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Elevated serum creatine kinase MB and creatine kinase BB-isoenzyme fractions after ultra-marathon running


To determine the incidence and range of serum creatine kinase MB (CK-MB) isoenzyme activity after ultra-marathon running, a popular test kit was used to measure total serum creatine kinase (CK) and CK MB-activity in 75 athletes immediately after they had completed an 88-km running race. Total serum CK activity was markedly elevated after the race (mean value: 637 U·l−1) and 45 (60%) runners showed abnormal CK-MB isoenzyme activities (greater than 4% of total CK activity — range 1–19%).

Electrophoresis of 31 sera with either CK-MB to total CK activity greater than 4% or with total CK activity greater than 854 U·l−1 showed that 31 (100%) had visible CK-MM bands, 21 (68%) had visible CK-BB bands, but only 14 (44%) had visible CK-MB bands.

We conclude that prolonged exercise increases the serum activity of all three CK-isoenzymes, and that the CK-MB test kit used in this study identified a greater number of sera with elevated post-race CK-MB isoenzyme activity than did electrophoresis. This discrepancy could result either from cross-reaction of elevated CK-BB activity with the test kit, or from relative insensitivity of the electrophoresis.

The tissue source and long-term significance of the elevated serum CK-MB and CK-BB isoenzyme activity induced by ultra-marathon running are uncertain. Until these issues are resolved, these biochemical findings in ultra-marathon runners must be interpreted with the appropriate caution.

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  1. Apple FS (1981) Presence of creatine kinase MB isoenzyme during marathon training. N Eng J Med 305: 764–765

  2. Armstrong JB, Lowden JA, Sherwin AL (1977) Brain isoenzyme of creatine kinase. II. — Species specificity of enzyme and presence of inactive form in striated muscle of rabbit and man. J Biol Chem 252: 3112–3116

  3. Berg A, Haralambie G (1978) Changes in serum creatine kinase and hexose isomerase activity with exercise duration. Eur J Appl Physiol 39: 191–201

  4. Bunch TW (1980) Blood test abnormalities in runners. Mayo Clin Proc 55: 113–117

  5. Diamond TH, Smith R, Goldman AP, Myburgh DP, Block JM, Visser F (1983) The dilemma of the creatine kinase cardiospecific iso-enzyme (CK-MB) in marathon runners. S Afr Med J 63: 37–41

  6. Grande P, Pederson A, Schaadt O, Corfitsen T, Anderson BT (1980) Cardiospecific serum enzyme CK-MB following physical exercise in acute myocardial infarction. Eur J Cardiol 11: 161–167

  7. Griffiths PD (1966) Serum levels of ATP: Creatine phosphotransferase (creatine kinase). The normal range and effect of muscular exercise. Clin Chim Acta 13: 413–420

  8. Kaste M, Sherman DG (1982) Creatine kinase isoenzyme activities in marathon runners. Lancet ii: 327–328

  9. Kielblock AJ, Manjoo M, Booysen J, Katzeff IE (1979) Creatine phosphokinase and lactate dehydrogenase levels after ultra-distance running. S Afr Med J 55: 1061–1064

  10. La Porte MA, Linde HW, Bruce DL, Fitzsimons EJ (1978) Elevation of creatine phosphokinase in young men after recreational exercise. JAMA 239: 2685–2686

  11. Lott JA, Stand JM (1980) Serum enzymes and isoenzymes in the diagnosis and differential diagnosis of myocardial ischaemia and necrosis. Clin Chem 26: 1241–2450

  12. Noakes TD, Carter JW (1976) Biochemical parameters in athletes before and after having run 160 kilometers. S Afr Med J 50: 1562–1566

  13. Noakes TD, Carter JW (1982) The responses of plasma biochemical parameters to a 56 km race compared in novice and experienced ultra-marathon runners. Eur J Appl Physiol 49: 176–186

  14. Noakes T, Opie L, Beck W, McKenchie J, Benchimol A, Desser K (1977) Coronary heart disease in marathon runners. Ann N Y Acad Sci 301: 563–619

  15. Nuttal FQ, Jones B (1968) Creatine kinase and glutamic oxaloacetic trans minase activity in serum — Kinetics of change with exercise and effect of physical conditioning. J Lab Clin Med 71: 847–854

  16. Olerud JE, Homer LD, Carroll HW (1976) Incidence of acute exertional rhabdomyolysis. Arch Intern Med 136: 692–697

  17. Olivier LR, de Waal A, Retief FJ, Marx JD, Kriel JR, Human GP, Potgieter GM (1978) Electrocardiographic and biochemical studies on marathon runners. S Afr Med J 53: 783–787

  18. Phillips J, Horner B, Ohman M, Horgan J (1982) Increased brain-type creatine phosphokinase in marathon runners. Lancet 1: 1310

  19. Refsum HE, StrØmme SB, Tveit B (1971) Changes in serum enzyme levels after 90 km cross-country skiing. Acta Physiol Scand 84: 16A-17A

  20. Riley WJ, Pyke FS, Roberts AD, England JF (1975) The effect of long-distance running on some biochemical variables. Clin Chim Acta 65: 83–89

  21. Sanders TM, Bloor CM (1975) Effects of repeated endurance exercise on serum enzyme activities in well-conditioned males. Med Sci Sports 7: 44–47

  22. Schiff HB, MacSearraigh ETM, Kallmeyer JC (1978) Myoglobinuria, rhabdomolysis and marathon running. Quart J Med 47: 463–472

  23. Schnohr P, Grande P, Christiansen C (1980) Enzyme activities in serum after extensive exercise, with special reference to creatine kinase MB. Acta Med Scand 208: 229–231

  24. Siegel AJ, Silverman LM, Lopes RE (1980) Creatine kinase elevations in marathon runners — Relationship to training and competition. Yale J Biol Med 53: 275–279

  25. Siegel AJ, Silverman LM, Holman BL (1981) Elevated creatine kinase MB isoenzyme levels in marathon runners. JAMA 246: 2049–2051

  26. Solomon HG (1979) “Abnormal” laboratory results in runners. JAMA 241: 2262

  27. Stansbie D, Aston JP, Powell NH, Willis N (1982) Creatine Kinase MB in marathon runners. Lancet 1: 1413–1414

  28. Vejjajiva A, Teasdale GM (1965) Serum creatine kinase and physical activity. Br Med J 1: 1653–1654

  29. Wong R, Swallen TO (1975) Cellulose acetate electrophoresis of creatine phosphokinase isoenzymes in the diagnosis of myocardial infarction. Am J Clin Pathol 64: 209–216

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Noakes, T.D., Kotzenberg, G., McArthur, P.S. et al. Elevated serum creatine kinase MB and creatine kinase BB-isoenzyme fractions after ultra-marathon running. Europ. J. Appl. Physiol. 52, 75–79 (1983).

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Key words

  • Serum creatine kinase
  • Creatine kinase MB and BB isoenzymes
  • Ultra-marathon running