only lets for a short walk.

The last visit of the tour will be the mountainous village of Curral das Freiras, nestled in a valley of difficult access by road. One can imagine the isolation of this area a few years ago, before modern tunnels allowed easier access from Funchal.

Natural pools in Porto Moniz
Porto Moniz
Coast view from Porto Moniz
Curral das Freiras

A perfect end for an island, worth of a longer visit.

Extras: two restaurants to recommend, O Polar and Santo Antônio, both in the surrounding area of Funchal, for typical espetadas.

FUNCHAL-MADEIRA ISLAND MARATHON (20/01/19 – 74)

Running "numbers" and race panel
Desktop office (bag pick-up)

January is not a month with many marathons to choose from in Europe, as weather conditions are quite hard. Other years I had gone for the Gran Canaria marathon, in the Canary Islands, although I decided it was time to run a new one, taking advantage of a short holiday break.

The island of Madeira belongs to Portugal, and is located north of the Canary Islands, offering ideal weather conditions all year round. The marathon takes place in the island capital, Funchal, offering also a half marathon and an 8k race.

Arriving to Madeira involves a stopover in Lisbon, and then a 1 hour and 45 minutes flight to Funchal, but there are many direct flights from all over Europe. On arrival I go straight to get my running number and complimentary t-shirt in the small headquarters, before heading to my hotel. Doing it on Friday, Saturday is free to visit some of the beautiful spots on the island, offering contrasting views from sea level to the mountains, and enjoy the traditional food, such the meat “espetadas” and “bolo do caco”.

Marathon start is scheduled shortly after dawn, at 8, with the half marathon at 10 and the short race at 11. A 10 minutes walk get me to the start line, where a small group of around 200 runners are gathering, and a temperature of around 17°C.

Marathon start area

Since Christmas I had been with a rebel cold. I kept running during the first days, and then decided to have a short break to recover, 2 weeks before race day. What I thought would be a couple of days off, extended, as days went through without much improvement, while trying unsuccessfully all kind of natural remedies (from onion to honey with lemon). After a week off, and just feeling the marathon too close, run two days, followed by cough attacks, just to avoid going to the marathon without any training in 11 days.

Knowing that my fitness level is not ideal, my thoughts on the start are mainly focused on enjoying the race and nice weather conditions.

The course is divided in two sections. In the first one we will run 4 long laps, in an out and back course, undulating and including a demanding hill. I go on an easy pace, and around the 10k mark I see that the timing carpet doesn’t beep when I run over it. Suddenly I realise that I am not running with the appropriate running number. We were provided with 2 exactly identical ones, one with an enclosed chip, and the other one, supposedly to be attached on the bag for the finish line, without it. I feel a mixture of anguish and disappointment for the confusion. Such a ridiculous mistake, although an issue to solve later.

The sea is often in sight, and some areas offer a pleasant shadow as temperature rises. Two hours into the race, some of the front runners start lapping me, while the half marathon runners also come in the course. For the last 7-8 miles we transition to the second section of the course, around the port and old town area, where we will run a further 3 laps. This section is flatter than the previous one, although more exposed to the Sun, and therefore hotter, especially with no front wind, and also with a cobblestone section, hard on the muscles at this race point, when my pace drops enough for the 4.00 pacer surpass me. I cross the finish line with my watch marking 4.03.31.

Luckily, although without intermediate times, my issue with timing was solved efficiently after the race, giving me an official time of 4.03.42, in 88th position out of 200 runners, for the only Spanish runner in the marathon. Race beaten, and an evening to enjoy around.

Score: 4.25 (out of 5)

Pros: weather conditions in January; considering the island geography, a relatively flat course; generous time limit of 6 hours and 30 minutes.

Cons: a sometimes confusing course, which could improve with laps over a unique longer section, (and if possible not including the cobblestones in the old town area).

Tip: Madeira offers some interesting trails, over a range of distances, to justify a later visit.

Finish area
Medal and watch time
Funchal coast (Maurten sponsored)

MARATHON OLYMPIC CHAMPIONS (VII) – Paris 1924: “ALBIN” STENROOS (1889-1971)

After the 1900 Olympic Games, Paris would be the first place to hold the Olympics twice. “Citius, Altius, Fortius” (or “Faster, Higher, Stronger”) became the motto for the Olympics for the first time, while Ireland would appear as independent country. The marathon distance was definitively established at 26 miles and 385 yards, as it had been run in the 1908 London Olympics.

Oskar Albinus Stenroos, known by its nickname of Albin, was born in Vehmaa, Finland, in 1889. He would be part of a golden Finnish generation, known as the “Flying Finn” that dominated the athletics during the 1920s, and included the marathon Olympic Champion Kolehmainen, who was the subject of his own entrance in our blog, and famous Paavo Nurmi, among others.

"Albin" Stenroos during the 1924 Olympic Marathon

Stenroos run his first marathon in 1909, although he decided to move to shorter distances, and would not return to run a marathon until 1924.  He won a bronze medal in the 10000 metres in the 1912 Olympics, and helped his country to win the silver medal in the cross-country event.  During the following years he would win a set of national cross country events in Finland, and set world records for the 20 and 30k distances. He didn’t compete in the 1920 Olympics, and feeling that qualification in the 5000 and 10000 metres for the 1924 Olympics would be too strong, he tried his luck and qualified for the marathon in the Olympic trial over a 40.2k distance in May 1924, a distance he hasn´t competed in the last 15 years.

On Sunday, July 13, 58 participants were in the start line for the Olympic marathon, that has been originally scheduled to start at 15, but delayed 2 hours because of the hot weather conditions, that the previous day have sent numerous participants in the cross-country event to hospital (and subsequently caused this event to be removed from further Olympics appearances).

The athlete from Greece Kranis took an early lead, followed at a short distance by the Canadian Cuthbert. By mile 9 the French athlete Verger came up front, while Stenroos started climbing positions from behind. Just before the midpoint he took the leadership, crossing the half marathon 30s ahead of his closest persecutor. His advantage increased as the miles passed, with no runner behind capable of closing the distance. Although the gold medal seemed sure for Stenroos, the fight for the other medal positions was hard.

Stenroos entered the stadium looking fresh, and ensured his victory in 2.41.22, with a gap of almost six minutes with the silver medallist, Italian Bertini. The athlete from the United States DeMar completed the podium positions one minute later. The warm weather took its toll, as only 30 runners were able to complete the course.

As for the winner Stenroos, his best result after the Olympics was finishing second in the Boston marathon of 1926. The following year he was unable to finish in Boston, and decided to close his running career.

Sources:

https://en.wikipedia.org/wiki/1924_Summer_Olympics

https://es.wikipedia.org/wiki/Albin_Stenroos

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

Start of the 1924 Olympic Marathon (Stade de Colombes, July 13th 1924)

THE ATHLETE´S HEART (2/2): PATHOLOGICAL CARDIAC ENLARGEMENT AND SUDDEN CARDIAC DEATH

It is important to differentiate if a cardiac enlargement is pathological, or a physiological adaptation to sport practice. Cardiac magnetic resonance is useful to assess myocardial thickness, chamber volumes, tissue composition and anatomy. It allows the location of myocardial fibrosis, which is specific to certain cardiomyopathies, and therefore differentiate at some extent if we are in front of a pathologically enlarged heart. Nevertheless there is not a single diagnostic test to distinguish between an adaptive or pathological heart, and usually the first assessments involve a normal electrocardiography test.

There are also more differences in a hypertrophied heart besides the morphological ones. A pathologically hypertrophied heart tends to consume glucose as substrate, while a healthy heart upregulates the fatty acid oxidation instead. Aerobic exercise has been associated with changes in the substrate utilization and increased myocardial metabolic efficiency, improving the cardiac remodelling associated with chronic hypertension or myocardial infarction. In diabetes aerobic exercise enhances insulin sensitivity and normalises myocardial metabolism.

Among the worst pathologies linked to structural cardiac hypertrophy is the sudden cardiac death (SCD). It has been documented in all type of competitive sports, although generally more commonly in those physically demanding. Besides the sport type, sex and ethnicity are factors involved in the sudden death risk, as it is more likely to happen in male participants (male to female ratio 5:1) and individuals of Afro-Caribbean descent (black to white ratio 8:1).

Although the SCD is less common than other causes of death, its occurrence in sport events, sometimes affecting supposedly young healthy participants, carries a lot of media attention, raising questions on the necessity of pre-activity screening. In young athletes (less than 35 years old) inherited ventricular arrhythmias are the abnormalities behind the SCD, while for older athletes atherosclerotic coronary artery disease is dominant.

As we commented previously a proper diagnosis is a clinical challenge, as erroneous disapproval of physical activity may prevent a healthy individual from the benefits of sports practice. Echocardiography and cardiovascular magnetic resonance are some of the main non-invasive techniques used to diagnose cardiac disease. Nevertheless, these techniques results are limited, as many times they are used in resting conditions. The ideal would be to use them during stress tests, although motion artefacts could be difficult to interpretate. New systems are becoming available, able to work in exercise conditions, that are offering encouraging results in the diagnosis of pathological cardiac conditions.

The therapeutic effects of aerobic exercise could represent a low-cost intervention, with no side effects, to improve the survival rate in cardiac hypertrophies linked to conditions such as hypertension, myocardial infarction or diabetes: RUN GIVES LIFE.

 

Bibliography:

Athlete’s heart and cardiovascular care of the athlete: scientific and clinical update.

Baggish AL, Wood MJ.

Circulation. 2011 Jun 14; 123(23):2723-35. doi: 10.1161/CIRCULATIONAHA.110.981571.

 

Evidence for distinct effects of exercise in different cardiac hypertrophic disorders.

Johnson EJ, Dieter BP, Marsh SA.

Life Sci. 2015 Feb 15; 123:100-6. doi: 10.1016/j.lfs.2015.01.007.

 

Athlete’s Heart: Diagnostic Challenges and Future Perspectives.

De Innocentiis C, Ricci F, Khanji MY, Aung N, Tana C, Verrengia E, Petersen SE, Gallina S.

Sports Med. 2018 Nov; 48(11):2463-2477. doi: 10.1007/s40279-018-0985-2.

Heart structure
Exercise-adapted cardiac magnetic resonance system

THE ATHLETE´S HEART (1/2): PHYSICAL CHANGES AND CARDIAC OUTPUT

Around the end of the XIX century we find the earliest studies on the heart and sports practice, when it was reported cardiac enlargement among Nordic skiers (Henschen) and university rowers (Darling), by physical examination. It was postulated that cardiac enlargement was a beneficial adaptation to the exercise, although this view was not accepted easily, and even today is sometimes contested. Some studies have tried to prove that the enlargements is a sign of overuse, and that prolonged sport participation could cause a premature cardiovascular collapse, even when there is no clear evidence to support the validity of this affirmation.

Already in the early XX century, studying the pulse rate and pattern among Boston marathon runners (White), it was firstly described bradycardia in long distance runners. Early chest radiographies confirmed the heart enlargement, while the development of the electrocardiography permitted to study the electrical properties of the heart.

Physical exercise demands oxygen from the body, in an amount directly related to the exercise intensity. During exercise the pulmonary system increases the oxygen uptake (VO2), while the cardiovascular system transport the oxygen in the blood to the muscles, in an amount called cardiac output which may increase 5-fold during maximal exercise. Cardiac output is quantified in litters per minute, and it is a product of the heart rate and the stroke volume.

A larger and stronger heart gives an increased stroke volume and lower heart rate at rest. During exercise the higher stroke volume will give a higher cardiac output, and a better ability for aerobic energy production. Heart rate may vary from 40 beats per minute at rest to nearly 200 during effort in a young athlete, and it is usually the key factor affecting cardiac output. Maximal heart rate doesn´t vary with training, although stroke volume increases with prolonged training, through cardiac chamber enlargement, that gives way to the so-called “athlete´s heart”, a beneficial remodelling involving heart enlargement and thicker ventricular walls.

In the 1970s the Morganroth´s hypothesis differentiated among strength training, characterised by concentric left ventricle hypertrophy (thicker wall), and endurance training, characterised by eccentric left ventricle hypertrophy (chamber enlargement). We could talk about specific cardiac remodelling depending on the sport, with disciplines like weightlifting, track and field events causing concentric hypertrophy, and others like long-distance running, cycling, rowing or swimming causing eccentric hypertrophy.

Morganroth´s theory is nowadays challenged, as it is extensively accepted that sports cause a balanced remodelling, independent of the discipline. This cardiac remodelling is similar in male and female athletes. Regarding ethnicity, black athletes tend to have thicker left ventricle walls than white athletes.

In the second part of our series about the athlete´s heart we will focus on the techniques used to study the differences between a healthy and pathological heart, and the importance of proper studies to prevent conditions such as the sudden cardiac death.

Morganroth´s cardiac hypertrophy hypothesis (1975)
Current cardiac hypertrophy model (from "Evidence for distinct effects of exercise in different cardiac hypertrophic disorders", Life Sci. 2015)

SIS GO Isotonic Energy Gel (60 mL)

SIS GO Energy gels (front)
SIS GO Energy gels (back)

 

I have been using for a while these gels as my energy source during long competitions, especially in the marathon. It is composed mainly of a mixture of maltodextrin and water, plus some preservatives and gelling agents, and acesulfame as sweetener.

The nutritional information is:

Per 100mL: 144kcal / 0g fat / 36g carbohydrates (of which sugars 1g) / 0g proteins / 0.01g salt

Per gel (60mL): 87kcal / 0g fat / 22g carbohydrates (of which sugars 0.6g) / 0g proteins / 0.01g salt

In the instructions it is said that you can take up to 3 gels per hour, without the need to consume water with them. For me this is one of their main advantages, as during races I don’t have to worry about the next water station to take one, as it happens with other commercial brands.

I usually take 5 gels for a marathon, first one in the kilometre 12, and then one every 6 kilometres: 18, 24, 30 and 36. That is roughly one every 30-35 minutes from the first hour (for a marathon time between 3.30 and 4.00), a bit under the recommended dosage, but I find difficult to carry more gels with me. Each 60 millilitres gel provides 22 grams of carbohydrates. That would give about 40 grams per exercise hour. You can also try consuming them for shorter distances.

Depending of your needs, buying in bulk can save you some money, as prices may vary between 1 and 2€ per gel. There are packages from 6 to 30, and selection boxes with different flavours that can be a good choice to get a taste, although I usually go for the orange one, as I am not particularly fond of the other choices. There are also caffeinated versions, if you want to try that extra edge.

Score: 5 (out of 5)

Pros: no need of water; texture; package resistance (not the first time a gel broke in the pocket) and opening ease.

Cons: not really, besides my own distaste of some flavour combinations in gels (blackcurrant for example).

2018 ANNUAL REPORT and 2019 OBJECTIVES

2018 Medal collection

 

The end of the year is always an appropriate time to think about our achievements and congratulate ourselves on everything we obtained, but also about to reflect on our failures and how to proceed better next year.

There are always reasons to be positive, if only because next year gives you a clear sheet to make your mark.

Achievements and some numbers: 

Learn how to set up a webpage and use WordPress.

13 marathons (23 total races) in 6 different countries (Spain 7; UK 2; Portugal, Switzerland, France and Italy 1).

2750 kilometres in training and competition, distributed in 191 days.

A marathon season best of 3.36.45 (Vías Verdes Plazaola).

Enjoy the night summer races.

Visit to Guatemala, my first Central America country.

Products support from Maurten and Satislent. THANK YOU!

Some disappointments:

Unable again to get a sub 3.30 marathon.

And by extension, again an unsatisfying time in my town half marathon.

Not enough time to update the blog as often as I would like.

Some objectives for next year:

Carry on running free of injuries.

Adding at least one new country in my running list.

Explore new marathons, especially the Vías Verdes circuit and the Melides-Tróia.

Get closer to the 100-marathons barrier.

Increase the number of followers of the site: without you there would be no reason for this blog.

And you: what is your plan for next year?

2018 Calendar (almost finished)

PISA MARATHON (16/12/18 – 73)

Piazza dei Miracoli

A marathon I hadn´t planned much in advance, as my initial intention of running 12 marathons in a year was already achieved. I had firstly heard about it to Santi Hitos (Spanish runner with more marathons on his legs, near 300) in the Plazaola Marathon, back in September, that had included it in his plans.

Checking logistics back in October, I found a cheap direct flight Madrid-Pisa, 35€ return, that I bought, and a cheap B&B just a couple hundred meters of the start/finish line, with free cancellation until a few days before the race, that I booked. With plenty of time I skipped registration, and let the time go by, to get a final decision later. If I decided not to go, I would only lose the flight.

After San Sebastian marathon, and feeling with motivation for an extra race, I decide to give it a go, and just register in the last days of November. I had some doubts about trying a 13th marathon, as I had already tried in 2014, in Tenerife, and was cancelled because of the bad weather. Time to overcome my superstitions, and an occasion to visit Pisa and make my debut on Italian soil.

Early flight on Saturday, means an even earlier bus to the airport. I get up at 2.30am, walk to the bus station and take the bus to Madrid. Already in the airport, a long wait of 3h before the flight to Pisa. During the flight, and by pure chance, I sit on the adjacent seat to Pepe Turón, experienced marathon runner from my hometown, that is going to run Pisa for a 5th time. The flight seems shorter than the 2 hours it is, as we talk about races, next year calendar and running experiences.

Tower inside
Cathedral view from Tower
Tower outside

Pisa airport is located very close to the town centre, and after arriving I decide to walk towards my accommodation. With a sunny, although cold day, is a good chance of enjoying Pisa´s old quarter, arriving to the Piazza dei Miracoli, which allocates some of the most beautiful buildings in Pisa, besides its world renowned Leaning Tower of Pisa. I check in the ticket office for the tower, as I had read online that was better to buy the tickets online in advance (with a 10€ surcharge!) because of the queues, but there is none, and decide to buy an entrance (18€) for later, so I have time to get to my B&B, leave luggage and have a quick lunch. Ascending the tower probably is a must in Pisa, although it is also possible to visit for free the nearby Cathedral and some money. The running expo is the next stop. It is in a sports centre, a bit far from the tourist places. It is not very big, and I pick my number and runner bag easily.

Running Expo
Running number

The morning appears cloudy and cold on race day. Temperature is going to oscillate between 1 and 5°C, with rain expected from 3pm. A very short walk gets me to the race start, at 9am, with 1800 runners registered for the marathon, and around that number for the other distances (officially half marathon, 14, 7 and 3K). There is no separation among runners, neither by time nor race. The square allocating us is quite small, although we leave it rapidly, to stroll around streets and follow the Arno riverside as we head outside Pisa.

Running between the 3.30 and 3.45 groups, the course get us to the seaside and the half marathon, with occasional front winds, following pine groves in a peaceful setting. We run parallel to the sea for 5 miles, although we only get brief glimpses, until reaching mile 18, when we start heading back to Pisa, following local roads, not always closed to the traffic on both directions. With the cold and wind, I run conservative, being surpassed by the 3.45 group with 2 miles to go. I know that the finish line is near, although we are still following side roads, and the Tower and Cathedral become visible only entering the Piazza.

Finish area view from the Tower
Start

Net time of 3.45.14, in position 839 out of 1714 finishers. Satisfying time considering the cold weather, I use the evening to stroll around, despite the heavy rain, and enjoy the Christmas setting.

With Pisa I finish my marathon running for 2018, where I have achieved 13 marathons for the first time. Italy becomes my country number 10, and first December marathon in my career.

Score: 3.25 (out of 5)

Pros: Pisa easily accessible by flight; airport at walking distance; central location for start/finish area, just on the side of the central square; affordable prices for food/travel/accommodation.

Cons: higher registration price for foreign runners; need of medical certificate (as with French races); lack of organization in the start; no much running in Pisa as such; sections with traffic in opposite direction, especially when returning to Pisa.

Magritte themed medal
Tuttomondo wall by Keith Haring
Cathedral interior

TRANSCRANIAL STIMULATION AND SPORTS PERFORMANCE

Faraday discovered in the XIX century that when an electrical current pass through a wire it generates a magnetic field. If a second wire is located nearby, an electrical current is generated.

In 1982 it was produced the first magnetic stimulator capable of nerve stimulation, and by 1985 it was firstly used to stimulate the human motor cortex in the brain, developing the transcranial magnetic stimulation (TMS). Using a coil with a rapidly changing magnetic field over the scalp, a series of weak electrical currents can excite the neural tissue. In 2008 the FDA (Food and Drugs Association) approved the TMS technique as a therapeutic approach for major depressive disorder.

A different cranial stimulation approach to the TMS is the transcranial direct current stimulation (TDCS), which uses a constant, low direct current delivered via electrodes on the head. Devices only need of two electrodes and an energy supply. Anodal stimulation is positive stimulation, while cathodal stimulation is negative. Unlike the TMS technique, TDCS has not been approved by the FDA, although it is approved in Europe to treat major depression.

Therefore, increases or decreases of neuronal activity can be achieved using the TMS or TDCS techniques. Neurons connecting to muscles have their location in the motor cortex, where pulses can be applied selectively at different locations, to act on specific muscle groups.

A motor evoked potential (or MEP), is an electrical potential recorded in a muscle after stimulation (of a certain intensity over a threshold) in the motor cortex. The size of the MEP response depends on the stimulus intensity and the excitability of cortical neurons and motoneurons. In a voluntary contraction neurons become more excitable, and the MEP size is larger than in resting conditions. In patients suffering from chronic fatigue syndrome, or depression, the MEP size is smaller than in control subjects, and their neurons may need a higher input to get activated. This would translate as an increased effort and fatigue sensation.

Muscle control is as important in sports as training and motivation. Approaches such as meditation, visualization, acupuncture and music are used by many athletes trying to maximize speed, power or effort duration. Transcranial stimulation could prove to be as useful as any of these techniques.

Twenty minutes of TDCS over the left temporal cortex (T3) in trained cyclists found improvements in peak power, and reduced heart rate and effort perception at submaximal workloads. In other study, also with cyclists, anodal stimulation on the motor cortex (M1), with the other electrode located in the contralateral shoulder, proved also useful in reducing the effort perception.

As fatigue not only affects muscular endurance, but also decision making, response time and skill, transcranial stimulation could also be used to enhance motor learning and performance. For example elite athletes improved cognitive performance and mood when receiving a current of 2 milliamps on the prefrontal cortex.

In the search of improving athletic capabilities beyond physiological limitations, a technological breakthrough as transcranial stimulation could surpass these performance barriers. Effort perception, endurance, fatigue and motor learning could be regulated to enhance performance. Its supplemental use will expand among athletes, as equipment becomes more accessible, raising new challenges for regulation among sports organisms.

Bibliography:

 

https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation

https://en.wikipedia.org/wiki/Transcranial_direct-current_stimulation

 

Transcranial magnetic stimulation and human muscle fatigue.

Taylor JL, Gandevia SC.

Muscle Nerve. 2001 Jan; 24(1):18-29.

 

Transcranial magnetic stimulation.

O’Shea J, Walsh V.

Curr Biol. 2007 Mar 20; 17(6): R196-9.

 

Transcranial magnetic stimulation in sport science: a commentary.

Goodall S, Howatson G, Romer L, Ross E.

Eur J Sport Sci. 2014; 14 Suppl 1: S332-40.

 

Transcranial Direct Current Stimulation and Sports Performance.

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TMS stimulation system
TDCS commercially available device