{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:06:42Z","timestamp":1788282402210,"version":"build-2803163510"},"reference-count":72,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background\/Objective<\/jats:title>\n                    <jats:p>Ultramarathon competitions represent an extreme challenge for the human body, stressing physiological systems. However, little is known about their effects on the red blood cell (RBC) system, particularly on RBC deformability. Moreover, potential modulators of RBC deformability, such as oxidative stress and nitric oxide (NO) signaling, have not yet been systematically investigated in the context of ultramarathon running. The aim of the study was to assess alterations in these parameters following a 230 km non-stop ultramarathon, complemented by hematological parameters and markers of hematological stress to uncover mechanistic links.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The investigation was conducted during the 2024 TorTour de Ruhr\u00ae. Twelve runners completed the race (3f\/9m; mean age: 48.1 \u00b1 6.9 years; 177.6 \u00b1 8.0 cm; 71.3 \u00b1 13.7 kg). Anthropometric data and venous blood sampling were collected pre- and post-race and analyzed using paired statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Body weight as well as blood, plasma and RBC volumes remained unchanged. Post-race, mean corpuscular volume (MCV) and RBC distribution width (RDW) decreased, whereas mean corpuscular hemoglobin (MCH) and MCH concentration (MCHC) increased. These hematological shifts were associated with a leftward shift of the osmotic deformability curve, suggesting reduced RBC volume that could, over time, compromise cell integrity. Although acute hemolysis was not evident, significantly reduced haptoglobin levels indicate considerable cellular stress and raise the possibility of delayed hemolysis, warranting follow-up investigations. Importantly, RBC deformability improved post-race and was paralleled by elevated NO concentration, increased RBC-NO synthase activation, and enhanced S-nitrosylation of spectrins. These findings point toward activation of the RBC-NO pathway in response to mechanical stress, potentially supporting microcirculatory function. RBC free radicals decreased and total antioxidant capacity increased, suggesting a balanced redox response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Overall, the ultramarathon induced complex but compensatory adaptations in the RBC system, where NO-mediated improvements in deformability may counteract stress-induced risks to cell integrity. Thus, despite no acute impairment of RBC function, adequate hydration, antioxidant-rich nutrition, and sufficient recovery may be emphasized to safeguard long-term RBC health in extreme endurance exercise.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2025.1715513","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:14:21Z","timestamp":1763702061000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Running on the edge: hematological responses to a non-stop ultramarathon with a focus on nitric oxide\u2013mediated red blood cell deformability"],"prefix":"10.3389","volume":"16","author":[{"given":"Marijke","family":"Grau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Bruns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"St\u00fccher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"John","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Munk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Siebers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Siebers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelm","family":"Bloch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Bizjak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2007","DOI":"10.1113\/EP088548","article-title":"Physiological sex differences affect the integrative response to exercise: acute and chronic implications","volume":"105","author":"Ansdell","year":"2020","journal-title":"Exp. Physiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"43","DOI":"10.2147\/OAJSM.S97468","article-title":"Changes in blood biochemical markers before, during, and after a 2-day ultramarathon","volume":"7","author":"Arakawa","year":"2016","journal-title":"Open Access J. Sports Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"887","DOI":"10.3390\/nu13030887","article-title":"Rehydration during endurance exercise: challenges, research, options, methods","volume":"13","author":"Armstrong","year":"2021","journal-title":"Nutrients"},{"key":"B4","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1055\/s-2003-44551","article-title":"Blood rheology and hemodynamics","volume":"29","author":"Baskurt","year":"2003","journal-title":"Seminars Thrombosis Hemostasis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1016\/j.jshs.2019.02.002","article-title":"Does endurance training improve red blood cell aging and hemorheology in moderate-trained healthy individuals?","volume":"9","author":"Bizjak","year":"2020","journal-title":"J. Sport Health Sci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.3390\/metabo12111138","article-title":"Running for your life: metabolic effects of a 160.9\/230 km non-stop ultramarathon race on body composition, inflammation, heart function, and nutritional parameters","volume":"12","author":"Bizjak","year":"2022","journal-title":"Metabolites"},{"key":"B7","doi-asserted-by":"publisher","first-page":"H1577","DOI":"10.1152\/ajpheart.00665.2002","article-title":"Effects of nitric oxide on red blood cell deformability","volume":"284","author":"Bor-Kucukatay","year":"2003","journal-title":"Am. J. Physiology. Heart Circulatory Physiology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"14275","DOI":"10.3390\/ijms232214275","article-title":"The influence of circadian rhythm on the activity of oxidative stress enzymes","volume":"23","author":"Budkowska","year":"2022","journal-title":"Int. J. Mol. Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1249\/MSS.0000000000003653","article-title":"Effects of three different distance\/elevation gain ultra-trail races on red blood cell oxidative stress and senescence, and blood rheology","volume":"57","author":"Carin","year":"2025","journal-title":"Med. Sci. Sports Exerc."},{"key":"B10","doi-asserted-by":"publisher","first-page":"353","DOI":"10.2165\/00007256-200737040-00020","article-title":"Fluid replacement and performance during the marathon","volume":"37","author":"Cheuvront","year":"2007","journal-title":"Sports Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1182\/blood.v61.5.899.bloodjournal615899","article-title":"Osmotic gradient ektacytometry: comprehensive characterization of red cell volume and surface maintenance","volume":"61","author":"Clark","year":"1983","journal-title":"Blood"},{"key":"B12","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1475-2891-12-13","article-title":"Water and sodium intake habits and status of ultra-endurance runners during a multi-stage ultra-marathon conducted in a hot ambient environment: an observational field based study","volume":"12","author":"Costa","year":"2013","journal-title":"Nutr. J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1055\/s-2008-1026073","article-title":"Effects of ultra-marathon training and racing on hematologic parameters and serum ferritin levels in well-trained athletes","volume":"3","author":"Dickson","year":"1982","journal-title":"Int. J. Sports Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1177\/036354659202000221","article-title":"Effect of shoe cushioning on the development of reticulocytosis in distance runners","volume":"20","author":"Dressendorfer","year":"1992","journal-title":"Am. J. Sports Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1136\/bjsm.33.1.27","article-title":"Changes in haematological parameters and iron metabolism associated with a 1600 kilometre ultramarathon","volume":"33","author":"Fallon","year":"1999","journal-title":"Br. J. Sports Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1080\/00913847.1983.11708609","article-title":"Hematological variations after endurance running with hard-and soft-soled running shoes","volume":"11","author":"Falsetti","year":"1983","journal-title":"Physician Sportsmed."},{"key":"B17","article-title":"Statistic","year":"","journal-title":"News release"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3791\/64843","article-title":"Immunostaining-based detection of dynamic alterations in red blood cell proteins","author":"Grau","year":"2023","journal-title":"J. Vis. Exp. JoVE"},{"key":"B19","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.jchromb.2007.02.002","article-title":"Recent methodological advances in the analysis of nitrite in the human circulation: nitrite as a biochemical parameter of the L-arginine\/NO pathway","volume":"851","author":"Grau","year":"2007","journal-title":"J. Chromatogr. B, Anal. Technol. Biomed. Life Sci."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e56759","DOI":"10.1371\/journal.pone.0056759","article-title":"RBC-NOS-dependent S-nitrosylation of cytoskeletal proteins improves RBC deformability","volume":"8","author":"Grau","year":"2013","journal-title":"PLoS ONE"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1835","DOI":"10.3389\/fphys.2018.01835","article-title":"Comparisons of blood parameters, red blood cell deformability and circulating nitric oxide between males and females considering hormonal contraception: a longitudinal gender study","volume":"9","author":"Grau","year":"2018","journal-title":"Front. Physiology"},{"key":"B22","doi-asserted-by":"publisher","first-page":"47","DOI":"10.3390\/biology10010047","article-title":"Sub-fractions of red blood cells respond differently to shear exposure following superoxide treatment","volume":"10","author":"Grau","year":"2021","journal-title":"Biology"},{"key":"B23","first-page":"1","article-title":"The Laser-assisted optical rotational cell analyzer (LORCA) as red blood cell aggregometer","volume":"25","author":"Hardeman","year":"2001","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"B24","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1055\/s-0028-1112144","article-title":"Changes of ROS during a two-day ultra-marathon race","volume":"30","author":"Hattori","year":"2009","journal-title":"Int. J. Sports Med."},{"key":"B25","volume-title":"Hematology: basic principles and practice","author":"Hoffman","year":"2018"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.3389\/fphys.2019.01300","article-title":"Physiological and pathophysiological responses to ultramarathon running in non-elite runners","volume":"10","author":"Hoppel","year":"2019","journal-title":"Front. Physiology"},{"key":"B27","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3390\/life11010036","article-title":"Shear stress and RBC-NOS Serine1177 phosphorylation in humans: a dose response","volume":"11","author":"Horobin","year":"2021","journal-title":"Life"},{"key":"B28","doi-asserted-by":"publisher","first-page":"656","DOI":"10.3389\/fphys.2018.00656","article-title":"Squeezing for life - properties of red blood cell deformability","volume":"9","author":"Huisjes","year":"2018","journal-title":"Front. Physiology"},{"key":"B29","doi-asserted-by":"publisher","first-page":"801","DOI":"10.13075\/ijomeh.1896.00610","article-title":"Changes in blood morphology and chosen biochemical parameters in ultra-marathon runners during a 100-km run in relation to the age and speed of runners","volume":"29","author":"Jastrz\u0119bski","year":"2016","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1111\/j.1749-6632.1998.tb09896.x","article-title":"Oxidative stress and aging. Role of exercise and its influences on antioxidant systems","volume":"854","author":"Ji","year":"1998","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"B31","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/JSM.0b013e31815cdd37","article-title":"Athletic performance and serial weight changes during 12- and 24-hour ultra-marathons","volume":"18","author":"Kao","year":"2008","journal-title":"Clin. J. Sport Med."},{"key":"B32","doi-asserted-by":"crossref","DOI":"10.5772\/50698","article-title":"Measurement techniques for red blood cell deformability: recent advances","volume-title":"Blood cell: an overview of studies in hematology","author":"Kim","year":"2012"},{"key":"B33","doi-asserted-by":"publisher","first-page":"52","DOI":"10.20463\/pan.2023.0029","article-title":"Effects of exercise timing and intensity on physiological circadian rhythm and sleep quality: a systematic review","volume":"27","author":"Kim","year":"2023","journal-title":"Phys. Activity Nutr."},{"key":"B34","doi-asserted-by":"publisher","first-page":"2943","DOI":"10.1182\/blood-2005-10-3992","article-title":"Red blood cells express a functional endothelial nitric oxide synthase","volume":"107","author":"Kleinbongard","year":"2006","journal-title":"Blood"},{"key":"B35","doi-asserted-by":"publisher","first-page":"634","DOI":"10.3389\/fphys.2018.00634","article-title":"Physiology and pathophysiology in ultra-marathon running","volume":"9","author":"Knechtle","year":"2018","journal-title":"Front. Physiology"},{"key":"B36","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.niox.2022.09.004","article-title":"Nitric oxide bioavailability for red blood cell deformability in the microcirculation: a review of recent progress","volume":"129","author":"Kobayashi","year":"2022","journal-title":"Nitric Oxide Biol. Chem."},{"key":"B37","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1161\/CIRCULATIONAHA.110.938852","article-title":"Exercise capacity and mortality in older men: a 20-year follow-up study","volume":"122","author":"Kokkinos","year":"2010","journal-title":"Circulation"},{"key":"B38","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3233\/BIR-16121","article-title":"Impact of training volume and intensity on RBC-NOS\/NO pathway and endurance capacity","volume":"54","author":"Koliamitra","year":"2017","journal-title":"Biorheology"},{"key":"B39","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3390\/thalassrep13010007","article-title":"New-generation ektacytometry study of red blood cells in different hemoglobinopathies and thalassemia","volume":"13","author":"Krishnevskaya","year":"2023","journal-title":"Thalass. Rep."},{"key":"B40","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3389\/fphys.2019.00036","article-title":"Shear stress ameliorates superoxide impairment to erythrocyte deformability with concurrent nitric oxide synthase activation","volume":"10","author":"Kuck","year":"2019","journal-title":"Front. Physiology"},{"key":"B41","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s12970-020-00364-7","article-title":"Analysis of food and fluid intake in elite ultra-endurance runners during a 24-h world championship","volume":"17","author":"Lavou\u00e9","year":"2020","journal-title":"J. Int. Soc. Sports Nutr."},{"key":"B42","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1007\/BF02388332","article-title":"Effect of prolonged physical exercise on intra-erythrocyte and plasma potassium","volume":"59","author":"Lijnen","year":"1989","journal-title":"Eur. J. Appl. Physiology Occup. Physiology"},{"key":"B43","doi-asserted-by":"publisher","first-page":"377","DOI":"10.2450\/2012.0167-11","article-title":"Foot-strike haemolysis after a 60-km ultramarathon","volume":"10","author":"Lippi","year":"2012","journal-title":"Blood Transfus. = Trasfus. del sangue"},{"key":"B44","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.jcma.2017.09.011","article-title":"The changes of red blood cell viscoelasticity and sports anemia in male 24-hr ultra-marathoners","volume":"81","author":"Liu","year":"2018","journal-title":"J. Chin. Med. Assoc. JCMA"},{"key":"B45","doi-asserted-by":"publisher","first-page":"332","DOI":"10.3389\/fphys.2013.00332","article-title":"Red blood cells in sports: effects of exercise and training on oxygen supply by red blood cells","volume":"4","author":"Mairb\u00e4url","year":"2013","journal-title":"Front. Physiology"},{"key":"B46","doi-asserted-by":"publisher","first-page":"191","DOI":"10.3109\/10715769309111602","article-title":"Changes in plasma antioxidant status during eccentric exercise and the effect of vitamin supplementation","volume":"19","author":"Maxwell","year":"1993","journal-title":"Free Radic. Res. Commun."},{"key":"B47","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1111\/aor.12997","article-title":"Oxidative stress increases erythrocyte sensitivity to shear-mediated damage","volume":"42","author":"McNamee","year":"2018","journal-title":"Artif. Organs"},{"key":"B48","doi-asserted-by":"publisher","first-page":"3392","DOI":"10.3390\/ijms24043392","article-title":"Circadian rhythms disrupted by light at night and mistimed food intake alter hormonal rhythms and metabolism","volume":"24","author":"Mel\u00e9ndez-Fern\u00e1ndez","year":"2023","journal-title":"Int. J. Mol. Sci."},{"key":"B49","doi-asserted-by":"publisher","first-page":"67","DOI":"10.4103\/aca.ACA_157_18","article-title":"Descriptive statistics and normality tests for statistical data","volume":"22","author":"Mishra","year":"2019","journal-title":"Ann. Cardiac Anaesth."},{"key":"B50","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3389\/fphys.2014.00084","article-title":"Red blood cell oxidative stress impairs oxygen delivery and induces red blood cell aging","volume":"5","author":"Mohanty","year":"2014","journal-title":"Front. Physiology"},{"key":"B51","doi-asserted-by":"publisher","first-page":"896","DOI":"10.3390\/ijms22020896","article-title":"Acute cycling exercise induces changes in red blood cell deformability and membrane lipid remodeling","volume":"22","author":"Nemkov","year":"2021","journal-title":"Int. J. Mol. Sci."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.3390\/nu10121995","article-title":"Nutrition in ultra-endurance: state of the art","volume":"10","author":"Nikolaidis","year":"2018","journal-title":"Nutrients"},{"key":"B53","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1038\/nature09702","article-title":"Circadian clocks in human red blood cells","volume":"469","author":"O'Neill","year":"2011","journal-title":"Nature"},{"key":"B54","doi-asserted-by":"publisher","first-page":"131","DOI":"10.5507\/bp.2011.027","article-title":"Biomarkers of oxidative stress in red blood cells","volume":"155","author":"Pandey","year":"2011","journal-title":"Biomed. Pap. Med. Fac. Univ. Palacky, Olomouc, Czechoslov."},{"key":"B55","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.freeradbiomed.2006.05.001","article-title":"The measurement of blood and plasma nitrite by chemiluminescence: pitfalls and solutions","volume":"41","author":"Pelletier","year":"2006","journal-title":"Free Radic. Biol. Med."},{"key":"B56","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1055\/s-0035-1555929","article-title":"Changes of hematological markers during a multi-stage ultra-marathon competition in the heat","volume":"37","author":"Rama","year":"2016","journal-title":"Int. J. Sports Med."},{"key":"B58","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.70252\/DFCX3206","article-title":"Differences between males and females in determining exercise intensity","volume":"13","author":"Rascon","year":"2020","journal-title":"Int. J. Exerc. Sci."},{"key":"B59","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1111\/j.1600-0838.2012.01481.x","article-title":"Hemolysis induced by an extreme mountain ultra-marathon is not associated with a decrease in total red blood cell volume","volume":"24","author":"Robach","year":"2014","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"B60","doi-asserted-by":"publisher","first-page":"8531","DOI":"10.3390\/ijms21228531","article-title":"Impact of trail running races on blood viscosity and its determinants: effects of distance","volume":"21","author":"Robert","year":"2020","journal-title":"Int. J. Mol. Sci."},{"key":"B61","doi-asserted-by":"publisher","first-page":"a029694","DOI":"10.1101\/cshperspect.a029694","article-title":"Health benefits of exercise","volume":"8","author":"Ruegsegger","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"B62","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1042\/bj2260545","article-title":"Hepatic thiol and glutathione efflux under the influence of vasopressin, phenylephrine and adrenaline","volume":"226","author":"Sies","year":"1985","journal-title":"Biochem. J."},{"key":"B63","doi-asserted-by":"publisher","first-page":"e71219","DOI":"10.1371\/journal.pone.0071219","article-title":"Exercise-induced blood lactate increase does not change red blood cell deformability in cyclists","volume":"8","author":"Simmonds","year":"2013","journal-title":"PLoS ONE"},{"key":"B64","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1111\/j.1365-2362.2007.01917.x","article-title":"Changes in free radical generation and antioxidant capacity during ultramarathon foot race","volume":"38","author":"Skenderi","year":"2008","journal-title":"Eur. J. Clin. Investigation"},{"key":"B65","doi-asserted-by":"publisher","first-page":"9","DOI":"10.2165\/00007256-199519010-00002","article-title":"Exercise, training and red blood cell turnover","volume":"19","author":"Smith","year":"1995","journal-title":"Sports Med."},{"key":"B66","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1519\/JSC.0000000000001584","article-title":"Variations in oxidative stress levels in 3 days Follow-up in ultramarathon Mountain race athletes","volume":"31","author":"Spanidis","year":"2017","journal-title":"J. Strength Cond. Res."},{"key":"B67","doi-asserted-by":"publisher","first-page":"655","DOI":"10.3390\/cimb47080655","article-title":"Redox homeostasis in red blood cells: from molecular mechanisms to antioxidant strategies","volume":"47","author":"Spinelli","year":"2025","journal-title":"Curr. Issues Mol. Biol."},{"key":"B68","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1179\/1351000214Y.0000000118","article-title":"Application of a new oxidation-reduction potential assessment method in strenuous exercise-induced oxidative stress","volume":"20","author":"Stagos","year":"2015","journal-title":"Redox Rep. Commun. Free Radic. Res."},{"key":"B69","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.niox.2008.10.004","article-title":"Intensive exercise induces changes of endothelial nitric oxide synthase pattern in human erythrocytes","volume":"20","author":"Suhr","year":"2009","journal-title":"Nitric Oxide Biol. Chem."},{"key":"B70","doi-asserted-by":"publisher","first-page":"e45982","DOI":"10.1371\/journal.pone.0045982","article-title":"Moderate exercise promotes human RBC-NOS activity, NO production and deformability through Akt kinase pathway","volume":"7","author":"Suhr","year":"2012","journal-title":"PLoS ONE"},{"key":"B71","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1152\/japplphysiol.00631.2001","article-title":"Footstrike is the major cause of hemolysis during running","volume":"94","author":"Telford","year":"2003","journal-title":"J. Appl. Physiology"},{"key":"B72","doi-asserted-by":"publisher","first-page":"503","DOI":"10.3233\/CH-189202","article-title":"Deformability of different red blood cell populations and viscosity of differently trained young men in response to intensive and moderate running","volume":"69","author":"Tomschi","year":"2018","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"B73","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1113\/jphysiol.1994.sp020077","article-title":"Effect of exercise intensity on potassium balance in muscle and blood of man","volume":"475","author":"V\u00f8llestad","year":"1994","journal-title":"J. Physiology"}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2025.1715513\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:14:23Z","timestamp":1763702063000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2025.1715513\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,21]]},"references-count":72,"alternative-id":["10.3389\/fphys.2025.1715513"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2025.1715513","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,21]]},"article-number":"1715513"}}