The mean fluid intake in these Ironman triathletes was 0.79 ± 0.43 L/h.

In a recent study on 100-km ultra-marathoners showing an association APO866 between fluid intake and limb swelling, the athletes consumed 0.63 ± 0.20 L/h [60]. Obviously, the 100-km ultra-marathoners consumed less fluid and developed an association between fluid intake and limb swelling in contrast to the present Ironman triathletes drinking more fluids without a relationship between fluid consumption and lower leg swelling. The pathogenesis of lower limb swelling in ultra-endurance athletes may involve the nature of exercise debris, the increased permeability of the capillaries allowing leakage of osmotic material, the ingestion of water to restore/maintain osmotic equilibrium, and the role of lymphatic circulation in clearing the oedemata. We assume that we cannot reduce the swelling in lower DAPT purchase legs in ultra-endurance athletes due to excessive fluid intake. Strengths and limitations of the present study and implications for future research A strength of this study was that anthropometric measurements were performed immediately upon arrival at the finish line. A limitation of the present study was that by measuring the entire lower

leg volume, or arm volume, we could not precisely quantify nor locate specifically where the changes in volume occurred. An implication for future research would therefore be to measure the volume of hands and feet separately from the arms and the legs using plethysmography. It would as well be useful to have a measurement method that allows us to differentiate the volume changes occurring in a body part into the different body compositions. Bioelectrical impedance analysis [61] for example is a commonly used method for estimating body compositions, although it measures the composition

of the whole body and not just of one body part [62]. However, this methodology may not provide valid estimates of total body water when hydration status is altered [63] since plasma osmolality and sodium concentration should be unchanged [64, 65]. Regarding the studies from Knechtle et al.[9], Milledge BCKDHA et al.[2] and Williams et al.[1] describing an increase in the mean leg volume not immediately after the endurance performance but shortly afterwards, it would also be appropriate to take another measurement later on after the race. Concluding that race time in these Ironman triathletes was relatively short to disturb the body fluid homeostasis [1, 2, 6, 66] it would EX 527 cell line furthermore be reasonable for future studies to perform these measurements during a longer race such as a Triple Iron ultra-triathlon [7]. Furthermore, we were not able to determine the effect that non-steroidal anti-inflammatory drugs (NSAIDs) had on the decrease of the renal function because we did not trace the consumption of NSAIDs.