ReviewSports medicine (Auckland, N.Z.)2011
Can neuromuscular fatigue explain running strategies and performance in ultra-marathons?: the flush model.
Review in Sports medicine (Auckland, N.Z.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
88 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- The Role of Muscle Mass in Endurance Performance and Neuromuscular Fatigue: A Systematic Review and Meta-Analysis.Sports medicine (Auckland, N.Z.) · 2025Pooled it
- Global trends and hot topics in electrical stimulation of skeletal muscle research over the past decade: A bibliometric analysis.Frontiers in neurology · 2022Pooled it
- Differences in time to task failure and fatigability between children and young adults: A systematic review and meta-analysis.Frontiers in physiology · 2022Pooled it
- Correlation properties of heart rate variability during endurance exercise: A systematic review.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2020Pooled it
- Acute Effects of Sleep Extension on Fatigue, Inhibitory Control, Short-Term Vigilance and Neuromuscular Function in Youth Elite Ice Hockey Players: A Randomised Crossover Trial.Journal of sleep research · 2026Trial
- Influence of Trail Running Footwear Foam on Running Economy and Perceptual Metrics.European journal of sport science · 2025Trial
- Prior Band-Resisted Squat Jumps Improves Running and Neuromuscular Performance in Middle-Distance Runners.Journal of sports science & medicine · 2019Trial
- Effects of extreme-duration heavy load carriage on neuromuscular function and locomotion: a military-based study.PloS one · 2012Trial
- Trial
- Highly Trained Female Runners Show Greater Durability and Physiological Resilience Than Performance-Matched Male Counterparts.Scandinavian journal of medicine & science in sports · 2026Article
- Task Failure in Endurance Sports: A Review.Sports medicine (Auckland, N.Z.) · 2026Review
- Mental Pain Responses of Ultramarathon Runners: A Scoping Review.Sports (Basel, Switzerland) · 2026Review
- Downhill Running-Induced Muscle Damage in Trail Runners: An Exploratory Study Regarding Training Background and Running Gait.Sports (Basel, Switzerland) · 2026Article
- Effects of running distance on per-step and cumulative lower-extremity loading during a simulated treadmill half marathon.Frontiers in public health · 2026Article
- Identifying Fatigue-Related Gait Patterns Using Multiple Inertial Measurement Units and Statistical Parametric Mapping: A Continuous Analysis of an Outdoor Full Marathon in Male Recreational Runners.Sports medicine - open · 2025Article
- A Narrative Hypothesis: The Important Role of Gut Microbiota in the Modulation of Effort Tolerance in Endurance Athletes.Nutrients · 2025Review
- Influence of deception of task duration on the sex-specific physiological responses to RPE-clamp cycle ergometry.European journal of applied physiology · 2025Article
- The Flush Model: A Novel Framework to Manage Surgeons' Mental Fatigue and Cognitive Load.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Review
- Continuous vertical jump test is a reliable alternative to wingate anaerobic test and isokinetic fatigue tests in evaluation of muscular fatigue resistance in endurance runners.BMC sports science, medicine & rehabilitation · 2025Article
- Biomechanical Changes and the Time Course of Recovery in Lower Extremities of Recreational Runners Following a Simulated Treadmill Half-Marathon.Sports medicine - open · 2025Article
28 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
While the industrialized world adopts a largely sedentary lifestyle, ultra-marathon running races have become increasingly popular in the last few years in many countries. The ability to run long distances is also considered to have played a role in human evolution. This makes the issue of ultra-long distance physiology important. In the ability to run multiples of 10 km (up to 1000 km in one stage), fatigue resistance is critical. Fatigue is generally defined as strength loss (i.e. a decrease in maximal voluntary contraction [MVC]), which is known to be dependent on the type of exercise. Critical task variables include the intensity and duration of the activity, both of which are very specific to ultra-endurance sports. They also include the muscle groups involved and the type of muscle contraction, two variables that depend on the sport under consideration. The first part of this article focuses on the central and peripheral causes of the alterations to neuromuscular function that occur in ultra-marathon running. Neuromuscular function evaluation requires measurements of MVCs and maximal electrical/magnetic stimulations; these provide an insight into the factors in the CNS and the muscles implicated in fatigue. However, such measurements do not necessarily predict how muscle function may influence ultra-endurance running and whether this has an effect on speed regulation during a real competition (i.e. when pacing strategies are involved). In other words, the nature of the relationship between fatigue as measured using maximal contractions/stimulation and submaximal performance limitation/regulation is questionable. To investigate this issue, we are suggesting a holistic model in the second part of this article. This model can be applied to all endurance activities, but is specifically adapted to ultra-endurance running: the flush model. This model has the following four components: (i) the ball-cock (or buoy), which can be compared with the rate of perceived exertion, and can increase or decrease based on (ii) the filling rate and (iii) the water evacuated through the waste pipe, and (iv) a security reserve that allows the subject to prevent physiological damage. We are suggesting that central regulation is not only based on afferent signals arising from the muscles and peripheral organs, but is also dependent on peripheral fatigue and spinal/supraspinal inhibition (or disfacilitation) since these alterations imply a higher central drive for a given power output. This holistic model also explains how environmental conditions, sleep deprivation/mental fatigue, pain-killers or psychostimulants, cognitive or nutritional strategies may affect ultra-running performance.
Indexed as
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.