Muscle Damage and Its Relationship with Muscle Fatigue

During a Half-Iron Triathlon

Juan Del Coso*, Cristina González-Millán, Juan José Salinero, Javier Abián-Vicén, Lidón Soriano,
Sergio Garde, Benito Pérez-González
Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain

Abstract
Background: To investigate the cause/s of muscle fatigue experienced during a half-iron distance triathlon.

Methodology/Principal Findings: We recruited 25 trained triathletes (3667 yr; 75.169.8 kg) for the study. Before and just
after the race, jump height and leg muscle power output were measured during a countermovement jump on a force
platform to determine leg muscle fatigue. Body weight, handgrip maximal force and blood and urine samples were also
obtained before and after the race. Blood myoglobin and creatine kinase concentrations were determined as markers of
muscle damage.

Results: Jump height (from 30.365.0 to 23.466.4 cm; P,0.05) and leg power output (from 25.662.9 to 20.764.6 W ? kg21;
P,0.05) were significantly reduced after the race. However, handgrip maximal force was unaffected by the race (430659 to
430662 N). Mean dehydration after the race was 2.361.2% with high inter-individual variability in the responses. Blood
myoglobin and creatine kinase concentration increased to 5166248 mg ? L21 and 4426204 U ? L21, respectively (P,0.05)
after the race. Pre- to post-race jump change did not correlate with dehydration (r = 0.16; P.0.05) but significantly
correlated with myoglobin concentration (r = 0.65; P,0.001) and creatine kinase concentration (r = 0.54; P,0.001).

Conclusions/significance: During a half-iron distance triathlon, the capacity of leg muscles to produce force was notably
diminished while arm muscle force output remained unaffected. Leg muscle fatigue was correlated with blood markers of
muscle damage suggesting that muscle breakdown is one of the most relevant sources of muscle fatigue during a triathlon.

Citation: Coso JD, González-Millán C, Salinero JJ, Abián-Vicén J, Soriano L, et al. (2012) Muscle Damage and Its Relationship with Muscle Fatigue During a Half-
Iron Triathlon. PLoS ONE 7(8): e43280. doi:10.1371/journal.pone.0043280
Editor: David F. Wieczorek, University of Cincinnati College of Medicine, United States of America
Received May 23, 2012; Accepted July 18, 2012; Published August 10, 2012
Copyright: ß 2012 Coso et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors have no support or funding to report.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: [email protected]

Introduction According to Jeukendrup [1], dehydration and carbohydrate

depletion are the most likely causes of fatigue during a triathlon
The triathlon is an endurance sport activity that combines race. Dehydration alone [4] or in combination with hyperthermia
phases of swimming, cycling and running. Although the most [5,6] may lessen maximal isometric strength production. Thus,
renowned distance for a triathlon race is the full distance (also drinking during exercise to avoid dehydration and hyperthermia
known as Iron distance), shorter triathlon races (e.g. Olympic or should be a primary goal for triathletes, especially to avoid a body
half-iron distances) have become popular since they are more mass loss superior to 2% [7]. However, it has been found that
accessible to amateur and recreational athletes. Independent of the triathletes do not dehydrate excessively and that the body mass loss
distance, the triathlon is one of the most fatiguing exercise experienced during the triathlon is mostly due to reduced fat and
activities since it combines long duration (from 1 h 50 min in the skeletal muscle mass [8,9]. In addition, it has been found that the
Olympic distance to more than 14 hours in the Ironman distance) dehydration level does not correlate with total race time in a triple
with high exercise intensity [1]. However, only a small number of iron triathlon [10]. According to these studies, triathletes seem well
studies have been geared to determine the muscle fatigue informed about the necessity of rehydrating during exercise,
experienced by triathletes. Margaritis et al. [2] found a decreased diminishing the deleterious effects of dehydration during a
capacity to generate force in the knee extensor and flexor muscles triathlon.
after a half-iron triathlon. Similarly, Suzuky et al. [3] found that During exercise, an insufficient supply of glucose may result in
jump height during squat and countermovement jumps (CMJ) hypoglycemia and consequently muscle fatigue. For this reason,
significantly decreased after an Iron triathlon along with a several investigations have established that the ingestion of
reduction in the maximal isometric strength of the knee extensors. carbohydrates improves endurance capacity by maintaining blood
Thus, it seems apparent that muscle performance is diminished glucose content [11,12]. Carbohydrate ingestion also helps to
after a triathlon race, but its origin remains elusive. maintain muscle force production and central nervous system
(CNS) activation during prolonged exercise [13]. In triathlon male

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 Muscle Damage in Triathlon

athletes, it has been found that race finishing time was inversely Table 1. Morphological characteristics of the participants and
related to carbohydrate intake during the race, although this their performance in the Half-Ironman triathlon race. Data are
relation was not found in females [14]. Since the rate of exogenous mean6SD and ranges for 25 healthy triathletes.
carbohydrate oxidation is close to1 g/min, a carbohydrate intake
of ,60 g/hour has been suggested [15]. Therefore, the intake of
carbohydrates during a triathlon to preserve the homeostasis of Mean ± SD Range
blood glucose is a crucial factor for avoiding muscle fatigue.
Age (yr) 35.766.5 25254
A reduction in plasma sodium concentration below 135 mmol ?
L21, mainly as a result of excessive fluid consumption, has been Height (cm) 17867 1602191
previously reported in triathletes [9,16]. This electrolyte imbalance Weight (kg) 75.169.8 58.4292.5
is considered as a serious medical problem during ultra-distance Body fat (%) 8.663.9 3.4216.0
events [1] since it is associated with weakness and mental Half-iron triathlons completed 17622 1297
confusion. Even coma and death may occur with sodium
Total race time 5:12:20600:34:59 04:05:55206:08:06
concentrations below 126 mmol ? L-1. However, the association
between the decrease in plasma sodium content and muscle fatigue 2.0 km swim time 00:33:52200:04:11 00:27:13200:42:33
has not been previously established in triathletes. During 90 km cycle time 02:44:53200:18:37 02:11:16203:17:07
prolonged cycling in the heat, Coso et al. [5] found that the Half-marathon time 01:49:01200:27:23 01:26:43–02:19:53
ingestion of rehydrating drinks with low sodium content reduced
plasma sodium concentration and worsened the maintenance of doi:10.1371/journal.pone.0043280.t001
isometric muscle strength. This negative effect on muscle strength
was present even when plasma sodium was not lower than Experimental Protocol
137 mmol ? L-1, so the reduction in sodium concentration may One to three days before the race, participants underwent a
affect muscle performance with values higher than those typically physical examination to ensure that they were in good health.
related with hyponatremia. Ninety-to-sixty minutes before the race, participants arrived at a
Another factor that could affect muscle fatigue in the triathlon is zone close to the start line to assess pre-exercise variables.
myofibril damage, mainly produced during the running leg. Participants voided and a urine sample was obtained to determine
Swimming and cycling are activities that produce minor muscle urine specific gravity (Usg) and other urinary variables. Partici-
damage in the involved muscles. However, running is a weight- pants’ body fat composition and pre-race body water content were
bearing activity that includes concentric and eccentric actions in then calculated using bioimpedance (BC-418, Tanita, Japan).
the leg muscles. In a recent study, it has been found that urinary After that, a 22-G catheter was inserted into an antecubital vein
myoglobin concentration (a marker of muscle breakdown) and a 7 mL blood sample was drawn. Next, participants
correlates with leg muscle power reduction after a marathon completed a 10 min warm-up consisting of dynamic exercises
[17], although other blood markers of muscle damage do not and practice jumps. After that, participants performed two
correlate with muscle fatigue after a triathlon [2]. The purpose of countermovement vertical jumps for maximal height on a force
this study was to investigate the cause/s of muscle fatigue which platform (Quattrojump, Kistler, Switzerland). Handgrip maximal
ensues during a half-iron distance triathlon. We hypothesized that force production in both hands was measured by using a handgrip
the source of muscle fatigue will be multifactorial, with dehydra- dynamometer (Grip-D, Takei, Japan). Finally, participants were
tion, hypoglycemia, electrolyte imbalance and muscle damage as weighed in their competition clothes (650 g scale; Radwag,
the main factors responsible for muscle force loss during a half-iron Poland) and headed to the start line to participate in a half-iron
triathlon. distance triathlon.
The race consisted of 1.9 km of swimming, 75 km of cycling
Methods (1100 m of net increase in altitude) and 21.1 km of running. The
triathlon was held in June 2011 in the surrounding area of a city
Subjects located at 975 m altitude. Mean6SD (range) dry temperature
Thirty one triathletes volunteered to participate in this during the event was 22.366.9uC (13230uC) with a relative
investigation. However, six of these participants failed to complete humidity of 72.868.0% (65285%). Water temperature during the
the triathlon race and their records were excluded from the study. swim section was 1961uC. No instructions about pace, drinking or
Thus, this investigation includes data from 25 healthy and well- feeding during the race were given to the participants to avoid any
trained triathletes. All the participants had previous experience of influence of this investigation on their habitual routines during the
at least 3 yrs and had trained for ,2 h ? day21, 4–5 days ? week-1 race. So, participants drank and consumed food ad libitum and
during the previous year. In addition, the participants had swam, cycled and ran at their own pace. Performance times for the
completed at least one prior triathlon in the half-iron distance. swimming, cycling and running phases and the total time are
The characteristics of the participants are summarized in Table 1. shown in Table 1.
Participants completed a short questionnaire on training status Within 3 min of the end of the race, participants went to a finish
and medical history. Potential participants with a history of muscle area and performed two countermovement vertical jumps (see
disorder, cardiac or kidney disease or those taking medications below). Post-race body weight and body water content were then
were excluded. recorded with the same devices and clothes used for the pre-race
measurement. Participants were instructed to avoid drinking from
Ethics Statement the finish line till the post-race weighing and an experimenter
Participants were fully informed of any risks and discomforts assured compliance. Then, participants rested for five minutes and
associated with the experiments before giving their informed a venous blood sample was obtained using the procedures
written consent to participate. The study was approved by the described previously. After that, subjects were provided with fluid
Camilo Jose Cela Ethics Committee in accordance with the latest (water and sports drinks) to promote urine production. Thirty to
version of the Declaration of Helsinki. 60 minutes after the race, a representative sample of the first post-

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 Muscle Damage in Triathlon

race void was collected in a sterile container. After that,

participants finished their participation in the study. The
dehydration level attained during the race was calculated as
percent reduction in body weight (pre-to post-race), assuming that
body mass changes was produced by a reduction in participants’
water content. Similarly, we calculated the reduction in body
water content using pre and post-race body water measurements
by bioimpedance.

Maximal countermovement jump

Before and just after the race, participants performed two
maximal countermovement jumps on a force platform (Quattro-
jump, Kistler, Switzerland) to assess changes in jump height and
leg power production. For this measurement, participants began
stationary in an upright position with their weight evenly
distributed over both feet. Each participant placed their hands
on their waist in order to remove the influence of the arms on the
jump. On command, the participant flexed their knees and Figure 2. Associations among jump height loss and blood
markers of muscle damage. Relationship between the changes in
jumped as high as possible while maintaining the hands on the jump height (x-axis) and serum myoglobin concentration (y-axis 1) and
waist and landed with both feet. After 1 min rest, the counter- serum creatine kinase concentration (y-axis 2) after a half-iron distance
movement jump was repeated. Leg muscle power output during triathlon. Data mean 6 SD for 25 experienced triathletes grouped by
the impulse phase (concentric part of the jump) and jump height their jump height loss after race.
were determined as previously described [17]. doi:10.1371/journal.pone.0043280.g002

Blood samples Spain), hemoglobin concentration and hematocrit were deter-

A portion of each blood sample (2 mL) was introduced into a mined within the same day. Changes in blood volume and plasma
tube with EDTA and blood glucose concentration (Accu-chek, volume from rest were calculated with the equations outlined by
Dill and Costill [18]. Red blood cell, white blood cell and platelet
counts were determined by using an automated blood counter.
The remaining blood (5 mL) was allowed to clot and serum was
separated by centrifugation (10 min at 5000 g) and frozen at
280uC until the day of analysis. On a later day, the serum portion
was analyzed for sodium, potassium and chloride concentrations
(Nova 16, NovaBiomedical, Spain). In addition, myoglobin,
creatine kinase (CK) and lactate dehydrogenase (LDH) concen-
trations were measured as blood markers of muscle damage.

Urine samples
Pre and post-race urine samples were immediately analyzed
(within 2 hours) for specific gravity (Usg), pH, protein, glucose,
ketones and bilirubin concentrations. We also determined the
presence of leukocytes and erythrocytes in the urine using reactive
strips (Combur Test, Roche, Switzerland). For these measure-
ments, the strip was dipped in the urine sample and the excess was
wiped off with a clean absorbent paper. Then, the test strip was
placed on the tray of a photometer (Urisys 1100, Roche
Switzerland) and the aforementioned variables were measured
after 1 min of incubation. After each ten sample batch, the
photometer was calibrated with control strips provided by the
manufacturer.

Statistical Analysis
Data are presented as mean 6 SD. Initially, we tested the
normality of each variable with the Shapiro-Wilk test. Changes in
the variables from pre to post-race were analyzed with Student’s t
test for paired samples. To simplify the presentation of data,
participants were grouped by their change in jump height using
10% intervals. Urine variables were presented by the frequency of
subjects that presented a determined value. We used Pearson’s
correlation to assess the association between two variables. The
Figure 1. Body mass and jump height changes after a half-iron
distance triathlon. Data are frequencies for 25 experienced significance level was set at P,0.05. We also performed a multiple
triathletes. regression analysis in a stepwise interactive mode, based on
doi:10.1371/journal.pone.0043280.g001 previous investigations [19] aiming to assess the influence of the

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 Muscle Damage in Triathlon

measured variables on the muscle fatigue experienced during a (P,0.05), leukocyte count by 20069% (P,0.05) while erythro-
half-iron triathlon (i.e., CMJ height loss). cytes remained unchanged. Post-race blood glucose concentration
For this calculation, the measured variables in the study were increased by 1565 mg ? dL21 in comparison to pre-race values
included based on their correlation with the residual (P,0.1) and (P,0.05). While sodium and chloride concentrations were
their intercorrelation with variables already in the equation. The significantly reduced after the race (P,0.05), and potassium
regression equation produced was accepted at a significance level concentration slightly increased (P,0.05). Finally, the concentra-
of P,0.01. The degree of variance on CMJ height loss explained tions of all the blood markers of muscle damage showed varying
by means of each parameter was calculated using regression increases, from pre to post race (P,0.05). There was a negative
coefficients. Using the standardized regression coefficients, the correlation between the CMJ jump height change and post-race
relative contribution of the different variables to the variance myoglobin concentration (r = 20.65; P,0.001) and post-race
explained was calculated as follows: creatine kinase concentration (r = 20.54; P,0.001; Figure 2),
but this correlation was not significant with the LDH concentra-
!
½standardized regression coefficient for parameter= tion (r = 0.01; P = 0.96).
Parnal contribution r2 ~
S½of all standardized regression coefficients inequation
Urinary responses
|r2 :
Before the race, all the twenty five triathletes had Usg below
1.020. Although Usg values significantly increased from pre-to
Finally, the r2values were adjusted for the number of cases and post-race (Table 3; P,0.05), only 2 participants (8% of the sample)
the number of parameters in the analysis. This statistical analysis exceeded 1.020 after the race. The half-iron triathlon increased
was performed using the SPSS v.18 software package (SPSS Inc., the urinary concentration of erythrocytes, leukocytes, proteins and
USA). ketones by varying amounts (P,0.05). On the contrary, urine pH
and bilirubin concentration remained unchanged after the race.
Results
Discussion
Dehydration and body water change
After the race, most participants had reduced their pre-exercise The aim of this investigation was to determine the sources of
body mass (from 75.269.6 to 73.369.5 kg; P,0.05) with a mean muscle fatigue experienced by triathletes during a half-iron
dehydration of 2.361.2%. However, the dehydration attained distance race. According to previous investigations, dehydration,
after the race was diverse among individuals (Figure 1A). Most hypoglycemia, electrolyte imbalance and muscle damage are
participants (44% of the total) reduced their body mass between 2 probable factors affecting muscle force output in the triathlon. In
and 3% while only 12% of participants dehydrated more than 4% the present investigation, we measured all these variables before
(peak dehydration was 4.3%). On the contrary, 8% of the and after a half-iron race and performed a multiple regression
triathletes slightly increased their body weight with a maximal gain analysis to determine the influence of each variable on the pre-post
of 0.3%. Body water followed a similar pattern (from 48.865.4 kg race change in CMJ height. The main outcomes were: (a) body
before the race to 46.565.5 kg after the race; P,0.05) with a mass loss (Figure 1A) and body water deficit after the race were
mean body water deficit of 4.262.1%. The dehydration level moderate and these variables were modestly correlated with jump
attained during the race and the body water deficit were height loss; (b) blood glucose content increased while serum
significantly correlated (r = 0.71; P,0.05). However, there was sodium and chloride concentrations decreased after the race
no significant correlation between dehydration and CMJ height (Table 2), although their values were far from constituting a serious
change (r = 20.16; P = 0.44) or body water loss and CMJ height electrolyte imbalance; (c) blood markers of muscle damage
change (r = 20.01; P = 0.96). strongly correlated with jump height loss (Figure 2), suggesting

Countermovement jump height and handgrip force Table 2. Blood responses before (Pre) and after (Post) a half-
Before the race, mean CMJ jump height was 30.365.0 cm and iron triathlon race. Data are mean 6 SD for 25 triathletes.
mean power output during the concentric phase of the jump was
25.662.9 W kg21. After the race, CMJ jump height
(23.466.4 cm; P,0.05) and jump power output (20.764.6 W/ Variable (units) Pre Post P value
kg; P,0.05) were significantly reduced by 23616% and 19615%, 21
Hemoglobin (g ? dL ) 14.760.8 15.260.9 ,0.05
respectively. Although all participants reduced their CMJ jump
from pre-exercise values, there was an elevated inter-individual Hematocrit (%) 45.462.4 46.362.4 ,0.05
variability in the responses (Figure 1B). On the contrary, handgrip Erythrocytes (109 ? L21) 49266310 48986351 NS
maximal force production in the dominant (from 438657 N pre- Leukocytes (109 ? L21) 5.561.0 16.162.5 ,0.05
exercise to 436665 N after the race; P = 0.85) and non-dominant Platelets (109 ? L21) 249636 286646 ,60.05
hand (from 422 N663 pre-exercise to 423659 N after the race; Glucose (mmol ? L21) 5.160.7 6.361.6 ,0.05
P = 0.77) was unaffected after the triathlon race.
Sodium (mmol ? L21) 141.461.6 140.461.9 ,0.05
Potassium (mmol ? L21) 4.560.2 4.760.7 ,0.05
Blood responses
From pre-race values, blood volume and plasma volume were Chloride (mmol ? L21) 101.262.0 98.362.4 ,0.05
significantly reduced by 2.963.0% and 4.363.0%, respectively Myoglobin (mg ? L21) 14617 5166248 ,0.05
(P,0.05). The changes in the remaining blood variables are shown Creatine kinase (U ? L21) 145672 4426204 ,0.05
in Table 2. As a consequence of plasma volume reduction, LDH (U ? L-1) 298666 5986252 ,0.05
hemoglobin and hematocrit concentration increased after the race
(P,0.05). Post-exercise platelet count increased by 1569% doi:10.1371/journal.pone.0043280.t002

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 Muscle Damage in Triathlon

samples was from skeletal muscle. As presented in Figure 2, those

triathletes with a higher reduction in jump height were the ones
with a higher concentration of myoglobin and CK after the race.
These data suggest that muscle breakdown produced in the
triathlon is one of the primary factors for muscle fatigue in
triathletes. While there is no study that has reported moderate-to-
severe muscle damage after swimming or cycling, the references to
muscle damage after endurance running are abundant [20,21,22].
The continuous foot strikes during the running leg demand
concentric and eccentric actions of the leg muscles and can
damage muscle fibers [23].
During an iron triathlon, Margaritis et al. [2] did not find an
association between blood CK concentration and the reduction in
knee extensor and flexor muscle force production during several
days after the race. These authors concluded that blood markers of
muscle damage cannot be used to predict the magnitude of the
Figure 3. Amount of variance explained (adjusted r2) for CMJ muscle function impairment during the triathlon. In contrast,
height loss after the half-iron triathlon. The best regression Coso et al. [17] found a relationship between the myoglobin
equation includes blood variables (post-exercise myoglobin, creatine concentration in the first urine after a marathon race and leg
kinase and chloride concentrations) and the dehydration attained after muscle power reduction, concluding that muscle damage is a good
the race. The remaining portion represents the unexplained variance. predictor of leg muscle fatigue after running. The present
doi:10.1371/journal.pone.0043280.g003
investigation also indicates that muscle damage, estimated by
blood myoglobin and CK concentrations, is the main factor
that muscle breakdown is one of the primary causes of muscle affecting muscle fatigue in triathletes. Thus, the strategies to
fatigue during a triathlon. With all these data, we have explained diminish the extent of muscle fatigue in triathletes should include
56% of the variance in muscle fatigue which ensued during a half- the avoidance of muscle damage.
iron triathlon (Figure 3). A dehydration level above 2% has been repeatedly related to
All the triathletes that participated in this study experienced a muscle force loss during endurance exercise events [7] and it has
reduction in jump height and leg power production after the race, been proposed as one of the main factors responsible for fatigue
a clear sign of muscle fatigue as found previously [3]. However, the during triathlon events [1]. In the present study, however, the
individual responses for jump height change were diverse variance in CMJ height loss explained by means of dehydration
(Figure 1B). The explanation for the variance in muscle fatigue was only 5% (Figure 3) which suggests that the influence of
responses after the triathlon race is presented in Figure 3. Pre-to- dehydration on muscle fatigue during the triathlon was minor.
post race change in jump height depended on the post-exercise Although dehydration was present in most triathletes, the levels
blood myoglobin concentration (23%), the post-exercise blood attained by the majority of triathletes were moderate (mean
chloride concentration (15%), the post-exercise blood CK 2.361.2%). Thirty two percent of the sample dehydrated less than
concentration (12%) and dehydration (5%). With this model we 2%, 52% of the participants dehydrated between 2 and 4% and
can determine which factors modulate muscle fatigue during a the remaining 12% dehydrated more than 4% (Figure 1A). The
triathlon race. Nonetheless, there is still a high proportion of poor association between dehydration and the loss of CMJ height
muscle fatigue variability that remains unexplained with our indicates that the triathletes with higher levels of dehydration did
experimental design, which warrants further investigation. not loss more jump height than the ones with better rehydration
According to the multifactorial analysis, 35% of jump height during the race. We assume that the proper drinking behavior
loss experienced by the triathletes is explained by means of blood showed by most triathletes in this study reduced the influence of
markers of muscle damage (i.e., myoglobin and CK). Although we dehydration on the muscle fatigue.
did not measure CK isoforms (e.g. MM, BB and MB) to The concurrence of sodium loss by sweating and the high intake
differentiate the origin of muscle breakdown, we assume that the of water or low-sodium drinks during long distance triathlon
largest part of the CK increase found in the post-race blood causes some triathletes to present hyponatremia (,135 mmol ?
L21; [9,16]). This electrolyte imbalance has been related to clinical
complications in exercise medicine, since its symptoms include
Table 3. Urinary responses before (Pre) and after (Post) a half- weakness, fainting or even death. However, blood sodium
iron triathlon race. Data are mean6SD for 25 triathletes. concentration may also play an important role in the preservation
of muscle function during exercise. Vrijens and Reher [24]
reported a relationship between decreased blood sodium concen-
Variable (units) Pre Post P value tration and time to fatigue during a prolonged cycling event.
Usg 1.01260.006 1.01860.006 ,0.05 Similarly, Coso et al. [5] found a relationship between sodium
pH 6.261.1 6.161.2 0.84
deficit and muscle fatigue during prolonged cycling even with a
mean sodium concentration above 137 mmol ? L21. In the present
Erythrocytes (U ? mL21) 1.460.3 18.3651.5 ,0.05
investigation, blood sodium concentration decreased from 141 to
21
Leukocytes (U ? mL ) 0.060.0 7.3611.6 ,0.05 140 mmol ? L21 but this variable was not correlated with CMJ
Proteins (mg ? dL21) 3.063.3 89.66134.9 ,0.05 height loss (r = 0.02; P = 0.92). In contrast, blood chloride content
Ketones (mg ? dL21) 0.261.0 24.4639.9 ,0.05 changed from 101 to 98 mmol ? L21 and post-exercise values
Bilirubin (mg ? dL21) 0.260.6 0.260.4 0.71
significantly correlated with CMJ height loss (r = 0.34; P,0.05). It
has been found that intramuscular sodium and chloride contents
doi:10.1371/journal.pone.0043280.t003 remain unchanged after prolonged exercise that produces profuse

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 Muscle Damage in Triathlon

sweating while the excitability of the muscle cell membrane is arm force while leg force was reduced disagrees with the existence
unaffected. Although lacking a clear explanation, maintaining of hyperthermia and its effects on CNS activation.
blood electrolyte concentration during exercise may help to Exercise, particularly high-intensity and endurance activities
preserve muscle function. produce several urinary abnormalities. Hematuria is one of the
During exercise of ,1 hour of duration, glucose supply for the most commonly found abnormalities after sports activity [31] and
skeletal muscle comes from glycogen stores in the muscle and liver. it is present with a higher frequency in weight-bearing exercise
If the exercise bout is of long duration (.1 hour), main glycogen activities (running vs cycling; [32]). Others studies have reported
stores deplete and blood borne glucose is also used as the energy that hematuria is present in 20-to-50% of marathon finishers
substrate, threatening blood glucose homeostasis [25]. It has been [33,34]. The present study found that erythrocyte concentration
found that hypoglycemia attenuates the activation of the CNS and increased from 1.460.3 to 18.3651.5 U ? mL-1 in the first urine
hence reduces the capacity to generate force in the active muscle after the triathlon. In addition, the prevalence of hematuria
[13]. For this reason, the reduction in blood glucose concentration increased from 0 to 36% after the race, with one participant above
has been proposed as a source of muscle fatigue during the 250 U ? mL21. Although there was no incidence of kidney
triathlon [1]. When blood glucose is maintained by ingesting complications after the race, these data suggest the necessity of
carbohydrates during exercise, muscle force and CNS activation obtaining an exercise history when urinary abnormalities are
are better preserved [13]. Interestingly, participants in this present in triathletes.
investigation increased by 0.860.5 mmol ? L21 the blood glucose In summary, during a half-iron triathlon in a temperate
concentration from pre-to-post exercise (Table 2), as has been environment, leg muscle function was significantly impaired while
previously found in other athletes participating in endurance muscle force in the upper extremities remained unchanged.
events [26]. Although we did not record carbohydrate ingestion Furthermore, the source of leg muscle fatigue experienced by
during the race, previous studies have found that triathletes have triathletes was diverse and depended on several factors. Post-
appropriate rates of carbohydrate intake, especially during the exercise myoglobin and creatine kinase concentrations correlated
cycling leg [14] According to our data, blood glucose concentra- with CMJ height loss after the race, indicating that muscle fiber
tion was well maintained in triathletes, reducing the influence of damage is one of the key factors for muscle fatigue in the triathlon.
hypoglycemia as a source of fatigue during a half-iron race. In contrast, dehydration and blood glucose concentration had a
Several studies have reported that muscle force production is minor role in muscle fatigue mainly due to appropriate
ameliorated in hyperthermic individuals with or without dehydra- rehydrating and feeding during the race. Strategies to lessen
tion [6,27,28]. During prolonged cycling in the heat that produced muscle fatigue during triathlon events should comprise a reduction
hyperthermia, Nybo and Nielsen [27] reported a reduction in both in muscle damage.
leg and arm force production, despite arm muscles not being
involved during the cycling activity. These authors suggested that
hyperthermia produces a central effect that affects muscle function
Acknowledgments
in both active and non active muscles, although different outcomes The authors wish to thank the subjects for their invaluable contribution to
have been found in another analogous study [29]. In the present the study. In addition, we are very grateful to the Organization of
investigation we did not assess body temperature, but during an Ecotrimad for their contribution to the study.
iron triathlon with an environmental temperature similar to the
present investigation (23.3 vs 22.3uC), mean core temperature in Author Contributions
triathletes was only 38.1uC [30]. In addition, while leg muscle Conceived and designed the experiments: JC CGM JJS JAV LS SG BPG.
power and jump height were reduced after the race, handgrip Performed the experiments: JC CGM JJS JAV LS SG BPG. Analyzed the
force remained unchanged from pre-to-post exercise, contrary to data: JC JJS JAV LS. Contributed reagents/materials/analysis tools: JC
the results reported by Nybo and Nielsen. The maintenance of CGM JJS JAV LS SG BPG. Wrote the paper: JC.

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