Do recent deaths during races suggest marathon running is inherently dangerous?
The three tragic deaths during the Detroit Marathon this weekend highlight the risks in running a marathon. Daniel Langdon, 36, Rick Brown, 65, and Jon Fenlon, 26, were competing in the half marathon and died within 16minutes of each other. Jon Fenlon collapsed just after crossing the finish line in 1:53:37. Although this follows the death last week of a 23 year old male competing in the Baltimore marathon, runner reported deaths in marathons are rare with these being the first in the Detroit event since 1994.
A study by Donald Redelmeier and Ari Greenwald published in the British Medical Journal randomly selected 26 marathons in the US with more than 1000 participants and followed each for up to 30 years from 1975- 2004. This amounted to 750 marathons and 3,292,268 participants encompassing 14 million hours of exercise. Over the 30 years there were 26 sudden cardiac deaths equivalent to 0.8 per 100,000 participants. The typical participant with sudden cardiac death was a middle aged man (average age 41 years, 81% men). 5 deaths were in individuals who had previously completed a marathon, with the most common location of death at or within 1mile of the finish. The risk of sudden cardiac death equated to about 2 deaths per million hours of exercise.
Whether due to the increase in popularity of marathon events or the increase in previously inactive people ‘wanting to have a go at one’ the incidences of deaths in marathons have increased in recent years. Deaths during marathon events are generally due to 4 factors:
- Heart Disease - One of the common causes of death in marathon runners due to heart attacks brought about by underlying coronary artery disease. These attacks are brought on by a combination of the physical stress of the event combined with the person’s lack of cardiac fitness.
- Sudden Cardiac Death - On average 12 young people a week die from sudden cardiac death. In 2007 the 28 year old professional runner Ryan Shay collapsed during the Olympic marathon trials. Ryan was young and highly trained and had previously run 7 marathons. His autopsy reported the cause of death to be Cardiac arrhythmia due to cardiac hypertrophy, meaning abnormal beating due to an enlarged heart.
- Water Intoxication - This occurs when there is so much water in the body that it dilutes vital minerals such as salt to dangerous levels. It can lead to confusion, headaches and fatal swelling of the brain. In 2007 22yr old fitness instructor David Rogers died from hypomatraemia after completing the London Marathon.
- Heat stroke - This is brought about by extreme dehydration. Learning to regulate body heat is important, rehydrating efficiently without becoming intoxicated by too much fluids. In the 2005 Great North Run half marathon four male runners died due to heat related illnesses.
Of the 24 autopsy reports available in Redelmeier’s study there were 21 cases of atherosclerosis, contributing factors included (2) coronary anomalies, (4) electrolyte abnormalities and (1) heat stroke.
People should not be discouraged from running full or half marathons as the health benefits of regular exercise by millions of people out weigh the tragic sudden deaths of a few participants. Whilst some deaths are medically related, a number of people who require emergency medical attention do so because they do not respect the marathon event.
My first marathon should have been a Golden Bond place in the London Marathon. The day before the race I awoke to my entire body and face swollen and red. A visit to the doctor revealed I just had a virus or allergic reaction to something and was advised not to run as I would be putting added to strain on my body attempting to complete a marathon while fighting an infection. Whilst being bitterly disappointed in missing the race I was persuaded that by running I was not only risking my own health but those of other runners if the medical teams had to treat me rather than another casualty. Three weeks later I was able to successfully run a different marathon, collect sponsorship for my chosen charity and I got a ballot place for London the following year.
Celebrities such as Katie Price being praised for completing the race whilst still suffering from the effects of a miscarriage days earlier or Jade Goody admitting to have done no training but congratulated for making it to mile 18, just suggest to the public who ‘fancy a go’ that the marathon is not too much of a physical challenge and doesn’t need to be taken seriously. Thankfully there are celebrities such as Nell McAndrew and Gordon Ramsey who show commitment to their training, health and race performance.
Whilst deaths associated with marathons are rare, if anything can be done to reduce them even more, it should be implemented. In Italy before participating in a marathon runners are required to complete a medical sports fitness test including an electrocardiogram (ECG). Although it may seem an expensive inconvenience if this was extended to other countries this may identify those at risk of cardiac related conditions and save lives. Additionally if required to provide evidence that you have trained sufficiently or participated in at least a half marathon, runners will have at least experienced some physical stress of endurance exercise and had the chance to learn how to deal with heat and efficiently rehydrate.
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