A half-marathon and a marathon run induce oxidative DNA damage, reduce antioxidant capacity to protect DNA against damage and modify immune function in hobby runners

This study investigated whether a 21.1 km (half-marathon) or a 42.195 km (marathon) run modulates DNA damage, antioxidant capacity in lymphocytes and plasma, and the immune system in healthy hobby runners. Ten and 12 volunteers who completed the Baden-Marathon race in Karlsruhe with a running distance of 21.1 km and 41.195 km, respectively, were assessed 10 days before and immediately after the finish. There was no increase in the levels of endogenous DNA strand breaks immediately after half-marathon or marathon races. A statistically significant increase in the levels of oxidative DNA damage in lymphocytes was found using endonuclease III but not formamidopyrimidine glycolase (Fpg). The resistance of DNA to oxidative damage induced by hydrogen peroxide in isolated lymphocytes was significantly decreased after both races. The levels of plasma antioxidants such as alpha-tocopherol, beta-carotene and lycopene were close to, or higher than, those considered optimal for reducing the risk of cardiovascular diseases and there were no significant changes after the races in antioxidant capacity of LDL (lag-time test) or plasma in ORAC, TEAC or paraoxonase assays. The number and percentage of granulocytes and monocytes able to generate oxidative burst were significantly increased after both races, but the lytic activity of NK cells was significantly increased at the end of the half-marathon; no effect was observed in the marathon runners. Thus, oxidative DNA damage in lymphocytes, decreased the antioxidant capacity to protect lymphocytes against DNA strand breaks and increased the formation of reactive species by phagocytes in well-nourished hobby runners indicating moderate oxidative damage during such high-intensity exercise.     

The effect of long-distance running on plasma immunoreactive glucagon levels

Twelve highly conditioned long-distance runners were studied to determine the effects of marathon (42 km) and 10,000 m running on plasma immunoreactive glucagon (IRG), serum immunoreactive insulin (IRI), and serum glucose (G) levels. Blood samples were drawn just prior to and immediately upon completion of the run. Marathon running resulted in no significant change in G, IRI, or IRG levels. After running 10,000 m, plasma IRG levels did not change significantly, while IRI and G increased significantly. In evaluating the pooled data from both runs, a significant inverse correlation was observed between delta G and delta IRG. This relationship between delta G and delta IRG suggests that glucagon plays a role in maintaining normal blood glucose levels during strenuous exercise.     

MicroRNAs as Biomarkers for Acute Atrial Remodeling in Marathon Runners (The miRathon Study – A Sub-Study of the Munich Marathon Study)

Introduction

Physical activity is beneficial for individual health, but endurance sport is associated with the development of arrhythmias like atrial fibrillation. The underlying mechanisms leading to this increased risk are still not fully understood. MicroRNAs are important mediators of proarrhythmogenic remodeling and have potential value as biomarkers in cardiovascular diseases. Therefore, the objective of our study was to determine the value of circulating microRNAs as potential biomarkers for atrial remodeling in marathon runners (miRathon study).

Methods

30 marathon runners were recruited into our study and were divided into two age-matched groups depending on the training status: elite (ER, ≥55 km/week, n = 15) and non-elite runners (NER, ≤40 km/week, n = 15). All runners participated in a 10 week training program before the marathon. MiRNA plasma levels were measured at 4 time points: at baseline (V1), after a 10 week training period (V2), immediately after the marathon (V3) and 24h later (V4). Additionally, we obtained clinical data including serum chemistry and echocardiography at each time point.

Results

MiRNA plasma levels were similar in both groups over time with more pronounced changes in ER. After the marathon miR-30a plasma levels increased significantly in both groups. MiR-1 and miR-133a plasma levels also increased but showed significant changes in ER only. 24h after the marathon plasma levels returned to baseline. MiR-26a decreased significantly after the marathon in elite runners only and miR-29b showed a non-significant decrease over time in both groups. In ER miRNA plasma levels showed a significant correlation with LA diameter, in NER miRNA plasma levels did not correlate with echocardiographic parameters.

Conclusion

MiRNAs were differentially expressed in the plasma of marathon runners with more pronounced changes in ER. Plasma levels in ER correlate with left atrial diameter suggesting that circulating miRNAs could potentially serve as biomarkers of atrial remodeling in athletes.     

Beta-endorphin activity and hypercapnic ventilatory responsiveness after marathon running

To investigate the hypothesis that endurance exercise may lead to a decrease in ventilatory chemosensitivity as possibly mediated by an increase in endogenous beta-endorphins, we measured hypercapnic ventilatory responsiveness (HCVR) and circulating beta-endorphin immunoreactivity in six runners before and after a marathon (42.2 km) race and after administration of 10 mg iv naloxone. Similar testing was performed at identical time periods on the day before the marathon as control data. On each occasion, HCVR was measured twice 15 min apart, and the mean value was used for analysis. Six active (training distance 50-104 km/wk) and experienced (no. of marathons completed, 1-25) runners participated in the study. There were no significant changes in beta-endorphin activity or HCVR on the control day. All runners experienced a rise in beta-endorphin activity from premarathon (21.3 +/- 16.0 pg/ml) to immediate postmarathon (89.6 +/- 84.9 pg/ml) values (P less than 0.05). However, HCVR showed no significant change at any of the three testing periods on the marathon day. To investigate whether a time delay may have affected the lack of response to naloxone, additional testing was performed in five subjects, except that 10 mg iv naloxone was given within 10 min after completion of the marathon, and then HCVR was measured. Although there was a greater than fourfold increase in beta-endorphin immunoreactivity after the marathon, there was no significant change in HCVR after naloxone administration. We conclude that natural increases in endogenous beta-endorphin activity associated with marathon running do not modulate central chemosensitivity.     

Administration of branched-chain amino acids during sustained exercise--effects on performance and on plasma concentration of some amino acids.

Previous studies have shown that sustained exercise in human subjects causes an increase in the plasma concentration ratio of free tryptophan: other large neutral amino acids [including the branched-chain amino acids (BCAA)]. This should favour the transport of tryptophan into the brain and also the synthesis of 5-hydroxytryptamine, which is thought to contribute to fatigue during prolonged exercise. A mixture of the three BCAA was given to subjects during a 30-km cross-country race or a marathon (42.2 km) and the effects on mental and physical performances were measured. The mental performance, measured as the performance in the Stroop Colour and Word Test (CWT), was improved after, as compared to before the 30-km cross-country race when a BCAA supplement was given during the race, whereas the CWT scores were similar before and after in the placebo group. The running performance in the marathon was improved for the "slower" runners (3.05 h-3.30 h) when BCAA was taken during the race; however, there was no significant effect on the performance in the "faster" runners (less than 3.05 h). The results showed that both mental and physical performance was improved by an intake of BCAA during exercise. In addition, the effects of exercise on the plasma concentration of the aromatic amino acids were altered when a BCAA supplement was given during the marathon.     

The responses of plasma biochemical parameters to a 56-km race in novice and experienced ultra-marathon runners

A number of blood biochemical parameters, including the activities of the plasma enzymes creatine kinase (CK), aspartate aminotransferase (ASAT), lactate dehydrogenase and alkaline phosphatase, were measured in 23 athletes before, and immediately after a 56-km running race. Of the 23 athletes, 18 had previously completed standard 42-km marathon or longer (up to 90-km) ultra-marathon races, whereas not one of the other five athletes had previously run in a long-distance race. After the race, plasma CK and ASAT activities had both risen at least 280% more in the novice runners despite their much slower mean running speed (9.8 +/- 0.4 vs. 13.8 +/- 0.3 hm/h). There were no other inter-group differences in the absolute levels of the other measured biochemical parameters, although the rise in plasma calcium during the race was significantly greater in the experienced marathon runners. This study shows that either higher levels of training, or previous ultra-marathon racing experience, or both, is associated with lower immediate post-exercise levels of plasma enzyme activity. This is compatible with the finding that physical training reduces post-exercise plasma enzyme levels.     

Effect of prolonged physical exercise on intra-erythrocyte and plasma potassium

The intracellular concentrations of sodium [Na+] and potassium [K+] and the water content in human erythrocytes were investigated in 21 male runners before and after a marathon. From 2 to 5 min after the race, the intra-erythrocyte [K+] was significantly decreased (p less than 0.001) by 7% whereas the plasma [K+], intra-erythrocyte [Na+] and the erythrocyte water content were unchanged. The change in the intra-erythrocyte [K+] observed immediately after the marathon, was negatively correlated with the race time (r = -0.44; p less than 0.05). Furthermore, the change in the plasma [K+] (r = -0.64; p less than 0.001) and the amount of K+ excreted in the urine during the race (r = 0.54; p less than 0.05) were also, respectively, negatively and positively correlated with the race time. It is concluded that during prolonged physical exercise the erythrocytes could serve as a kind of K+ reservoir that is drained with increasing magnitude of body K+ loss. This might explain why in the faster marathon runners, in whom the urinary K+ loss is smaller and the K+ intake is greater than in the slower runners during race, the intra-erythrocyte [K+] is unchanged after a marathon whereas in the slower runners it is decreased.     

Marathon running: physiological and chemical changes accompanying late-race functional deterioration

Twenty-one experienced runners were studied before, during and immediately after a marathon race to ascertain whether either depletion of energy substrate or rise in body temperature, or both, contribute to late-race slowing of running pace. Seven runners drank a glucose/electrolyte (GE) solution ad libitum (Na+ 21 mmol l-1, K+ 2.5 mmol l-1, Cl- 17 mmol l-1, PO4(2-) 6 mmol l-1, glucose 28 mmol l-1) throughout the race; 6 drank water and 8 drank the GE solution diluted 1:1 with water. Although average running speeds for the three groups were not significantly different during the first two-thirds (29 km) of the race, rectal temperature was significantly higher (P < 0.05) and reduction of plasma volume was greater (P < 0.05) in runners who replaced sweat losses with water. During the last one-third of the race, the average running pace of the water-replacement group slowed by 37.2%; the pace slowed by 27.9% in the 8 runners who replaced their sweat loss with GE diluted 1:1 with water (1/2 GE) and 18.2% in runners who replaced fluid loss with full-strength solution (GE). Eleven runners (5 in the water group, 4 in the 1/2 GE group and 2 in the GE group) lapsed into a walk/run/walk pace during the last 6 miles of the race. Ten of these had a rectal temperature of 39 degrees C or greater after 29 km of running, and plasma volume in these runners was reduced by more than 10%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Faecal blood loss in response to exercise.

Recently qualitative tests have indicated that gastrointestinal bleeding during exercise may be an important contributory factor in sports anaemia. In six healthy men who walked 37 km on four consecutive days faecal haemoglobin content remained normal (reference range 0.10-2.53 mg/g faeces) with no significant differences between values. In 28 marathon runners who refrained from taking drugs or food containing blood the median faecal haemoglobin content increased by 0.42 mg/g faeces (95% confidence interval 0.12 to 0.83 mg/g) from 1.06 (0.86 to 1.31) mg/g before the race. In 13 runners who had taken drugs before the race the corresponding increase in the median faecal haemoglobin content was 0.87 (-0.03 to 2.20) mg/g from the value before the race of 0.93 (0.46 to 1.55) mg/g. Prolonged walking had no effect on gastrointestinal blood loss. Intense endurance exercise in the form of marathon running induced a significant but clinically unimportant increase. This may be exaggerated by the ingestion of drugs and assume importance in causing iron deficiency and sports anaemia. The use of drugs, particularly analgesics, by marathon runners should be actively discouraged.     

Alterations in plasma-volume-corrected blood components of marathon runners and concomitant relationship to performance

The study was undertaken to determine the effects of running a marathon on concentration of various blood components resulting from phenomena other than fluid loss, and these were related to performance times. Twenty male marathon runners ranging from 20 to 50 years of age participated in the study. Blood samples were collected before and after the subjects ran in a marathon. Blood samples were analyzed for sodium, potassium, glucose, lactate dehydrogenase, creatinine, creatine phosphokinase, triglycerides, cholesterol, hematocrit, hemoglobin, protein, white blood cell number, uric acid, carbon dioxide, and iron. All of the blood parameters increased significantly in concentration with the exceptions of glucose and carbon dioxide which decreased. After accounting for plasma-volume loss (COR), there remained significant increases in blood serum lactate dehydrogenase, creatinine, creatine phosphokinase, uric acid, iron, and whole-blood white blood cell number. Significant decreases in COR serum sodium, protein, glucose, and carbon dioxide were found. Lactate dehydrogenase and creatine phosphokinase concentration changes support the concept of acute damage to muscle tissue resulting from marathon running. No strong relationship between performance time and other measured variables was found. COR measures were more representative of marathon induced blood changes from physiological dynamics other than plasma volume change than presently reported findings.     

Blood platelet activation and increase in thrombin activity following a marathon race

To see whether strenuous prolonged exertion increases blood platelet activation and thrombin activity in healthy well-trained men, 16 male amateur runners (mean age 31,8) were studied. A marathon race (mean time 2 h 44 min 30 s) caused a significant increase in plasma beta-thromboglobulin (beta-TG), platelet factor 4 (PF4), fibrinopetide A (FPA) and factor VIII (F VIII) activity. Sixty min after exertion beta-TG and F VIII activity were still significantly elevated. FPA continued to rise, reaching peak values 60 min after the run. 22 h after finishing the race F VIII activity was still significantly elevated. The study has demonstrated the great inter-individual variability of marathon race-induced haemostatic changes. The elevation of beta-TG varied from 42% to 156%, F VIII from 112% to 625%, and in three runners FPA reached more than 900% of its pre-exercise value. In some individuals the haemostatic changes observed could be potentially unfavourable for coronary heart disease prevention.     

Effects of a concurrent strength and endurance training on running performance and running economy in recreational marathon runners

The purpose of this study was to investigate the effects of a concurrent strength and endurance training program on running performance and running economy of middle-aged runners during their marathon preparation. Twenty-two (8 women and 14 men) recreational runners (mean ± SD: age 40.0 ± 11.7 years; body mass index 22.6 ± 2.1 kg·m?2) were separated into 2 groups (n = 11; combined endurance running and strength training program [ES]: 9 men, 2 women and endurance running [E]: 7 men, and 4 women). Both completed an 8-week intervention period that consisted of either endurance training (E: 276 ± 108 minute running per week) or a combined endurance and strength training program (ES: 240 ± 121-minute running plus 2 strength training sessions per week [120 minutes]). Strength training was focused on trunk (strength endurance program) and leg muscles (high-intensity program). Before and after the intervention, subjects completed an incremental treadmill run and maximal isometric strength tests. The initial values for VO2peak (ES: 52.0 ± 6.1 vs. E: 51.1 ± 7.5 ml·kg?1·min?1) and anaerobic threshold (ES: 3.5 ± 0.4 vs. E: 3.4 ± 0.5 m·s?1) were identical in both groups. A significant time × intervention effect was found for maximal isometric force of knee extension (ES: from 4.6 ± 1.4 to 6.2 ± 1.0 N·kg?1, p < 0.01), whereas no changes in body mass occurred. No significant differences between the groups and no significant interaction (time × intervention) were found for VO2 (absolute and relative to VO2peak) at defined marathon running velocities (2.4 and 2.8 m·s?1) and submaximal blood lactate thresholds (2.0, 3.0, and 4.0 mmol·L?1). Stride length and stride frequency also remained unchanged. The results suggest no benefits of an 8-week concurrent strength training for running economy and coordination of recreational marathon runners despite a clear improvement in leg strength, maybe because of an insufficient sample size or a short intervention period.     

Metabolic factors limiting performance in marathon runners

Each year in the past three decades has seen hundreds of thousands of runners register to run a major marathon. Of those who attempt to race over the marathon distance of 26 miles and 385 yards (42.195 kilometers), more than two-fifths experience severe and performance-limiting depletion of physiologic carbohydrate reserves (a phenomenon known as 'hitting the wall'), and thousands drop out before reaching the finish lines (approximately 1-2% of those who start). Analyses of endurance physiology have often either used coarse approximations to suggest that human glycogen reserves are insufficient to fuel a marathon (making 'hitting the wall' seem inevitable), or implied that maximal glycogen loading is required in order to complete a marathon without 'hitting the wall.' The present computational study demonstrates that the energetic constraints on endurance runners are more subtle, and depend on several physiologic variables including the muscle mass distribution, liver and muscle glycogen densities, and running speed (exercise intensity as a fraction of aerobic capacity) of individual runners, in personalized but nevertheless quantifiable and predictable ways. The analytic approach presented here is used to estimate the distance at which runners will exhaust their glycogen stores as a function of running intensity. In so doing it also provides a basis for guidelines ensuring the safety and optimizing the performance of endurance runners, both by setting personally appropriate paces and by prescribing midrace fueling requirements for avoiding 'the wall.' The present analysis also sheds physiologically principled light on important standards in marathon running that until now have remained empirically defined: The qualifying times for the Boston Marathon.     

Creatine kinase-MB isoenzyme adaptations in stressed human skeletal muscle of marathon runners

The creatine kinase (CK) isoenzyme composition was determined in serial gastrocnemius muscle biopsies obtained from 12 male marathon runners. The mean muscle CK-MB composition significantly increased after chronic exercise (training) from 5.3% (pretraining) to 7.7% (premarathon) as well as after acute exercise (postmarathon) to 10.5% of the total CK activity (P less than 0.05). However, no significant differences in total CK activities were detected. Additionally, mitochondrial CK and CK-BB isoenzymes were present in muscle homogenates. A significant correlation was observed in the increase in mean serum total CK (3,322 U/l) and CK-MB (174 U/l) activities 24 h after the race (r = 0.98, P less than 0.05). These results show that gastrocnemius muscle adapts to long-distance training and racing with increased CK-MB activities and imply that skeletal muscle is the major source of elevated serum CK-MB activities in marathon runners.     

Modeling: optimal marathon performance on the basis of physiological factors

This paper examines current concepts concerning "limiting" factors in human endurance performance by modeling marathon running times on the basis of various combinations of previously reported values of maximal O2 uptake (VO2max), lactate threshold, and running economy in elite distance runners. The current concept is that VO2max sets the upper limit for aerobic metabolism while the blood lactate threshold is related to the fraction of VO2max that can be sustained in competitive events greater than approximately 3,000 m. Running economy then appears to interact with VO2max and blood lactate threshold to determine the actual running speed at lactate threshold, which is generally a speed similar to (or slightly slower than) that sustained by individual runners in the marathon. A variety of combinations of these variables from elite runners results in estimated running times that are significantly faster than the current world record (2:06:50). The fastest time for the marathon predicted by this model is 1:57:58 in a hypothetical subject with a VO2max of 84 ml.kg-1.min-1, a lactate threshold of 85% of VO2max, and exceptional running economy. This analysis suggests that substantial improvements in marathon performance are "physiologically" possible or that current concepts regarding limiting factors in endurance running need additional refinement and empirical testing.     

Thermoregulation during marathon running in cool, moderate, and hot environments.

A well-trained subject, age 38, ran continously for periods ranging from 60 to 165 min on a motor-driven treadmill at 255.7 m/min while confronted with an airflow equivalent to running speed in cool, moderate, and hot environments. After a period of intensive heat acclimatization, treadmill runs were repeated in the moderate and hot conditions. Measurements were also obtained outdoors in a competitive marathon race. Sweat rate (SR) and mean skin temperature (Ts) were linearly related to Tdb. Acclimatization did not alter VO2max or metabolic rate during the treadmill runs, but heart rat (HR),rectal temperature (Tre), and Ts were lower, SR was higher, and maximal run duration longer in the hot environment, postacclimatization. Maximum runs in the hot environment were terminated by a spiralling increase in Tre to hyperthermic levels, due largely to a marked reduction in cutaneous blood flow, probably reflecting cardiovascular overload from the combined muscular and thermoregulatory blood flow demands, coupled with the effects of progressive dehydration. Utilizing partitional calorimetry and the subject's metabolic heat production, two examples of limiting environmental conditions for his marathon running speed were given.     

Skeletal muscle creatine kinase MB alterations in women marathon runners

Total creatine kinase (CK) and CK MB activities were determined in gastrocnemius muscle and serum obtained from 14 female marathon runners. The level of CK MB in muscle increased significantly (p less than 0.05) after chronic exercise training from 5.3% to 10.5% of the total CK activity, but not after acute exercise (post-marathon 8.9%). No significant differences in total CK activities were detected. However, the total CK activity in the muscles were significantly (p less than 0.05) less than those previously reported from the muscle of men runners (1800 U/g, 3000 U/g respectively). No significant correlation existed between fiber type and muscle CK MB activity. Additionally, trace amounts of mitochondrial CK and CK BB were present in muscle homogenates. A significant correlation was observed in the increase in mean serum total CK (597 UL-1) and CK MB (23 UL-1) activities 24 h after the race (r = 0.97, p less than 0.05). These results suggest that gastrocnemius muscle in women adapts to training with increased CK MB activities and imply that skeletal muscle is the major source of elevated serum CK MB activities in women marathon runners.     

Changes in adrenal and testicular activity monitored by salivary sampling in males throughout marathon runs

Measurement of cortisol and testosterone in saliva samples provided by marathon runners at 6.4 km (4-mile) intervals has been used for monitoring acute changes in adrenal and testicular activity, and the changes compared with mean values in timed samples on five rest days. The collection of mixed whole saliva was well accepted; the missed sample rate in the 8 runners in the Cardiff marathon was less than 10%. On rest days, salivary cortisol and testosterone were within the normal male range and showed a circadian rhythm; mean values at 08.00 h (23.5 nmol L-1; 258 pmol L-1, p less than 0.001, p less than 0.001 respectively) were higher than at 22.00 h (2.8 nmol L-1; 130 pmol L-1). In samples collected at 09.00 h, immediately prior to the Cardiff marathon, cortisol (25.1 nmol L-1) and testosterone (304 pmol L-1) were higher than the mean values (14.9 nmol L-1; 209 pmol L-1) on non-run days. Concentrations of both steroids increased during the marathon; testosterone peaked (442 pmol L-1) at 21 miles, whereas cortisol continued to increase, being maximal (87.9 nmol L-1) at 30 min after completion of the run. Four of the runners in the Cardiff marathon also participated in the Bristol marathon and the changing patterns in salivary hormones were strictly comparable. Salivary sampling would appear to be of value in monitoring acute and rhythmic changes in endocrine function in marathon runners. The temporal relationship between changes in salivary cortisol and testosterone are consistent with direct inhibition of testicular secretion by high cortisol concentrations.     

Salivary cortisol for monitoring adrenal activity during marathon runs

In non-elite male runners (n = 8), changes in adrenal activity were monitored by measurement of salivary cortisol in samples collected at 4-mile intervals during marathon runs. These changes were compared with those in similarly timed samples collected on rest days. Immediately prior to the Cardiff marathon, at 09.00 h, mean salivary cortisol concentrations (21.5 nmol/l) were higher than those in similarly timed rest day samples (14.9 nmol/l). Cortisol concentrations increased during the marathon, and although values at 25 miles were high (79.4 nmol/l), maximum values (87.9 nmol/l) were observed in samples collected 30 min after completion of the run. Some Cardiff marathon runners also participated in the Bristol marathon (n = 4) and a non-competitive event (n = 3). The changing pattern in secretory activity was similar in all events. The easy collection of saliva without cessation of exercise is ideal for monitoring the hormonal response to exercise.     

Reduced Incidence of Cardiac Arrhythmias in Walkers and Runners

Purpose

Walking is purported to reduce the risk of atrial fibrillation by 48%, whereas jogging is purported to increase its risk by 53%, suggesting a strong anti-arrhythmic benefit of walking over running. The purpose of these analyses is to compare incident self-reported physician-diagnosed cardiac arrhythmia to baseline energy expenditure (metabolic equivalent hours per day, METhr/d) from walking, running and other exercise.

Methods

Proportional hazards analysis of 14,734 walkers and 32,073 runners.

Results

There were 1,060 incident cardiac arrhythmias (412 walkers, 648 runners) during 6.2 years of follow-up. The risk for incident cardiac arrhythmias declined 4.4% per baseline METhr/d walked by the walkers, or running in the runners (P = 0.0001). Specifically, the risk declined 14.2% (hazard ratio: 0.858) for 1.8 to 3.6 METhr/d, 26.5% for 3.6 to 5.4 METhr/d, and 31.7% for ≥5.4 METhr/d, relative to <1.8 METhr/d. The risk reduction per METhr/d was significantly greater for walking than running (P<0.01), but only because walkers were at 34% greater risk than runners who fell below contemporary physical activity guideline recommendations; otherwise the walkers and runners had similar risks for cardiac arrhythmias. Cardiac arrhythmias were unrelated to walking and running intensity, and unrelated to marathon participation and performance.

Conclusions

The risk for cardiac arrhythmias was similar in walkers and runners who expended comparable METhr/d during structured exercise. We found no significant risk increase for self-reported cardiac arrhythmias associated with running distance, exercise intensity, or marathon participation. Rhythm abnormalities were based on self-report, precluding definitive categorization of the nature of the rhythm disturbance. However, even if the runners’ arrhythmias include sinus bradycardia due to running itself, there was no increase in arrhythmias with greater running distance.