Applied sports nutrition support, dietary intake and body composition changes of a female athlete completing 26 marathons in 26 days: a case study.

Author:McManus, Chris J.
Position:Clinical report


Multi-day endurance running (MDER) events are becoming increasingly prevalent among recreational and elite runners (Khodaee and Ansari, 2012; Moran et al., 2011). It is well accepted that adhering to optimal nutritional strategies to meet the physical and environmental conditionals of MDER events is complex (Moran et al., 2011). Furthermore, fatigue is attributed to a multifaceted phenomenon during MDER events, often a combination of dehydration, hyperthermia, carbohydrate depletion, central fatigue and hypoglycaemia (Pfeiffer et al., 2012). Athletes undertaking endurance events are also particularly susceptible to injuries and illnesses.

Athletes and supporting practitioners must appreciate the unique environment, training demands and nutritional preparation required to successfully complete a MDER event. Despite numerous studies reporting food and fluid intake for male athletes during MDER events, to the authors' knowledge, no studies have presented dietary data for female athletes undertaking these types of events. By providing analysis of the interventions provided and an outline of the dietary intake of a recreational female athlete, it will inform future athletes and support staff alike, assisting in identifying and setting individual nutrition strategies for MDER events.

In accordance with the Declaration of Helsinki and University of Essex, ethical requirements, informed consent, along with a Physical Activity Readiness Questionnaire (PAR-Q) was obtained from the athlete prior to undertaking physiological testing. The athlete has also provided consent for the publication of the case study.

Case report


In October 2012, the athlete approached the Human Performance Unit (HPU), seeking support in the lead up to and during (August, 2013) the undertaking of 26 marathons in 26 consecutive days. The individual was a 38 year old female (V[O.sub.2]max 48.9 ml x [kg.sup.-1] x [min.sup.-1]; body mass 65.0 kg; height 1.65 m; BMI 23.7 kg x [m.sup.-2]). She had little previous experience of endurance running, and was completing the event as a piece of performance art rather than purely as an athletic challenge.

MDER event information

The challenge undertaken was a solo event, in which the same 1-mile course (Edinburgh 'Royal Mile', Scotland, 55.9506[degrees] N, 3.1856[degrees] W) was repeatedly traversed each day. The course presented an ascent/descent of 58.7 meters dependent on direction (max 7% gradient). Furthermore, the 26 days coincided with the Edinburgh Fringe Festival when large numbers of pedestrians would present physical obstacles to the course being traversed. The athlete began each marathon at 7:00 am. The ambient temperature varied from 7[degrees]C-23 [degrees]C throughout the 26 days. One person assisted with data collection, food provision and general logistics each day positioned at the mid-point along the 'Royal Mile'; where the athlete would pass every mile.

Needs analysis

A needs analysis was undertaken, starting with evidence gathering, drawing upon published literature, to facilitate the creation of a client specific action plan. The subsequent phase involved measurement of the athlete's physiology, anthropometry and a dietary assessment. The physiological demands (Laursen and Rhodes, 2001), training principles (Zaryski and Smith, 2005), nutritional demands (Getzin et al., 2011; Knechtle, 2013; O'Brien et al., 1993; Pfeiffer et al., 2012) and risk/management of injuries (Khodaee and Ansari., 2012; Krabak et al., 2011; 2013) of undertaking a marathon and/or ultra-endurance events have been well documented.

Areas of scientific support provided included; periodised training advice (Laursen and Rhodes, 2001), and sports psychology support to aid with athlete mental coping strategies (Zaryski and Smith, 2005). Dietary considerations included; (1) nutrition strategies to support training, (2) before, during and post exercise strategies (Peters, 2003; Burke et al., 2011), (3) strategies to support optimal immune function (Gleeson et al, 2004) and (4) building a food plan for during the event taking account of the athlete's food preferences (Burke, 2002; Clark et al, 1992).

Case formulation and intervention selection

It was agreed that support provision would focus on three primary areas; (1) food and fluid strategies to optimise training, recovery and event specific requirements, (2) physiological testing, training advice and monitoring and (3) sports psychology support. For the purpose of this article, the focus will be on the sports nutrition intervention and dietary intake during the event, coupled with anthropometric measures. Figure 1 provides an overview of the sessions with the athlete over the 12 months.

Prior to the first nutrition consultation in March 2013; a structured plan was presented to the athlete, outlining the key dietary topics in the build-up to the MDER event. A progressive nutrition plan was proposed to develop the athlete's nutrition knowledge, empowering the athlete to make decisions based upon the daily training load, timing...

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