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, Tom Audenshaw 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.

Athletes are such a group of people who you would think would pay more attention to their body. In 1996 spending on supplements in US was $6.5 billion and in 2002 was $18 billion with sports nutritional products making up one third of sales, so sports supplements are a huge market.

It was interesting to read a recent study in the Singapore Medical Journal, which examined the use of nutritional supplements by university athletes in Singapore. As most studies have focused on Caucasian populations, this study looked at university students in Asia, who would be highly educated with access to scientific literature, yet also exposed to traditional herbal products since birth. Over 75% of the 82 athletes questioned used supplements, consuming on average up to 3 products a day. The most popular products included sports drinks (90%), vitamin C (49%) multivitamins (30%) and glucosamine (20%). Over 90% of the athletes were Chinese which could explain why other popular products were traditional/herbal preparations such as essence of chicken (11%), edible birds nest (11%), and ginseng. Interestingly only one athlete took creatine. Similar to studies of their peers in the West, the most popular products were sports drinks and vitamin/mineral supplements. However, whilst the majority of Western university females reportedly consume supplements for general health benefits and male athletes aim to enhance sporting performance, all but one of the Singapore students consumed supplements for health benefits. This could be because elite sports aren’t as prestigious as in the West. You could speculate that some of those taking supplements for sports may be ignorant or blasé to the risks if they are intent on enhancing sporting performance. But surprisingly in this study, it is the university educated people taking supplements to improve their health, who don’t investigate the health risks of what they are consuming.

The study found that:

• 93% didn’t know where to obtain reliable information
• 86.4% unaware supplementation can have adverse health effects.
• More than 1/3 had no or minimal knowledge about the product they consumed
• Males were more likely than females (81% vs 52%) to research a product and those with more knowledge were more likely to use supplements.
• Before using 65.9% sought info from the media, internet, coaches and fellow athletes.
• The most frequent explaination (38.5%) for not seeking further information was that ‘the product must be safe since it is commonly available’

Whilst this study may have limitations, it is concerning that people are unaware of the health effects of their supplements, nor do they know where to get reliable information from. I agree with the conclusions of the authors, which should be taken on board by those taking supplements for either health benefits or sporting performance.

• Supplements with scientific evidence may only benefit specific athletes.
• Athletes must be aware of the additive or synergistic effects of the supplements.
• Endorsements by well known personalities fail to mention the long hours of training and sound nutrition which were responsible for their success.
• Whilst some products have sound scientific backing, many traditional/herbal preparations have not been validated by rigorous scientific investigation.
• Use supplements with caution and examine the product for safety, efficacy, potency and legality with a healthcare professional prior to use.

One man dies from prostate cancer every hour in the UK (10,000 each year). Prostate cancer is the most common cancer in men in the UK, with 35,000 men diagnosed with it every year in the UK although over 70% of newly diagnosed prostate cancer patients survive over 5 years.

What is prostate cancer?

In men the prostate gland lies underneath the bladder and its main job is to make most of the fluid that carries sperm. Prostate cancer can develop when cells in the prostate gland start to grow in an uncontrolled way. In most men prostate cancer grows slowly and may not cause any problems. But some prostate cancers grow quickly and need early treatment to stop or delay them from growing

What are the risk factors?

• Age: Most men diagnosed with prostate cancer are over 50, although more than 8 out of 10 cancer cases (85%) are diagnosed in men over the age of 60.
• Ethnicity: African Caribbean men are 3 times more likely to develop prostate cancer than white men.
• Family: 2 ½ times more likely to develop prostate cancer if your father or brother has had it.
• Diet: No one knows how to prevent prostate cancer but diet and a healthy active lifestyle may be important in protecting against the disease. A diet high in animal fat will increase your risk so you should eat more fruit and vegetables and maintain a healthy weight

What are the symptoms?

Some men with prostate cancer may have no symptoms at all although some symptoms may include:

• Weak or reduced urine flow
• Needing to urinate more often, especially at night
• A feeling your bladder has not emptied properly
• Difficulty starting to pass urine
• Needing to rush to the toilet
• New pain in the lower back, hips or pelvis
• Problems getting or keeping an erection
• Less commonly may experience pain when passing urine, ejaculating or in the testicles, or have blood in the urine or semen (but this is rare)

You don’t need to have all these symptoms to have prostate cancer nor does having some of these symptoms mean that you have it. Other prostate problems such as Benign Prostatic Hyperplasia (BPH) or prostatitis, which is caused by an infection of the gland have similar symptoms and the only way to know for sure to is go to your GP to get checked out.

What are the tests for prostate problems?

There are a few tests the doctor may carry out to find out if you have a prostate problem.

• A urine ‘dipstick’ test to check for infection
• A blood test called a prostate specific antigen test, to test for a protein produced by the prostate gland
• A physical examination
• Test to measure speed of urine flow
• Ultrasound scan to test whether your bladder is emptying properly

Your GP may do all or some of these tests or send you to see a urologist at the hospital who specialises in urinary problems

More information you can contact your doctor or the Prostate Cancer Charity either online www.prostate-cancer.org.uk or you can call their free and confidential helpline on 0800 074 8383.

Its estimated that every week, 12 young people lose their lives to sudden cardiac death in the UK. Whilst sport does not cause the problem of sudden death syndrome, it can exacerbate an existing undiagnosed condition and the high risk group is the young.  80% of those that die have had no discernible symptoms. The only way to identify those young people that are “asymptomatic” is through screening.  

Sudden Cardiac Death (SCD) is an umbrella term for a number of different heart conditions that affect fit and healthy people which, if not treated can result in a dramatic and or / spontaneous death. In about one in 20 cases of sudden cardiac death, no recognised cause can be found – even after post-mortem. This is then called Sudden Arrhythmic Death Syndrome (SADS). Many experts are now claiming that the actual number of deaths recorded could just be ‘the tip of the iceberg’ with many causes being wrongly recorded at post mortem as asthma, epilepsy or even drowning.

SADS has affected many families in the UK and also of world level athletes. In 2008 Neil Desai, a world ranked squash player died on his 22^nd birthday. Neil was the recipient of the TASS (Talented Athlete Scholarship Scheme) sports scholarship for a number of years, which provides funding, and prescribes athletes intense training programmers and diets, yet he was not given any health checks before embarking on these activities. His mother hopes that we will soon implement a nationwide testing policy, especially as we encourage youngsters to train for the 2012 Olympics.

The charity CRY aims to raise awareness of Sudden Arrhythmia Death Syndrome (SADS). As well as campaigning and lobbying and the provision of its subsidised cardiac screening programme for young people (35 and under), the charity also provides counselling and support to bereaved families as well as young individuals who may be diagnosed.

CRY’s honorary president Sir Ian Botham OBE, said: “The sudden death of an apparently fit young person is impossible for surviving families and friends to make sense of. Speaking as a parent and a grandparent, I am delighted that the issue is being addressed in this way through this screening tour where young people will be given the opportunity to be tested so that conditions identified can be treated.  That is why the work that CRY is doing with Philips to bring about this tour is so important.”

The mobile unit, donated by Philips, consists of three rooms where Philips’ ECG and ECHO equipment will be used to test people. A team of doctors and cardiologists will be present at all locations throughout the tour. The tour has also been made possible by charity CRY, through the fundraising efforts of families whose lives have been affected by Sudden Death Syndrome (SDS) or Sudden Cardiac Death (SCD), and the Gwyneth Forrester Trust.

Free appointments are still available and can be booked online at www.testmyheart.org

For those wanting to support the work of CRY, July 26^th sees the CRY Heart of London Bridges 5 mile Sponsored Walk. The walk will start at Victoria Embankment Gardens and cross Golden Jubilee, Westminster, Waterloo, Blackfriars, Millennium, London and Tower Bridges – before finishing at Hay’s Galleria on the south side of the Thames near London Bridge.  It will provide CRY families and supporters with an opportunity to get together and commemorate or support young people whilst enjoying a beautiful walk along the banks of the Thames

More information and details of how to enter can be found at www.c-r-y.org.uk/bridges_walk_2009.htm