An ultra-marathon leads to an energy deficit resulting in a reduction of both body fat and skeletal muscle mass. The fastest ultra-marathon race times are generally achieved at the age of 35–45 years or older for both women and men, and the age of peak performance increases with increasing race distance or duration. Women are slower than men, but the sex difference in performance decreased in recent years to ~10–20% depending upon the length of the ultra-marathon. Previous experience (e.g., number of finishes in ultra-marathon races and personal best marathon time) is the most important predictor variable for a successful ultra-marathon performance followed by specific anthropometric (e.g., low body mass index, BMI, and low body fat) and training (e.g., high volume and running speed during training) characteristics.

Ultra-marathoners are older and have a larger weekly training volume, but run more slowly during training compared to marathoners. Female ultra-marathoners account for ~20% of the total number of finishers. A typical ultra-marathoner is male, married, well-educated, and ~45 years old. The number of ultra-marathon races and the number of official finishers considerably increased in the last decades especially due to the increased number of female and age-group runners.

In this overview, we summarize the findings of the literature with regards to physiology and pathophysiology of ultra-marathon running.

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