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Centre for Human Performance
Biochemical Markers After Sporting Incapacitation Study BASIS
Exploration of candidate biological markers (in blood, urine and saliva) that may help better identify and treat cases of collapse associated with exercise, including Exertional Heat Stroke (EHS).
The Challenge
Prolonged endurance exercise undoubtedly carries many important health benefits but is also associated with illness and injury during or soon after participation. Rarely, incapacitation from increased metabolic heat production and/or severe environmental conditions may take the form of EHS, which can be fatal.
Differentiating milder forms of exercise- and heat-related-illness from life-threatening EHS can be difficult for medical providers and there is limited ability to predict how much additional medical care will be needed in the hours and days following collapse. There is also no consensus or readily-accessible tool for making decisions on return-to-play and -participation following EHS, despite knowledge that a first episode can increase risk of future illness during exercise. These challenges can be compounded when collapse occurs in more remote locations with less readily available access to medical support, as in adventure races or military settings.
We wanted to find out whether a range of biological markers measured in blood would tell the difference between heat-related illness caused by marathon participation, including EHS, and healthy runners; and to follow how these markers would change over time. We also wanted to look for evidence suggesting organ injury (brain, gut, kidneys) and to improve our understanding of changes in cardiac function, blood pressure control and inflammatory responses in collapse versus successful marathon completion.
THE APPROACH
One hundred healthy entrants to the 2019 Brighton Marathon were recruited for blood tests and measures of cardiovascular function before the run and on the finish line. A further eight cases of heat-related collapse had similar measurements in the medical tent and both groups went on to provide later blood tests (at 1, 4 and 24 hours after race completion). As well as presenting a substantial logistical challenge, with access to runners and in-loading of research equipment affected by closure of large parts of Brighton for the race weekend, the study also demanded managing a large research team spread across multiple locations; keeping participants warm and dignified while examining and imaging their hearts in a chilly beach-based research tent; and dynamically-identifying and following collapsed cases as they passed through the marathon medical evacuation chain. Use of Leeds Beckett University dewars filled with liquid nitrogen allowed us to rapidly freeze and store biological samples and contributed to a ‘cold chain’ stretching all the way from the South coast, via London, to our laboratory facilities in the North of England.
THE IMPACT
On the day, we were able to demonstrate how assessing the function of the heart using echocardiography can guide treatment strategies for heat-related collapse in the medical tent and also help to rule out other illnesses, such as heart attacks. In healthy runners, we demonstrated an increase in a novel echocardiographic index in that may help to offset dehydration and heat-related changes during or after the marathon. Compared with successful marathon finishers, cases of heat-related collapse showed evidence for brain, gut and kidney injury that was more pronounced and a pattern of inflammatory response that helps to explain their lower blood pressure. Even healthy participants (half!) showed a degree of kidney injury and our follow-up measurements are helping us to understand whether these changes are medically significant.
Overall, our findings have informed our preparations for BASIS2, to be conducted at the next Brighton Marathon weekend, with plans in place for extended measurements such as in-race body temperature and tissue glucose monitoring, plus less-invasive/easier to administer salivary sampling. They will also provide the foundation for future studies of potentially preventive treatments aimed at the inflammatory response to exercise, which could help to prevent collapse or abort EHS at an early stage.
- Faconti L, Parsons I, Farukh B, McNally R, Nesti L, Fang L, Stacey M, Hill N, Woods D, Chowienczyk P. Post-exertional increase in first-phase ejection fraction in recreational marathon runners. JRSM Cardiovasc Dis. 2020 May 18;9:2048004020926366. doi: 10.1177/2048004020926366
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