To date, research in UER has focused predominantly on acute injuries and medical problems, as well as physiological, biochemical, nutritional, performance, and training-related aspects.
Participation in UER decreased significantly in 2020 due to the worldwide coronavirus disease 2019 (COVID-19) pandemic. The popularity of UER has increased over the last 2 decades and, in 2019 alone, over 669,000 runners contested more than 7000 UER events around the world. Ultra-endurance running (UER) can be defined either by running distance (races that exceed the marathon distance of 42.195 km) or running time (exceeding 6 h), including multi-day or multi-stage events. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. It is well established that physical activity reduces all-cause mortality and can prolong life.
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