Mindfulness-Based Interventions for Ultra-Trail Running: A Narrative Review of Mechanisms, Applications, and Future Directions

Abstract:

Objectives: Ultra-trail running presents unique psychological challenges, including prolonged pain, cognitive fatigue, and emotional volatility across events exceeding 42.195 km and/or lasting more than 6 hr. Given increasing attention to mental health concerns in ultra-endurance runners, this review synthesized evidence on whether mindfulness-based interventions may support both performance optimization and psychological well-being in this growing athletic domain.

Methods: We conducted a narrative integrative review synthesizing literature from six databases (1988–2024) across three domains: (1) conceptualizing ultra-trail performance beyond physiological factors; (2) examining the effects of mindfulness-based interventions (MBIs) on sport-relevant psychological mechanisms; and (3) developing evidence-informed recommendations for ultra-trail-specific adaptations. The review followed the Scale for the Assessment of Narrative Review Articles (SANRA) scale principles for methodological rigor.

Results: Our synthesis suggested that mechanisms targeted by mindfulness-based training may map onto key ultra-trail demands, potentially supporting executive functions (including working memory), emotion regulation, flow-related processes, and pain-related appraisal. Four evidence-based protocols provide frameworks that can be adapted to ultra-endurance contexts. Key implementation strategies include progressive periodization, sport-specific techniques, individualized mindfulness menus for different race phases, and a dual focus on performance and well-being. Practical applications emphasize creating supportive coaching environments and using technology for progress monitoring. However, direct research in ultra-trail populations is limited, and methodological heterogeneity limits definitive conclusions.

Conclusions: MBIs represent a promising dual-purpose approach for ultra-trail athletes, potentially enhancing performance while protecting mental health. Future research should prioritize feasibility studies, randomized controlled trials with sport-specific outcomes, and longitudinal investigations. Systematic adaptation following established frameworks could develop validated mindfulness interventions addressing the unique intersection of extreme physical demands and psychological resilience in ultra-endurance sports. Preregistration: This study is not preregistered.