Associations of cardiac autonomic modulation and urinary adrenal hormones with marathon finishing time in middle-aged male athletes
9 affiliations
- 1Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
- 2Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- 3Department of Sports Medicine, Semmelweis University, Budapest, Hungary
- 4Department of Medicine DIMED, University of Padova, Padua, Italy
- 5Laboratory Medicine Unit, University Hospital of Padova, Padua, Italy
- 6Unit of Endocrinology, University-Hospital of Padova, Padua, Italy
- 7Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- 8Department of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023–2027, University of Milan, Milan, Italy
- 9Ospedale Riabilitativo di Alta Specializzazione (ORAS), Motta di Livenza, Italy
Abstract
Background: The autonomic nervous and endocrine systems are involved in the physiological adaptation to exercise, and in experimental settings both the sympathovagal balance and the adrenal function are associated with athletic performance. In this real-life field study, the association between non-invasive markers of cardiac autonomic modulation, urinary adrenal hormone levels, and marathon finishing time in middle-aged Caucasian male athletes was investigated.
Methods: A prospective study was conducted in male marathon runners aged ≥30 years. Continuous single-lead electrocardiographic (ECG) recordings were obtained using a wearable chest device from the day before the marathon until after its completion. Urinary adrenal hormone levels were measured before and after the race. Univariate linear regression analyses were performed to correlate general characteristics, nocturnal heart rate variability (HRV) parameters, and hormonal parameters with marathon finishing time. A multivariable model was then applied including age, body mass index (BMI), and training hours.
Results: 104 athletes were enrolled in the study and 73 (median age 48 years, interquartile range = 16) had adequate data quality for the final analysis. Several HRV parameters correlated with better performance at univariate analysis; lower minimum nocturnal heart rate and vagal predominance, expressed as higher 2 Like Variations (2LV) values remained independently associated with shorter finishing time. Among hormonal variables, the post-/pre-race ratio of urinary normetanephrine hourly output and cortisol/cortisone ratio remained significant at multivariable analysis. Only BMI, but not age and training history, remained significant in a model integrating HRV and hormones.
Conclusions: Under real-world marathon conditions, specific HRV indices and endocrine markers showed promising value as indicators of physiological readiness with endurance exercise in male master athletes.
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BibTeX
@article{antoni2026associations,
title = {{Associations of cardiac autonomic modulation and urinary adrenal hormones with marathon finishing time in middle-aged male athletes}},
author = {Amedeo De Antoni and Lucia Silvia Giobbi and Sergei Bondarev and Martina Calligione and Francesca Graziano and Simone Ungaro and Matteo Pizzolato and Alessandro Gianni and Giulia Pivetta and Lorenzo Da Rin De Monego and Girolamo Architetto and Giorgia Antonelli and Giovanna Tretti and Filippo Ceccato and Angelica Carandina and Ludovico Furlan and Greta Salafia and Francesca Magna and Thais Marques da Silva and Martina Montagnana and Nicola Montano and Alessandro Zorzi and Eleonora Tobaldini},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1932814},
url = {https://doi.org/10.3389/fcvm.2026.1932814},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Associations of cardiac autonomic modulation and urinary adrenal hormones with marathon finishing time in middle-aged male athletes
AU - Amedeo De Antoni
AU - Lucia Silvia Giobbi
AU - Sergei Bondarev
AU - Martina Calligione
AU - Francesca Graziano
AU - Simone Ungaro
AU - Matteo Pizzolato
AU - Alessandro Gianni
AU - Giulia Pivetta
AU - Lorenzo Da Rin De Monego
AU - Girolamo Architetto
AU - Giorgia Antonelli
AU - Giovanna Tretti
AU - Filippo Ceccato
AU - Angelica Carandina
AU - Ludovico Furlan
AU - Greta Salafia
AU - Francesca Magna
AU - Thais Marques da Silva
AU - Martina Montagnana
AU - Nicola Montano
AU - Alessandro Zorzi
AU - Eleonora Tobaldini
PY - 2026
DA - 2026/10/12
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1932814
UR - https://doi.org/10.3389/fcvm.2026.1932814
AB - Background: The autonomic nervous and endocrine systems are involved in the physiological adaptation to exercise, and in experimental settings both the sympathovagal balance and the adrenal function are associated with athletic performance. In this real-life field study, the association between non-invasive markers of cardiac autonomic modulation, urinary adrenal hormone levels, and marathon finishing time in middle-aged Caucasian male athletes was investigated. Methods: A prospective study was conducted in male marathon runners aged ≥30 years. Continuous single-lead electrocardiographic (ECG) recordings were obtained using a wearable chest device from the day before the marathon until after its completion. Urinary adrenal hormone levels were measured before and after the race. Univariate linear regression analyses were performed to correlate general characteristics, nocturnal heart rate variability (HRV) parameters, and hormonal parameters with marathon finishing time. A multivariable model was then applied including age, body mass index (BMI), and training hours. Results: 104 athletes were enrolled in the study and 73 (median age 48 years, interquartile range = 16) had adequate data quality for the final analysis. Several HRV parameters correlated with better performance at univariate analysis; lower minimum nocturnal heart rate and vagal predominance, expressed as higher 2 Like Variations (2LV) values remained independently associated with shorter finishing time. Among hormonal variables, the post-/pre-race ratio of urinary normetanephrine hourly output and cortisol/cortisone ratio remained significant at multivariable analysis. Only BMI, but not age and training history, remained significant in a model integrating HRV and hormones. Conclusions: Under real-world marathon conditions, specific HRV indices and endocrine markers showed promising value as indicators of physiological readiness with endurance exercise in male master athletes.
SN - 2297-055X
ER -