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Glycaemic Effects of a 156-km Ultra-trail Race in Athletes: An Observational Field Study

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Abstract

Background

Ultra-trail running races pose appreciable physiological challenges, particularly for glucose metabolism. Previous studies that yielded divergent results only measured glycaemia at isolated times.

Objectives

We aimed to explore the impact of an ultra-endurance race on continuously measured glycaemia and to understand potential physiological mechanisms, as well as the consequences for performance and behavioural alertness.

Methods

Fifty-five athletes (78% men, 43.7 ± 9.6 years) ran a 156-km ultra-trail race (six 26-km laps, total elevation 6000 m). Participants wore a masked continuous glucose monitoring sensor from the day before the race until 10 days post-race. Blood was taken at rest, during refuelling stops after each lap, and after 24-h recovery. Running intensity (% heart rate reserve), performance (lap times), psychological stress, and behavioural alertness were explored. Linear mixed models and logistic regressions were carried out.

Results

No higher risk of hypo- or hyperglycaemia was observed during the exercise phases of the race (i.e. excluding stops for scientific measurements and refuelling) compared with resting values. Laps comprising a greater proportion of time spent at maximal aerobic intensity were nevertheless associated with more time > 180 mg/dL (P = 0.021). A major risk of hyperglycaemia appeared during the 48-h post-race period compared with pre-race (P < 0.05), with 31.9% of the participants spending time with values > 180 mg/dL during recovery versus 5.5% during resting. Changes in circulating insulin, cortisol, and free fatty acids followed profiles comparable with those usually observed during traditional aerobic exercise. However, creatine phosphokinase, and to a lesser extent lactate dehydrogenase, increased exponentially during the race (P < 0.001) and remained high at 24-h post-race (P < 0.001; respectively 43.6 and 1.8 times higher vs. resting). Glycaemic metrics did not influence physical performance or behavioural alertness.

Conclusion

Ultra-endurance athletes were exposed to hyperglycaemia during the 48-h post-race period, possibly linked to muscle damage and inflammation. Strategies to mitigate muscle damage or subsequent inflammation before or after ultra-trail races could limit recovery hyperglycaemia and hence its related adverse health consequences.

Trial Registration Number

NCT05538442 2022–09-21 retrospectively registered.

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Acknowledgements

The authors would like to thank the participants in this study. We thank J. Naturel and J. Lutun (Lille University) and V. Deprez and M-A Allain (Lille University Hospital) for their administrative support; J. Dereumetz (Lille University) for her help with data analyses; A. Bertrand (Statistical Methodology and Computing Service, UCLouvain, Belgium) for support with statistical analyses; and S. Platt (International Eyes SARL) for revising the English. We also thank A. Oliveira Alves and M. Osmont (Paris Cité University) for blood sampling and P. Pigny, F. Zerimech, and J. Demaret (Lille University Hospital) for blood analyses. Glycaemic analyses were carried out at the EURASPORT facility managed by S. Berthoin (Lille University).

Author information

Author notes

  1. Benoît Mauvieux and Elodie Lespagnol have contributed equally to this work.

Authors and Affiliations

  1. Univ. Lille, Univ. Artois, Univ. Littoral Côte d’Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France

    Cassandra Parent, Elodie Lespagnol, Rémy Hurdiel, Pauline Baron, François-Xavier Gamelin & Elsa Heyman

  2. Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada

    Cassandra Parent & Rémi Rabasa-Lhoret

  3. Department of Nutrition, Université de Montréal, Montréal, Québec, Canada

    Cassandra Parent & Rémi Rabasa-Lhoret

  4. UR 7480 Vertex - Université de Caen, Caen, France

    Benoît Mauvieux, Corentin Hingrand, Pierre-Louis Delaunay, Stéphane Besnard & Virginie Gabel

  5. Département de Médecine Générale, Faculté de Médecine - Département du Grand Est de Recherche en Soins Primaires, Université de Lorraine, Nancy, France

    Jean-Charles Vauthier

  6. Institute for Research in bioMedicine and Epidemiology of Sport (IRMES), Paris, France

    Philippe Noirez

  7. T3S, INSERM UMR-S 1124, University of Paris Cité, Paris, France

    Philippe Noirez

  8. Département des Sciences de l’activité Physique, Université du Québec à Montréal, Montreal, Canada

    Philippe Noirez

  9. PSMS, University of Reims Champagne Ardenne, Reims, France

    Philippe Noirez & Quentin Martinet

  10. CNRS, UMR 6118, Transferts d’eau et de Matière dans les Milieux Hétérogènes Complexes - Géosciences, Université Rennes, Rennes, France

    Joris Heyman

  11. Laboratoire de Biochimie et Biologie Moléculaire, CHU de Lille, Pôle de Biologie Pathologie Génétique, Lille, France

    Patrice Maboudou

  12. Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne Billancourt, France

    Romain Jouffroy

  13. Centre de Recherche en Epidémiologie et Santé des Populations - U1018, INSERM - Paris Saclay University, Paris, France

    Romain Jouffroy

  14. EA 7329 - Institut de Recherche Médicale et d’Épidémiologie du Sport – Institut National du Sport, de l’Expertise et de la Performance, Paris, France

    Romain Jouffroy

  15. Institut Universitaire de France, Paris, France

    Elsa Heyman

  16. Laboratoire Interpsy (UR 4432), Université de Lorraine, Nancy, France

    Jean-Charles Vauthier

  17. CHU de Caen, Caen, France

    Stéphane Besnard

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  1. Cassandra Parent
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  2. Benoît Mauvieux
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Correspondence to Elsa Heyman.

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Funding

This protocol was partly financed by the RIN TREMPLIN APEEX (Adaptation Physiologiques En Environnements Extrêmes – 2020/2022) supported by the Normandy Region – France and the European Regional Development Fund (ERDF). This study was undertaken as part of the project run by the International Joint Laboratory REGALE-1 (Glycemic Regulation During Exercise in Type 1 Diabetes), bringing together the URePSSS (Lille University) and IRCM (Montréal) and involving an international ‘SPORT-1’ Chair for R. Rabasa-Lhoret (I-SITE ULNE, WILL grant). This study was supported in part by grants from the Type 1 Running Team Association. EH received a grant from the Institut Universitaire de France, and CP received grant assistance as a doctoral student from the Hauts-de-France Regional Authority.

Competing Interests

The authors declare no competing interests.

Ethics Approval

Approval institution, Ouest III Ethics Committee; ethics number, 2021-A01765-36; date of approval, 26 October 2021. Trial registration number, NCT05538442 2022-09-21, retrospectively registered. The study was performed in accordance with the ethical standards in the Declaration of Helsinki.

Consent to Participate

All participants were fully informed of the nature and possible risks of the experimental procedures before their written informed consent was obtained.

Consent to Publication

Not applicable.

Code Availability

Not applicable.

Authors’ Contributions

All authors read and approved the final version. EH and BM designed the experiments. FXG and RRL gave advice on some methodological points. CP, EL, EH, JCV, RH, PLD, SB, PN, VG, PB, QM, and RJ carried out the experiments and collected the data. PM performed blood analyses. EH and CP analysed the data. JH created algorithms for analyses of glycaemic excursions and variability. BM and CH recruited the participants, organized the protocol and the race, and submitted the protocol to the ethics committee. EH and CP wrote the manuscript. All authors were involved in reviewing the manuscript. EH has guaranteed the integrity of the study throughout its duration and, as such, had full access to data and takes responsibility for the integrity of the data and accuracy of the data analysis.

Data Availability Statements

All data related to this article are available on http://www.data.gouv.fr/fr/ platform (https://doi.org/10.57745/EO2SBC).

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Parent, C., Mauvieux, B., Lespagnol, E. et al. Glycaemic Effects of a 156-km Ultra-trail Race in Athletes: An Observational Field Study. Sports Med (2024). https://doi.org/10.1007/s40279-024-02013-4

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