title: Exertional Rhabdomyolysis during a 246-km continuous running race.
abstract: BACKGROUND
  To evaluate the effect of continuous, moderate-intensity ultra-endurance running exercise on skeletal muscle and hepatic damage, as indicated by serum enzyme activity measured immediately following the race.
  
  
  METHODS
  Thirty-nine runners of the Spartathlon race (a 246-km continuous race from Athens to Sparta, Greece) who managed to complete the race within the 36-h limit participated in this study. Mean finishing time of the study participants was 33.3+/-0.5 h and their average age, height, and body mass were 41+/-1 yr, 174+/-1 cm, and 67.5+/-1.1 kg, respectively. Blood samples, taken a day before and immediately after completion of the race, were assayed for the following variables: creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (gamma-GT).
  
  
  RESULTS
  A dramatic increase in most of muscle and liver damage indicators was observed. The mean values for CK, LDH, AST, and ALT after the race were 43,763+/-6,764, 2,300+/-285, 1,182+/-165, and 264+/-37 IU.L, respectively. These values were 29,384+/-4,327, 585+/-89, 5,615+/-902, and 1,606+/-331% higher than the corresponding values before the race (P<0.001) for CK, LDH, AST, and ALT, respectively. However, there was not a significant increase in gamma-GT levels.
  
  
  CONCLUSIONS
  Muscle and liver damage indicators were elevated at the highest level ever reported as a result of prolonged exercise, although no severe symptoms that required hospitalization were observed in any of the participants. The data suggest that even moderate-intensity exercise of prolonged duration can induce asymptomatic exertional rhabdomyolysis.
authors.affiliation: Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, GREECE. ksken@hua.gr
authors.forename: Katerina P
authors.initials: KP
authors.lastname: Skenderi
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Kavouras
authors.forename: Costas A
authors.initials: CA
authors.lastname: Anastasiou
authors.forename: Nikos
authors.initials: N
authors.lastname: Yiannakouris
authors.forename: Antonia-Leda
authors.initials: AL
authors.lastname: Matalas
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D003402:Creatine Kinase / Q000032:analysis; D004906:Erythrocyte Count; D004909:Erythrocyte Indices; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007958:Leukocyte Count; D008099:Liver / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D010807:Physical Endurance / Q000502:physiology; D012206:Rhabdomyolysis / Q000097:blood / Q000209:etiology*; D012420:Running / Q000502:physiology*; D013997:Time Factors; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D006454:Hemoglobins; D007770:L-Lactate Dehydrogenase; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase