Running Advice

After reading an article about a couple of runners collapsing and dying at the Philadelphia Marathon/Half Marathon last week...I thought I should share this article.

I didn't run today.  I actually woke up with a wicked cough and called into work sick and haven't left the couch all day.   

Running Doc's steps to avoid sudden collapse 

The prevailing theory about sudden death (fatal cardiac arrhythmia) in healthy patients in an endurance event, as we have discussed here before, is that either a caffeine load of more than 200 mg has caused enough decreased blood flow to disrupt an ischemic area’s electrical rhythm, or the release of muscle byproducts has caused a small plaque to activate platelets and a small clot to form in a coronary artery. Either of these things can cause a fatal arrhythmia. Limiting caffeine and taking a baby aspirin should help eliminate these possibilities.

The X-spot is where a runner knows he (or she) is going to finish the race, or where he can see the finish line and push to a hard sprint finish. This adrenaline rush, we think, might push the electrical system of the heart to an arrhythmia if the muscle is ischemic by one of the two mechanisms described above or if the participant has underlying heart disease. Not pushing yourself that last mile and taking it as you have the last few miles might make participating safer. So would encouraging announcers not to goad runners by saying things like, "If you can hear my voice you can break 4 hours!"

I am looking forward to our next IMMDA meeting when our group will be outlining a worldwide study on sudden death in our sport. As of now we only have some small evidence from a few studies and a lot of anecdotal evidence and theory. Our study should put more science into our recommendation.

In the meantime, as I've said repeatedly, we continue to advise the following on race day:

1. Take a baby aspirin (81mg) the morning of the event.

2. Limit caffeine that morning to less than 200 mg.

3. Take the last mile like the previous without a fast sprint.

These recommendations make sense to me and my fellow marathon medical directors. When our patients ask us, "How can I prevent becoming the next one?" our advice - right after urging them to get a comprehensive physical - consists of the three steps listed above. I hope you follow this advice, in conjunction with your physician, as well.