Death by Marathon
A number of people have asked my opinion regarding the risk of dying during a marathon. I consider myself qualified to comment on this—not because I am a cardiologist—but since I recently ran a marathon and felt like I was dying at about the 15th mile (and the 16th, and the 17th, and the 18th, etc.). Since this is not a posthumous blog entry you can assume that I survived all 26.2 miles and have recovered enough to write about it.
The same can’t be said of the three unfortunate individuals who made the news in Detroit this week. As many of you may know this year’s Detroit Marathon was marred by the sudden deaths of three participants—all within minutes of each other. This tragedy has people wondering about the advisability of doing something as crazy as running a marathon and speculating that long distance running may actually be harmful for you. I’d like to dispel a number of misconceptions surrounding this notion.
The sport of distance running has been around as long as humans have existed, but the popularity of running among the general population really didn’t take off until the mid-1970s. With his best-selling book, The Complete Book of Running, Jim Fixx jumpstarted the jogging revolution and inspired millions of Americans to pull on their knee-high white socks, lace up their Nike Waffle Trainers and hit the open roads. Only 7 years after the publication of his book Jim Fixx, at the age of 52, became the face of controversy when he dropped dead from a heart attack shortly after a daily jog. Couch potatoes everywhere herald this event as vindication for a sedentary lifestyle (never mind the fact that Mr. Fixx, who took up running only after the age of 35, came from a family where his father was dead from heart disease by the age of 42).
Since Jim Fixx’s demise there have been numerous high-profile deaths related to competitive running. Every couple of years a story will hit the news of a previously healthy athlete who dies suddenly during competitive exercise. As an example, just two years ago, elite runner Ryan Shay collapsed in the U.S marathon trials and died despite efforts at resuscitation (the news later came out that Mr. Shay had a history of an enlarged heart and at one point had been advised to curtail his competitive career). When you add to these stories the tragedy of the 3 runners in Detroit it starts to look like a pattern.
Or does it? Every weekend thousands of runners take to the streets for races of one length or another. While most are not marathons, the races are likely long enough to tax the stamina of the participants (incidentally, the 3 victims of the Detroit race were not actually participating in the full marathon, only the 13.1-mile half marathon). Despite these massive numbers we only rarely hear of race-related deaths. So why do we have 3 die in one race?
In an insightful article in The New Yorker magazine about 10 years ago, surgeon and author Atul Gawande took to task the many people who get worked up over “cancer clusters”—communities in which there seems to be an unusual number of cancers. Despite reports of unusually high rates of malignancy in certain areas, aggressive investigation by epidemiologists only rarely turns up anything more than what can be explained by random variation. The problem, Dr. Gawande says, is that we humans tend to see remarkable—but isolated—episodes and then extrapolate erroneous generalizations:
“Human beings evidently have a deep-seated tendency to see meaning in the ordinary variations that are bound to appear in small samples. For example, most basketball players and fans believe that players have hot and cold streaks in shooting. In a paper entitled “The Hot Hand in Basketball,” Amos Tversky and two colleagues painstakingly analyzed the shooting of individual players in more than 80 games played by the Philadelphia 76ers, the New Jersey Nets, and the New York Knicks during the 1980-81 season. It turned out that basketball players—even notorious “streak shooters”—have no more runs of hits or misses than would be expected by chance.”
Another example of this is the Florida shark attack scare of 2001—the so-called “summer of the shark.” East coast beaches went vacant because of the news reports of one shark attack after another. In the end, the rate of shark attacks was only minimally higher that year than usual and within statistically expected variation.
Rather than drawing conclusions from what happened in Detroit let’s look at hard data. A report in the Journal of the American College of Cardiology assessed the risk of death in over 200,000 marathon runners and concluded that the risk of suffering cardiac arrest during a marathon was only 0.002% (1 in 50,000). A more recent study put the risk of marathon death at 0.8 in 100,000. To put this in perspective, death from a lightning strike is just slightly more probable at 1 in 79,746.
Now compare this to healthy but sedentary individuals. The best data we have come from a 1984 publication that suggests that the risk of sudden cardiac death is two and a half times higher in sedentary individuals than those who routinely exercise.
A commentary by a physiologist in the Encyclopedia of Sports Medicine and Science puts these recent deaths in perspective:
“On the day James Fixx died, 1000 other Americans would also have died of heart attacks. Few if any would have received nationwide coverage. Yet almost all of those deaths would have occurred in persons who were sedentary, or were smokers, or who had uncontrolled high blood pressure and elevated blood cholesterol concentrations. If only those sudden deaths occurring in athletes are reported in the press, it is understandable why the public acquires a distorted impression of the relationship between exercise and heart disease.”
So, go train for a marathon, but know this: although you may feel like you’re dying, the odds are pretty good that you’ll survive. Just stay out of the lightning storms.
Dr. Van De Graaff
Dear Susan: I read in one online article that they looked at that very closely and found nothing out of the ordinary. But, of course, I can't seem to be able to locate that article now. Some expert I am. Dr. Van De Graaff
Dr. Van De Graaff
Dear Loverunning, Congratulations on running your marathon. I hope you have many more in you. I can't think of a good reason why you'd be having more palpitations since you finished running (for my take on palpitations, see http://blogalegent.com/Cardiology-Palpitations) and I would expect you to be able to continue with your distance running. I assume your doctor also ran a TSH (thyroid) test on you? The only additional study I would recommend would be an echocardiogram to verify that you have no structural abnormality with your heart. Good luck and keep us posted. Dr. Van De Graaff
I ran a marathon about three weeks ago; I am 35 years old and so far apart from gestational diabetes I do not have any other health issues. But after the marathon noticing rapid heart beats; everything came back normal (ekg and blood work) excpet for lymphocytes which is 23 (ref range is 25-41); wbc is 72. Doctor says nothing is wrong with me, but this is worrying me and I *really* would like to run again. Thanks
I really liked the post. It looks like you put a lot of research into this one. I like all of your references, they are very interesting. I have heard that study on basketball players quoted on ESPN or TNT and usually in reference to Reggie Miller. This is good work, however, it is not motivating enough to get me to run a marathon.
I enjoyed the piece Dr. Van De Graaff. I think the media does over-dramatize this issue without considering the other factors that may have lead to those runners' deaths. When I tell my friends that I am training for another marathon, they bring up the fatalities because that is only what they remeber when reading stories like the Detroit Marathon incidents. If i used their logic, then I probably should not fly either. I found an interesting article in The New York Times: Parker-Pope, T. (2009, October 26). The Human Body Is Built for Distance. The New York Times. Side note: Marathons may have adverse effects on hips though.
Has anyone thought to look into if there was too much carbon monoxide in the tunnel they ran through before collapsing??
I am a runner who was diagnosed with Hyper-thyroid last year. Before the diagnosis, I thought I was going crazy. I was experiencing rapid heart beats, sweating, dizzy spells, and a feeling that I couldn’t focus. For the last six months or so my labs have come back normal, but on occasion I still experience these episodes. I’m wondering if I am having panic attacks or if there is something really wrong. What’s really strange is that when I run long distance I can seem to control my heart rate but the smaller 5k is where I run into problems.
Dr. Van De Graaff
Pamela, I can't say why you continue to experience occasional episodes of palpitations, etc. while running shorter distances. You may be getting closer to your anaerobic threshold with the shorter runs (if you are pushing yourself a little harder than in the long runs) and this may be triggering more symptoms. I don't think you should worry that there's something wrong if you and your doctor are keeping your hyperthyroidism in check. It's probably just another one of those "glitches" that I wrote about in last week's blog. By the way, don't feel bad that you thought you were crazy. As runners, we're all a little crazy. Dr. Van De Graaff
This post highlighted one of the problems with our news media. They have a tendency to latch onto a topic and hype it to no end (kind of like the summer of the sharks you mentioned in your post) and then drop it all together and move onto another story. (When was the last time you've heard anything on the ozone layer?) I'm pretty sure there hasn't been an increase in six-year-old boys being carried away in homemade hot air balloons this year, and yet that's all I've heard about the last couple of weeks.