The Science of Suffering: Endurance Athletes Inform Personalized Care for Trauma and Cancer Patients

Biochemistry professor uses ultramarathons as a laboratory to study parallels between elite athletes and patients

7 minute read

by Kelsea Pieters | September 12, 2025 - from https://news.cuanschutz.edu/news-stories/the-science-of-suffering-endurance-athletes-inform-personalized-care-for-trauma-and-cancer-patients

Ultrarunners, trauma patients and cancer patients. In the ways their bodies undergo a profound energy crisis – self-inflicted in one case, sudden or prolonged calamity in the others – researchers are gaining insights into dynamic responses in the blood.

It is hoped that the “omics-performance” data from the athletes, through real-time blood draws at ultramarathons and cycling races, will translate into tailored, personalized treatments for the patients. The science is based on a cutting-edge assessment of thousands of molecules in the blood – the collective measurement of which is termed “omics” – that combine to create a molecular signature of energy systems, damage, inflammation and recovery.

So far, with CU Anschutz researchers at the forefront, studies show that the same metabolic pathways that help an elite athlete manage energy, inflammation and tissue repair can be targeted to help a patient regain strength after chemotherapy, surgery and traumatic injury.

“If we can understand how resilient bodies manage deep stress, we can help vulnerable patients during their treatments and recoveries,” said Travis Nemkov, PhD, associate professor of biochemistry and molecular genetics at the CU Anschutz School of Medicine.

Mountains turn into living laboratory

The Colorado mountains outside of Steamboat Springs have provided a living, high-exertion laboratory for Nemkov. He has enlisted ultrarunners, including two CU Anschutz faculty members, to be test cases for how the human body breaks down, adapts and rebuilds.

Nemkov studies this rupture-to-repair biological cycle in bodies being pushed to extremes. His elite-athlete subjects have included cyclists at the Tour de France and runners at the Ultra-Trail du Mont-Blanc (UTMB), a more than 100-mile trail race with nearly 30,000 feet of elevation change through the Alps of Italy, France and Switzerland. In 2019, Nemkov’s team examined blood samples of 12 UTMB racers before, during and after the race.

Their analysis showed that the ultrarunners’ blood began to display inflammatory signatures that looked similar to trauma patients. After those studies in Europe, Nemkov looked for a closer-to-home venue to expand this research, getting help from CU Anschutz colleagues and ultramarathoners Mitch Cohen, MD, Anthony Saviola, PhD, and Ryan Marker, PhD.

Scaling up near Rabbit Ears Pass

At the 2024 Run Rabbit Run ultramarathons – 100- and 50-mile races – Nemkov found the perfect fit for scaling up his data collections. The event’s proximity and community’s buy-in were bonuses. His team was hoping to double the size of their UTMB study and instead saw nearly 150 racers, including Cohen and Saviola, volunteer to participate on the first day of recruitment.

“I was hallucinating, seeing bears at the finish line, completely drained. The data said I was in a deficit. It was wild to see science reflect exactly how I felt.”– Anthony Saviola, PhD

Nemkov’s team also implemented a new blood sample-gathering platform that stores dried blood without the cumbersome requirement of dry ice. Thanks to funding support and CU Anschutz partnerships with the Specialized Center of Research Excellence (SCORE) on Sex Differences, the Colorado Nutrition Obesity Research Center (NORC) and the BfitBwell Cancer Exercise Program directed by Marker, his team created a protocol and gained Institutional Review Board approval to recruit athletes for a more in-depth analysis of what happens to their bodies throughout competition.

The runners provided blood samples before, during and after the race to offer a robust assessment of omics-performance: examining thousands of metabolites, fats and proteins. On top of that, nearly 60 participants mailed back a sample 24 hours after finishing, and both Saviola and Cohen hand-delivered Nemkov samples 48 and 72 hours later as well. The combined data offered a molecular look at exertion, fatigue, damage and recovery associated with running ultramarathons.

Two-fold information

“The usefulness of the results are two-fold,” Nemkov said. “First, we homed in on signatures of endurance, fuel use and fatigue, which will help us implement better care for patients across our medical community. Because this process required us to scale up our informatics and reporting capabilities, we can now routinely perform these types of analyses on increasingly large cohorts.”

Moreover, as a token of the team’s appreciation, every participant received a personalized, multi-page, detailed report of “everything that was happening within them as they raced and how they stacked up amongst other participants,” Nemkov said.

Feeling ‘under-trained’

For Cohen, a professor of surgery at the CU Anschutz School of Medicine, running an ultramarathon isn’t much different than treating a trauma patient. “You’re managing an energy crisis and doing whatever it takes to keep the system going,” said the trauma surgeon and veteran endurance athlete.

Joining him on the Steamboat trails last year was Saviola, an Assistant Professor of Biochemistry and Molecular Genetics. Saviola also has numerous ultra races under his belt, including the Cocodona 250, a 250-mile race from Black Canyon City to Flagstaff, Ariz.

Saviola trained by logging 70 to 80 miles and 15,000 to 20,000 feet of climbing per week with a focus on long, rolling runs to build sustained speed. “I wanted to see how far I could push myself,” he said.

Cohen, a veteran runner with several 100 mile finishes under his belt, entered last year’s race feeling “under-trained.” His weeks averaged 10 to 15 hours of running, heavy on the vertical climbs. “For me, ultras are like surgery: You troubleshoot, problem-solve and keep moving forward until it’s over.”

Tales of under-stress bodies

Both Cohen and Saviola delivered strong performances at last year’s Run Rabbit Run, but their bodies told different stories in the metabolic study. Saviola finished the 100-miler in 26.5 hours, placing as the 24^th male, and his “Omics Performance Score” showed that his body worked hard for the result.

“I was hallucinating, seeing bears at the finish line, completely drained,” he said. “The data said I was in a deficit. It was wild to see science reflect exactly how I felt.”

Cohen’s run, meanwhile, was hampered by sudden gastrointestinal distress that derailed his carefully planned fueling strategy. But his data showed something surprising. “Even though I wasn’t fueling well, I was mobilizing reasonable energy stores,” he said. “I had more in the tank than I thought. That’s the value of science: It tells you what your brain can’t.”

The findings gave Saviola ideas for refining his disciplined approach – “Now I want to train smarter,” he said – while Cohen walked away with a reaffirmed philosophy: that endurance is as much about adaptability as it is about mileage.

Striking parallels

Overall, data from last year’s race revealed striking parallels between the physiology of ultramarathoners and patients recovering from a major illness or injury. In some runners, inflammation began to spike after 24 to 36 hours of finishing the race, the same timeframe as people who have experienced a major physical trauma.

Those connections are more than academic. To carry out the Run Rabbit Run study, Nemkov teamed up with Marker, assistant professor and program director of BfitBwell, an exercise program for cancer survivors that uses this type of data to design personalized exercise plans. All training sessions in BfitBwell, offered through the CU Anschutz Health and Wellness Center, are tailored to the specific needs of the individual.

“Evidence continues to emerge that exercise is a potent strategy for improving treatment responses, symptom burden, and even survival in cancer survivors. Our hope is that we can use omics to help pinpoint how we prescribe exercise as a therapy for these individuals to maximize these benefits,” said Marker, who himself is a Run Rabbit Run alumnus of 2013. Understanding “healthy” fatigue in endurance athletes is now helping the team better understand cancer-related fatigue in survivors and how to tailor exercise prescriptions to remediate it.

So, no matter what energy drain happens to a patient – chemotherapy, traumatic injury or post-surgical recovery – molecular data provided by athletes pushing themselves to the literal mountaintop may inform more-tailored treatments.

“Our goal is to use what we learn from athletes to help patients recover stronger,” Nemkov said.