Physical activity is preventative against all-cause mortality, but there is growing evidence that ultra-endurance running (UER) may have pathological implications for multiple body systems.

In susceptible individuals, the most noteworthy maladaptations occur in the cardiovascular system (particularly right ventricular dysfunction), and the renal and musculoskeletal systems.

More epidemiological studies with larger cohorts are needed to better elucidate the complex pathophysiology of long-term health problems in UER.