{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:05:00Z","timestamp":1784311500874,"version":"3.55.0"},"reference-count":162,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>IRONMAN\u00ae 70.3 events represent a rapidly expanding endurance discipline characterized by distinct physiological demands, performance determinants, and race-specific risk profiles. Despite their global popularity, no systematic review has synthesized evidence exclusively focused on this distance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To consolidate current knowledge on performance predictors, physiological responses, training characteristics, nutritional strategies, environmental influences, and medical considerations in IRONMAN\u00ae 70.3 triathletes, and to identify gaps requiring further investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic search of PubMed, Scopus, SciELO, EBSCO and Google Scholar was conducted up to 25\n                      <jats:sup>th<\/jats:sup>\n                      November 2025. Search terms were developed according to PRISMA guidelines and included variations of \u2018Ironman 70.3\u2019, \u2018half triathlon\u2019 and \u2018middle-distance triathlon\u2019. Eligible studies reporting physiological, anthropometric, nutritional, environmental, medical, or performance-related outcomes specific to IRONMAN\u00ae 70.3. Risk of bias was assessed using the Newcastle\u2013Ottawa Scale, the Cochrane RoB tool, and the NIH Quality Assessment Tool, according to study design.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 86 studies were included, predominantly observational in design, with sample sizes ranging from 1 to 852,721 participants, mostly trained male triathletes aged 25\u201339 years. Participation has increased across age groups, with pronounced growth among female and masters triathletes. Peak performance in professional male triathletes is reached at approximately age 28, and in female triathletes at age 32. Across large datasets, cycling appeared to be the strongest predictor of overall race time, accounting for the largest proportion of performance variance. Physiologically, competition was associated with transient reductions in immune function, reversible muscle damage, and shifts in hydration and electrolyte balance, while higher intracellular water and efficient fat oxidation were associated with better outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Evidence specific to IRONMAN\u00ae 70.3 is limited by small sample sizes, heterogeneous designs, male-dominated cohorts, and insufficient sex-specific analyses. Future research should distinguish recreational from elite triathletes, incorporate balanced sex representation, and apply standardized physiological and environmental monitoring to refine targeted recommendations for performance, health, and safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0352506","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:43:54Z","timestamp":1784310234000},"page":"e0352506","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Performance, physiology, and determinants of success in IRONMAN\u00ae 70.3: A systematic review"],"prefix":"10.1371","volume":"21","author":[{"given":"Isabel","family":"von K\u00e4nel-Cordoba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Wilhelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano Bernardes","family":"Leite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilia S.","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pantelis T.","family":"Nikolaidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Forte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Chlibkova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasa","family":"Duric","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Rosemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1247-6754","authenticated-orcid":true,"given":"Katja","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2412-9103","authenticated-orcid":true,"given":"Beat","family":"Knechtle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"pone.0352506.ref001","year":"2025"},{"issue":"1","key":"pone.0352506.ref002","doi-asserted-by":"crossref","first-page":"498","DOI":"10.3390\/ijerph19010498","article-title":"Benefits on hematological and biochemical parameters of a high-intensity interval training program for a half-marathon in recreational middle-aged women runners","volume":"19","author":"JB Bonet","year":"2022","journal-title":"International J Environmental Research and Public Health"},{"issue":"2","key":"pone.0352506.ref003","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1080\/0361073X.2017.1276378","article-title":"Aging and Half-Ironman Performance","volume":"43","author":"MJ Stones","year":"2017","journal-title":"Experimental Aging Research"},{"issue":"6","key":"pone.0352506.ref004","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.3390\/ijerph17062148","article-title":"The Age-Related Performance Decline in Ironman 70.3","volume":"17","author":"K J\u00e4ckel","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0352506.ref005","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2147\/OAJSM.S32922","article-title":"Age and gender differences in half-Ironman triathlon performances - the Ironman 70.3 Switzerland from 2007 to 2010","volume":"3","author":"B Knechtle","year":"2012","journal-title":"Open Access J Sports Med"},{"key":"pone.0352506.ref006","doi-asserted-by":"crossref","first-page":"1567676","DOI":"10.3389\/fspor.2025.1567676","article-title":"Women in the triathlon-the differences between female and male triathletes: a narrative review","volume":"7","author":"M Loosli","year":"2025","journal-title":"Front Sports Act Living"},{"issue":"1","key":"pone.0352506.ref007","doi-asserted-by":"crossref","first-page":"20903","DOI":"10.1038\/s41598-024-71866-6","article-title":"Europe has the fastest Ironman race courses and the fastest Ironman age group triathletes","volume":"14","author":"B Knechtle","year":"2024","journal-title":"Sci Rep"},{"key":"pone.0352506.ref008","first-page":"121","article-title":"Personal best times in an Olympic distance triathlon and in a marathon predict Ironman race time in recreational male triathletes","volume":"2","author":"CA R\u00fcst","year":"2011","journal-title":"Open Access J Sports Med"},{"key":"pone.0352506.ref009","year":"2024"},{"key":"pone.0352506.ref010","doi-asserted-by":"crossref","first-page":"654552","DOI":"10.3389\/fphys.2021.654552","article-title":"What is the best discipline to predict overall triathlon performance? An analysis of sprint, Olympic, Ironman\u00ae 70.3, and Ironman\u00ae 140.6","volume":"12","author":"CV Sousa","year":"2021","journal-title":"Frontiers in Physiology"},{"issue":"10","key":"pone.0352506.ref011","doi-asserted-by":"crossref","first-page":"3651","DOI":"10.3390\/ijerph17103651","article-title":"Sex Differences in Swimming Disciplines-Can Women Outperform Men in Swimming?","volume":"17","author":"B Knechtle","year":"2020","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"pone.0352506.ref012","author":"T Hetling","year":"2020"},{"issue":"6","key":"pone.0352506.ref013","first-page":"902","article-title":"Concordance analysis between the segments and the overall performance in olympic triathlon in elite triathletes","volume":"11","author":"J Olaya-Cuartero","year":"2022","journal-title":"Biology (Basel)"},{"issue":"1","key":"pone.0352506.ref014","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3390\/sports7010024","article-title":"Cycling as the Best Sub-8-Hour Performance Predictor in Full Distance Triathlon","volume":"7","author":"CV Sousa","year":"2019","journal-title":"Sports (Basel)"},{"key":"pone.0352506.ref015","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1146\/annurev-psych-010418-102803","article-title":"How to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses","volume":"70","author":"AP Siddaway","year":"2019","journal-title":"Annual Review of Psychology"},{"issue":"2","key":"pone.0352506.ref016","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1096\/fj.07-9492LSF","article-title":"Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses","volume":"22","author":"ME Falagas","year":"2008","journal-title":"FASEB J"},{"issue":"1","key":"pone.0352506.ref017","doi-asserted-by":"crossref","first-page":"23","DOI":"10.5195\/jmla.2022.1283","article-title":"MeSH and text-word search strategies: precision, recall, and their implications for library instruction","volume":"110","author":"MM DeMars","year":"2022","journal-title":"J Med Libr Assoc"},{"issue":"12","key":"pone.0352506.ref018","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1055\/s-0034-1398681","article-title":"Changes in Kidney Functions during Middle-distance Triathlon in Male Athletes","volume":"36","author":"JR Poortmans","year":"2015","journal-title":"Int J Sports Med"},{"issue":"3","key":"pone.0352506.ref019","first-page":"271","article-title":"Anthropometric characteristics of Chilean amateur triathletes: A pilot study","volume":"21","author":"JA Sanhueza","year":"2017","journal-title":"Spanish Journal of Human Nutrition and Dietetics"},{"issue":"2","key":"pone.0352506.ref020","article-title":"Behavior of chlorine in the half-Ironman triathlon competition","volume":"3","author":"M Citizen-Mendon\u00e7a","year":"2007","journal-title":"Motricidad"},{"issue":"2","key":"pone.0352506.ref021","first-page":"56","article-title":"Behavior of magnesium ions in a semi-Ironman triathlon event","volume":"4","author":"M Mendon\u00e7a","year":"2025","journal-title":"Motricity"},{"issue":"3","key":"pone.0352506.ref022","doi-asserted-by":"crossref","first-page":"246","DOI":"10.4100\/jhse.2009.43.06","article-title":"Significant sodium plasma reduction after a half-Ironman triathlon in Brazilian triathletes","volume":"4","author":"M Mendon\u00e7a","year":"2009","journal-title":"Journal of Human Sport and Exercise"},{"issue":"9","key":"pone.0352506.ref023","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0138376","article-title":"Changes in Serum Free Amino Acids and Muscle Fatigue Experienced during a Half-Ironman Triathlon","volume":"10","author":"F Areces","year":"2015","journal-title":"PLoS One"},{"issue":"2","key":"pone.0352506.ref024","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1249\/01.mss.0000246999.09718.0c","article-title":"Oxidative stress in half and full Ironman triathletes","volume":"39","author":"WL Knez","year":"2007","journal-title":"Med Sci Sports Exerc"},{"issue":"1","key":"pone.0352506.ref025","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1590\/0001-37652014112912","article-title":"Half-ironman induces changes in the kidney function of triathletes","volume":"86","author":"EF Puggina","year":"2014","journal-title":"An Acad Bras Cienc"},{"key":"pone.0352506.ref026","doi-asserted-by":"crossref","first-page":"3062807","DOI":"10.1155\/2020\/3062807","article-title":"Acute Effects of Triathlon Race on Oxidative Stress Biomarkers","volume":"2020","author":"S Mrakic-Sposta","year":"2020","journal-title":"Oxid Med Cell Longev"},{"issue":"1","key":"pone.0352506.ref027","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00421-016-3507-7","article-title":"ACTN3 X-allele carriers had greater levels of muscle damage during a half-ironman","volume":"117","author":"J Del Coso","year":"2017","journal-title":"Eur J Appl Physiol"},{"issue":"8","key":"pone.0352506.ref028","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1249\/MSS.0b013e31816dc89e","article-title":"Neutrophil death induced by a triathlon competition in elite athletes","volume":"40","author":"AC Levada-Pires","year":"2008","journal-title":"Med Sci Sports Exerc"},{"issue":"10","key":"pone.0352506.ref029","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.1249\/MSS.0b013e3181a327a2","article-title":"Induction of lymphocyte death by short- and long-duration triathlon competitions","volume":"41","author":"AC Levada-Pires","year":"2009","journal-title":"Med Sci Sports Exerc"},{"issue":"3","key":"pone.0352506.ref030","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S1665-2681(19)31855-1","article-title":"Liver overload in Brazilian triathletes after half-ironman competition is related muscle fatigue","volume":"7","author":"M B\u00fcrger-Mendon\u00e7a","year":"2008","journal-title":"Ann Hepatol"},{"issue":"3","key":"pone.0352506.ref031","first-page":"466","article-title":"Changes in the water balance in connection with the level of performance in the Half Ironman","volume":"15","author":"K Lenka","year":"2015","journal-title":"Journal of Physical Education and Sport"},{"issue":"2","key":"pone.0352506.ref032","first-page":"89","article-title":"Effect of ultra-resistance exercises on oxidative stress parameters","volume":"15","author":"CD Schneider","year":"2009","journal-title":"Brazilian Journal of Sports Medicine"},{"issue":"4","key":"pone.0352506.ref033","doi-asserted-by":"crossref","DOI":"10.2478\/v10038-011-0042-6","article-title":"Changes in Body Composition after Endurance Training and Triathlon Competition","volume":"12","author":"E Puggina","year":"2011","journal-title":"Human Movement"},{"issue":"1","key":"pone.0352506.ref034","first-page":"10","article-title":"Half Ironman influence on blood markers","volume":"32","author":"C Gallo-Salazar","year":"2014","journal-title":"Archivos de Medicina del Deporte"},{"issue":"2","key":"pone.0352506.ref035","first-page":"115","article-title":"Effects of training and a triathlon on indicators of muscle injury and inflammation","volume":"38","author":"EF Puggina","year":"2016","journal-title":"Brazilian Journal of Sports Science"},{"issue":"4","key":"pone.0352506.ref036","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1007\/s00421-024-05677-y","article-title":"An ultra-endurance event leads to changes in circulating regulatory T-cells, CD4+ na\u00efve and CD8+ effector memory T-cells in the 48h post-race recovery period","volume":"125","author":"H Lithgow","year":"2025","journal-title":"Eur J Appl Physiol"},{"issue":"10","key":"pone.0352506.ref037","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0074722","article-title":"Endurance exercise diverts the balance between Th17 cells and regulatory T cells","volume":"8","author":"C Perry","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"pone.0352506.ref038","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/imj.12625","article-title":"Acute effects of different degrees of ultra-endurance exercise on systemic inflammatory responses","volume":"45","author":"M Comassi","year":"2015","journal-title":"Intern Med J"},{"issue":"2","key":"pone.0352506.ref039","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2165\/00007256-200535020-00004","article-title":"Medical considerations in triathlon competition: recommendations for triathlon organisers, competitors and coaches","volume":"35","author":"GM Dallam","year":"2005","journal-title":"Sports Med"},{"issue":"9","key":"pone.0352506.ref040","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1097\/00005768-199709000-00009","article-title":"In vivo cell-mediated immunity and vaccination response following prolonged, intense exercise","volume":"29","author":"H Bruunsgaard","year":"1997","journal-title":"Med Sci Sports Exerc"},{"issue":"10","key":"pone.0352506.ref041","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1161\/CIRCULATIONAHA.115.019464","article-title":"Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil","volume":"133","author":"RE Moon","year":"2016","journal-title":"Circulation"},{"issue":"8","key":"pone.0352506.ref042","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.ajem.2009.08.004","article-title":"Swimming-induced pulmonary edema in triathletes","volume":"28","author":"CC 3rd Miller","year":"2010","journal-title":"Am J Emerg Med"},{"issue":"7","key":"pone.0352506.ref043","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1097\/00005768-200007000-00004","article-title":"Effects of half ironman competition on the development of late potentials","volume":"32","author":"DER Warburton","year":"2000","journal-title":"Med Sci Sports Exerc"},{"issue":"6","key":"pone.0352506.ref044","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1097\/00005768-200006000-00005","article-title":"Cardiac fatigue following prolonged endurance exercise of differing distances","volume":"32","author":"GP Whyte","year":"2000","journal-title":"Med Sci Sports Exerc"},{"issue":"7","key":"pone.0352506.ref045","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1249\/01.MSS.0000131958.18154.1E","article-title":"Altered cardiac function and minimal cardiac damage during prolonged exercise","volume":"36","author":"R Shave","year":"2004","journal-title":"Med Sci Sports Exerc"},{"issue":"3","key":"pone.0352506.ref046","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s00421-013-2789-2","article-title":"Compression stockings do not improve muscular performance during a half-ironman triathlon race","volume":"114","author":"J Del Coso","year":"2014","journal-title":"Eur J Appl Physiol"},{"issue":"2","key":"pone.0352506.ref047","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/JSM.0b013e3182427003","article-title":"Evaluation for ulnar neuropathy at the elbow in Ironman triathletes: physical examination and electrodiagnostic evidence","volume":"22","author":"J Bales","year":"2012","journal-title":"Clin J Sport Med"},{"issue":"18","key":"pone.0352506.ref048","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1080\/02640414.2014.915425","article-title":"Relationship between physiological parameters and performance during a half-ironman triathlon in the heat","volume":"32","author":"J Del Coso","year":"2014","journal-title":"J Sports Sci"},{"key":"pone.0352506.ref049","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.3389\/fphys.2018.01826","article-title":"Long-Haul Northeast Travel Disrupts Sleep and Induces Perceived Fatigue in Endurance Athletes","volume":"9","author":"CJ Stevens","year":"2018","journal-title":"Front Physiol"},{"key":"pone.0352506.ref050","year":"2025"},{"key":"pone.0352506.ref051","doi-asserted-by":"crossref","DOI":"10.1093\/milmed\/usaa118","article-title":"Swimming-Induced Pulmonary Edema in an Active-Duty Female Triathlete","volume":"185","author":"JB Haran","year":"2020","journal-title":"Mil Med"},{"issue":"2","key":"pone.0352506.ref052","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1152\/japplphysiol.00641.2006","article-title":"Sex differences in left ventricular function and beta-receptor responsiveness following prolonged strenuous exercise","volume":"102","author":"JM Scott","year":"2007","journal-title":"J Appl Physiol (1985)"},{"issue":"3","key":"pone.0352506.ref053","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/JSM.0b013e318249945b","article-title":"A temporal model for nonelite triathlon race injuries","volume":"22","author":"T Rimmer","year":"2012","journal-title":"Clin J Sport Med"},{"issue":"3","key":"pone.0352506.ref054","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1249\/JSR.0000000000000367","article-title":"Patient presentations and medical logistics at full and half ironman distance triathlons","volume":"16","author":"SA Turris","year":"2017","journal-title":"Current Sports Medicine Reports"},{"key":"pone.0352506.ref055","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.12688\/f1000research.12388.1","article-title":"Medical support during an Ironman 70.3 triathlon race","volume":"6","author":"HR Yang","year":"2017","journal-title":"F1000Res"},{"key":"pone.0352506.ref056","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/1375181","article-title":"Adherence to Follow-Up Recommendations by Triathlon Competitors Receiving Event Medical Care","author":"JD Joslin","year":"2017","journal-title":"Emergency Medicine International"},{"issue":"3","key":"pone.0352506.ref057","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.jemermed.2008.07.030","article-title":"Deep venous thromboembolism in a triathlete","volume":"38","author":"K Tao","year":"2010","journal-title":"J Emerg Med"},{"issue":"3","key":"pone.0352506.ref058","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/00005768-199903000-00004","article-title":"Hematocrits of triathletes: is monitoring useful?","volume":"31","author":"ML O\u2019Toole","year":"1999","journal-title":"Med Sci Sports Exerc"},{"issue":"5","key":"pone.0352506.ref059","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.otsr.2017.04.004","article-title":"High-impact sport after hip resurfacing: The Ironman triathlon","volume":"103","author":"J Girard","year":"2017","journal-title":"Orthop Traumatol Surg Res"},{"issue":"1","key":"pone.0352506.ref060","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1186\/s13256-024-04482-7","article-title":"Clavicle fracture and triathlon performance: a case report","volume":"18","author":"L Gerdesmeyer","year":"2024","journal-title":"J Med Case Rep"},{"issue":"1","key":"pone.0352506.ref061","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1123\/jcsp.2014-0010","article-title":"Risk for Exercise Addiction: A Comparison of Triathletes Training for Sprint-, Olympic-, Half-Ironman-, and Ironman-Distance Triathlons","volume":"8","author":"J Youngman","year":"2014","journal-title":"Journal of Clinical Sport Psychology"},{"issue":"5","key":"pone.0352506.ref062","doi-asserted-by":"crossref","first-page":"140","DOI":"10.3390\/sports13050140","article-title":"Physiological changes across a sport season in a nine-time world-champion triathlete: A case report","volume":"13","author":"A Gonzalez-Custodio","year":"2025","journal-title":"Sports"},{"issue":"5","key":"pone.0352506.ref063","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1249\/MSS.0b013e31827d17eb","article-title":"Age and sex differences pertaining to modes of locomotion in triathlon","volume":"45","author":"JL Stevenson","year":"2013","journal-title":"Med Sci Sports Exerc"},{"issue":"5","key":"pone.0352506.ref064","doi-asserted-by":"crossref","first-page":"440","DOI":"10.3390\/atmos11050440","article-title":"Measured UV radiation from Ironman, sprint and triathlon competitors over the Olympic distance","volume":"11","author":"NJ Downs","year":"2020","journal-title":"Atmosphere"},{"key":"pone.0352506.ref065","doi-asserted-by":"crossref","first-page":"524","DOI":"10.18633\/biotecnia.v26.2283","article-title":"Asociaci\u00f3n entre la composici\u00f3n corporal y la fuerza explosiva en triatletas aficionados de media distancia","volume":"26","author":"DC Garc\u00eda-Chaves","year":"2024","journal-title":"BIOtecnia"},{"key":"pone.0352506.ref066","author":"E Watters","year":"2024"},{"key":"pone.0352506.ref067","first-page":"1","article-title":"Differences in the bioelectrical activity of the main muscle groups of the lower extremity in the road or triathlon position.","volume-title":"Selected Problems of Biomechanics of Sport and Rehabilitation","author":"R Drozdek","year":"2014"},{"key":"pone.0352506.ref068","first-page":"223","article-title":"Factors influencing pacing in triathlon","volume":"5","author":"SS Wu","year":"2014","journal-title":"Open Access J Sports Med"},{"issue":"4","key":"pone.0352506.ref069","doi-asserted-by":"crossref","first-page":"3619","DOI":"10.3390\/ijerph20043619","article-title":"A Machine Learning Approach to Finding the Fastest Race Course for Professional Athletes Competing in Ironman\u00ae 70.3 Races between 2004 and 2020","volume":"20","author":"M Thuany","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"pone.0352506.ref070","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s00421-014-3096-2","article-title":"Pacing strategies during the swim, cycle and run disciplines of sprint, Olympic and half-Ironman triathlons","volume":"115","author":"SSX Wu","year":"2015","journal-title":"Eur J Appl Physiol"},{"key":"pone.0352506.ref071","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/2052-1847-6-37","article-title":"Changes in transition times in \u201cIronman Hawaii\u201d between 1998 and 2013","volume":"6","author":"CA R\u00fcst","year":"2014","journal-title":"BMC Sports Sci Med Rehabil"},{"issue":"1","key":"pone.0352506.ref072","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s40798-025-00948-0","article-title":"Modeling performance in IRONMAN\u00ae70.3 age group triathletes","volume":"11","author":"M Thuany","year":"2025","journal-title":"Sports Med Open"},{"key":"pone.0352506.ref073","doi-asserted-by":"crossref","first-page":"1214929","DOI":"10.3389\/fspor.2024.1214929","article-title":"Cycling is the most important predictive split discipline in professional Ironman\u00ae 70.3 triathletes","volume":"6","author":"K Weiss","year":"2024","journal-title":"Front Sports Act Living"},{"issue":"2","key":"pone.0352506.ref074","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s11332-024-01306-5","article-title":"Key factors influencing cycling performance and overall race time in the Ironman 70.3 for amateur athletes","volume":"21","author":"L Vivan","year":"2024","journal-title":"Sport Sci Health"},{"key":"pone.0352506.ref075","first-page":"524","article-title":"Relationship between body composition and physical performance in amateur middle-distance triathletes","volume":"26","author":"AM Manrique","year":"2024","journal-title":"BIOtecnia"},{"key":"pone.0352506.ref076","author":"I Fister","year":"2017"},{"issue":"131","key":"pone.0352506.ref077","doi-asserted-by":"crossref","first-page":"14","DOI":"10.33607\/bjshs.v4i131.1463","article-title":"A Descriptive Analysis of the Fastest Race Courses for Triathletes","volume":"4","author":"M Thuany","year":"2024","journal-title":"BJSHS"},{"key":"pone.0352506.ref078","year":"2024"},{"issue":"2","key":"pone.0352506.ref079","first-page":"263","article-title":"Hydration and thermoregulation during a half-ironman performed in tropical climate","volume":"14","author":"M Baillot","year":"2015","journal-title":"J Sports Sci Med"},{"issue":"3","key":"pone.0352506.ref080","first-page":"183","article-title":"Images of destinations projected on the website of the sporting event: A case of Ironman 70.3 Qujing","volume":"20","author":"L Yan","year":"2019","journal-title":"Journal for Congress and Event Tourism"},{"issue":"4","key":"pone.0352506.ref081","first-page":"708","article-title":"Polarized and Pyramidal Training Intensity Distribution: Relationship with a Half-Ironman Distance Triathlon Competition","volume":"18","author":"S Selles-Perez","year":"2019","journal-title":"J Sports Sci Med"},{"key":"pone.0352506.ref082","year":"2025"},{"issue":"1","key":"pone.0352506.ref083","doi-asserted-by":"crossref","first-page":"28688","DOI":"10.1038\/s41598-025-14578-9","article-title":"Sex-specific differences in performance and pacing in the world\u2019s longest triathlon in history","volume":"15","author":"B Knechtle","year":"2025","journal-title":"Scientific Reports"},{"key":"pone.0352506.ref084","doi-asserted-by":"crossref","first-page":"185","DOI":"10.2478\/hukin-2018-0077","article-title":"Changes in triathletes\u2019 performance and body composition during a specific training period for a half-ironman race","volume":"67","author":"S Sell\u00e9s-P\u00e9rez","year":"2019","journal-title":"J Hum Kinet"},{"key":"pone.0352506.ref085","unstructured":"Schiessel DL, Zavadski F, Benneman GD, Abe M. Estrat\u00e9gias de alimenta\u00e7\u00e3o, hidrata\u00e7\u00e3o e suplementa\u00e7\u00e3o, em per\u00edodo de treinamento e competi\u00e7\u00e3o de triatletas no Ironman 140.6 e 70.3 Brasil. 2018;12(70)."},{"issue":"4","key":"pone.0352506.ref086","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1123\/ijspp.1.4.408","article-title":"Muscle glycogenolysis and resynthesis in response to a half Ironman triathlon: a case study","volume":"1","author":"TL Gillum","year":"2006","journal-title":"Int J Sports Physiol Perform"},{"issue":"8","key":"pone.0352506.ref087","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1249\/MSS.0000000000001278","article-title":"Multiple-Transportable Carbohydrate Effect on Long-Distance Triathlon Performance","volume":"49","author":"DS Rowlands","year":"2017","journal-title":"Med Sci Sports Exerc"},{"issue":"7","key":"pone.0352506.ref088","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1139\/apnm-2015-0599","article-title":"Many non-elite multisport endurance athletes do not meet sports nutrition recommendations for carbohydrates","volume":"41","author":"G Masson","year":"2016","journal-title":"Appl Physiol Nutr Metab"},{"issue":"2","key":"pone.0352506.ref089","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1249\/MSS.0b013e31822dc809","article-title":"Nutritional intake and gastrointestinal problems during competitive endurance events","volume":"44","author":"B Pfeiffer","year":"2012","journal-title":"Med Sci Sports Exerc"},{"issue":"2","key":"pone.0352506.ref090","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/sms.12427","article-title":"Effects of oral salt supplementation on physical performance during a half-ironman: A randomized controlled trial","volume":"26","author":"J Del Coso","year":"2016","journal-title":"Scand J Med Sci Sports"},{"issue":"3","key":"pone.0352506.ref091","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1123\/ijsnem.2018-0124","article-title":"Case study: Long-term low-carbohydrate, high-fat diet impairs performance and subjective well-being in a world-class vegetarian long-distance triathlete","volume":"29","author":"I Mujika","year":"2019","journal-title":"Int J Sport Nutr Exerc Metab"},{"issue":"2","key":"pone.0352506.ref092","doi-asserted-by":"crossref","first-page":"208","DOI":"10.3390\/nu17020208","article-title":"A Preliminary Study of Nutrients Related to the Risk of Relative Energy Deficiency in Sport (RED-S) in Top-Performing Female Amateur Triathletes: Results from a Nutritional Assessment","volume":"17","author":"D Langa","year":"2025","journal-title":"Nutrients"},{"issue":"2","key":"pone.0352506.ref093","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s00726-007-0582-4","article-title":"Creatine supplementation reduces plasma levels of pro-inflammatory cytokines and PGE2 after a half-ironman competition","volume":"35","author":"RA Bassit","year":"2008","journal-title":"Amino Acids"},{"key":"pone.0352506.ref094","doi-asserted-by":"crossref","first-page":"561013","DOI":"10.3389\/fpsyg.2020.561013","article-title":"Refined analysis of a cross-sectional doping survey among recreational triathletes: support for the nutritional supplement gateway hypothesis","volume":"11","author":"S Heller","year":"2020","journal-title":"Front Psychol"},{"key":"pone.0352506.ref095","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1186\/2193-1801-3-538","article-title":"The best triathletes are older in longer race distances - a comparison between Olympic, Half-Ironman and Ironman distance triathlon","volume":"3","author":"R Knechtle","year":"2014","journal-title":"Springerplus"},{"issue":"1","key":"pone.0352506.ref096","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s40798-023-00636-x","article-title":"Comparing the performance gap between males and females in the older age groups in IRONMAN\u00ae 70.3: An internet-based cross-sectional study of more than 800,000 race records","volume":"9","author":"B Knechtle","year":"2023","journal-title":"Sports Med Open"},{"issue":"1","key":"pone.0352506.ref097","doi-asserted-by":"crossref","first-page":"11492","DOI":"10.1038\/s41598-023-38181-y","article-title":"Predicting overall performance in Ironman 70.3 age group triathletes through split disciplines","volume":"13","author":"PT Nikolaidis","year":"2023","journal-title":"Sci Rep"},{"issue":"6","key":"pone.0352506.ref098","first-page":"766","article-title":"Preparation for an Half-Ironmantm Triathlon amongst Amateur Athletes: Finishing Rate and Physiological Adaptation","volume":"13","author":"F Lalonde","year":"2020","journal-title":"Int J Exerc Sci"},{"issue":"3","key":"pone.0352506.ref099","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jsams.2013.04.014","article-title":"Predictive variables for half-Ironman triathlon performance","volume":"17","author":"N Gilinsky","year":"2014","journal-title":"J Sci Med Sport"},{"issue":"1","key":"pone.0352506.ref100","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1080\/02614367.2021.1948592","article-title":"The influence of triathletes\u2019 serious leisure traits on sport constraints, involvement, and participation","volume":"41","author":"S-M Ma","year":"2021","journal-title":"Leisure Studies"},{"issue":"5","key":"pone.0352506.ref101","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.jshs.2020.04.001","article-title":"Exercise-induced oxidative stress: Friend or foe?","volume":"9","author":"SK Powers","year":"2020","journal-title":"J Sport Health Sci"},{"issue":"2","key":"pone.0352506.ref102","doi-asserted-by":"crossref","first-page":"108","DOI":"10.2165\/00007256-199213020-00006","article-title":"Exercise, muscle damage and fatigue","volume":"13","author":"HJ Appell","year":"1992","journal-title":"Sports Med"},{"issue":"9","key":"pone.0352506.ref103","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1007\/s00421-013-2670-3","article-title":"Changes in body composition in triathletes during an Ironman race","volume":"113","author":"SM Mueller","year":"2013","journal-title":"Eur J Appl Physiol"},{"issue":"2","key":"pone.0352506.ref104","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1136\/bjsm.2007.038034","article-title":"Effect of a multistage ultra-endurance triathlon on body composition: World Challenge Deca Iron Triathlon 2006","volume":"42","author":"B Knechtle","year":"2008","journal-title":"Br J Sports Med"},{"issue":"13","key":"pone.0352506.ref105","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1055\/s-0034-1371839","article-title":"Increases in intracellular water explain strength and power improvements over a season","volume":"35","author":"AM Silva","year":"2014","journal-title":"Int J Sports Med"},{"issue":"4","key":"pone.0352506.ref106","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1080\/17461391.2013.813971","article-title":"Somatotype, training and performance in Ironman athletes","volume":"14","author":"M Kandel","year":"2014","journal-title":"Eur J Sport Sci"},{"issue":"6","key":"pone.0352506.ref107","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.3390\/nu11061289","article-title":"Nutrition and Supplement Update for the Endurance Athlete: Review and Recommendations","volume":"11","author":"K Vitale","year":"2019","journal-title":"Nutrients"},{"issue":"3","key":"pone.0352506.ref108","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1123\/ijsnem.2016-0284","article-title":"Decrease in Ionized and Total Magnesium Blood Concentrations in Endurance Athletes Following an Exercise Bout Restores within Hours-Potential Consequences for Monitoring and Supplementation","volume":"27","author":"R Terink","year":"2017","journal-title":"Int J Sport Nutr Exerc Metab"},{"issue":"4","key":"pone.0352506.ref109","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1007\/s00421-020-04566-4","article-title":"Exercise-induced muscle damage: mechanism, assessment and nutritional factors to accelerate recovery","volume":"121","author":"I Markus","year":"2021","journal-title":"Eur J Appl Physiol"},{"issue":"3","key":"pone.0352506.ref110","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1152\/physrev.2000.80.3.1107","article-title":"Creatine and creatinine metabolism","volume":"80","author":"M Wyss","year":"2000","journal-title":"Physiol Rev"},{"issue":"1","key":"pone.0352506.ref111","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1053\/j.jrn.2007.10.031","article-title":"Renal alterations during exercise","volume":"18","author":"G Bellinghieri","year":"2008","journal-title":"J Ren Nutr"},{"issue":"1","key":"pone.0352506.ref112","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40798-025-00810-3","article-title":"Physiology and Pathophysiology of Marathon Running: A Narrative Review","volume":"11","author":"L Braschler","year":"2025","journal-title":"Sports Med Open"},{"issue":"11","key":"pone.0352506.ref113","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.gcb.2008.08.007","article-title":"Foie et sport","volume":"32","author":"J Watelet","year":"2008","journal-title":"Gastroenterol Clin Biol"},{"issue":"6","key":"pone.0352506.ref114","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1249\/MSS.0b013e318243253d","article-title":"Prevalence of Allergy and Upper Respiratory Tract Symptoms in Runners of the London Marathon","volume":"44","author":"P Robson-Ansley","year":"2012","journal-title":"Medicine & Science in Sports & Exercise"},{"issue":"1","key":"pone.0352506.ref115","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3390\/jfmk9010015","article-title":"Exercise-induced asthma: managing respiratory issues in athletes","volume":"9","author":"J Ora","year":"2024","journal-title":"J Funct Morphol Kinesiol"},{"key":"pone.0352506.ref116","article-title":"Swimming-induced pulmonary oedema in triathletes: A narrative review of epidemiology, risk factors and prevention","author":"B Knechtle","year":"2025","journal-title":"Sports Medicine and Health Science"},{"issue":"4","key":"pone.0352506.ref117","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1249\/JSR.0000000000001157","article-title":"Swimming-induced pulmonary edema: evaluation, diagnosis, and treatment","volume":"23","author":"S Steele","year":"2024","journal-title":"Curr Sports Med Rep"},{"issue":"6","key":"pone.0352506.ref118","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/j.1398-9995.2008.01686.x","article-title":"Mechanisms of asthma in Olympic athletes--practical implications","volume":"63","author":"T Haahtela","year":"2008","journal-title":"Allergy"},{"issue":"10","key":"pone.0352506.ref119","first-page":"347","article-title":"May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review","volume":"9","author":"F Graziano","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"issue":"8","key":"pone.0352506.ref120","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3810\/psm.2000.08.1157","article-title":"A guide to treating ironman triathletes at the finish line","volume":"28","author":"LB Mayers","year":"2000","journal-title":"Phys Sportsmed"},{"issue":"2","key":"pone.0352506.ref121","first-page":"261","article-title":"Echocardiographic findings in former professional cyclists after long-term deconditioning of more than 30 years","volume":"9","author":"P Luthi","year":"2008","journal-title":"Eur J Echocardiogr"},{"key":"pone.0352506.ref122","author":"Ginevrag","year":"2025"},{"issue":"1","key":"pone.0352506.ref123","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1186\/s13018-023-04166-w","article-title":"Extracorporeal shock wave therapy inhibits osteoclast differentiation by targeting NF-\u03baB signaling pathway","volume":"18","author":"B Chen","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"pone.0352506.ref124","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s40279-017-0690-6","article-title":"Training the Gut for Athletes","volume":"47","author":"AE Jeukendrup","year":"2017","journal-title":"Sports Med"},{"issue":"3","key":"pone.0352506.ref125","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2165\/00007256-200939030-00002","article-title":"Physiological differences between cycling and running: lessons from triathletes","volume":"39","author":"GP Millet","year":"2009","journal-title":"Sports Med"},{"issue":"1","key":"pone.0352506.ref126","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s12603-018-1129-y","article-title":"Total Body Water and Intracellular Water Relationships with Muscle Strength, Frailty and Functional Performance in an Elderly Population","volume":"23","author":"M Serra-Prat","year":"2019","journal-title":"J Nutr Health Aging"},{"key":"pone.0352506.ref127","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12970-018-0207-1","article-title":"Understanding the factors that effect maximal fat oxidation","volume":"15","author":"T Purdom","year":"2018","journal-title":"J Int Soc Sports Nutr"},{"issue":"1","key":"pone.0352506.ref128","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1600-0838.2007.00765.x","article-title":"Influence of different racing positions on mechanical and electromyographic patterns during pedalling","volume":"19","author":"S Dorel","year":"2009","journal-title":"Scand J Med Sci Sports"},{"key":"pone.0352506.ref129","doi-asserted-by":"crossref","first-page":"135","DOI":"10.5114\/jhk\/185877","article-title":"The effects of resistance training on sport-specific performance of elite athletes: A systematic review with meta-analysis","volume":"91","author":"H Makaruk","year":"2024","journal-title":"J Hum Kinet"},{"key":"pone.0352506.ref130","year":"2025"},{"key":"pone.0352506.ref131","year":"2025"},{"issue":"1","key":"pone.0352506.ref132","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF00376431","article-title":"Physiological changes and gastro-intestinal symptoms as a result of ultra-endurance running","volume":"64","author":"NJ Rehrer","year":"1992","journal-title":"Eur J Appl Physiol Occup Physiol"},{"issue":"2","key":"pone.0352506.ref133","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1080\/15438621003627059","article-title":"An Ironman Triathlon Does Not Lead to a Change in Body Mass in Female Triathletes","volume":"18","author":"B Knechtle","year":"2010","journal-title":"Research in Sports Medicine"},{"issue":"3","key":"pone.0352506.ref134","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1080\/15438627.2018.1447472","article-title":"Changes in physiological and performance variables in non-professional triathletes after taking part in an Olympic distance triathlon","volume":"26","author":"G Olcina","year":"2018","journal-title":"Res Sports Med"},{"issue":"5","key":"pone.0352506.ref135","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1007\/s40279-023-01823-2","article-title":"Effects of Creatine Monohydrate on Endurance Performance in a Trained Population: A Systematic Review and Meta-analysis","volume":"53","author":"J Fern\u00e1ndez-Landa","year":"2023","journal-title":"Sports Med"},{"issue":"10","key":"pone.0352506.ref136","doi-asserted-by":"crossref","DOI":"10.1111\/jfbc.13916","article-title":"Creatine supplementation effect on recovery following exercise-induced muscle damage: A systematic review and meta-analysis of randomized controlled trials","volume":"45","author":"Y Jiaming","year":"2021","journal-title":"J Food Biochem"},{"issue":"1","key":"pone.0352506.ref137","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/2046-7648-1-5","article-title":"Age-related changes in ultra-triathlon performances","volume":"1","author":"B Knechtle","year":"2012","journal-title":"Extrem Physiol Med"},{"issue":"3","key":"pone.0352506.ref138","doi-asserted-by":"crossref","first-page":"681","DOI":"10.2466\/05.25.PMS.111.6.681-693","article-title":"Predictor variables for a 100-km race time in male ultra-marathoners","volume":"111","author":"B Knechtle","year":"2010","journal-title":"Percept Mot Skills"},{"key":"pone.0352506.ref139","first-page":"175","article-title":"Age of peak performance in elite male and female Ironman triathletes competing in Ironman Switzerland, a qualifier for the Ironman world championship, Ironman Hawaii, from 1995 to 2011","volume":"3","author":"CA R\u00fcst","year":"2012","journal-title":"Open Access J Sports Med"},{"key":"pone.0352506.ref140","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s40064-016-1704-9","article-title":"Half-marathoners are younger and slower than marathoners","volume":"5","author":"B Knechtle","year":"2016","journal-title":"Springerplus"},{"issue":"6","key":"pone.0352506.ref141","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1152\/japplphysiol.00774.2002","article-title":"Greater rate of decline in maximal aerobic capacity with age in endurance-trained than in sedentary men","volume":"94","author":"AE Pimentel","year":"2003","journal-title":"J Appl Physiol (1985)"},{"key":"pone.0352506.ref142","doi-asserted-by":"crossref","first-page":"2130993","DOI":"10.1155\/2022\/2130993","article-title":"Effects of Short- and Long-Term Detraining on Maximal Oxygen Uptake in Athletes: A Systematic Review and Meta-Analysis","volume":"2022","author":"J Zheng","year":"2022","journal-title":"Biomed Res Int"},{"issue":"8","key":"pone.0352506.ref143","article-title":"The Effect of Aging on Relationships between Lean Body Mass and VO2max in Rowers","volume":"11","author":"C-H Kim","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"pone.0352506.ref144","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1113\/jphysiol.2007.141879","article-title":"Endurance exercise performance in Masters athletes: age-associated changes and underlying physiological mechanisms","volume":"586","author":"H Tanaka","year":"2008","journal-title":"J Physiol"},{"issue":"1","key":"pone.0352506.ref145","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1139\/H07-174","article-title":"Determinants of VO2 max decline with aging: an integrated perspective","volume":"33","author":"AC Betik","year":"2008","journal-title":"Appl Physiol Nutr Metab"},{"issue":"9","key":"pone.0352506.ref146","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1249\/MSS.0000000000003730","article-title":"Rest Activity Rhythms and Their Association with Cardiorespiratory Fitness and Walking Energetics in Older Adults: Study of Muscle, Mobility, and Aging","volume":"57","author":"ML Erickson","year":"2025","journal-title":"Med Sci Sports Exerc"},{"issue":"1","key":"pone.0352506.ref147","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1042\/cs0840095","article-title":"Muscle weakness in women occurs at an earlier age than in men, but strength is preserved by hormone replacement therapy","volume":"84","author":"SK Phillips","year":"1993","journal-title":"Clin Sci (Lond)"},{"issue":"5","key":"pone.0352506.ref148","article-title":"High-intensity interval training and cardiorespiratory fitness in adults: An umbrella review of systematic reviews and meta-analyses","volume":"34","author":"ET-C Poon","year":"2024","journal-title":"Scand J Med Sci Sports"},{"issue":"9","key":"pone.0352506.ref149","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1080\/02640414.2012.760747","article-title":"Age and gender interactions in short distance triathlon performance","volume":"31","author":"F Etter","year":"2013","journal-title":"J Sports Sci"},{"key":"pone.0352506.ref150","doi-asserted-by":"crossref","first-page":"113110","DOI":"10.1016\/j.physbeh.2020.113110","article-title":"Previous experience, aerobic capacity and body composition are the best predictors for Olympic distance triathlon performance: Predictors in amateur triathlon","volume":"225","author":"PJ Puccinelli","year":"2020","journal-title":"Physiol Behav"},{"key":"pone.0352506.ref151","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2147\/OAJSM.S65977","article-title":"Sex difference in top performers from Ironman to double deca iron ultra-triathlon","volume":"5","author":"B Knechtle","year":"2014","journal-title":"Open Access J Sports Med"},{"issue":"2","key":"pone.0352506.ref152","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1519\/JSC.0000000000004329","article-title":"Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations","volume":"37","author":"JL Nuzzo","year":"2023","journal-title":"J Strength Cond Res"},{"key":"pone.0352506.ref153","author":"B Knechtle","year":"2006"},{"key":"pone.0352506.ref154","author":"S Lacke","year":"2022"},{"key":"pone.0352506.ref155","doi-asserted-by":"crossref","first-page":"835705","DOI":"10.3389\/fphys.2022.835705","article-title":"Road to Tokyo 2020 Olympic Games: Training Characteristics of a World Class Male Triathlete","volume":"13","author":"R Cejuela","year":"2022","journal-title":"Front Physiol"},{"issue":"5","key":"pone.0352506.ref156","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3390\/sports7050101","article-title":"Training and Competition Readiness in Triathlon","volume":"7","author":"N Etxebarria","year":"2019","journal-title":"Sports (Basel)"},{"issue":"8","key":"pone.0352506.ref157","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1007\/s40279-024-02034-z","article-title":"Comparison of Polarized Versus Other Types of Endurance Training Intensity Distribution on Athletes\u2019 Endurance Performance: A Systematic Review with Meta-analysis","volume":"54","author":"P Silva Oliveira","year":"2024","journal-title":"Sports Med"},{"key":"pone.0352506.ref158","doi-asserted-by":"crossref","first-page":"113344","DOI":"10.1016\/j.physbeh.2021.113344","article-title":"Impact of training volume and experience on amateur Ironman triathlon performance","volume":"232","author":"R Sinisgalli","year":"2021","journal-title":"Physiol Behav"},{"issue":"9","key":"pone.0352506.ref159","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1007\/s40279-025-02277-4","article-title":"Human Resilience and Pain Coping Strategies: A Review of the Literature Giving Insights from Elite Ultra-Endurance Athletes for Sports Science, Medicine and Society","volume":"55","author":"CA Paley","year":"2025","journal-title":"Sports Med"},{"key":"pone.0352506.ref160","doi-asserted-by":"crossref","first-page":"277","DOI":"10.2147\/OAJSM.S85310","article-title":"Variables that influence Ironman triathlon performance - what changed in the last 35 years?","author":"B Knechtle","year":"2015","journal-title":"Open Access J Sports Med"},{"issue":"4","key":"pone.0352506.ref161","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1515\/jbcpp-2022-0129","article-title":"Impact of mental toughness on athlete\u2019s performance and interventions to improve","volume":"34","author":"PR Soundara Pandian","year":"2022","journal-title":"J Basic Clin Physiol Pharmacol"},{"issue":"5","key":"pone.0352506.ref162","doi-asserted-by":"crossref","first-page":"409","DOI":"10.3390\/medicina57050409","article-title":"No trends in the age of peak performance among the best half-marathoners and marathoners in the world between 1997-2020","volume":"57","author":"M Thuany","year":"2021","journal-title":"Medicina (Kaunas)"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352506","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:44:15Z","timestamp":1784310255000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352506"}},"subtitle":[],"editor":[{"given":"Stefano","family":"Amatori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":162,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0352506","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]}}}