Skip to main content
SpringerLink
Log in

Ultra-Endurance Exercise and Oxidative Damage

Implications for Cardiovascular Health

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

At least 30 minutes of moderate-intensity physical activity accumulated on most, preferably all days is considered the minimum level necessary to reduce the risk of developing cardiovascular disease. Despite an unclear explanation, some epidemiological data paradoxically suggest that a very high volume of exercise is associated with a decrease in cardiovascular health. Although ultra-endurance exercise training has been shown to increase antioxidant defences (and therefore confer a protective effect against oxidative stress), an increase in oxidative stress may contribute to the development of atherosclerosis via oxidative modification of low-density lipoprotein (LDL). Research has also shown that ultra-endurance exercise is associated with acute cardiac dysfunction and injury, and these may also be related to an increase in free radical production. Longitudinal studies are needed to assess whether antioxidant defences are adequate to prevent LDL oxidation that may occur as a result of increased free radical production during very high volumes of exercise. In addition, this work will assist in understanding the accrued effect of repeated ultra-endurance exercise-induced myocardial damage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med 1999; 340 (2): 115–126

    Article  PubMed  CAS  Google Scholar 

  2. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993; 362 (6423): 801–809

    Article  PubMed  CAS  Google Scholar 

  3. Paffenbarger RJ, Hyde RT, Wing AL, et al. Physical activity, all-cause mortality, and longevity of college alumni. N Engl 1 Med 1986; 314 (10): 605–613

    Article  Google Scholar 

  4. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273 (5): 402–407

    Article  PubMed  CAS  Google Scholar 

  5. Australian Government, Department of Health and Ageing. An active way to better health: national physical activity guidelines for adults [online]. Available from URL: http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/phd-physical-activity-adults-pdf-cnt.htm/$File/adults_phys.pdf [Accessed 2006 Apr 4]

  6. Sarna S, Sahi T, Koskenvuo M, et al. Increased life expectancy of world class male athletes. Med Sci Sports Exerc 1993; 25 (2): 237–244

    PubMed  CAS  Google Scholar 

  7. Lee IM, Hsieh CC, Paffenbarger RJ. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA 1995; 273 (15): 1179–1184

    Article  PubMed  CAS  Google Scholar 

  8. Quinn TJ, Sprague HA, Van Huss WD, et al. Caloric expenditure, life status, and disease in former male athletes and non-athletes. Med Sci Sports Exerc 1990; 22 (6): 742–750

    PubMed  CAS  Google Scholar 

  9. Dhalla NS, Temsah RM, Netticadan T. Role of oxidative stress in cardiovascular diseases. J Hypertens 2000; 18 (6): 655–673

    Article  PubMed  CAS  Google Scholar 

  10. Sen CK. Oxidants and antioxidants in exercise. J Appl Physiol 1995; 79 (3): 675–686

    PubMed  CAS  Google Scholar 

  11. Boveris A, Chance B. The mitochondrial generation of hydrogen peroxide: general properties and effect of hyperbaric oxygen. Biochem J 1973; 134 (3): 707–716

    PubMed  CAS  Google Scholar 

  12. Sjodin B, Hellsten Westing Y, Apple FS. Biochemical mechanisms for oxygen free radical formation during exercise. Sports Med 1990; 10 (4): 236–254

    Article  PubMed  CAS  Google Scholar 

  13. Niess AM, Dickhuth HH, Northoff H, et al. Free radicals and oxidative stress in exercise: immunological aspects. Exerc Immunol Rev 1999; 5: 22–56

    PubMed  CAS  Google Scholar 

  14. Bindoli A, Cavallini L, Rigobello MP, et al. Modification of the xanthine-converting enzyme of perfused rat heart during ischemia and oxidative stress. Free Radic Biol Med 1988; 4 (3): 163–167

    Article  PubMed  CAS  Google Scholar 

  15. Parks DA, Williams TK, Beckman JS. Conversion of xanthine dehydrogenase to oxidase in ischemic rat intestine: a reevaluation. Am J Physiol 1988; 254 (5 Pt 1): G768–G774

    PubMed  CAS  Google Scholar 

  16. Corte ED, Stirpe F. The regulation of rat liver xanthine oxidase: involvement of thiol groups in the conversion of the enzyme activity from dehydrogenase (type D) into oxidase (type O) and purification of the enzyme. Biochem J 1972; 126 (3): 739–745

    PubMed  CAS  Google Scholar 

  17. Kuppusamy P, Zweier JL. Characterization of free radical generation by xanthine oxidase: evidence for hydroxyl radical generation. J Biol Chem 1989; 264 (17): 9880–9884

    PubMed  CAS  Google Scholar 

  18. Parks DA, Granger DN. Xanthine oxidase: biochemistry, distribution and physiology. Acta Physiol Scand Suppl 1986; 548: 87–99

    PubMed  CAS  Google Scholar 

  19. Bury TB, Pirnay F. Effect of prolonged exercise on neutrophil myeloperoxidase secretion. Int J Sports Med 1995; 16 (6): 410–412

    Article  PubMed  CAS  Google Scholar 

  20. Bousquet J, Chanez P, Mercier J, et al. Monocytes, exercise, and the inflammatory response. Exerc Immunol Rev 1996; 2: 35–44

    Google Scholar 

  21. Evans WJ, Cannon JG. The metabolic effects of exercise-induced muscle damage. Exerc Sport Sci Rev 1991; 19: 99–125

    Article  PubMed  CAS  Google Scholar 

  22. Woods JA, Davis JM. Exercise, monocyte/macrophage function, and cancer. Med Sci Sports Exerc 1994; 26 (2): 147–156

    Article  PubMed  CAS  Google Scholar 

  23. Smith JA. Neutrophils, host defense, and inflammation: a double-edged sword. J Leukoc Biol 1994; 56 (6): 672–686

    PubMed  CAS  Google Scholar 

  24. McCarthy DA, Dale MM. The leucocytosis of exercise: a review and model. Sports Med 1988; 6 (6): 333–363

    Article  PubMed  CAS  Google Scholar 

  25. Gabriel HH, Heine G, Kroger K, et al. Exercise and atherogenesis: where is the missing link? Exerc Immunol Rev 1999; 5: 96–102

    PubMed  CAS  Google Scholar 

  26. Pyne DB. Regulation of neutrophil function during exercise. Sports Med 1994; 17 (4): 245–258

    Article  PubMed  CAS  Google Scholar 

  27. Weiss SJ. Tissue destruction by neutrophils. N Engl J Med 1989; 320 (6): 365–376

    Article  PubMed  CAS  Google Scholar 

  28. Halliwell B, Gutteridge JM. Oxygen free radicals and iron in relation to biology and medicine: some problems and concepts. Arch Biochem Biophys 1986; 246 (2): 501–514

    Article  PubMed  CAS  Google Scholar 

  29. Thomas CE, Morehouse LA, Aust SD. Ferritin and superoxidedependent lipid peroxidation. J Biol Chem 1985; 260 (6): 3275–3280

    PubMed  CAS  Google Scholar 

  30. Biemond P, Swaak AJ, Beindorff CM, et al. Superoxide-dependent and -independent mechanisms of iron mobilization from ferritin by xanthine oxidase: implications for oxygen-free-radical-induced tissue destruction during ischaemia and inflammation. Biochem J 1986; 239 (1): 169–173

    PubMed  CAS  Google Scholar 

  31. Hellsten Y, Frandsen U, Orthenblad N, et al. Xanthine oxidase in human skeletal muscle following eccentric exercise: a role in inflammation. J Physiol 1997; 498 (Pt 1): 239–248

    PubMed  CAS  Google Scholar 

  32. Haber F, Weiss J. The catalytic decomposition of hydrogen peroxide by iron salts. Proc R Soc Lond 1934; 147: 332–351

    Article  CAS  Google Scholar 

  33. McCord JM, Day ED. Superoxide-dependent production of hydroxyl radical catalyzed by iron-EDT A complex. FEBS Lett 1978; 86 (1): 139–142

    Article  PubMed  CAS  Google Scholar 

  34. Goldfarb AH. Nutritional antioxidants as therapeutic and preventive modalities in exercise-induced muscle damage. Can J Appl Physiol 1999; 24 (3): 249–266

    Article  PubMed  CAS  Google Scholar 

  35. Camhi SL, Lee P, Choi AM. The oxidative stress response. New Horiz 1995: 3 (2): 170–182

    PubMed  CAS  Google Scholar 

  36. Flohe L. Role of GSH peroxidase in lipid peroxide metabolism. In: Yagi K, editor. Lipid peroxidation in biology and medicine. New York: Academic, 1982: 6377–6381

    Google Scholar 

  37. Stocker R. Induction of haem oxygenase as a defence against oxidative stress. Free Radic Res Commun 1990; 9 (2): 101–112

    Article  PubMed  CAS  Google Scholar 

  38. Marini M, Frabetti F, Musiani D, et al. Oxygen radicals induce stress proteins and tolerance to oxidative stress in human lymphocytes. Int J Radiat Biol 1996; 70 (3): 337–50

    Article  PubMed  CAS  Google Scholar 

  39. Navab M, Imes SS, Hama SY, et al. Monocyte transmigration induced by modification of low density lipoprotein in cocul-tures of human aortic wall cells is due to induction of monocyte chemotactic protein 1 synthesis and is abolished by high density lipoprotein. J Clin Invest 1991; 88 (6): 2039–2046

    Article  PubMed  CAS  Google Scholar 

  40. Frei B, England L, Ames BN. Ascorbate is an outstanding antioxidant in human blood plasma. Proc Natl Acad Sci USA 1989; 86 (16): 6377–6381

    Article  PubMed  CAS  Google Scholar 

  41. Frei B, Kim MC, Ames BN. Ubiquinol-10 is an effective lipid — soluble antioxidant at physiological concentrations. Proc Natl Acad Sci U S A 1990; 87 (12): 4879–4883

    Article  PubMed  CAS  Google Scholar 

  42. Stocker R, Bowry VW, Frei B. Ubiquinol-10 protects human low density lipoprotein more efficiently against lipid peroxidation than does alpha-tocopherol. Proc Natl Acad Sci USA 1991; 88 (5): 1646–1650

    Article  PubMed  CAS  Google Scholar 

  43. Davies KJ, Quintanilha AT, Brooks GA, et al. Free radicals and tissue damage produced by exercise. Biochem Biophys Res Commun 1982; 107 (4): 1198–1205

    Article  PubMed  CAS  Google Scholar 

  44. Bailey DM, Young IS, McEneny J, et al. Regulation of free radical outflow from an isolated muscle bed in exercising humans. Am J Physiol Heart Circ Physiol 2004; 287 (4): H1689–H1699

    Article  PubMed  CAS  Google Scholar 

  45. Halliwell B, Chirico S. Lipid peroxidation: its mechanism, measurement, and significance. Am J Clin Nutr 1993; 57 (5 Suppl.): 715S–724S

    PubMed  CAS  Google Scholar 

  46. Springfield JR, Levitt MD. Pitfalls in the use of breath pentane measurements to assess lipid peroxidation. J Lipid Res 1994; 35 (8): 1497–1504

    PubMed  CAS  Google Scholar 

  47. Jenkins RR. Exercise and oxidative stress methodology: a critique. Am J Clin Nutr 2000; 72 (2 Suppl.): 670S–674S

    PubMed  CAS  Google Scholar 

  48. Janero DR. Malondialdehyde and thiobarbituric acid-reactivity as diagnostic indices of lipid peroxidation and peroxidative tissue injury. Free Radic Biol Med 1990; 9 (6): 515–540

    Article  PubMed  CAS  Google Scholar 

  49. Wade CR, van Rij AM. Plasma malondialdehyde, lipid peroxides, and the thiobarbituric acid reaction. Clin Chem 1989; 35 (2): 336

    PubMed  CAS  Google Scholar 

  50. Meagher EA, FitzGerald GA. Indices of lipid peroxidation in vivo: strengths and limitations. Free Radic Biol Med 2000; 28 (12): 1745–1750

    Article  PubMed  CAS  Google Scholar 

  51. Ayres S, Baer J, Subbiah MT. Exercised-induced increase in lipid peroxidation parameters in amenorrheic female athletes. Fertil Steril 1998; 69 (1): 73–77

    Article  PubMed  CAS  Google Scholar 

  52. Almar M, Villa JG, Cuevas MJ, et al. Urinary levels of 8-hydroxydeoxyguanosine as a marker of oxidative damage in road cycling. Free Radic Res 2002; 36 (3): 247–253

    Article  PubMed  CAS  Google Scholar 

  53. Orhan H, van Holland B, Krab B, et al. Evaluation of a multi-parameter biomarker set for oxidative damage in man: increased urinary excretion of lipid, protein and DNA oxidation products after one hour of exercise. Free Radic Res 2004; 38 (12): 1269–1279

    Article  PubMed  CAS  Google Scholar 

  54. Nieman DC, Henson DA, McAnulty SR, et al. Vitamin E and immunity after the Kona Triathlon World Championship. Med Sci Sports Exerc 2004; 36 (8): 1328–1335

    Article  PubMed  CAS  Google Scholar 

  55. Dillard CJ, Litov RE, Savin WM, et al. Effects of exercise, vitamin E, and ozone on pulmonary function and lipid peroxidation. J Appl Physiol 1978; 45 (6): 927–932

    PubMed  CAS  Google Scholar 

  56. Pincemail J, Camus G, Roesgen A, et al. Exercise induces pentane production and neutrophil activation in humans. Effect of propranolol. Eur J Appl Physiol Occup Physiol 1990; 61 (3–4): 319–322

    Article  PubMed  CAS  Google Scholar 

  57. Lovlin R, Cottle W, Pyke I, et al. Are indices of free radical damage related to exercise intensity. Eur J Appl Physiol Occup Physiol 1987; 56 (3): 313–316

    Article  PubMed  CAS  Google Scholar 

  58. Maughan RJ, Donnelly AE, Gleeson M, et al. Delayed-onset muscle damage and lipid peroxidation in man after a downhill run. Muscle Nerve 1989; 12 (4): 332–336

    Article  PubMed  CAS  Google Scholar 

  59. Sparrow CP, Parthasarathy S, Steinberg D. A macrophage receptor that recognizes oxidized low density lipoprotein but not acetylated low density lipoprotein. J Biol Chem 1989; 264 (5): 2599–2604

    PubMed  CAS  Google Scholar 

  60. Brown MS, Goldstein JL. Atherosclerosis: scavenging for receptors. Nature 1990; 343 (6258): 508–509

    Article  PubMed  CAS  Google Scholar 

  61. Alessio HM. Exercise-induced oxidative stress. Med Sci Sports Exerc 1993; 25 (2): 218–224

    PubMed  CAS  Google Scholar 

  62. Ogita H, Liao J. Endothelial function and oxidative stress. Endothelium 2004; 11 (2): 123–132

    Article  PubMed  CAS  Google Scholar 

  63. Steinberg D, Parthasarathy S, Carew TE et al. Beyond cholesterol. Modifications of low-density lipoprotein that increase its atherogenicity. N Engl J Med 1989; 320 (14): 915–924

    Article  PubMed  CAS  Google Scholar 

  64. Witztum JL. The oxidation hypothesis of atherosclerosis. Lancet 1994; 344 (8925): 793–795

    Article  PubMed  CAS  Google Scholar 

  65. Sanchez-Quesada JL, Homs-Serradesanferm R, Serrat-Serrat J, et al. Increase of LDL susceptibility to oxidation occurring after intense, long duration aerobic exercise. Atherosclerosis 1995; 118 (2): 297–305

    Article  PubMed  CAS  Google Scholar 

  66. Wetzstein CJ, Shern-Brewer RA, Santanam N, etal. Does acute exercise affect the susceptibility of low density lipoprotein to oxidation? Free Radic Biol Med 1998; 24 (4): 679–682

    Article  PubMed  CAS  Google Scholar 

  67. Liu ML, Bergholm R, Makimattila S, et al. A marathon run increases the susceptibility of LDL to oxidation in vitro and modifies plasma antioxidants. Am J Physiol 1999; 276 (6 Pt 1): E1083–E1091

    PubMed  CAS  Google Scholar 

  68. Mastaloudis A, Leonard SW, Traber MG. Oxidative stress in athletes during extreme endurance exercise. Free Radic Biol Med 2001; 31 (7): 911–922

    Article  PubMed  CAS  Google Scholar 

  69. Paffenbarger RJ, Brand RJ, Sholtz RI, et al. Energy expenditure, cigarette smoking, and blood pressure level as related to death from specific diseases. Am J Epidemiol 1978; 108 (1): 12–18

    PubMed  Google Scholar 

  70. Villeneuve PJ, Morrison HI, Craig CL, et al. Physical activity, physical fitness, and risk of dying. Epidemiology 1998; 9 (6): 626–631

    Article  PubMed  CAS  Google Scholar 

  71. Lee IM, Paffenbarger RJ. Physical activity and stroke incidence: the Harvard Alumni Health Study. Stroke 1998; 29 (10): 2049–2054

    Article  PubMed  CAS  Google Scholar 

  72. Shaper AG, Wannamethee G, Weatherall R. Physical activity and ischaemic heart disease in middle-aged British men. Br Heart J 1991; 66 (5): 384–394

    Article  PubMed  CAS  Google Scholar 

  73. Coyle EF. Physiological determinants of endurance exercise performance. J Sci Med Sport 1999; 2 (3): 181–189

    Article  PubMed  CAS  Google Scholar 

  74. O’Toole ML, Douglas PS, Hiller WD. Lactate, oxygen uptake, and cycling performance in triathletes. Int J Sports Med 1989; 10 (6): 413–418

    Article  PubMed  Google Scholar 

  75. Laslett L, Eisenbud E, Lind R. Evidence of myocardial injury during prolonged strenuous exercise. Am J Cardiol 1996; 78 (4): 488–490

    Article  PubMed  CAS  Google Scholar 

  76. Douglas PS, O’Toole ML, Hiller WD, et al. Cardiac fatigue after prolonged exercise. Circulation 1987; 76 (6): 1206–1213

    Article  PubMed  CAS  Google Scholar 

  77. Rif ai N, Douglas PS, O’Toole M, et al. Cardiac troponin T and I, echocardiographic [correction of electrocardiographic] wall motion analyses, and ejection fractions in athletes participating in the Hawaii Ironman Triathlon. Am J Cardiol 1999; 83 (7): 1085–1089

    Article  Google Scholar 

  78. La Gerche A, Boyle A, Wilson AM, et al. No evidence of sustained myocardial injury following an Ironman distance triathlon. Int J Sports Med 2004; 25 (1): 45–49

    Article  Google Scholar 

  79. Douglas PS, O’Toole ML, Hiller WD, et al. Electrocardiographic diagnosis of exercise-induced left ventricular hypertrophy. Am Heart J 1988; 116 (3): 784–790

    Article  PubMed  CAS  Google Scholar 

  80. Douglas PS. Cardiac considerations in the triathlete. Med Sci Sports Exerc 1989; 21 (5 Suppl.): S214–S218

    PubMed  CAS  Google Scholar 

  81. Neumayr G, Gaenzer H, Pfister R, et al. Plasma levels of cardiac troponin I after prolonged strenuous endurance exercise. Am J Cardiol 2001; 87 (3): 369–371, A10

    Article  PubMed  CAS  Google Scholar 

  82. Starnes JW, Bowles DK. Role of exercise in the cause and prevention of cardiac dysfunction. Exerc Sport Sci Rev 1995; 23: 349–373

    Article  PubMed  CAS  Google Scholar 

  83. Corretti MC, Koretsune Y, Kusuoka H, et al. Glycolytic inhibition and calcium overload as consequences of exogenously generated free radicals in rabbit hearts. J Clin Invest 1991; 88 (3): 1014–1025

    Article  PubMed  CAS  Google Scholar 

  84. Radak Z, Taylor AW, Ohno H, et al. Adaptation to exercise-induced oxidative stress: from muscle to brain. Exerc Immunol Rev 2001; 7: 90–107

    PubMed  CAS  Google Scholar 

  85. Banerjee AK, Mandal A, Chanda D, et al. Oxidant, antioxidant and physical exercise. Mol Cell Biochem 2003; 253 (1–2): 307–312

    Article  PubMed  CAS  Google Scholar 

  86. Urso ML, Clarkson PM. Oxidative stress, exercise, and antioxidant supplementation. Toxicology 2003; 189 (1–2): 41–54

    Article  PubMed  CAS  Google Scholar 

  87. Kanter MM, Lesmes GR, Kaminsky LA, et al. Serum creatine kinase and lactate dehydrogenase changes following an eighty kilometer race. Relationship to lipid peroxidation. Eur J Appl Physiol Occup Physiol 1988; 57 (1): 60–63

    Article  PubMed  CAS  Google Scholar 

  88. Margaritis I, Tessier F, Richard MJ, et al. No evidence of oxidative stress after a triathlon race in highly trained competitors. Int J Sports Med 1997; 18 (3): 186–190

    Article  PubMed  CAS  Google Scholar 

  89. Ginsburg GS, Agil A, O’Toole M, et al. Effects of a single bout of ultraendurance exercise on lipid levels and susceptibility of lipids to peroxidation in triathletes. JAMA 1996; 276 (3): 221–225

    Article  PubMed  CAS  Google Scholar 

  90. Sastre J, Asensi M, Gasco E, et al. Exhaustive physical exercise causes oxidation of glutathione status in blood: prevention by antioxidant administration. Am J Physiol 1992; 263 (5 Pt 2): R992–R995

    PubMed  CAS  Google Scholar 

  91. Stocker R, Keaney Jr JF. Role of oxidative modifications in atherosclerosis. Physiol Rev 2004; 84 (4): 1381–1478

    Article  PubMed  CAS  Google Scholar 

  92. Alessio HM, Goldfarb AH. Lipid peroxidation and scavenger enzymes during exercise: adaptive response to training. J Appl Physiol 1988; 64 (4): 1333–1336

    PubMed  CAS  Google Scholar 

  93. Holloszy JO, Booth FW. Biochemical adaptations to endurance exercise in muscle. Annu Rev Physiol 1976; 38: 273–291

    Article  PubMed  CAS  Google Scholar 

  94. Tiidus PM, Houston ME. Antioxidant and oxidative enzyme adaptations to vitamin E deprivation and training. Med Sci Sports Exerc 1994: 26 (3): 354–359

    PubMed  CAS  Google Scholar 

  95. Moller P, Wallin H, Knudsen LE. Oxidative stress associated with exercise, psychological stress and life-style factors. Chem Biol Interact 1996; 102 (1): 17–36

    Article  PubMed  CAS  Google Scholar 

  96. Jenkins RR, Krause K, Schofield LS. Influence of exercise on clearance of oxidant stress products and loosely bound iron. Med Sci Sports Exerc 1993; 25 (2): 213–217

    PubMed  CAS  Google Scholar 

  97. Ebbeling CB, Clarkson PM. Exercise-induced muscle damage and adaptation. Sports Med 1989; 7 (4): 207–234

    Article  PubMed  CAS  Google Scholar 

  98. Smith JA, Telford RD, Mason IB, et al. Exercise, training and neutrophil microbicidal activity. Int J Sports Med 1990; 11 (3): 179–187

    Article  PubMed  CAS  Google Scholar 

  99. Kanter MM, Nolte LA, Holloszy JO. Effects of an antioxidant vitamin mixture on lipid peroxidation at rest and postexercise. J Appl Physiol 1993; 74 (2): 965–969

    PubMed  CAS  Google Scholar 

  100. Goldfarb AH, Sen CK. Antioxidant supplementation and the control of oxygen toxicity during exercise. In: Sen CK, Packer L, Hanninen O, editors. Exercise and oxygen toxicity. Amsterdam: Elsevier Science, 1994: 163–189

    Google Scholar 

  101. Mastaloudis A, Morrow JD, Hopkins DW, et al. Antioxidant supplementation prevents exercise-induced lipid peroxidation, but not inflammation, in ultramarathon runners. Free Radic Biol Med 2004; 36 (10): 1329–1341

    Article  PubMed  CAS  Google Scholar 

  102. Nieman DC, Henson DA, McAnulty SR, et al. Influence of vitamin C supplementation on oxidative and immune changes after an ultramarathon. J Appl Physiol 2002; 92 (5): 1970–1977

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. School of Human Movement Studies, The University of Queensland, St Lucia, Brisbane, Queensland, Australia

    Wade L. Knez, Jeff S. Coombes & David G. Jenkins

Authors
  1. Wade L. Knez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeff S. Coombes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David G. Jenkins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wade L. Knez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Knez, W.L., Coombes, J.S. & Jenkins, D.G. Ultra-Endurance Exercise and Oxidative Damage. Sports Med 36, 429–441 (2006). https://doi.org/10.2165/00007256-200636050-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-200636050-00005

Keywords

Search

Navigation