“Dr, should I run the Marathon? “

With the increasing popularity of the “Marathons”, running has become an “in-thing”. Suddenly, it’s trending on twitter and Facebook has groups of runners, which plan which next event to attend. Marathon runners travel all over the country to run various Marathons organised by various bodies. Apart from sporting industry, a chunk of humanitarian organisation and philanthropic causes have embraced Marathon running. In other words:” I’m running a half marathon this year” has become the new “coolness” mantra. Everybody – from your neighbour to your boss is suddenly running at least the half marathon. So much so you feel almost guilty for not running.

And then- comes the shocking headlines. Almost every year, a couple of persons die “at the finish line”(Ironic, I know! ). The press, in its characteristically shrill and unabashedly biased tone, describes in details the picture of a 40 something over achiever, the epitome of health, and has been “running since years”- until he collapsed and croaked at the last marathon of his life. Experts- from cardiologists to fitness coaches -have their “15 minutes of fame”- and discuss their views on the case. The stress of corporate life and “dire need of Yoga to restore the balance in life” is then discussed. But then the din dies down, and the marketing giants flex their muscles, running becomes good again, running shoes companies sell their sneakers for thousands of rupees once again- till the next unfortunate death. Then; the cycle is repeated.The laity are as uninformed as ever : Should you run the marathon? Is a question -which more often than not goes unanswered.

Let me, as a cardiologist give my views on the topic.

Diseases responsible for the most deaths in runners are diseases which they have, but are unaware of. Which are these? The list is long, but a cardiology consult would rule out many of these. Coronary artery disease, hypertrophic cardiomyopathy, Aortic (and other valvular)stenosis aberrant course of coronary arteries, Long QT syndromes are the “usual suspects” ; but there are at least a dozen more . Presence of any of these is actually a contra indication to ANY running – not just Marathon running.

So are you “safe” if you don’t have these, and are otherwise healthy?

Apparently not. And here’s why-

High endurance high intensity sustained exercise, like marathon running causes the body to incur an “oxygen debt”. This “oxygen debt” causes tiny foci of “anoxic myocytes”- oxygen starved heart muscle cells-which ultimately, over many such sessions of high intensity running – die. These “islands” of dead heart muscle cells, in the midst of healthy myocyte cause “heterogeneity”- that is they are “different”. These may “misfire” – and cause the heart to beat fast and stop.

This is a common mechanism by which a healthy marathon runner dies.

Of course – not all marathon runners develop these dead heart muscles over time. Who does? Difficult to predict. But commonly -though not exclusively -they develop in an under conditioned runner or one who tries to “peak fast”.

My point is this-and you hope you get it. The “usual suspects ” diseases proscribe marathon running. But, even if you do not have any of them- you STILL have a chance of dying. Too bad, that’s how the cookie crumbles.

Any athletic endeavour caries a risk. Boxers can get memory loss, Parkinsonism and of course, brain hemorrhage and death. F1 racers risk cremation in their prized cars in event of an accident. Football players, cricketers, even recreational sportsmen like surfers flirt with death day in and day out. Compared to that, the risk of mortality following a Marathon run seems abysmally low. The risk of dying following a Marathon run, is lower than the risk of dying during Childbirth, for example. But I doubt if the statistic will mean much to the bereaved family of a dead runner.

So how do I answer the question : ” Dr , Do I run the Marathon? ”

Actually, it is quite simple.

1. Are you HEALTHY enough to run? ( Rule out the “usual suspects”)

2. What is the reason you want to run?

Is it a passion to run, or merely a passing phase or peer pressure?

If it’s a passion , run by all means. People accept greater risks for their passion everyday.

However, if it’s merely for “style” or to “post a picture on Facebook”, please abstain.

It’s just not worth dying for a fad, or to please the world!

-Penned by Dr Kaushal Chhatrapati

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