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The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon

Uwe HW Schütz12*, Arno Schmidt-Trucksäss3, Beat Knechtle4, Jürgen Machann5, Heike Wiedelbach1, Martin Ehrhardt1, Wolfgang Freund1, Stefan Gröninger6, Horst Brunner1, Ingo Schulze7, Hans-Jürgen Brambs1 and Christian Billich1

Author Affiliations

1 Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Germany

2 Outpatient Rehabilitation Centre at University Hospital of Ulm, Germany

3 Institute of Exercise and Health Sciences, Sports Medicine, University of Basel, Switzerland

4 Health Center St. Gallen and Department of General Practice, University Hospital of Zürich, Switzerland

5 Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Germany

6 Siemens Healthcare, Magnetic Resonance, Stuttgart, Germany

7 Main organizer and race director TransEurope FootRace 2009, Horb, Germany

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BMC Medicine 2012, 10:78  doi:10.1186/1741-7015-10-78

Published: 19 July 2012



The TransEurope FootRace 2009 (TEFR09) was one of the longest transcontinental ultramarathons with an extreme endurance physical load of running nearly 4,500 km in 64 days. The aim of this study was to assess the wide spectrum of adaptive responses in humans regarding the different tissues, organs and functional systems being exposed to such chronic physical endurance load with limited time for regeneration and resulting negative energy balance. A detailed description of the TEFR project and its implemented measuring methods in relation to the hypotheses are presented.


The most important research tool was a 1.5 Tesla magnetic resonance imaging (MRI) scanner mounted on a mobile unit following the ultra runners from stage to stage each day. Forty-four study volunteers (67% of the participants) were cluster randomized into two groups for MRI measurements (22 subjects each) according to the project protocol with its different research modules: musculoskeletal system, brain and pain perception, cardiovascular system, body composition, and oxidative stress and inflammation. Complementary to the diverse daily mobile MR-measurements on different topics (muscle and joint MRI, T2*-mapping of cartilage, MR-spectroscopy of muscles, functional MRI of the brain, cardiac and vascular cine MRI, whole body MRI) other methods were also used: ice-water pain test, psychometric questionnaires, bioelectrical impedance analysis (BIA), skinfold thickness and limb circumference measurements, daily urine samples, periodic blood samples and electrocardiograms (ECG).


Thirty volunteers (68%) reached the finish line at North Cape. The mean total race speed was 8.35 km/hour. Finishers invested 552 hours in total. The completion rate for planned MRI investigations was more than 95%: 741 MR-examinations with 2,637 MRI sequences (more than 200,000 picture data), 5,720 urine samples, 244 blood samples, 205 ECG, 1,018 BIA, 539 anthropological measurements and 150 psychological questionnaires.


This study demonstrates the feasibility of conducting a trial based centrally on mobile MR-measurements which were performed during ten weeks while crossing an entire continent. This article is the reference for contemporary result reports on the different scientific topics of the TEFR project, which may reveal additional new knowledge on the physiological and pathological processes of the functional systems on the organ, cellular and sub-cellular level at the limits of stress and strain of the human body.

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