Effect of Endurance Exercise on Markers of Oxidative Stress: A Systematic Review

Abstract

Purpose

The aim of this review was to methodically consider oxidative stress biomarkers in endurance performance events. The health benefits of exercise come at the cost of reactive oxygen species production. Reactive oxygen species and the continued development of oxidative stress may bring about muscular damage and inflammation, ultimately impairing exercise performance.

Methods

A search for applicable articles was performed using PubMed/Medline, Scopus, and ScienceDirect with dates of January 1, 2010, to April 30, 2023. Inclusion criteria consisted of (1) original, peer-reviewed studies with human participants; (2) studies written in English; (3) studies available as full free text. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and flow-chart were followed.

Results

Thirty studies were included in the final review. Four studies collected blood and urine samples, while 26 studies collected blood samples only for assessment. Thirteen studies on ultramarathons, seven on military training and survival, four on Ironman and endurance running, and one on running/cycling and swimming were discovered throughout the course of the research. Well-trained, elite, recreational, amateur, moderately active, ultra-marathon runners, triathletes, cadets/soldiers, physical education students, and untrained individuals comprised the study subjects.

Conclusion

According to the evidence, extended duration events do not always induce supraphysiological oxidative stress and muscle damage which are indicated by the presence of absence of reactive oxygen species and inflammatory biomarkers. Still, more importantly, oxidative damage markers of lipids, proteins, and different enzymatic and non-enzymatic antioxidants develop depending on the individual’s level of training.

Keywords

Endurance training / Free radicals / Military performance / Oxidative stress / Reactive oxygen species

References

[1] AndersonE, DurstineJL. Physical activity, exercise, and chronic diseases: a brief review. Sports Med Health Sci, 2019, 113-10.

[2] Andrade MS, Ferrer CRL, Vancini RL, Nikolaidis PT, Knechtle B, Rosemann T, Bachi ALL, Seffrin A, de Lira CAB. The effect of muscle strength on Marathon Race-Induced muscle soreness. Int J Environ Res Public Health. 2021;18(21):11258.

[3] Atakan MM, Li Y, Koşar ŞN, Turnagöl HH, Yan X. Evidence-based effects of high-intensity interval training on exercise capacity and health: a review with historical perspective. Int J Environ Res Public Health. 2021;18(13):7201.

[4] BairdMF, GrahamSM, BakerJS, BickerstaffGF. Creatine-kinase- and exercise-related muscle damage implications for muscle performance and recovery. J Nutr Metabolism, 2012, 2012: 960363.

[5] BartlettJD, HawleyJA, MortonJP. Carbohydrate availability and exercise training adaptation: too much of a good thing?. Eur J Sport Sci, 2015, 1513-12.

[6] BessonT, et al. . Sex differences in endurance running. Sports medicine (Auckland. NZ), 2022, 5261235-57

[7] BirbenE, SahinerUM, SackesenC, ErzurumS, KalayciO. Oxidative stress and antioxidant defense. World Allergy Organ J, 2012, 519-19.

[8] Bouviere J, Fortunato RS, Dupuy C, Werneck-de-Castro JP, Carvalho DP, Louzada RA. Exercise-stimulated ROS sensitive signaling pathways in skeletal muscle. Antioxid (Basel). 2021;10(4):537.

[9] BrancaccioP, MaffulliN, LimongelliFM. Creatine kinase monitoring in sport medicine. Br Med Bull, 2007, 81–82: 209-30.

[10] BrawnerCA, ChurillaJR, KeteyianSJ. Prevalence of physical activity is lower among individuals with chronic disease. Med Sci Sports Exerc, 2016, 4861062-7.

[11] ChalchatE, et al. . Circulating microRNAs after a 24-h ultramarathon run in relation to muscle damage markers in elite athletes. Scand J Med Sci Sports, 2021, 3191782-95.

[12] ChevionS, et al. . Plasma antioxidant status and cell injury after severe physical exercise. Proc Natl Acad Sci U S A, 2003, 10095119-23.

[13] CollinF. Chemical basis of reactive oxygen species reactivity and involvement in neurodegenerative diseases. Int J Mol Sci, 2019, 20102407.

[14] CooperCE, VollaardNB, ChoueiriT, WilsonMT. Exercise, free radicals and oxidative stress. Biochem Soc Trans, 2002, 302280-5.

[15] CowleyE, OlenickA, McNultyK. Invisible sportswomen: the Sex Data Gap in Sport and Exercise Science Research. Women Sport Phys Activity J, 2021, 29: 1-6.

[16] DanielssonT, et al. . Blood biomarkers in male and female participants after an ironman-distance triathlon. PLoS ONE, 2017, 126e0179324-0179324.

[17] DeanerRO, BalishSM, LombardoMP. Sex differences in sports interest and motivation: an evolutionary perspective. Evolutionary Behav Sci, 2016, 10273-97.

[18] Demirci-ÇekiçS, et al. . Biomarkers of oxidative stress and antioxidant defense. J Pharm Biomed Anal, 2022, 209: 114477.

[19] DevriesMC, JakobiJM. Importance of considering sex and gender in exercise and nutrition research. Appl Physiol Nutr Metabolism = Physiologie Appliquee Nutr et Metab, 2021, 466iii-vii.

[20] Di Meo S, Napolitano G, Venditti P. Mediators of physical activity protection against ROS-Linked skeletal muscle damage. Int J Mol Sci. 2019;20(12):3024.

[21] Di Meo S, Venditti P, Napolitano G. Physiological and pathological role of ROS: benefits and limitations of antioxidant treatment 2.0. Int J Mol Sci. 2022;23(16):9437.

[22] DillardCJ, LitovRE, SavinWM, DumelinEE, TappelAL. Effects of exercise, vitamin E, and ozone on pulmonary function and lipid peroxidation. J Appl Physiol, 1978, 456927-32.

[23] EyiletenC, et al. . Alterations in circulating MicroRNAs and the relation of MicroRNAs to maximal oxygen consumption and intima-media thickness in Ultra-marathon runners. Int J Environ Res Public Health, 2021, 18147234.

[24] EyiletenC, et al. . Altered circulating MicroRNA profiles after endurance training: a cohort study of Ultramarathon runners. Front Physiol, 2021, 12: 792931.

[25] FahrenholtzIL, et al. . Within-day energy deficiency and reproductive function in female endurance athletes. Scand J Med Sci Sports, 2018, 2831139-46.

[26] Gagnon DD, Dorman S, Ritchie S, Mutt SJ, Stenbäck V, Walkowiak J, Herzig KH. Multi-day prolonged low- to moderate-intensity endurance Exercise mimics training improvements in metabolic and oxidative profiles without concurrent chromosomal changes in healthy adults. Front Physiol. 2019;10:1123.

[27] Guerrero C, Collado-Boira E, Martinez-Navarro-I, Hernando B, Hernando C, Balino P, Muriach M. Impact of plasma oxidative stress markers on post-race recovery in Ultramarathon runners: a sex and age perspective overview. Antioxid (Basel). 2021;10(3):355.

[28] Halliwell B, Gutteridge JMC. Free radicals in biology and medicine. New York City: Oxford University Press; 2015.

[29] HamadehMJ, DevriesMC, TarnopolskyMA. Estrogen supplementation reduces whole body leucine and carbohydrate oxidation and increases lipid oxidation in men during endurance exercise. J Clin Endocrinol Metab, 2005, 9063592-9.

[30] HamarslandH, PaulsenG, SolbergPA, SlaathaugOG, RaastadT. Depressed physical performance outlasts hormonal disturbances after military training. Med Sci Sports Exerc, 2018, 50102076-84.

[31] HeF, et al. . Redox Mechanism of Reactive Oxygen Species in Exercise. Front Physiol, 2016, 7: 486-486.

[32] Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane handbook for systematic reviews of interventions. 2nd Edition. Chichester (UK): John Wiley & Sons; 2019.

[33] Hoppel F, Calabria E, Pesta DH, Kantner-Rumplmair W, Gnaiger E, Burtscher M. Effects of ultramarathon running on mitochondrial function of platelets and oxidative stress parameters: a pilot study. Front Physiol. 2021;12:632664.

[34] Il’yasovaD, ScarbroughP, SpasojevicI. Urinary biomarkers of oxidative status. Clin Chim Acta, 2012, 41319–201446-53.

[35] IslamMN, et al. . Superoxide dismutase: an updated review on its health benefits and industrial applications. Crit Rev Food Sci Nutr, 2022, 62267282-300.

[36] JanciauskieneS. The Beneficial Effects of Antioxidants in Health and diseases. Chronic Obstr Pulm Dis, 2020, 73182-202

[37] Jówko E, Różański P, Tomczak A. Effects of a 36-h survival training with sleep deprivation on oxidative stress and muscle damage biomarkers in young healthy men. Int J Environ Res Public Health. 2018;15(10):2066.

[38] KabasakalisA, et al. . Blood oxidative stress markers after Ultramarathon Swimming. J Strength Conditioning Res, 2011, 253805-11.

[39] KaufmannCC, et al. . Effect of marathon and ultra-marathon on inflammation and iron homeostasis. Scand J Med Sci Sports, 2021, 313542-52.

[40] Kawamura T, Muraoka I. Exercise-Induced oxidative stress and the effects of antioxidant intake from a physiological viewpoint. Antioxid (Basel). 2018;7(9):119.

[41] KłapcińskaB, et al. . Metabolic responses to a 48-h ultra-marathon run in middle-aged male amateur runners. Eur J Appl Physiol, 2013, 113112781-93.

[42] KnechtleB, NikolaidisPT. Physiology and pathophysiology in Ultra-marathon running. Front Physiol, 2018, 9: 634.

[43] KnechtleB, et al. . Do women reduce the gap to men in ultra-marathon running?. Springerplus, 2016, 51672.

[44] KnezWL, CoombesJS, JenkinsDG. Ultra-endurance exercise and oxidative damage: implications for cardiovascular health. Sports medicine (Auckland. NZ), 2006, 365429-41

[45] Ko SH, Jung Y. Energy metabolism changes and dysregulated lipid metabolism in postmenopausal women. Nutrients. 2021;13(12):4556.

[46] LaufsU, et al. . Treatment options for Statin-Associated muscle symptoms. Deutsches Arzteblatt Int, 2015, 11244748-55

[47] Le GoffC, et al. . The impact of an ultra-trail on the dynamic of cardiac, inflammatory, renal and oxidative stress biological markers correlated with electrocardiogram and echocardiogram. Acta Cardiol, 2021, 767739-47.

[48] Lecina M, Castellar C, Pradas F, López-Laval I. 768-km multi-stage ultra-trail case study-muscle damage, biochemical alterations and strength loss on lower limbs. Int J Environ Res Public Health. 2022;19(2):876.

[49] Legaz-ArreseA, et al. . Impact of an endurance training program on exercise-induced cardiac biomarker release. Am J Physiol Heart Circ Physiol, 2015, 3088H913-920.

[50] Lian D, Chen MM, Wu H, Deng S, Hu X. The role of oxidative stress in skeletal muscle myogenesis and muscle disease. Antioxid (Basel). 2022;11(4):755.

[51] LiberatiA, et al. . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical Res ed), 2009, 339: b2700.

[52] LiguoriI, et al. . Oxidative stress, aging, and diseases. Clin Interv Aging, 2018, 13: 757-72.

[53] LuY, WiltshireHD, BakerJS, WangQ. Effects of High Intensity Exercise on oxidative stress and antioxidant status in untrained humans: a systematic review. Biology (Basel), 2021, 10121272

[54] MaherCG, SherringtonC, HerbertRD, MoseleyAM, ElkinsM. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther, 2003, 838713-21.

[55] MartinezMP, KannanK. Simultaneous Analysis of Seven Biomarkers of Oxidative Damage to Lipids, proteins, and DNA in urine. Environ Sci Technol, 2018, 52116647-55.

[56] Martinez-NavarroI, Montoya-ViecoA, ColladoE, HernandoB, HernandoC. Ultra Trail Performance is differently predicted by endurance variables in men and women. Int J Sports Med, 2022, 437600-7.

[57] McKenzie JE, Brennan SE, Ryan RE, Thomson HJ, Johnston RV. Summarizing study characteristics and preparing for synthesis. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane handbook for systematic reviews of interventions. 2nd Edition. Chichester (UK): John Wiley & Sons; 2019.

[58] McKenzie JE, Brennan SE, Ryan RE, Thomson HJ, Johnston RV, Thomas J. Defining the criteria for including studies and how they will be grouped for the synthesis. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane handbook for systematic reviews of interventions. 2nd Edition. Chichester (UK): John Wiley & Sons; 2019.

[59] McNultyKL, et al. . The effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic women: a systematic review and Meta-analysis. Sports medicine (Auckland. NZ), 2020, 50101813-27

[60] MichielsenEC, WodzigWK, Van Dieijen-VisserMP. Cardiac troponin T release after prolonged strenuous exercise. Sports medicine (Auckland. NZ), 2008, 385425-35

[61] MilletGY, et al. . Physiological and biological factors associated with a 24 h treadmill ultra-marathon performance. Scand J Med Sci Sports, 2011, 21154-61.

[62] MorrisG, GevezovaM, SarafianV, MaesM. Redox regulation of the immune response. Cell Mol Immunol, 2022, 19101079-101.

[63] MoseleyAM, ElkinsMR, Van der WeesPJ, PinheiroMB. Using research to guide practice: the Physiotherapy evidence database (PEDro). Braz J Phys Ther, 2020, 245384-91.

[64] Mrakic-SpostaS, et al. . Effects of Mountain Ultra-marathon running on ROS Production and oxidative damage by Micro-invasive Analytic techniques. PLoS ONE, 2015, 1011e0141780.

[65] Mrakic-SpostaS, et al. . Acute effects of Triathlon race on oxidative stress biomarkers. Oxidative Med Cell Longev, 2020, 2020: 3062807.

[66] Munteanu IG, Apetrei C. Analytical methods used in determining antioxidant activity: a review. Int J Mol Sci. 2021;22(7):3380.

[67] MurphyMP, et al. . Guidelines for measuring reactive oxygen species and oxidative damage in cells and in vivo. Nat Metabolism, 2022, 46651-62.

[68] Myers J. Exercise. Cardiovasc Health Circulation. 2003;107(1):e2–5.

[69] NiemanDC, et al. . Immune and inflammation responses to a 3-day period of intensified running versus cycling. Brain Behav Immun, 2014, 39: 180-5.

[70] PartykaA, WaśkiewiczZ. The consequences of Training and Competition to the Musculoskeletal System in Ultramarathon runners: a narrative review. Front Physiol, 2021, 12: 738665.

[71] PateRR, PrattM, BlairSN. Physical activity and public health: a recommendation from the centers for disease control and prevention and the American college of sports medicine. JAMA, 1995, 2735402-7.

[72] PeakeJM, et al. . Modulating exercise-induced hormesis: does less equal more?. J Appl Physiol, 2015, 1193172-89.

[73] PesericoCS, MachadoFA. Association between endurance performance, oxidative stress, and antioxidant markers during a running training program in untrained men. Sport Sci Health, 2022, 181249-56.

[74] PetterssonJ, et al. . Muscular exercise can cause highly pathological liver function tests in healthy men. Br J Clin Pharmacol, 2008, 652253-9.

[75] PinhoRA, et al. . Oxidative stress and inflammatory parameters after an Ironman race. Clin J Sport Medicine: Official J Can Acad Sport Med, 2010, 204306-11.

[76] PizzinoG, et al. . Oxidative stress: Harms and benefits for Human Health. Oxidative Med Cell Longev, 2017, 2017: 8416763.

[77] PlavinaL, et al. . Antioxidative system capacity after a 10-day-long intensive training course and one-month-long recovery in military cadets. Phys Activity Rev, 2021, 9: 2021.

[78] PowersSK, JacksonMJ. Exercise-induced oxidative stress: cellular mechanisms and impact on muscle force production. Physiol Rev, 2008, 8841243-76.

[79] PowersSK, et al. . Exercise-induced oxidative stress: friend or foe?. J Sport Health Sci, 2020, 95415-25.

[80] PowersSK, GoldsteinE, SchragerM, JiLL. Exercise training and skeletal muscle antioxidant enzymes: an update. Antioxidants, 2023, 12139.

[81] RadakZ, ZhaoZ, KoltaiE, OhnoH, AtalayM. Oxygen consumption and usage during physical exercise: the balance between oxidative stress and ROS-dependent adaptive signaling. Antioxid Redox Signal, 2013, 18101208-46.

[82] RahalA, et al. . Oxidative stress, prooxidants, and antioxidants: the interplay. Biomed Res Int, 2014, 2014: 761264-761264.

[83] Ramos-Campo D, Ávila-Gandía V, Alacid F, Soto-Méndez F, Alcaraz PE, López-Román FJ, Rubio-Arias JÁ. Muscle damage, physiological changes and energy balance in ultra-endurance mountain event athletes. Appl Physiol Nutr Metab. 2016;41(8):872–8.

[84] ReidMB. Redox interventions to increase exercise performance. J Physiol, 2016, 594185125-33.

[85] ReuterS, GuptaSC, ChaturvediMM, AggarwalBB. Oxidative stress, inflammation, and cancer: how are they linked?. Free Radic Biol Med, 2010, 49111603-16.

[86] RevanS, ErolA. Effects of endurance training on exhaustive exercise-induced oxidative stress markers. Afr J Pharm Pharmacol, 2011, 5: 437-41.

[87] RiegelB, et al. . Self-care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare professionals from the American Heart Association. J Am Heart Assoc, 2017, 69e006997.

[88] RifkindJM, MohantyJG, NagababuE. The pathophysiology of extracellular hemoglobin associated with enhanced oxidative reactions. Front Physiol, 2014, 5: 500

[89] RoebuckGS, et al. . Psychological factors Associated with Ultramarathon runners’ Supranormal Pain Tolerance: a pilot study. J pain: Official J Am Pain Soc, 2018, 19121406-15.

[90] RosalesXQ, et al. . Fidelity of gamma-glutamyl transferase (GGT) in differentiating skeletal muscle from liver damage. J Child Neurol, 2008, 237748-51.

[91] RowlandsDS, et al. . Oxidative stress, inflammation, and muscle soreness in an 894-km relay trail run. Eur J Appl Physiol, 2012, 11251839-48.

[92] Różański P, Jówko E, Tomczak A. Assessment of the levels of oxidative stress, muscle damage, and psychomotor abilities of special force soldiers during military survival training. Int J Environ Res Public Health. 2020;17(13):4886.

[93] Ruzicic R, Jakovljevic V. and Djordjevic D. Oxidative stress in training, overtraining and detraining: from experimental to applied Research. Serbian J Experimental Clin Res. 2016;17(4):343–8.

[94] Sánchez-Rodríguez MA, Mendoza-Núñez VM. Oxidative stress indexes for diagnosis of health or disease in humans. Oxid Med Cell Longev. 2019;2019:4128152.

[95] ScheerV. Participation trends of Ultra endurance events. Sports Med Arthrosc Rev, 2019, 2713-7.

[96] ScheerV, Rojas-ValverdeD. Long-term health issues in ultraendurance runners: should we be concerned?. BMJ Open Sport Exerc Med, 2021, 73e001131.

[97] ScheerV, et al. . Potential long-term health problems Associated with Ultra-endurance running: a narrative review. Sports Med (Auckland. NZ), 2022, 524725-40

[98] SchefferDL, LatiniA. Exercise-induced immune system response: anti-inflammatory status on peripheral and central organs. Biochim Biophys Acta Mol Basis Dis, 2020, 186610165823-165823.

[99] SchieberM, ChandelNS. ROS function in redox signaling and oxidative stress. Curr Biology: CB, 2014, 2410R453-462.

[100] Sharifi-Rad M, Anil Kumar NV, Zucca P, Varoni EM, Dini L, Panzarini E, Rajkovic J, Tsouh Fokou PV, Azzini E, Peluso I, Prakash Mishra A, Nigam M, El Rayess Y, Beyrouthy ME, Polito L, Iriti M, Martins N, Martorell M, Docea AO, Setzer WN, Calina D, Cho WC, Sharifi-Rad J. Lifestyle, oxidative stress, and antioxidants: back and forth in the Pathophysiology of chronic diseases. Front Physiol. 2020;11:694.

[101] SiesH, CadenasE. Oxidative stress: damage to intact cells and organs. Philos Trans R Soc Lond B Biol Sci, 1985, 3111152617-31.

[102] SiesH, JonesDP. Reactive oxygen species (ROS) as pleiotropic physiological signalling agents. Nat Rev Mol Cell Biol, 2020, 217363-83.

[103] SimioniC, et al. . Oxidative stress: role of physical exercise and antioxidant nutraceuticals in adulthood and aging. Oncotarget, 2018, 92417181-98.

[104] SpanidisY, et al. . Variations in oxidative stress levels in 3 days follow-up in Ultramarathon Mountain race athletes. J Strength Cond Res/Natl Strength Cond Assoc, 2017, 313582-94

[105] SteinJA, et al. . Biomarkers of oxidative stress, diet and exercise distinguish soldiers selected and non-selected for special forces training. Metabolomics, 2023, 19439.

[106] TanskanenMM, et al. . Association of military training with oxidative stress and overreaching. Med Sci Sports Exerc, 2011, 4381552-60.

[107] TaylorKS, MahtaniKR, AronsonJK. Summarising good practice guidelines for data extraction for systematic reviews and meta-analysis. BMJ Evidence-Based Med, 2021, 26388-90.

[108] Thirupathi A, Pinho RA, Ugbolue UC, He Y, Meng Y, Gu Y. Effect of running exercise on oxidative stress biomarkers: a systematic review. Front Physiol. 2021;11:610112.

[109] ThirupathiA, et al. . Effect of different Exercise modalities on oxidative stress: a systematic review. Biomed Res Int, 2021, 2021: 1947928.

[110] Tian D, Meng J. Exercise for prevention and relief of cardiovascular disease: prognoses, mechanisms, and approaches. Oxid Med Cell Longev. 2019;2019:3756750.

[111] TillerNB, et al. . Do sex differences in Physiology Confer a female advantage in Ultra-endurance Sport? Sports medicine (Auckland. NZ), 2021, 515895-915

[112] TomczakA, JówkoE. Survival Training effects on oxidative stress and muscle damage biomarkers of Naval cadets. Aerosp Med Hum Perform, 2020, 919720-4.

[113] TorresMJ, et al. . 17β-Estradiol directly lowers mitochondrial membrane Microviscosity and improves bioenergetic function in skeletal muscle. Cell Metabol, 2018, 271167-e179167.

[114] TurrensJF. Mitochondrial formation of reactive oxygen species. J Physiol, 2003, 552Pt 2335-44.

[115] van BeekJHDA, et al. . The genetic architecture of liver enzyme levels: GGT, ALT and AST. Behav Genet, 2013, 434329-39.

[116] Vázquez-MezaH, Vilchis-LanderosMM, Vázquez-CarradaM, Uribe-RamírezD, Matuz-MaresD. Cellular compartmentalization, Glutathione Transport and its relevance in some pathologies. Antioxidants, 2023, 124834.

[117] VezzoliA, et al. . Oxidative stress Assessment in response to Ultraendurance Exercise: thiols Redox Status and ROS Production according to duration of a competitive race. Oxidative Med Cell Longev, 2016, 2016: 6439037.

[118] VollaardNB, CooperCE, ShearmanJP. Exercise-induced oxidative stress in overload training and tapering. Med Sci Sports Exerc, 2006, 3871335-41.

[119] WagnerKH, et al. . Well-trained, healthy triathletes experience no adverse health risks regarding oxidative stress and DNA damage by participating in an ultra-endurance event. Toxicology, 2010, 2782211-6.

[120] WagnerKH, ReichholdS, NeubauerO. Impact of endurance and ultraendurance exercise on DNA damage. Ann N Y Acad Sci, 2011, 1229: 115-23.

[121] WangF, WangX, LiuY, ZhangZ. Effects of Exercise-Induced ROS on the pathophysiological functions of skeletal muscle. Oxidative Med Cell Longev, 2021, 2021: 3846122.

[122] WarburtonDE, NicolCW, BredinSS. Health benefits of physical activity: the evidence. CMAJ: Can Med Association J = J de l’Association medicale canadienne, 2006, 1746801-9.

[123] WaśkiewiczZ, et al. . Acute metabolic responses to a 24-h ultra-marathon race in male amateur runners. Eur J Appl Physiol, 2012, 11251679-88.

[124] Wesolowski LT, Semanchik PL, White-Springer SH. Beyond antioxidants: selenium and skeletal muscle mitochondria. Front Veterinary Sci. 2022;9:1011159.

[125] ZhuJW, ReedJL, Van SpallHGC. The underrepresentation of female athletes in sports research: considerations for cardiovascular health. Eur Heart J, 2021, 43171609-11.

[126] Zuo J, Zhang Z, Luo M, Zhou L, Nice EC, Zhang W, Wang C, Huang C. Redox signaling at the crossroads of human health and disease. MedComm (2020). 2022;3(2):e127.

RIGHTS & PERMISSIONS

Beijing Sport University