Marathon Training: Gender and Age Aspects

  • Jennifer L. ReedEmail author
  • Jenna C. Gibbs


No presentation of marathon running would be complete without a discussion of gender and age aspects. Marathon running is one of the world’s oldest sports dating back to the ancient Greeks. However, it is only in the last 40 years that women and older runners have begun training for and competing in these 42 km (marathon distance) foot races. In the pages that follow, we will provide a brief history of several notable women and older runners that have shaped the history of marathon running. We will review the physiological differences such as body composition and oxygen carrying capacity between men and women as it relates to marathon training and performance. We will discuss the performance differences such as finishing time and pace strategy between men and women as well as comment on gender-specific training and injury characteristics. Specific to female runners, we will report on menstrual disturbances that may result from high exercise energy expenditure and/or low dietary energy intake frequently observed among runners, and training and running considerations during pregnancy. As apparent and highly researched are the physiological considerations of marathon running, the equally important musculoskeletal and psychological factors such as bone loss and disordered eating will be discussed. We will briefly review the cardiovascular, pulmonary and neuromuscular changes that occur with aging, and the impact of these changes on marathon training and performance. Finally, we will discuss the risk of medical problems and running-related injuries in older marathon runners and the emerging trend of younger marathon runners (<18 years of age).


Aging Marathon Running Women 



We would like to sincerely thank Dr. Lisa Cote, a Postdoctoral Fellow in the Division of Prevention and Rehabilitation specifically associated with the Canadian Women’s Heart Health Centre at the University of Ottawa Heart Institute, for providing her expertise and assistance in preparing the vascular health section.


  1. Ackerman KE, Nazem T, Chapko D et al (2011) Bone microarchitecture is impaired in adolescent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls. J Clin Endocrinol Metab 96:3123–3133PubMedPubMedCentralCrossRefGoogle Scholar
  2. Ackerman KE, Putman M, Guereca G et al (2012) Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes. Bone 51:680–687PubMedPubMedCentralCrossRefGoogle Scholar
  3. Ackerman KE, Cano Sokoloff N, G Denm et al (2015) Fractures in relation to menstrual status and bone parameters in young athletes. Med Sci Sports Exerc 47:1577–1586Google Scholar
  4. Ainsworth BE, Haskell WL, Whitt MC et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498–S504PubMedCrossRefGoogle Scholar
  5. American Academy of Pediatrics Committee on Sports Medicine (1990) Risks in distance running for children. Pediatrics 86:799–800Google Scholar
  6. American College of Sports Medicine (2014) ACSM’s guidelines for exercise testing and prescription, 9th edn. Lippincott Williams & Wilkins, Baltimore (MD)Google Scholar
  7. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: American Psychiatric AssociationGoogle Scholar
  8. Arimura C, Nozaki T, Takakura S et al (2010) Predictors of menstrual resumption by patients with anorexia nervosa. Eat Weight Disord 15:e226–e233PubMedGoogle Scholar
  9. Avolio AP, Deng FQ, Li WQ et al (1985) Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation 71:202–210PubMedCrossRefGoogle Scholar
  10. Bale P, Rowell S, Colley E (1985) Anthropometric and training characteristics of female marathon runners as determinants of distance running performance. J Sports Sci 3:115–126PubMedCrossRefGoogle Scholar
  11. Barrack MT, Rauh MJ, Barkai HS et al (2008) Dietary restraint and low bone mass in female adolescent endurance runners. Am J Clin Nutr 87:36–43PubMedGoogle Scholar
  12. Beals KA, Manore MM (2000) Behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders. Int J Sport Nutr Exerc Metab 10:128–143PubMedGoogle Scholar
  13. Beilock SL, Feltz DL, Pivarnik JM (2001) Training patterns of athletes during pregnancy and postpartum. Res Q Exerc Sport 72:39–46PubMedCrossRefGoogle Scholar
  14. Bennell KL, Malcolm SA, Thomas SA et al (1995) Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis. Clin J Sport Med 5:229–235PubMedCrossRefGoogle Scholar
  15. Bennell K, Matheson G, Meeuwisse W et al (1999) Risk factors for stress fractures. Sports Med 28:91–122PubMedCrossRefGoogle Scholar
  16. Black MA, Cable NT, Thijssen DH et al (2009) Impact of age, sex, and exercise on brachial artery flow-mediated dilatation. Am J Physiol Heart Circ Physiol 297:H1109–H1116PubMedPubMedCentralCrossRefGoogle Scholar
  17. Boles CA, Ferguson C (2010) The female athlete. Radiol Clin North Am 48:1249–1266PubMedCrossRefGoogle Scholar
  18. Brooks SV, Faulkner JA (1990) Contraction-induced injury: recovery of skeletal muscles in young and old mice. Am J Physiol 258:C436–C442PubMedGoogle Scholar
  19. Brooks SV, Opiteck JA, Faulkner JA (2001) Conditioning of skeletal muscles in adult and old mice for protection from contraction-induced injury. J Gerontol A Biol Sci Med Sci 56:B163–B171PubMedCrossRefGoogle Scholar
  20. Buist I, Bredeweg SW, Lemmink KA et al (2010) Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study. Am J Sports Med 38:273–280PubMedCrossRefGoogle Scholar
  21. Bullen BA, Skrinar GS, Beitins IZ et al (1985) Induction of menstrual disorders by strenuous exercise in untrained women. N Engl J Med 312:1349–1353PubMedCrossRefGoogle Scholar
  22. Burfoot A (2007) The history of the marathon: 1976-present. Sports Med 37:284–287PubMedCrossRefGoogle Scholar
  23. Burke EJ (1977) Physiological effects of similar training programs in males and females. Res Q 48:510–517PubMedGoogle Scholar
  24. Burke LM, Loucks AB, Broad N (2006) Energy and carbohydrate for training and recovery. J Sports Sci 24:675–685PubMedCrossRefGoogle Scholar
  25. Bus SA (2003) Ground reaction forces and kinematics in distance running in older-aged men. Med Sci Sports Exerc 35:1167–1175PubMedCrossRefGoogle Scholar
  26. Caine D, DiFiori J, Maffulli N (2006) Physeal injuries in children’s and youth sports: reasons for concern? Br J Sports Med 40:749–760PubMedPubMedCentralCrossRefGoogle Scholar
  27. Carter SL, Rennie C, Tarnopolsky MA (2001) Substrate utilization during endurance exercise in men and women after endurance training. Am J Physiol Endocrinol Metab 280:E898–E907PubMedGoogle Scholar
  28. Cheuvront SN, Carter R, Deruisseau KC et al (2005) Running performance differences between men and women: an update. Sports Med 35:1017–1024PubMedCrossRefGoogle Scholar
  29. Christo K, Prabhakaran R, Lamparello B et al (2008) Bone metabolism in adolescent athletes with amenorrhea, athletes with eumenorrhea, and control subjects. Pediatrics 121:1127–1136PubMedPubMedCentralCrossRefGoogle Scholar
  30. Climatic heat stress and the exercising child and adolescent (2000) American Academy of Pediatrics. Committee on Sports Medicine and Fitness. Pediatrics 106:158–159Google Scholar
  31. Cobb KL, Bachrach LK, Greendale G et al (2003) Disordered eating, menstrual irregularity, and bone mineral density in female runners. Med Sci Sports Exerc 35:711–719PubMedCrossRefGoogle Scholar
  32. Coggan AR, Spina RJ, Rogers MA et al (1990) Histochemical and enzymatic characteristics of skeletal muscle in master athletes. J Appl Physiol 1985(68):1896–1901Google Scholar
  33. Cureton K, Bishop P, Hutchinson P et al (1986) Sex difference in maximal oxygen uptake. Effect of equating haemoglobin concentration. Eur J Appl Physiol Occup Physiol 54:656–660PubMedCrossRefGoogle Scholar
  34. Dalle Grave R, Calugi S, Marchesini G (2008) Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome. Compr Psychiatry 49:346–352Google Scholar
  35. Daniels J, Daniels N (1992) Running economy of elite male and elite female runners. Med Sci Sports Exerc 24:483–489PubMedCrossRefGoogle Scholar
  36. Davies GA, Wolfe LA, Mottola MF et al (2003) Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. Can J Appl Physiol 28:330–341PubMedCrossRefGoogle Scholar
  37. Davis C, Katzman DK, Kaptein S et al (1997) The prevalence of high-level exercise in the eating disorders: etiological implications. Compr Psychiatry 38:321–326PubMedCrossRefGoogle Scholar
  38. De Souza MJ, Metzger DA (1991) Reproductive dysfunction in amenorrheic athletes and anorexic patients: a review. Med Sci Sports Exerc 23:995–1007PubMedCrossRefGoogle Scholar
  39. De Souza MJ, Williams NI (2004) Physiological aspects and clinical sequelae of energy deficiency and hypoestrogenism in exercising women. Hum Reprod Update 10:433–448PubMedCrossRefGoogle Scholar
  40. De Souza MJ, Miller BE, Loucks AB et al (1998) High frequency of luteal phase deficiency and anovulation in recreational women runners: blunted elevation in follicle-stimulating hormone observed during luteal-follicular transition. J Clin Endocrinol Metab 83:4220–4232PubMedGoogle Scholar
  41. De Souza CA, Shapiro LF, Clevenger CM et al (2000) Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilation in healthy men. Circulation 102:1351–1357CrossRefGoogle Scholar
  42. De Souza MJ, Van Heest J, Demers LM et al (2003) Luteal phase deficiency in recreational runners: evidence for a hypometabolic state. J Clin Endocrinol Metab 88:337–346PubMedCrossRefGoogle Scholar
  43. De Souza MJ, Lee DK, VanHeest JL et al (2007) Severity of energy-related menstrual disturbances increases in proportion to indices of energy conservation in exercising women. Fertil Steril 88:971–975PubMedCrossRefGoogle Scholar
  44. De Souza MJ, West SL, Jamal SA et al (2008) The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women. Bone 43:140–148PubMedCrossRefGoogle Scholar
  45. De Souza MJ, Toombs RJ, Scheid JL et al (2010) High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod 25:491–503PubMedCrossRefGoogle Scholar
  46. De Souza et al (2014) Clin J Sports Med 24(2):96–119Google Scholar
  47. Deaner RO, Carter RE, Joyner MJ et al (2015) Men are more likely than women to slow in the marathon. Med Sci Sports Exerc 47:607–616PubMedPubMedCentralCrossRefGoogle Scholar
  48. Dedrick ME, Clarkson PM (1990) The effects of eccentric exercise on motor performance in young and older women. Eur J Appl Physiol Occup Physiol 60:183–186PubMedCrossRefGoogle Scholar
  49. Demorest RA, Landry GL (2003) Prevention of pediatric sports injuries. Curr Sports Med Rep 2:337–343PubMedCrossRefGoogle Scholar
  50. Dill DB, Robinson S, Ross JC (1967) A longitudinal study of 16 champion runners. J Sports Med Phys Fitness 7:4–27PubMedGoogle Scholar
  51. Drinkwater BL, Nilson K, Chesnut CH 3rd et al (1984) Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 311:277–281PubMedCrossRefGoogle Scholar
  52. Dueck CA, Matt KS, Manore MM et al (1996) Treatment of athletic amenorrhea with a diet and training intervention program. Int J Sport Nutr 6:24–40PubMedGoogle Scholar
  53. Fielding RA, Meredith CN, O’Reilly KP et al (1991) Enhanced protein breakdown after eccentric exercise in young and older men. J Appl Physiol 1985(71):674–679Google Scholar
  54. Fukuchi RK, Stefanyshyn DJ, Stirling L et al (2014) Flexibility, muscle strength and running biomechanical adaptations in older runners. Clin Biomech (Bristol, Avon) 29:304–310Google Scholar
  55. Gentile MG, Manna GM, Pastorelli P et al (2011) Resumption of menses after 32 years in anorexia nervosa. Eat Weight Disord 16:e223–e225 Google Scholar
  56. Gibbs JC, Williams NI, Scheid JL et al (2011) The association of a high drive for thinness with energy deficiency and severe menstrual disturbances: confirmation in a large population of exercising women. Int J Sport Nutr Exerc Metab 21:280–290PubMedGoogle Scholar
  57. Gibbs JC, Williams NI, Mallinson RJ et al (2013) Effect of high dietary restraint on energy availability and menstrual status. Med Sci Sports Exerc 45:1790–1797PubMedCrossRefGoogle Scholar
  58. Golden NH, Jacobson MS, Schebendach J et al (1997) Resumption of menses in anorexia nervosa. Arch Pediatr Adolesc Med 151:16–21PubMedCrossRefGoogle Scholar
  59. Grinspoon S, Baum H, Lee K et al (1996) Effects of short-term recombinant human insulin-like growth factor I administration on bone turnover in osteopenic women with anorexia nervosa. J Clin Endocrinol Metab 81:3864–3870PubMedGoogle Scholar
  60. Hagmar M, Eriksson MJ, Lindholm C et al (2006) Endothelial function in post-menopausal former elite athletes. Clin J Sport Med 16:247–252PubMedCrossRefGoogle Scholar
  61. Hale R (1984) Factors important to women engaged in vigorous physical activity. In: Strauss R (ed) Sports Medicine. W. B. Saunders, Philadelphia, pp 1–441Google Scholar
  62. Hankonen N, Absetz P, Ghisletta P et al (2010) Gender differences in social cognitive determinants of exercise adoption. Psychol Health 25:55–69PubMedCrossRefGoogle Scholar
  63. Hawkins SA, Wiswell RA (2003) Rate and mechanism of maximal oxygen consumption decline with aging: implications for exercise training. Sports Med 33(12):877–888Google Scholar
  64. Helgerud J (1994) Maximal oxygen uptake, anaerobic threshold and running economy in women and men with similar performances level in marathons. Eur J Appl Physiol Occup Physiol 68:155–161PubMedCrossRefGoogle Scholar
  65. Hilton LK, Loucks AB (2000) Low energy availability, not exercise stress, suppresses the diurnal rhythm of leptin in healthy young women. Am J Physiol Endocrinol Metab 278:E43–E49PubMedGoogle Scholar
  66. Hirschmuller A, Frey V, Konstantinidis L et al (2012) Prognostic value of Achilles tendon Doppler sonography in asymptomatic runners. Med Sci Sports Exerc 44:199–205PubMedCrossRefGoogle Scholar
  67. Hopkins WG, Hewson DJ (2001) Variability of competitive performance of distance runners. Med Sci Sports Exerc 33:1588–1592PubMedCrossRefGoogle Scholar
  68. Hopkins P, Powers SK (1982) Oxygen uptake during submaximal running in highly trained men and women. Am Correct Ther J 36:130–132PubMedGoogle Scholar
  69. Hunter SK, Stevens AA (2013) Sex differences in marathon running with advanced age: physiology or participation? Med Sci Sports Exerc 45:148–156PubMedCrossRefGoogle Scholar
  70. Hunter SK, Stevens AA, Magennis K et al (2011) Is there a sex difference in the age of elite marathon runners? Med Sci Sports Exerc 43:656–664PubMedCrossRefGoogle Scholar
  71. Ihle R, Loucks AB (2004) Dose-response relationships between energy availability and bone turnover in young exercising women. J Bone Miner Res 19:1231–1240PubMedCrossRefGoogle Scholar
  72. International Association of Athletics Federation (2015). Available from: 18 Nov 2015
  73. International Association of Athletics Federation (2015). Available from: 18 Nov 2015
  74. Jee H, Park J, Oh JG et al (2013) Effect of a prolonged endurance marathon on vascular endothelial and inflammation markers in runners with exercise-induced hypertension. Am J Phys Med Rehabil 92:513–522PubMedCrossRefGoogle Scholar
  75. Joyner MJ (1993) Physiological limiting factors and distance running: influence of gender and age on record performances. Exerc Sport Sci Rev 21:103–133PubMedCrossRefGoogle Scholar
  76. Kelsey JL, Bachrach LK, Procter-Gray E et al (2007) Risk factors for stress fracture among young female cross-country runners. Med Sci Sports Exerc 39:1457–1463PubMedCrossRefGoogle Scholar
  77. Kim JH, Malhotra R, Chiampas G et al (2012) Cardiac arrest during long-distance running races. N Engl J Med 366:130–140PubMedCrossRefGoogle Scholar
  78. Knechtle B, Knechtle P, Rosemann T et al (2010a) Sex differences in association of race performance, skin-fold thicknesses, and training variables for recreational half-marathon runners. Percept Mot Skills 111:653–668PubMedCrossRefGoogle Scholar
  79. Knechtle B, Knechtle P, Rosemann T (2010b) Race performance in male mountain ultra-marathoners: anthropometry or training? Percept Mot Skills 110:721–735PubMedCrossRefGoogle Scholar
  80. Kopp-Woodroffe SA, Manore MM, Dueck CA et al (1999) Energy and nutrient status of amenorrheic athletes participating in a diet and exercise training intervention program. Int J Sport Nutr 9:70–88PubMedGoogle Scholar
  81. Kuga K, Yamaguchi I, Sugishita Y (1993) Age-related changes of sinus node function and autonomic regulation in subjects without sinus node disease–assessment by pharmacologic autonomic blockade. Jpn Circ J 57:760–768PubMedCrossRefGoogle Scholar
  82. Lakatta EG (2003) Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part III: cellular and molecular clues to heart and arterial aging. Circulation 107:490–497PubMedCrossRefGoogle Scholar
  83. Lakatta EG, Levy D (2003) Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a “set up” for vascular disease. Circulation 107:139–146PubMedCrossRefGoogle Scholar
  84. Lamont LS (2005) Gender differences in amino acid use during endurance exercise. Nutr Rev 63:419–422PubMedCrossRefGoogle Scholar
  85. Lampe JW, Slavin JL, Apple FS (1986) Poor iron status of women runners training for a marathon. Int J Sports Med 7:111–114PubMedCrossRefGoogle Scholar
  86. Lang T, Streeper T, Cawthon P et al (2010) Sarcopenia: etiology, clinical consequences, intervention, and assessment. Osteoporos Int 21:543–559PubMedPubMedCentralCrossRefGoogle Scholar
  87. Lappe JM, Stegman MR, Recker RR (2001) The impact of lifestyle factors on stress fractures in female army recruits. Osteoporos Int 12:35–42PubMedCrossRefGoogle Scholar
  88. Lara B, Salinero JJ, Del Coso J (2014) The relationship between age and running time in elite marathoners is U-shaped. Age (Dordr) 36:1003–1008CrossRefGoogle Scholar
  89. Lawson EA, Donoho D, Miller KK et al (2009) Hypercortisolemia is associated with severity of bone loss and depression in hypothalamic amenorrhea and anorexia nervosa. J Clin Endocrinol Metab 94:4710–4716PubMedPubMedCentralCrossRefGoogle Scholar
  90. Lebenstedt M, Platte P, Pirke KM (1999) Reduced resting metabolic rate in athletes with menstrual disorders. Med Sci Sports Exerc 31:1250–1256PubMedCrossRefGoogle Scholar
  91. Leyk D, Erley O, Gorges W et al (2009) Performance, training and lifestyle parameters of marathon runners aged 20–80 years: results of the PACE-study. Int J Sports Med 30:360–365PubMedCrossRefGoogle Scholar
  92. Lokey EA, Tran ZV, Wells CL et al (1991) Effects of physical exercise on pregnancy outcomes: a meta-analytic review. Med Sci Sports Exerc 23:1234–1239PubMedCrossRefGoogle Scholar
  93. Loucks AB, Thuma JR (2003) Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab 88:297–311PubMedCrossRefGoogle Scholar
  94. Loucks AB, Kiens B, Wright HH (2011) Energy availability in athletes. J Sports Sci 29(Suppl 1):S7–S15PubMedCrossRefGoogle Scholar
  95. Maher AC, Tarnopolsky MA (2013) Substrate utilization in female athletes implications for fuel selection and macronutrient requirements. In: Beals KA (ed) Nutrition and the female athlete: from research to practice. CRC Press Taylor & Francis Group, Boca Raton, FLGoogle Scholar
  96. Mallinson RJ, Williams NI, Olmsted MP et al (2013) A case report of recovery of menstrual function following a nutritional intervention in two exercising women with amenorrhea of varying duration. J Int Soc Sports Nutr 10:34PubMedPubMedCentralCrossRefGoogle Scholar
  97. March DS, Vanderburgh PM, Titlebaum PJ et al (2011) Age, sex, and finish time as determinants of pacing in the marathon. J Strength Cond Res 25:386–391PubMedCrossRefGoogle Scholar
  98. Martinsen M, Bratland-Sanda S, Eriksson AK et al (2010) Dieting to win or to be thin? A study of dieting and disordered eating among adolescent elite athletes and non-athlete controls. Br J Sports Med 44:70–76PubMedCrossRefGoogle Scholar
  99. McKean KA, Manson NA, Stanish WD (2006) Musculoskeletal injury in the masters runners. Clin J Sport Med 16:149–154PubMedCrossRefGoogle Scholar
  100. Misra M, Prabhakaran R, Miller KK et al (2008) Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1. J Clin Endocrinol Metab 93:1231–1237PubMedPubMedCentralCrossRefGoogle Scholar
  101. Mitchell GF, Parise H, Benjamin EJ et al (2004) Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham heart study. Hypertension 43:1239–1245PubMedCrossRefGoogle Scholar
  102. Mohtadi N (2005) Rehabilitation of anterior cruciate ligament injuries: a review. Clin J Sport Med 15:287–288PubMedCrossRefGoogle Scholar
  103. Mond JM, Calogero RM (2009) Excessive exercise in eating disorder patients and in healthy women. Aust N Z J Psychiatry 43:227–234PubMedCrossRefGoogle Scholar
  104. Moreau KL, Donato AJ, Seals DR et al (2003) Regular exercise, hormone replacement therapy and the age-related decline in carotid arterial compliance in healthy women. Cardiovasc Res 57:861–868PubMedCrossRefGoogle Scholar
  105. Moreau KL, Gavin KM, Plum AE et al (2006) Oxidative stress explains differences in large elastic artery compliance between sedentary and habitually exercising postmenopausal women. Menopause 13:951–958PubMedCrossRefGoogle Scholar
  106. Myburgh KH, Berman C, Novick I et al (1999) Decreased resting metabolic rate in ballet dancers with menstrual irregularity. Int J Sport Nutr 9:285–294PubMedGoogle Scholar
  107. Myerson M, Gutin B, Warren MP et al (1992) Total body bone density in amenorrheic runners. Obstet Gynecol 79:973–978PubMedGoogle Scholar
  108. Nattiv A (2000) Stress fractures and bone health in track and field athletes. J Sci Med Sport 3:268–279PubMedCrossRefGoogle Scholar
  109. Nattiv A, Loucks AB, Manore MM et al (2007) American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc 39:1867–1882PubMedCrossRefGoogle Scholar
  110. Noakes TD (1987) Heart disease in marathon runners: a review. Med Sci Sports Exerc 19:187–194PubMedCrossRefGoogle Scholar
  111. O’Donnell E, Harvey PJ, De Souza MJ (2009) Relationships between vascular resistance and energy deficiency, nutritional status and oxidative stress in oestrogen deficient physically active women. Clin Endocrinol (Oxf) 70:294–302CrossRefGoogle Scholar
  112. O’Donnell E, Goodman JM, Harvey PJ (2011) Clinical review: Cardiovascular consequences of ovarian disruption: a focus on functional hypothalamic amenorrhea in physically active women. J Clin Endocrinol Metab 96:3638–3648PubMedCrossRefGoogle Scholar
  113. O’Keefe JH, Lavie CJ (2013) Run for your life … at a comfortable speed and not too far. Heart 99:516–519PubMedCrossRefGoogle Scholar
  114. Papanek PE (2003) The female athlete triad: an emerging role for physical therapy. J Orthop Sports Phys Ther 33:594–614PubMedCrossRefGoogle Scholar
  115. Pate RR, O’Neill JR (2007) American women in the marathon. Sports Med 37(4–5):294–298PubMedCrossRefGoogle Scholar
  116. Pate RR, Sparling PB, Wilson GE et al (1987) Cardiorespiratory and metabolic responses to submaximal and maximal exercise in elite women distance runners. Int J Sports Med 8(Suppl 2):91–95PubMedCrossRefGoogle Scholar
  117. Pierce GL, Eskurza I, Walker AE et al (2011) Sex-specific effects of habitual aerobic exercise on brachial artery flow-mediated dilation in middle-aged and older adults. Clin Sci (Lond) 120:13–23CrossRefGoogle Scholar
  118. Pollock ML (1977) Submaximal and maximal working capacity of elite distance runners. Part I: cardiorespiratory aspects. Ann N Y Acad Sci 301:310–322PubMedCrossRefGoogle Scholar
  119. American College of Obstetricians and Gynecologists (2002) ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol 99:171–173Google Scholar
  120. Rader EP, Faulkner JA (2006a) Recovery from contraction-induced injury is impaired in weight-bearing muscles of old male mice. J Appl Physiol 1985(100):656–661Google Scholar
  121. Rader EP, Faulkner JA (2006b) Effect of aging on the recovery following contraction-induced injury in muscles of female mice. J Appl Physiol 1985(101):887–892Google Scholar
  122. Radtke T, Schmidt-Trucksass A, Brugger N et al (2014) Ultra-endurance sports have no negative impact on indices of arterial stiffness. Eur J Appl Physiol 114:49–57PubMedCrossRefGoogle Scholar
  123. Rauh MJ, Nichols JF, Barrack MT (2010) Relationships among injury and disordered eating, menstrual dysfunction, and low bone mineral density in high school athletes: a prospective study. J Athl Train 45:243–252PubMedPubMedCentralCrossRefGoogle Scholar
  124. Reed JL, Bowell JL, Hill BR et al (2011) Exercising women with menstrual disturbances consume low energy dense foods and beverages. Appl Physiol Nutr Metab 36:382–394PubMedCrossRefGoogle Scholar
  125. Reed JL, De Souza MJ, Mallinson RJ et al (2015) Energy availability discriminates clinical menstrual status in exercising women. J Int Soc Sports Nutr 12:11PubMedPubMedCentralCrossRefGoogle Scholar
  126. Rice SG (2000) Development of an injury surveillance system: results from a longitudinal study of high school athletes. In: Ashare AB (ed) Safety in ice hockey. American Society for Testing and Materials, West Conshohocken, PA, pp 3–18CrossRefGoogle Scholar
  127. Roberts WO (2007) Can children and adolescents run marathons? Sports Med 37:299–301PubMedCrossRefGoogle Scholar
  128. Roberts WO, Nicholson WG (2010) Youth marathon runners and race day medical risk over 26 years. Clin J Sport Med 20:318–321PubMedCrossRefGoogle Scholar
  129. Rodriguez NR, Di Marco NM, Langley S (2009) American college of sports medicine position stand. Nutrition and athletic performance. Med Sci Sports Exerc 41:709–731PubMedCrossRefGoogle Scholar
  130. Rogers MA, Evans WJ (1993) Changes in skeletal muscle with aging: effects of exercise training. Exerc Sport Sci Rev 21:65–102PubMedCrossRefGoogle Scholar
  131. Santos-Lozano A, Collado PS, Foster C et al (2014) Influence of sex and level on marathon pacing strategy. Insights from the New York City race. Int J Sports Med 35:933–938PubMedCrossRefGoogle Scholar
  132. Saunders PU, Pyne DB, Telford RD et al (2004) Factors affecting running economy in trained distance runners. Sports Med 34:465–485PubMedCrossRefGoogle Scholar
  133. Schwabe K, Schwellnus M, Derman W et al (2014a) Medical complications and deaths in 21 and 56 km road race runners: a 4-year prospective study in 65 865 runners–SAFER study I. Br J Sports Med 48:912–918PubMedCrossRefGoogle Scholar
  134. Schwabe K, Schwellnus MP, Derman W et al (2014b) Less experience and running pace are potential risk factors for medical complications during a 56 km road running race: a prospective study in 26 354 race starters–SAFER study II. Br J Sports Med 48:905–911PubMedCrossRefGoogle Scholar
  135. Seals DR, Desouza CA, Donato AJ et al (2008) Habitual exercise and arterial aging. J Appl Physiol 105:1323–1332PubMedPubMedCentralCrossRefGoogle Scholar
  136. Seefeldt V, Malina RM, Clark MA (2002) Factors affecting levels of physical activity in adults. Sports Med 32:143–168PubMedCrossRefGoogle Scholar
  137. Shaffer RA, Rauh MJ, Brodine SK et al (2006) Predictors of stress fracture susceptibility in young female recruits. Am J Sports Med 34:108–115PubMedCrossRefGoogle Scholar
  138. Speechly DP, Taylor SR, Rogers GG (1996) Differences in ultra-endurance exercise in performance-matched male and female runners. Med Sci Sports Exerc 28:359–365PubMedGoogle Scholar
  139. Sternfeld B, Quesenberry CP Jr, Eskenazi B et al (1995) Exercise during pregnancy and pregnancy outcome. Med Sci Sports Exerc 27:634–640PubMedCrossRefGoogle Scholar
  140. Stray-Gundersen J, Chapman RF, Levine BD (2001) “Living high-training low” altitude training improves sea level performance in male and female elite runners. J Appl Physiol 1985(91):1113–1120Google Scholar
  141. Sundgot-Borgen J (1994) Risk and trigger factors for the development of eating disorders in female elite athletes. Med Sci Sports Exerc 26:414–419PubMedCrossRefGoogle Scholar
  142. Sundgot-Borgen J, Torstveit MK (2007) The female football player, disordered eating, menstrual function and bone health. Br J Sports Med 41(Suppl 1):i68–i72PubMedPubMedCentralCrossRefGoogle Scholar
  143. Sundgot-Borgen J, Torstveit MK (2010) Aspects of disordered eating continuum in elite high-intensity sports. Scand J Med Sci Sports 20(Suppl 2):112–121PubMedCrossRefGoogle Scholar
  144. Taddei S, Virdis A, Mattei P et al (1995) Aging and endothelial function in normotensive subjects and patients with essential hypertension. Circulation 91:1981–1987PubMedCrossRefGoogle Scholar
  145. Taddei S, Galetta F, Virdis A et al (2000) Physical activity prevents age-related impairment in nitric oxide availability in elderly athletes. Circulation 101:2896–2901PubMedCrossRefGoogle Scholar
  146. Tanaka H, DeSouza CA, Seals DR (1998) Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol 18:127–132PubMedCrossRefGoogle Scholar
  147. Tanaka H, Dinenno FA, Monahan KD et al (2000) Aging, habitual exercise, and dynamic arterial compliance. Circulation 102:1270–1275PubMedCrossRefGoogle Scholar
  148. Tarnopolsky MA (2000) Gender differences in substrate metabolism during endurance exercise. Can J Appl Physiol 25:312–327PubMedCrossRefGoogle Scholar
  149. Tarnopolsky MA (2008) Sex differences in exercise metabolism and the role of 17-beta estradiol. Med Sci Sports Exerc 40:648–654PubMedCrossRefGoogle Scholar
  150. Tate CA, Holtz RW (1998) Gender and fat metabolism during exercise: a review. Can J Appl Physiol 23:570–582PubMedCrossRefGoogle Scholar
  151. Taylor AW, Johnson MJ (2008) Physiology of exercise and healthy aging. Human Kinetics, Champaign, ILGoogle Scholar
  152. Thompson J, Manore M, Sheeshka J (2005) Nutrition: a functional approach. Second Canadian edn. Pearson, Toronto, OntarioGoogle Scholar
  153. Trappe S (2007) Marathon runners: how do they age? Sports Med 37(4–5):302–305PubMedCrossRefGoogle Scholar
  154. Trappe SW, Costill DL, Fink WJ et al (1995) Skeletal muscle characteristics among distance runners: a 20-yr follow-up study. J Appl Physiol 1985(78):823–829Google Scholar
  155. Trubee NW, Vanderburgh PM, Diestelkamp WS et al (2014) Effects of heat stress and sex on pacing in marathon runners. J Strength Cond Res 28:1673–1678PubMedCrossRefGoogle Scholar
  156. Vaitkevicius PV, Fleg JL, Engel JH et al (1993) Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 88:1456–1462PubMedCrossRefGoogle Scholar
  157. van der Worp MP, ten Haaf DS, van Cingel R et al (2015) Injuries in runners; a systematic review on risk factors and sex differences. PLoS One 10:e0114937PubMedPubMedCentralCrossRefGoogle Scholar
  158. Vescovi JD, Scheid JL, Hontscharuk R et al (2008) Cognitive dietary restraint: impact on bone, menstrual and metabolic status in young women. Physiol Behav 95:48–55PubMedCrossRefGoogle Scholar
  159. Vitzthum VJ (2009) The ecology and evolutionary endocrinology of reproduction in the human female. Am J Phys Anthropol 140(Suppl 49):95–136PubMedCrossRefGoogle Scholar
  160. Vlachopoulos C, Dima I, Aznaouridis K et al (2005) Acute systemic inflammation increases arterial stiffness and decreases wave reflections in healthy individuals. Circulation 112:2193–2200PubMedCrossRefGoogle Scholar
  161. Vrazel J, Saunders RP, Wilcox S (2008) An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot 23:2–12PubMedCrossRefGoogle Scholar
  162. Wade GN, Schneider JE (1992) Metabolic fuels and reproduction in female mammals. Neurosci Biobehav Rev 16:235–272PubMedCrossRefGoogle Scholar
  163. Wang BW, Ramey DR, Schettler JD et al (2002) Postponed development of disability in elderly runners: a 13-year longitudinal study. Arch Intern Med 162:2285–2294PubMedCrossRefGoogle Scholar
  164. Warburton DE, Nicol CW, Bredin SS (2006) Health benefits of physical activity: the evidence. CMAJ 174:801–809PubMedPubMedCentralCrossRefGoogle Scholar
  165. Warden SJ, Davis IS, Fredericson M (2014) Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther 44:749–765PubMedCrossRefGoogle Scholar
  166. Warren MP (1980) The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 51:1150–1157PubMedCrossRefGoogle Scholar
  167. Warren MP, Brooks-Gunn J, Fox RP et al (2002) Osteopenia in exercise-associated amenorrhea using ballet dancers as a model: a longitudinal study. J Clin Endocrinol Metab 87:3162–3168PubMedCrossRefGoogle Scholar
  168. Webner D, DuPrey KM, Drezner JA et al (2012) Sudden cardiac arrest and death in United States marathons. Med Sci Sports Exerc 44:1843–1845PubMedCrossRefGoogle Scholar
  169. Wen DY, Puffer JC, Schmalzried TP (1997) Lower extremity alignment and risk of overuse injuries in runners. Med Sci Sports Exerc 29:1291–1298PubMedCrossRefGoogle Scholar
  170. Williams NI, Young JC, McArthur JW et al (1995) Strenuous exercise with caloric restriction: effect on luteinizing hormone secretion. Med Sci Sports Exerc 27:1390–1398PubMedGoogle Scholar
  171. Williams NI, Bullen BA, McArthur JW et al (1999) Effects of short-term strenuous endurance exercise upon corpus luteum function. Med Sci Sports Exerc 31:949–958PubMedCrossRefGoogle Scholar
  172. Williams NI, Helmreich DL, Parfitt DB et al (2001a) Evidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training. J Clin Endocrinol Metab 86:5184–5193PubMedCrossRefGoogle Scholar
  173. Williams NI, Caston-Balderrama AL, Helmreich DL et al (2001b) Longitudinal changes in reproductive hormones and menstrual cyclicity in cynomolgus monkeys during strenuous exercise training: abrupt transition to exercise-induced amenorrhea. Endocrinology 142:2381–2389PubMedGoogle Scholar
  174. Williams NI, Reed JL, Leidy HJ et al (2010) Estrogen and progesterone exposure is reduced in response to energy deficiency in women aged 25–40 years. Hum Reprod 25:2328–2339PubMedPubMedCentralCrossRefGoogle Scholar
  175. Wiswell RA, Jaque SV, Marcell TJ et al (2000) Maximal aerobic power, lactate threshold, and running performance in master athletes. Med Sci Sports Exerc 32:1165–1170PubMedCrossRefGoogle Scholar
  176. Zanker CL, Swaine IL (1998) Bone turnover in amenorrhoeic and eumenorrhoeic women distance runners. Scand J Med Sci Sports 8:20–26PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of Prevention and RehabilitationUniversity of Ottawa Heart InstituteOttawaCanada
  2. 2.Department of KinesiologyUniversity of WaterlooWaterlooCanada

Personalised recommendations