The Relationship Between Psychological Stress and Anxiety with Gastrointestinal Symptoms Before and During a 56 km Ultramarathon Running Race

Abstract

Background: This study assessed relationships and sex differences between psychological state (recovery, stress, anxiety, and self-confidence) and gastrointestinal symptoms (GIS) prior to and during a 56 km ultramarathon running race and identified predictive factors of race GIS. Forty-four (26 males, 18 females) ultramarathon competitors completed anxiety, recovery, stress and GIS questionnaires for three days prior to the race and immediately pre-race. Race GIS were assessed immediately post-race. Spearman's rank order, Mann-Whitney U tests and regression analyses were used to determine correlations and identify sex differences between psychological state and GIS and determine predictors of race GIS.

Results: Race GIS were significantly correlated with recovery (r_s = - 0.381, p = 0.011), stress (r_s = 0.500, p = 0.001) and anxiety (r_s = 0.408, p = 0.006), calculated as the mean of the three days preceding the race and on race morning. The correlation between anxiety and GIS was strongest in the 24 h immediately prior to the race (all r_s > 0.400, and all p < 0.05), but unclear patterns were identified for stress and recovery. Regression analyses showed 36% and 40% of variation in the severity and number of race GIS was accounted for by body mass and measures of stress, anxiety, and GIS over the three days preceding the race and on race morning (both p < 0.001). There were no sex differences in the number and severity of GIS leading up to or during the race (all p > 0.05), however, females reported greater state anxiety (p = 0.018) and lower self-confidence than males (p = 0.006) over the three days preceding the race and on race morning.

Conclusion: Endurance athletes that experience GIS during competition should investigate elevated stress and/or anxiety as a potential contributor and identify if management strategies can reduce the occurrence and severity of GIS.

Keywords: Competitive anxiety; Competitive stress; Endurance exercise; Gastrointestinal discomfort.

Fig. 1

Schematic of the protocols conducted throughout this study. CSAI-2, Competitive State Anxiety Inventory-2; SRSS, Short Recovery and Stress Scale. Screening and training status assessment included the following measurements: height (cm), body mass (kg), age (years), biological sex, training history (years of experience), weekly training volume (hours per week)

Fig. 2

Correlation with gastrointestinal symptoms (GIS) in the days prior to a 56 km Ultramarathon running race. Correlation (Spearman’s rho) between recovery (A), stress (B) and total anxiety (C) with number and severity of GIS over the 3 days prior to (T-3, T-2, T-1) and on the morning of (T0) a 56 km Ultramarathon running race (all n = 44). *Statistically significant correlation between both number and severity of GIS with the relevant variable (p < 0.05)