Physiology and Pathophysiology of Marathon Running: A narrative Review.
Level 5 - mechanism / opinion, no new human data
Narrative review without systematic quantitative synthesis
PubMed 39871014 · doi:10.1186/s40798-025-00810-3
What was done
Authors conducted a narrative review of literature from PubMed, Scopus, and Google Scholar examining the physiological benefits and risks of marathon training and racing across multiple organ systems. Studies covering running across sexes, ages, performance levels, and race types were considered, while studies restricted to other sports were excluded. Out of 1,021 identified articles, 329 studies were included.
What was found
The abstract reports no quantitative effect sizes or risk ratios. Narratively, chronic marathon training was reported to lower all-cause mortality, improve cardiovascular risk factors, cardiac adaptations, lung function, bone health, skeletal muscle metabolism, hematopoiesis, natural killer cell cytotoxicity, gastrointestinal motility, and quality of life in chronic kidney disease, while reducing colorectal and hepatocellular cancer risk. Acutely, marathon racing induces transient biomarker shifts and functional impairments across cardiovascular, renal, hepatic, gastrointestinal, endocrine, immune, and musculoskeletal systems—including acute kidney injury, electrolyte disturbances, reduced lung function, elevated cortisol, lowered testosterone, and inflammation with temporary immunosuppression. These acute perturbations typically peak within 1 to 3 days post-race and normalize within one week, though rare severe events (sudden cardiac death, acute liver failure) occur.
Why it matters
This review provides a comprehensive multi-organ reference consolidating the chronic adaptations of endurance training alongside the acute, transient pathophysiology induced by marathon racing.
Limits
As a narrative review, it lacks formal systematic review methodology, meta-analytic pooling, and standardized quality or risk of bias assessments. The abstract does not provide numerical effect estimates or incidence rates, and findings rely largely on observational studies and short-term surrogate biomarker endpoints rather than long-term clinical trial outcomes.
Cited by
- supports Very high levels of exercise, such as marathon running or triathlon training, can cause immunosuppression.