Introduction:
Health behaviors are essential for disease prevention in endurance sports. This study was to evaluate the level of health behaviors among marathon and ultramarathon runners and examined associations with sociodemographic, training, health, psychological, and motivational factors to determine independent predictors of health-promoting behaviors.

Material and methods:
A study was conducted among 1,432 long-distance runners participating in marathon and ultramarathon events in Poland. The final sample included 786 marathon runners and 646 ultramarathon runners, aged 18–73 years (40.1 ± 11.3 years). The study group comprised 367 women and 1,065 men. Data were collected using an original questionnaire and the standardized Health Behavior Inventory (HBI).

Results:
Most participants had completed 2–10 marathons (60.21%), with men showing better performance (p < 0.00001) and more frequent ultramarathon participation (p = 0.018). Pain during training was common (81.42%), and over half continued training despite symptoms. A moderate level of health behaviors predominated, with no differences between marathon and ultramarathon runners (p = 0.61), but higher levels in men (p = 0.004). In multivariable analysis, ultramarathon participation was not an independent predictor (p = 0.212), while higher HBI scores were associated with mental condition (p < 0.001), stress coping (p = 0.040), and health motivation (p < 0.001); male sex was associated with lower HBI (p = 0.003).

Conclusions:
Long-distance running does not automatically correspond to a high level of health-promoting behaviors. Despite positive self-rated health, the high prevalence of pain and continued training despite symptoms highlight the need for targeted educational strategies focusing on recovery management and on mental well-being, self-regulation, and health-oriented motivation.