It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.

众所周知，体育锻炼可以降低全因死亡率并延长寿命。超耐力跑 (UER) 是一项越来越受欢迎的极限运动，包括超过马拉松距离、超过 6 小时的跑步比赛和/或多日固定距离的跑步比赛。严重的急性不良事件很少见，但越来越多的证据表明 UER 可能导致长期的健康问题。本综述的目的是介绍有关 UER 引起的潜在长期健康问题的当前知识状态，特别是关键器官系统的潜在适应不良，包括心血管、呼吸、肌肉骨骼、肾脏、免疫、胃肠道、神经和皮肤系统。特别考虑到青年、大师和女运动员，他们所有人都可能更容易受到某些长期健康问题的影响。我们提出了未来研究支持运动员对长期问题易感性的病理生理机制的方向。虽然所有身体系统都可能受到 UER 的影响，但耐力运动最明显的影响之一是对心血管系统的影响，包括右心室功能障碍和潜在的心律失常和高血压风险增加。还有证据表明，罕见的 UER 急性肾损伤病例可能导致进行性肾瘢痕形成和慢性肾病。特定于女性运动员的数据有限，由于能量可用性和性激素浓度之间的相互作用，她们可能面临某些与 UER 相关的健康问题的更大风险。的确，在针对女性的 UER 训练计划的设计中不考虑性别差异可能会对运动员的寿命产生负面影响。希望本次审查将为风险分层提供信息，并促进有关 UER 及其对长期健康影响的进一步研究。