Beat Knechtle, Pantelis T Nikolaidis

It is well known that elderly people up to 90 years of age are able to finish a marathon. We have no knowledge, however, how runners at the age of 90 years or older pace during a long run. In this case report, we describe the pacing of a 94-year-old man competing in a 6-hour run in order to prepare for a marathon at the age of 95 years in category M95. In the "6-Stunden-Lauf " held in Brugg, Switzerland, participants have to run as many laps of 0.934 km as possible on a completely flat circuit within 6 hours to achieve as many kilometers as possible. Before and after the competition we measured body weight, percentage of body fat, fat-free mass and percentage of body water using a bioelectrical impedance scale. On the day before the start, 24 hours after the finish and then every 24 hours for the following 4 days, capillary blood samples at a fingertip were drawn to determine hemoglobin, hematocrit, leukocytes, platelets, C-reactive protein, creatine kinase, creatinine and potassium and sodium. The runner achieved 26 laps during the 6 hours, equal to 24.304 km. Lap times increased continuously and running speed decreased nearly linearly. A large main effect of time point (hours) of the race on running speed was observed (p=0.015,η2=0.48) with running speed being slower in the last hour than that in the first hour (3.5±1.4 km/h versus 5.3±0.4 km/h). Body mass decreased by 0.6%, percent body fat by 1.4% and fat-free mass by 0.7%. During recovery, hemoglobin, hematocrit and the number of thrombocytes increased, whereas the number of leukocytes remained unchanged. C-reactive protein was highest on day 1 after the race and decreased by day 4 nearly to zero. Creatine kinase was slightly elevated pre-race, highest the day after the race and remained slightly elevated until day 4. Creatinine and potassium were increased pre-race but returned to normal values during recovery. Sodium remained within normal values on all days. Based on the linear decrease in running speed, we extrapolated for the marathon distance to run a marathon in age group M95 (i.e., male marathoners aged 95-99 years). In the worst-case scenario (i.e., the athlete develops maximal fatigue), he would stop the race before 40 km, in the best scenario (i.e., the athlete develops minimal fatigue), he would achieve an overall race time of ~8.3 hours and in the most probable scenario (i.e., the athlete can continue in the same manner), the final race time will be longer than 11 hours.