Background: In previous studies, ultra-endurance performance has been associated with training and psychological variables. However, performance under extreme conditions is understudied, mainly due to difficulties in making field measures. Aim: The aim of this study was to analyze the role of training, hydration, nutrition, oral health status, and stress-related psychological factors in athletes’ performance in ultra-endurance mountain events. Methods: We analyzed the variables of race time and training, hydration state, nutrition, oral health status, and stress-related psychological factors in 448 ultra-endurance mountain race finishers divided into three groups according to race length (less than 45 km, 45–90 km, and greater than 90 km), using a questionnaire. Results: Higher performance in ultra-endurance mountain races was associated with better oral health status and higher accumulative altitude covered per week as well as higher positive accumulative change of altitude per week during training. In longer distance races, experience, a larger volume of training, and better hydration/nutrition prior to the competition were associated with better performance. Conclusions: Ultra-endurance mountain athletes competing in longer races (>90 km) have more experience and follow harder training schedules compared with athletes competing in shorter distances. In longer races, a larger fluid intake before the competition was the single best predictor of performance. For races between 45 and 90 km, training intensity and volume were key predictors of performance, and for races below 45 km, oral health status was a key predictor of performance. Psychological factors previously reported as ultra-endurance mountain race performance predictors were inconsistent or failed to predict the performance of athletes in the present research.
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