London Marathon death: Is it safe to run 26 miles?

Apr 25, 2016

After a handful of deaths following the popular event, we examine the statistics

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The death of a 31-year-old Army captain who collapsed while running the London Marathon on Sunday has raised new concerns about the safety of long-distance running.

Afghanistan veteran David Seath had a cardiac arrest three miles short of the finish while running for Help for Heroes, reports the BBC. Despite receiving immediate medical attention and being rushed to hospital, he died the same day.

The exact cause of death is yet to be established, but it comes two years after 42-year-old Robert Berry collapsed and died at the finish line and four years after 30-year-old Claire Squires died, also close to the finish line.

Given the number of people who take part in the race each year, are the safety concerns justified?

How safe are marathons? 
A study presented to the American College of Cardiology in 2009 found that the risk of sudden death during a marathon is 0.8 per 100,000 people. By comparison, the report found that triathlons – which ask users to complete three sequential endurance races in swimming, running and cycling – have a significantly higher risk of sudden death at 1.5 in 100,000. To put this into perspective, the risk of dying in childbirth in the UK in 2012 was 8.6 in 100,000 births, according to the Daily Telegraph.

How does it affect the heart? 
A number of independent studies have found that marathons appear to cause damage to the heart in the short term, but researchers are unsure whether the effects are lasting. Some note that there are cardiovascular advantages to regular running. "Being fit is protective", Dr James Freeman, a fellow in cardiovascular medicine at Stanford University School of Medicine told the New York Times. Professor Sanjay Sharma, medical director for the London Marathon, told the BBC that most people who have died during the London marathon have had previous heart conditions or heart disease.

Should we be worried? 
Research published in the New England Journal of Medicine looked at 11 million runners who had completed marathons and half-marathons between 2000 and 2010. Over the decade, 59 of the runners had heart attacks, of which 42 died, which led the NEJM to conclude that "marathons and half-marathons are associated with a low overall risk of cardiac arrest and sudden death".

A study carried out by Canadian researchers found that running long distances may cause temporary damage to the heart, but that any ill-effects are likely to be short-lived. "I don't think most people who are going to run a marathon need to worry", Davinder Jassal, an assistant professor of cardiology, radiology, and physiology involved with the research told the New York Times. "The indications are that nothing serious is going on."

But Judy O'Sullivan, Senior Cardiac Nurse at the British Heart Foundation, emphasises the need for proper training and says people should consult their doctors if they have any worries. "We would always advise anyone who has any concerns to visit their GP before taking part," she said.

Last year, a study published in the European Heart Journal recommended that marathon runners and other endurance athletes have their hearts tested while active to avoid potential sudden death while training or competing.

Professor Andre La Gerche and his colleagues in Australia and Belgium found that problems in the way the heart's right ventricle works become apparent only during exercise and cannot be detected when an athlete is resting.

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The acute damage to cardiac tissue may be a possibility but the vast majority of cases of cardiac arrest during intense physical activity is due to underlying pathologies that the first symptom can be a cardiac arrest. The number of people in the UK who have these pathologies such as Hypertrophic Cardiomyopathy or Arrhymogenic Right Ventricle Cardiomyopathy is unknown as there in no national registry yet. Physical exercise puts the body under strain and high demand of blood, pumped by the heart, if there is a fault in the heart then this is why we find out and the first symptom is usually cardiac arrest. However, it must be stressed that the benefits of exercise in preventing long term cardiovascular disorders and as a prevention of multiple diseases far outweighs the risk. In some of these pathologies we can identify and provide treatment for (not cure) through a national screening program. A fantastic charity to check out is Cardiac Risk in the Young (CRY)