Marathon runners: Should we screen all of them?

June 25, 2012

A physician runner ponders the question of whether or not physicals should be mandatory for all long-distance runners.

Please consult with your physician before starting any fitness program.

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Strangely enough, I am not alone. According to Running USA's Annual Marathon Report, since 1980 a 255% growth has occurred in the number of U.S. marathon finishers. In fact, in 2010, the number of estimated finishers was 507,000, which was up 8.6% from the previous year. With the obesity rate higher than it has ever been, does this increase appear as ironic to you as it does to me?

As I have watched the number of marathon participants continue to increase, it is with deep interest that I also have noted the disturbing news that comes when yet another runner dies during a marathon. This phenomenon is in accordance with legend, as the original marathon runner, Pheidippides, supposedly collapsed and died after running 26 miles to victory at the Battle of Marathon.

In today's world of modern medicine, however, it somehow seems alarming that such tragedies still occur. That probably explains the expanding coverage in the media.

My first recollection of hearing news like this was several years ago when a runner died in a marathon held on a freakishly warm October day in Chicago. After this event, I began to notice more articles on the topic in mainstream media. In November 2011, two marathoners sadly and unexpectedly lost their lives while running the Philadelphia marathon. A general statistical review reveals an approximate 1 in 100,000 death rate among runners in racing events.

The literature points to undiagnosed cardiomyopathy/congenital abnormality or silent coronary heart disease as the most common causes of sudden death during marathons. Heart disease is most common in those aged more than 35 years, and undiagnosed congenital defects are the most common in those aged fewer than 35 years. The list is rounded out by hyponatremia and heat-related illnesses as causes of fatality.