Feet swelling in a multistage ultraendurance triathlete: a case study

Figures & data

Table 1 Daily air temperature before the start of the race, maximum temperature during the day, and temperature at the finish of each stage

Day	Start	Daily highest	Finish	General weather conditions
	(°C)	(°C)	(°C)
1	21.7	31.9	21.8	Sun
2	23.2	22.1	19.4	Little rain
3	21.5	18.5	17.2	Little rain
4	17.8	22.2	20.1	Little rain
5	19.4	21.9	18.6	Heavy rain
6	19.8	17.2	16.4	Clouds, wind
7	14.0	19.3	15.4	Clouds, wind
8	14.0	11.0	11.0	Heavy rain
9	16.7	17.1	16.6	Heavy rain
10	17.2	17.6	16.3	Heavy rain

Note: The general weather conditions during the day are also presented.

Figure 1 Changes in split and overall race times across the 10 days.

Figure 2 Association between fluid intake and change in foot volume during the stages (A) and associations between volume of the foot at the end of the stages with total body water (B), creatinine (C), and urea (D) at the end of the stages.

Table 2 Changes in anthropometric characteristics in the morning before the stages, in the evening after the stages, and the difference between the values

Variable	D1	D2	D3	D4	D5	D6	D7	D8	D9	D10	r^2	P-value
Morning before the stages
Body mass (kg)	78.0	77.3	77.9	77.6	78.1	78.3	77.5	76.7	76.2	76.5	0.48	0.02*
Fat-free mass (kg)	62.9	61.6	61.8	62.4	63.2	64.4	62.7	61.3	62	62.2	0.01	0.82
Percentage body fat (%)	15.1	16.1	16.5	15.4	14.1	13.5	14.9	14.6	14.4	13.2	0.50	0.02*
Circumference calf (cm)	39.1	37.5	39.5	38.9	39.2	39.3	38.1	38.1	38.2	38.1	0.13	0.30
Circumference foot (cm)	22.9	24	24.2	24.2	25.2	24.8	24.2	24.3	24.3	24.4	0.24	0.15
Skinfold tibia (mm)	4.0	4.0	6.0	5.6	5.8	5.8	4.5	4.6	4.4	4.3	0.01	0.76
Skinfold foot (mm)	2.2	2.4	2.4	2.6	2.8	2.8	2.2	2.3	2.3	2.4	0.00	0.89
Total body water (L)	61.9	61.1	60.8	61.8	62.8	63.8	64.1	64.7	65.1	66.2	0.89	<0.0001*
Volume of the foot (mL)	1,120	1,140	1,170	1,210	1,190	1,240	1,200	1,160	1,180	1,230	0.36	0.068
Evening after the stages
Body mass (kg)	76.5	76.2	75.8	76.0	78.1	77.7	77.2	76.2	77.0	76.6	0.08	0.42
Fat-free mass (kg)	62.1	62.7	62.4	64.1	64.2	64.9	62.6	62.3	62.7	62.4	0.00	0.93
Percentage body fat (%)	14.6	13.5	13.4	12	13.5	12.2	14.7	12.6	14.3	14.3	0.01	0.76
Circumference calf (cm)	38.2	38.5	40.2	40.4	40.6	40.7	38.2	38.3	38.3	38.2	0.08	0.43
Circumference foot (cm)	23.2	24.5	24.3	24.5	25.4	25.6	24.6	24.6	24.7	24.6	0.21	0.18
Skinfold tibia (mm)	5.2	6.2	6.1	6.2	6.3	6.3	5.5	5.6	5.7	5.8	0.02	0.72
Skinfold foot (mm)	2.2	2.6	2.6	2.6	3.0	3.1	2.6	2.5	2.6	2.5	0.03	0.64
Total body water (L)	62.4	63.4	63.5	64.9	63.7	65.0	66.4	67.4	68.5	69.5	0.92	<0.0001*
Volume of the foot (mL)	1,140	1,160	1,200	1,240	1,250	1,270	1,250	1,230	1,250	1,270	0.66	0.0041*
Difference between the values
Body mass (kg)	−1.5	−1.1	−2.1	−1.6	0	−0.6	−0.3	−0.5	0.8	0.1	0.64	0.005*
Fat-free mass (kg)	−0.8	1.1	0.6	1.7	1	0.5	−0.1	1.0	0.7	0.2	0.00	0.86
Percentage body fat (%)	−0.5	−2.6	−3.1	−3.4	−0.6	−1.3	−0.2	−2.0	−0.1	1.1	0.34	0.07
Circumference calf (cm)	−0.9	1.0	0.7	1.5	1.4	1.4	0.1	0.2	0.1	0.1	0.01	0.79
Circumference foot (cm)	0.3	0.5	0.1	0.3	0.2	0.8	0.4	0.3	0.4	0.2	0.00	0.93
Skinfold tibia (mm)	1.2	2.2	0.1	0.6	0.5	0.5	1.0	1.0	1.3	1.5	0.00	0.86
Skinfold foot (mm)	0.0	0.2	0.2	0.0	0.2	0.3	0.4	0.2	0.3	0.1	0.17	0.23
Total body water (L)	0.5	2.3	2.7	3.1	0.9	1.2	2.3	2.7	3.4	3.3	0.30	0.08
Volume of the foot (mL)	20	20	30	30	60	30	50	70	70	40	0.52	0.018*

Note:

* Significant change across stages.

Abbreviation: D, day.

Table 3 Changes in energy and fluid turnover during the ten stages

Turnover	Variable	D1	D2	D3	D4	D5	D6	D7	D8	D9	D10	r^2	P-value
Energy	Energy intake during the stage (kcal)	5,800	6,020	6,230	5,320	5,530	5,340	4,960	4,820	4,420	4,220	0.87	<0.0001*
	Energy intake after the stage (kcal)	2,520	1,780	2,900	1,850	2,960	2,960	3,620	2,520	2,230	2,230	0.02	0.72
	Energy expenditure during the stage (kcal)	9,820	8,750	7,960	7,940	7,350	7,020	7,330	6,970	7,950	6,920	0.60	0.0081*
	Energy expenditure after the stage (kcal)	1,460	1,410	1,390	1,230	1,380	1,440	1,410	1,380	1,100	1,290	0.27	0.12
	Total energy intake (kcal)	8,320	7,800	9,130	7,170	8,490	8,300	8,580	7,340	6,650	6,450	0.38	0.058
	Total energy expenditure (kcal)	11,280	10,160	9,350	9,170	8,730	8,460	8,740	8,350	9,050	8,210	0.67	0.0037*
	Energy deficit (kcal)	2,960	2,360	220	2,000	240	160	160	1,010	2,400	1,760	0.04	0.57
Fluid	Fluid intake during the stage (L)	4.3	4.9	4.1	3.9	4.8	3.5	5.2	7.8	6.5	5.7	0.40	0.05
	Fluid intake after the stage (L)	3.6	2.7	3.7	3.6	3.5	3.1	3.7	3.6	3.5	2.1	0.09	0.40
	Total fluid intake (L)	7.9	7.6	7.8	7.5	8.3	6.6	8.9	11.4	10	7.8	0.23	0.16
	Urine output during the stage (L)	1	0.5	4.1	2.5	2.3	1.6	2.2	2.5	2.4	2.2	0.08	0.44
	Urine output after the stage (L)	0.3	1.1	1.9	2.4	2.1	2.2	2.4	2.3	2.2	2.1	0.50	0.022*
	Total urine output (L)	1.3	1.6	6	4.9	4.4	3.8	4.6	4.8	4.6	4.3	0.25	0.13

Note:

* Significant change across stages.

Abbreviation: D, day.

Table 4 Changes in urine and blood parameters in the morning before the stages, in the evening after the stages, and the difference between the values

Variable	D1	D2	D3	D4	D5	D6	D7	D8	D9	D10	r^2	P-value
Morning before the stages
Urine specific gravity (g/mL)	1.020	1.002	1.025	1.025	1.020	1.025	1.025	1.020	1.025	1.020	0.01	0.77
Sodium (mmol/L)	136	136	136	135	135	135	135	135	137	136	0.00	0.88
Potassium (mmol/L)	4.8	4.7	5.3	4.7	4.8	4.8	5.1	4.9	4.8	4.5	0.07	0.45
Creatinine (µmol/L)	77	80	82	85	88	90	92	95	98	100	0.97	<0.0001*
Hematocrit (%)	48	48	47	47	47	46	47	47	46	47	0.44	0.037*
Hemoglobin (g/L)	17	16	16	16	15	15	15	15	15	15	0.73	0.0016*
Urea (mmol/L)	5.1	6.9	7.5	8	9.1	8.2	8.7	7.5	8.1	8.2	0.04	7.5
Evening after the stages
Urine specific gravity (g/mL)	1.025	1.025	1.030	1.030	1.030	1.030	1.030	1.030	1.030	1.030	0.48	0.02*
Sodium (mmol/L)	138	140	138	140	138	140	137	139	142	142	0.26	0.12
Potassium (mmol/L)	5.3	4.9	4.8	5.3	5.1	4.9	5.3	4.9	4.9	4.9	0.13	0.31
Creatinine (µmol/L)	91	93	96	98	100	102	106	110	111	113	0.99	<0.0001*
Hematocrit (%)	46	46	45	45	45	44	45	44	45	45	0.37	0.063
Hemoglobin (g/L)	16	15	15	15	14	14	14	15	14	15	0.27	0.12
Urea (mmol/L)	7.2	8.2	8.4	9.5	9.4	9.3	9.4	9.3	10.1	10.2	0.84	0.0002*
Difference between the values
Urine specific gravity (g/mL)	0.005	0.005	0.005	0.005	0.01	0.005	0.005	0.01	0.005	0.01	0.24	0.14
Sodium (mmol/L)	2	4	2	5	3	5	2	4	5	6	0.33	0.08
Potassium (mmol/L)	0.5	0.2	−0.5	0.6	0.3	0.1	0.2	0	0.1	0.4	0.00	0.93
Creatinine (µmol/L)	14	13	14	13	12	12	14	15	13	13	0.00	0.95
Hematocrit (%)	−2	−2	−2	−2	−2	−2	−2	−3	−1	−2	0.01	0.83
Hemoglobin (g/L)	−1	−1	−1	−1	−1	−1	−1	0	−1	0	0.37	0.06
Urea (mmol/L)	2.1	1.3	0.9	1.5	0.3	1.1	0.7	1.8	2	2	0.04	0.56

Note:

* Significant change across stages.

Abbreviation: D, day.