161
Journal of Epidemiology
Vol. 14, No. 5 September 2004
Anthropometric, Lifestyle and Biomarker Assessment of J apanese 
Non-professional Ultra-marathon Runners
BACKGROUND: Anthropometric characteristics, lifestyle, and baseline biological markers of J apanese
non-professional ultra-marathon runners have not been fully assessed.
METHODS: We evaluated anthropometric characteristics, lifestyle, and baseline biological markers of
180 J apanese amateur ultra-marathon runners (144 males [mean age: 50.5± 9.4 (standard deviation)
years] and 36 females [48.9± 6.9]), and compared them with those of participants in a community
heath check-up program and with the figures in the literature. We furthermore evaluated baseline blood
indices according to monthly running distance with analysis of variance adjusted for age, body mass
index, smoking and alcohol drinking habits.
RESULTS: The ultra-marathon runners demonstrated more favorable values for body mass index and
bone density, and the proportion of smoking, and undertaking physical activity (for both sexes), eating
breakfast (for males), and having daily bowel movements (for females), while greater proportion of alco-
hol drinking habit (for both sexes), than the comparison group. Average monthly running distances and
standard deviations (km) were 257.2± 128.9 for males and 209.0± 86.2 for females. Male runners pos-
sessed beneficial markers, including lowered triglyceride and elevated high-density lipoprotein choles-
terol, and their values showed hockey-stick (or inverse hockey-stick) patterns depending on their
monthly running distance. Some subjects running more than 300 km/month exhibited signs of an over-
reaching/training syndrome, including somewhat lowered hemoglobin, ferritin and white blood cell
count, and elevated creatine kinase and lactate dehydrogenase.
CONCLUSIONS: Together with a desirable lifestyle, J apanese non-professional ultra-marathon runners
with vigorous exercise habit demonstrated a preferable health status according to biological indices.
J  Epidemiol 2004;14:161-167.
Key words: biomarker measures, health indices, lifestyle-related diseases, physical activity, non-profes-
sional ultra-marathon runners.
Received April 5, 2004, and accepted August 6, 2004.
This study was supported, in part, by a Grant-in-Aid from the Japan Society for the Promotion of Science under the auspices of
the Ministry of Education, Culture, Science, Sports, and Technology, Japan. Biochemical analyses, in part, were conducted
according to the Postal Check by the Public Health Research Foundation and SRL Shizuoka, Inc.
1 Department of Health Promotion and Preventive Medicine, Nagoya City University Graduate School of Medical Sciences.
2 Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute.
3 Kitasato University of Medical Technology.
4 Kasugai City Health Care Center.
5 Aichi Bunkyo Women’s College.
6 Department of Preventive Nutraceutical Sciences, Nagoya City University Graduate School of Pharmaceutical Sciences.
7 Yokohama Rehabilitation Center.
8 Nagoya Bunri University.
9 Department of Bone and Orthopaedics, Nagoya City University Graduate School of Medical Sciences.
10 Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health.
11 Department of Health Science, Faculty of Psychological and Physical Sciences, Aichi Gakuin University.
Address for correspondence: Shinkan Tokudome, Department of Health Promotion and Preventive Medicine, Nagoya City
University Graduate School of Medical Sciences, Mizuho-ku, Nagoya 467-8601, Japan.
Shinkan Tokudome,1 Kiyonori Kuriki,2 Norihiro Yamada,3 Hiromitsu Ichikawa,1 Machiko Miyata,1
Kiyoshi Shibata,4 Hideki Hoshino,5 Shinji Tsuge,6 Mizuho Tokudome,7 Chiho Goto,8 Yuko Tokudome,8
Masaaki Kobayashi,9 Hideyuki Goto,9 Sadao Suzuki,1 Yoshihiro Okamoto,1 Masato Ikeda,10 and 
Yuzo Sato.11
Original A rticle
morphisms, including human 8-oxoguanine DNA glycosylase 1
(h-OGG1), aldehyde dehydrogenase 2 (ALDH2), peroxisome pro-
liferators-activated receptor gamma (PPARγ ), leptin, angiotensin
converting enzyme (ACE), β -adrenergic receptor, and CD36
genes. The protocol was approved by the institutional review
board of the Nagoya City University Graduate School of Medical
Sciences and by the chairman and organizing committee of the
race.
We administered our questionnaire to 202 runners by mail and
obtained information on anthropometric characteristics and
lifestyle, including sex, age (date of birth), height, and dietary,
smoking and alcohol drinking habits. We checked unfilled items
on the race day along with securing information on smoking,
alcohol drinking and supplements taken during the race.
For external comparison, the values of anthropometric charac-
teristics and lifestyle of the participants in a community health
check-up program in 2002, except for calcaneal bone density,
body temperature, and resting pulse rate, were utilized. We
received written informed consent from these participants, and the
protocol was approved by the institutional review board of the
Nagoya City University Graduate School of Medical Sciences.
For calcaneal bone density, body temperature, and resting pulse
rate, we used the figures reported in the literature for compari-
son.24-26
Energy intake was assessed by the short food frequency ques-
tionnaire (FFQ).27 A regression equation was applied, adopting
intake frequency of foods/food groups, average portion size and
nutrient concentrations/100 g of foods28 as independent variables
and energy intake as a dependent variable. Anthropometric mea-
surements and sampling of blood, urine and saliva were per-
formed at the pre- (baseline), mid-, and post-race stages. We mea-
sured body weight, body temperature at the tympanum (Nipro 43-
130, Morishita Jintan, K.K.) and blood lactate (Lactate Pro, LT-
1710, Kyoto Daiichi Kagaku Co., Ltd.). Calcaneal bone density
(Speed of Sound) (Stiffness [%]) was gauged ultrasonographical-
ly once on three measurement occasions (A-1000 Express, GE
LUNAR). 
We analyzed urine for protein, glucose, occult blood, urobilin,
urobilinogen, and pH at the site (Urisys 2400, Sysmex K.K.).
Baseline serum parameters, including total protein, blood urea
nitrogen (BUN), uric acid, aspartate aminotransferase (AST), ala-
nine aminotransferase (ALT), gamma-glutamyltransferase (GTT),
lactate dehydrogenase (LDH), creatine kinase (CK), creatinine,
total cholesterol, high-density lipoprotein cholesterol (HDL-C),
total bilirubin, triglyceride, free fatty acid (Hitachi 7600, Hitachi
K.K.), myoglobin (radioimmunoassay), lipid peroxide (enzyme
method), white blood cells (WBCs), red blood cells (RBCs),
hemoglobin (Hb), hematocrit, mean corpuscular volume, mean
corpuscular hemoglobin, mean corpuscular hemoglobin concen-
tration, platelets (XE2100, Sysmex K.K.), ferritin (chemical
immunoluminiscence), HbA1c (HPLC analysis), and serum elec-
trolytes, including sodium (Na), potassium (K), and chlorine (Cl)
(Hitachi 7600, Hitachi K.K.), were assayed.29 Resting pulse in bed
Lifestyle and Biomarkers of Ultra-marathon Runners
There are advantages and disadvantages to physical activity, exer-
cise, and sports. Advantages include elevated bowel motility,1,2
modification of lipid metabolism and amelioration of insulin
resistance and glucose intolerance,3-5 improvement of cardiovas-
cular parameters, and prevention of obesity.6,7 Decreased serum
concentrations of arachidonic acid and prostaglandin E2, reduced
generation of radical oxygen species,8-15 enhancing oxygen radi-
cals absorbance capacity and immune surveillance,16-19 including
an increased natural killer cell activity, and diminishing cancer
risk1,2,20 may all be achieved. Thus, appropriate physical activity in
the long-term may decrease mortality from lifestyle-related dis-
eases, prolong active life expectancy, alleviate mental stress, sup-
port mental health and self-efficacy, and finally, enhance quality
of life.6,7,21-23
On the other hand, disadvantages include damage in the
hematopoietic system, skeletal or muscular injuries, oxidative
stress/damage, cardiac arrest, arrhythmia, and sudden
death.2,6,7,9,11,13-18 As is well known, moreover, there exists an over-
reaching/training syndrome, and research is needed to clarify the
type, intensity, duration, and frequency of physical activity/exer-
cise/sports favorable to our health.
Here, we studied anthropometric characteristics, lifestyle, and
baseline biomarker measures among non-professional but vigor-
ously-trained runners entering an ultra-distance race, and com-
pared them with those of people receiving an annual health check-
up program and with reference values in the literature. We also
assessed baseline blood indices according to their monthly run-
ning distance.
METHODS
Ultra-marathon race
The ultra-marathon race is not a competitive one. It is nicknamed
"Maranic" (marathon and picnic), and the tenth race was held in
Gifu Prefecture, Japan, during July 27-28, 2002. The midsummer
weather was partly cloudy, very hot and sultry. According to the
meteorological authority, the temperature was approximately
35℃, and the relative humidity was about 55% at noon on both
days. The race covered 130 km of distance running and moun-
taineering over two days. On the first day, at 11 a.m., the partici-
pants started a full-length marathon race to be completed within 6
hr and 30 min. On the second morning, at 3:30 a.m., they resumed
the race to run approximately 90 km, including climbing up to a
mountain lake approximately 1,100 m high, then returning to the
starting point within 15 hr and 30 min.
Subjects and methods
Six weeks prior to the race, we asked 325 ultra-marathon runners
entering the Maranic race to enroll in our study. Of these, 202
runners agreed to participate in the project. We received written
informed consent from them for completing a questionnaire sur-
vey, measuring anthropometric characteristics and bone density,
sampling of blood, urine, and saliva, and analyzing genetic poly-
162
function. The remaining 180 subjects (144 males and 36 females)
were included in this study.
Mean ages were 50.5 ±
9.4 (±
standard deviation) years for
males and 48.9 ±
6.9 for females, respectively. The differences
of means between the groups were obvious: that is, the values for
BMI, body temperature (℃), and resting pulse rate were smaller,
while those for calcaneal bone density (Stiffness [%] ) (for both
sexes) were greater (Table 1). The percentages of smoking and
enjoying physical activity (for both sexes), eating breakfast (for
males), and having daily bowel movements (for females) were
more favorable than for the comparison group. However, the pro-
portion of alcohol drinking habit (for both sexes) was greater in
runners than the general public.
Blood analysis
Average figures for all blood measures were located within the
ranges of the reference values (Table 2). They were mostly favor-
able readings in both sexes. However, hematological markers,
such as Hb, ferritin, and WBCs, shifted to be lower than the stan-
dard values. On the other hand, damage/repair markers of the
musculo-skeletal system, including CK and LDH, tended to be
greater than the reference values.
Urine analysis
Positive rates for urine glucose of 9.9% for males and 14.6% for
females were greater than those in the general people partly
because urine was collected on a spot sampling basis (data not
shown).
Tokudome S, et al.
in the morning was surveyed by mail after the race.
Statistical analysis
Anthropometric characteristics and lifestyle values, including
bone density,24 body temperature at the tympanum,25 and resting
pulse,26 were age-adjusted, adopting the reference population or
the study subjects in the literature as standard. The means ± 95%
confidence interval were computed, and contrasted with those of
the participants in a community health check-up program in 2002
or with reference values in the literature. Baseline blood and urine
biomarkers were compared with reference values.29 Full-length
and ultra-marathon completion rates, time and blood indices
among males were collated according to monthly running dis-
tance (km/month) (≤100, 101-200, 201-300, and 301+) with
analysis of variance adjusted for age, body mass index (BMI
[kg/m2]), smoking, and alcohol drinking.30 Tukey's post hoc multi-
ple t-test was performed to examine differences in the least square
means, and the linear trends were statistically verified. The p val-
ues smaller than 0.05 were considered statistically significant.
RESULTS
Anthropometric measures, and major lifestyle characteristics
Of our participants, 187 runners actually attended the race, and
anthropometric measures were taken together with sampling of
biomaterials. Seven participants were excluded from the analysis:
three with uncompleted questionnaires, and two who were late for
the pre-race examination. One finally declined pre- and mid-race
blood sampling, and one was excluded due to abnormal liver
163
Item
Body mass index (kg/m2) 
Eating breakfast (%)
Energy intake (kcal)
Smoking habit (%)
Alcohol drinking habit (%)
Undergoing physical activity (%) 
Sleep duration (hours)
Having daily bowel movements (%)
Calcaneal bone density (Stiffness [%])‡
Body temperature at the tympanum (℃)§
Resting pulse (bpm)‖
Table 1. Comparison of anthropometric characteristics and lifestyle between Japanese non-professional ultra-marathon runners and 
people receiving  an annual community health check-up program and other reference people.
ultra-marathon runners*
(n=144)
22.2 (21.7-22.8)
96.5 (94.2-98.9)
2,302 (1,936-2,668)
7.3 (1.7-12.9)
78.6 (70.4-86.7)
100
6.8 (6.6-7.1)
91.4 (86.0-96.8)
101.2 (97.6-104.7)
36.2 (36.1-36.4)
53.6 (52.5-54.8)
reference values†
23.3 (23.1-23.4)
90.0 (88.5-91.6)
2,117 (2,095-2,139)
31.1 (28.6-33.6)
58.5 (55.9-61.2)
40.2 (37.7-42.8)
7.0 (6.9-7.0)
88.9 (87.3-90.6)
85.9 (83.9-87.9)
36.9 (36.9-36.9)
65.9 (64.2-67.5)
ultra-marathon runners
(n=36)
21.2 (20.3-22.1)
93.9 (89.5-98.4)
1,732 (1,428-2,037)
1.0 (0-2.4)
48.3 (24.1-72.5)
100
6.4 (5.9-6.8)
96.5 (92.0-100)
93.7 (84.6-102.8)
36.3 (35.9-36.6)
54.7 (52.5-56.9)
reference values
22.5 (22.4-22.7)
92.4 (91.2-93.6)
1,956 (1,942-1,970)
6.6 (5.5-7.7)
18.7 (16.9-20.4)
42.1 (39.9-44.3)
6.6 (6.6-6.7)
70.5 (68.4-72.5)
73.5 (72.4-74.6)
36.9 (36.9-36.9)
66.5 (64.7-68.3)
males
females
* : Age-adjusted means ± 95% confidence intervals adopting corresponding reference populations or study subjects in the literature as
standard.
† : Values of people receiving annual health check-up program among 1,346 males and 2,043 females, except for calcaneal bone densi-
ty, body temperature, and resting pulse rate.
‡ : For comparison, values of calcaneal bone density were cited from the reference No. 24. 
§ : For comparison, values of body temperature were cited from the reference No. 25. 
‖ : For comparison, values of resting pulse were cited from the reference No. 26.
Lifestyle and Biomarkers of Ultra-marathon Runners
164
Total protein (g/dL)
Blood urine nitrogen (BUN, mg/dL)
Uric acid (mg/dL)
Aspartate aminotransferase (AST, IU/L)
Alanine aminotransferase (ALT, IU/L)
Gamma-glutamyltransferase (GTT, IU/L)
Lactate dehydrogenase (LDH, IU/L)
Creatine kinase (CK, IU/L)
Creatinine (mg/dL)
Myoglobin (ng/mL)
Total cholesterol (mg/dL)
High-density lipoprotein cholesterol (HDL-C, mg/dL)
Total bilirubin (mg/dL)
Triglyceride (mg/dL)
Free fatty acid (mEq/L)
Lipid peroxide (nmol/mL)
White blood cell count (WBCs, /μ L)
Red blood cell count (RBCs, 104/μ L)
Hemoglobin (Hb, g/dL)
Hematocrit (%)
Mean corpuscular volume (fl)
Mean corpuscular hemoglobin (pg)
Mean corpuscular hemoglobin concentration (%)
Ferritin (ng/mL)
Platelet count (104/μ L)
Hemoglobin A1c (HbA1c, %)
Sodium (Na, mEq/L)
Potassium (K, mEq/L)
Chlorine (Cl, mEq/L)
Table 2. Comparison of blood indices between Japanese non-professional ultra-marathon runners and reference values.
Ultra-marathon runners (n=144)
mean ± standard deviation
7.2 ±
0.4
18 ±
4
5.8 ±
1.3
25 ±
10
27 ±
13
44 ±
36
198 ±
35
183 ±
139
0.64 ±
0.14
43 ±
15
206 ±
34 
62 ±
15 
0.4 ±
0.2 
121 ±
66
0.36 ±
0.16
2.9 ±
0.7
5,553 ±
1,188
457 ±
38
14.3 ±
1.1
42.9 ±
3.2
94.0 ±
4.9
31.2 ±
1.7
33.2 ±
0.9
55.4 ±
40.3
22.6 ±
4.6
5.1 ±
0.4
142 ±
2
4.1 ±
0.6
105 ±
2
Reference values*
6.7 - 8.3
6 - 20 
3.7 - 7.6
10 - 40
5 - 40
≤ 70
115 - 245
57 - 197
0.61 - 1.04
≤ 60
150 - 219
41 - 86
0.2 - 1.0 
50 - 149
0.14 - 0.85
1.8 - 4.7
3,900 - 9,800
427 - 570
13.5 - 17.6
39.8 - 51.8
82.7 - 101.6
28.0 - 34.6
31.6 - 36.6
27 - 320
13.1 - 36.2
4.3 - 5.8
136 - 147
3.6 - 5.0 
98 - 109
Ultra-marathon runners (n=36)
mean ± standard deviation
7.1 ±
0.4
17 ±
4
4.1 ±
0.8
22 ±
9
21 ±
13
21 ±
8
197 ±
29
150 ±
91
0.48 ±
0.09
30 ±
9
218 ±
34
69 ±
14
0.4 ±
0.2 
93 ±
35
0.35 ±
0.17
2.6 ±
0.6
5,197 ±
1,281
412 ±
30
12.7 ±
1.1
39.1 ±
2.6
94.8 ±
4.2
30.7 ±
1.6
32.4 ±
1.0 
20.4 ±
14.5
22.2 ±
4.0 
4.8 ±
0.3
141 ±
2
4.1 ±
0.4
105 ±
2
Reference values
6.7 - 8.3
6 - 20 
2.5 - 5.4
10 - 40
5 - 40
≤ 30
115 - 245
32 - 180
0.47 - 0.79
≤ 60
150 - 219
41 - 96
0.2 - 1.0 
50 - 149
0.14 - 0.85
1.8 - 4.7
3,500 - 9,100
376 - 500
11.3 - 15.2
33.4 - 44.9
79.0 - 100.0 
26.3 - 34.3
30.7 - 36.6
3.4 - 89
13.0 - 36.9
4.3 - 5.8
136 - 147
3.6 - 5.0 
98 - 109
males
females
*: Reference values are from the Test Directory 2002.29
Tokudome S, et al.
165
Total protein (g/dL)
Blood urine nitrogen (BUN, mg/dL)
Uric acid (mg/dL)
Aspartate aminotransferase (AST, IU/L)
Alanine aminotransferase (ALT, IU/L)
Gamma-glutamyltransferase (GTT, IU/L)
Lactate dehydrogenase (LDH, IU/L)
Creatine kinase (CK, IU/L)
Creatinine (mg/dL)
Myoglobin (ng/mL)
Total cholesterol (mg/dL)
High-density lipoprotein cholesterol (HDL-C, mg/dL)
Total bilirubin (mg/dL)
Triglyceride (mg/dL)
Free fatty acid (mEq/L)
Lipid peroxide (nmol/L)
White blood cell count (WBCs, /μ L)
Red blood cell count (RBCs, 104/μ L)
Hemoglobin (Hb, g/dL)
Hematocrit (%)
Mean corpuscular volume (fl)
Mean corpuscular hemoglobin (pg)
Mean corpuscular hemoglobin concentration (%)
Ferritin (ng/mL)
Platelet count (104/μ L)
Hemoglobin A1c (HbA1c, %)
Sodium (Na, mEq/L)
Potassium (K, mEq/L)
Chlorine (Cl, mEq/L)
Table 3. Blood indices according to average monthly running distance adjusted for age, body mass index, smoking and alcohol
drinking in Japanese male non-professional ultra-marathon runners.
-100
(n=20)
7.2
19
5.9
22 
26 
37 
190 
143 
0.66
43.0
200 
58 
0.5 
145 
0.35
2.9 
5656 
456 
14.2 
42.4 
93.2 
31.2 
33.5 
60.8 
22.5 
5.1 
142 
4.1 
105
101-200
(n=44)
7.2
18
5.9 
26 
25 
47 
196 
169 
0.61
41.8
203 
61 
0.4 
#
127 
0.34
2.9 
5735 
459 
14.4 
43.2 
94.1 
31.4 
33.3 
59.7 
23.3 
5.0 
142 
4.1 
105
201-300
(n=46)
7.2
19
5.8
25 
30 
42 
*
194 
*
168 
0.67
44.0
204 
62 
0.5 
110 
0.35
3.0 
*
5601 
462 
*
14.4 
43.5 
94.3 
31.3 
33.2 
#
58.5 
22.7 
5.2 
142 
4.2 
105
301+
(n=34)
7.2
19
5.7
27 
29 
46 
213 
246 
0.63
44.7
216 
67 
0.4 
114 
0.38
2.8 
5191 
449 
13.9 
42.1 
94.1 
31.1 
33.0 
42.6 
21.7 
5.1 
141 
4.2 
105
*
*
*
linear trend
*
**
*
#
#
*
*
*
Average monthly running distance (km/month)
#: Marginally significant, * p<0.05, ** p<0.01．
Lifestyle and Biomarkers of Ultra-marathon Runners
166
cal antioxidant molecules of uric acid and bilirubin.8,12 Ferritin
levels, however, decreased in proportion to monthly running dis-
tance, along with lower body temperature25 and resting pulse
rates26,33 were noted among the subjects. Taking into account these
findings, we are now planning to make pre-, mid- and post-race
comparisons of blood, urine and saliva bio-parameters, including
serum d-ROM and Mn-SOD, and urinary 8-OHdG and biopy-
rrins, as markers of reactive oxygen species and oxygen radical
absorbance capacity.8-15
Participants running more than 300 km/month exhibited signs
of an over-reaching/training syndrome, including lowered Hb,
ferritin and WBCs suggesting damage in the hematopoietic sys-
tem to some degree, and elevated CK and LDH indicating injuries
in musculo-skeletal organs. Vigorous exercisers running around
200 km/month, even those running less than 100 km/month, who
were insufficiently trained to run an ultra-marathon race, had
preferable biomarker indices, implying that such exercises are
favorable to health. Namely, triglyceride was decreased and
HDL-cholesterol was elevated according to their monthly running
distance. Thus, people committed to vigorous exercise probably
do not suffer from obesity, high lipidemia/cholesterol,6,7 high
blood pressure or high insulin resistance.3-5 Furthermore, they
undoubtedly enjoy a low risk of coronary heart disease, cere-
brovascular diseases and fat-related cancers, including colon,
prostate and breast cancer.1,2,20
In conclusion, the study subjects were admittedly rather self-
selected as being non-professional marathon runners and pos-
sessed desirable demographic characteristics and lifestyle, even
when compared with health-conscious people receiving an annual
health check-up program. Runners committing to vigorous run-
ning up to around 200 km/month, but not over-reaching/training,
appear to have preferable biomarker indices, suggesting that vig-
orous aerobic exercise is favorable to health, particularly for
sedentary or physically-inactive workers. Further research is war-
ranted to elucidate the type, intensity, duration, and frequency of
physical activity/exercise/sports beneficial to promote health, to
reduce the risk of lifestyle-related diseases and to enhance the
quality of life.
ACKNOWLEDGMENTS
We appreciate the runners having willingly participated in our
study and the chairman and organizing committee of the Maranic
race. We thank Dr. Nagaya T, Ms. Fujii T, Ms. Kubo Y, Ms.
Nakanishi N, Ms. Ito Y, Ms. Higuchi K, Ms. Watanabe M, and
Dr. Moore MA for their technical and language assistance.
REFERENCES
1. Friedenreich CM, Orenstein MR. Physical activity and cancer
prevention: etiologic evidence and biological mechanisms. J
Nutr 2002;132 (suppl.):3456S-64S.
2. Moore MA, Park CB, Tsuda H. Physical exercise: a pillar for
Completion rates and time according to monthly running dis-
tance
Average monthly running distances (km) were 257.2 ± 128.9 (98
- 444) (minimum - maximum) for males and 209.0 ± 86.2 (23 -
222) for females. They mainly selected running, although some
concurrently chose swimming, bicycling and other aerobic exer-
cises and occasionally took part in weight/resistance training.
Ninety-three percent (167 out of 180 of the study subjects) com-
pleted the first day full-length marathon, and 60% (108 out of
180) the 2-day ultra-marathon race. Full-length and ultra-
marathon completion rates were positively, while completion time
was inversely dependent on their monthly running distance for
either sex (data not shown).
Differences in blood indices according to monthly running dis-
tance
The number of male runners by monthly running distance
(km/month) of ≤100, 101-200, 201-300, 301+ were 20, 44, 46,
and 34, respectively. As a whole, there were no significant dis-
crepancies in anthropometric characteristics, including BMI, body
temperature, resting pulse rate and bone density, according to
monthly running distance (data not shown). Most blood measure-
ments also showed no remarkable differences in proportion to
monthly running distance after adjustment for age, BMI, smok-
ing, and alcohol drinking, either (Table 3). Triglyceride was
decreased according to monthly running distance, while HDL-
cholesterol was steadily elevated. Some readings, however,
revealed hockey-stick (or inverse hockey-stick) patterns, includ-
ing lowered Hb, ferritin and WBCs, and elevated CK and LDH.
The linear trends were statistically/marginally significant except
for Hb and triglyceride.
DISCUSSION
Most of the present subjects followed the recommended Seven
Heath Practices, including (1) hours of sleep, (2) smoking, (3)
body weight, (4) alcohol drinking, (5) physical exercise, (6) eat-
ing breakfast, and (7) eating between meals, proposed by Breslow
et al.31 They showed preferable demographic characteristics and
lifestyle, even when compared with health-conscious people
receiving an annual health check-up program. Above all, they
engaged in vigorous exercise regularly. Most maintained a desir-
able body weight and bone density,24 and smoked less;32 however,
they experienced greater energy from alcoholic beverages than
the general population, at least partly because they regularly
expended energy by running. Alcohol consumption, however, up
to 30 g net ethanol per day, may not be harmful, provided the sub-
ject is not a carrier of hepatitis B/C viruses, or has not
hetero/mutant type genetic polymorphisms of ALDH-2.
Most blood measures showed no remarkable variation accord-
ing to monthly running distance after adjustment for age, BMI,
smoking, and alcohol drinking, in line with homeostasis and
adaptation.9,13,14,18 No significant differences were observed in typi-
system: regulation, integration, and adaptation. Physiol Rev
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167

Anthropometric, lifestyle and biomarker assessment of Japanese non-professional ultra-marathon runners.
Tokudome, Shinkan,Kuriki, Kiyonori,Yamada, Norihiro,Ichikawa, Hiromitsu,Miyata, Machiko,Shibata, Kiyoshi,Hoshino, Hideki,Tsuge, Shinji,Tokudome, Mizuho,Goto, Chiho,Tokudome, Yuko,Kobayashi, Masaaki,Goto, Hideyuki,Suzuki, Sadao,Okamoto, Yoshihiro,Ikeda, Masato,Sato, Yuzo