Little is known about coping in individuals who experience pain in other contexts and whether coping impacts outcomes in the same way. This literature, however, is based primarily on populations with painful injuries and illnesses. The described pattern of intake and macronutrient quantities were positively appraised by the five runners.An important and substantial body of literature has established that maladaptive and adaptive coping strategies significantly impact pain-related outcomes. Final classification of the runners ranged from 11th to 175th of 970 finishers in 2013, and 132nd of 805 in 2011. Key issues encountered by runners included difficulty consuming foods due to dry mouth, and unpalatability of sweet foods (energy gels, sports drinks) when heated in the sun. During-stage carbohydrate intake was 42 (20–64) g/hour. Fluid consumption was ad libitum with no symptoms or medical treatment required for dehydration or hyponatremia. Planned energy (13,550 (10,323–18,142) kJ/day), protein (1.3 (0.8–1.8) g/kg/day), and carbohydrate (6.2 (4.3–9.2) g/kg/day) intakes on the fully self-sufficient days were slightly below guideline recommendations, due to the need to balance nutritional needs with food mass to be carried. Competitors are required to carry all equipment and food (except water) for the race duration, a minimum of 8,360 kJ/day and total pack weight of 6.5–15 kg. MdS is a 7-day, six-stage ultra-running stage race held in the Sahara Desert (total distance of timed stages 1–5 was 233.2 km in 2011, 223.4 km in 2013). This case study describes the nutrition plans, intakes and experiences of five ultra-marathon runners who completed the Marathon des Sables in 20 age 37 (28–43) y, height 184 (180–190) cm, body mass 77.5 (71–85.5) kg, marathon personal best 3:08 (2:40–3:32).
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