New Delhi, Sept. 4 -- The pace had been steady over the initial 10km of the Trofeo Kima, a 52km trail race in Italy. Kieren D'Souza arrived at the second aid station and stocked up on nutrition. He then took a moment to strap on a helmet that would be essential over the next 30-odd kilometres. Rockfall was just one of the many hazards he was up against last month.

The profile of the race seems deceptive-a trail ultramarathon with 4,200 metres of elevation gain that climbs as high as 2,950 metres. It requires experience and ability in equal measure. But beyond running, it demands skills to navigate technical sections on rock and slab, and a big heart to handle the exposure.

"As you climb, certain sections need you to be on all fours. And...