Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Wednesday, 13 January 2010

Are marathons healthy?

When I was 21, I ran a lot, but wouldn't consider running a marathon because I thought it was "too long to be healthy". But at age 25, I found myself running my first marathon and loving it. Since that time, I haven't spent much time considering whether running marathons or longer races is actually healthy. Let's face it, when you enjoy something so much, you don't tend to look at it objectively.

But on Monday, the day after we ran the Kalundborg Winter Marathon, I found myself unable to think straight. Patients and colleagues alike would ask me questions or give me information and I would stare at them as if they were a teacher from Charlie Brown. Normally I would attribute behaviour like this to low blood sugar or lack of sleep. But I am certain neither of these were the case. And my boss said I looked ill and that she was concened about me. Despite being a physician, I find myself unable to explain these untoward effects other than attributing it all to "exhaustion".

Here I am looking kind of dead after the race:

To determine whether or not a marathon is "healthy", one should probably consider the immediate, secondary and long-term effects it has on the body.

1. Short-term health effects:

It is hard to find many short-term health benefits. There is of course that rush of adrenaline and another benefit for most people is burning calories. Negative effects on health include muskuloskeletal injuries, hyponatremia (from drinking too much water), heat stroke, kidney failure (seen rarely in ultras) and the extremely rare but feared sudden cardiac death. In looking at studies of people who die from heart problems in a marathon, these are exclusively people with underlying heart conditions, whether they know it or not. There is also damage and death of cardiac muscle cells during a marathon, shown in multiple studies by a rise in troponin in the blood after a marathon, as one sees with a heart attack. I'll get back to the meaning of that long-term in a bit.

A great study in the British Medical Journal (BMJ. 2007 Dec 22;335(7633):1275-7.) looked at large marathons in cities all around the world and found that one is more likely to die of an accident in the city outside of the race than to die during the race. I think that helps put the issue of marathon safety in perspective. And one of the best things about marathons may be that they result in so many road closures, that numerous traffic-related deaths are prevented.

I have also never come across serious problems pregnant women have had while running marathons. But you can bet your life savings that when the first pregnant woman does make the news for a marathon-related health problem, pregnant women all over the world will decide not to run at all when pregnant.

2. Secondary effects:

Not only does one feel tired, but there is quite a bit of evidence that one's immunesystem functions abnormally for up to 72 hours after a race.

2. Long-term health effects of a marathon:

First of all, it is extremely hard to do good research on the long-term health effects of a marathon, when marathon runners tend to be healthier people in the first place.

But, I did come across one interesting study in a literature search:

It appears that prevalence of hypertension, hypercholesterolemia, and diabetes decreases with the frequency of marathon participation independent of annual running distance (Med Sci Sports Exerc. 2009 Mar;41(3):523-9).

As far the long-term effects on the heart, no concensus has been reached. All studies are small and they have found conflicting results (read this article in the New York Times for more info

Anyone else have thoughts on the subject?

Here are so more pictures from Kalundborg Winter Marathon and a video clip of the marathon from Danish tv:

First the link to the video:

And some pics from Tor Rønnow (minus the naked ladies, thanks, Tor!):

Running Song of the Day: All through the night by Cindi Lauper


Danni said...

It seems that conditioning and effort factor in significantly. When I'm ultra-training, a marathon isn't, in of itself, particularly tiring. Now, if I raced it as hard as I could I'd be sore and wiped. After my last 100 I went to work on Monday after finishing around 10 a.m. Sunday. I was a little brain dead but not too much so.

Sarah said...

My mom recently called to warn me: she had just read an article about people dropping dead during marathons. I asked her how many people she thought died while sitting on the couch during that same time period. She's actually very supportive, but it sure puts things in perspective.

Anonymous said...

I just got my cds in the mail and can't wait to run to them... thanks so much!
Quick question - i love the action pics you take during your runs, but where do you stash your camera? I know for ultras you have your backpack, but for marathons, what do you do?

Jan Mueller said...

I love that text! And the comments are also pretty good. I especially like Sarah's - the "warning" by concerned family members, that they read or heard about somebody dropping dead during a marathon and the great response. This will be in my standard repertoire from now on, too :-)
By the way, who already signed in here for the Gore-Tex Transalpine Run 2010?! :-) Can't wait!

Marie-Aline said...

I don't think marathons are (too) unhealthy, if one allows time for recovery. Some runners I know do one every month, which I think is stupid (unless maybe you are an ultrarunner and use marathons as training runs, but having no experience there, I would not comment).
I am all the more convinced that recovery is key after what happened to me: did my first marathon in Nov2005, and was psyched by my time: 3.10 without much specific training or racing too hard. As a result, did not feel tired, started thinking about the next one as soon as I passed the finish line, and started doing 12 milers a week after the race... 2 weeks later, my ankle was feeling so painful I could hardly walk, let alone run. For a year, diagnosed with a tendinitis, was running on and off (mostly off), which was very frustrating. Then the "tendinitis" turned out to be a split tendon, requiring surgery, then 6 months totally off running. Bottom line: almost 18 months without proper running, and an ankle which has never totally got back to normal, meaning I am not sure I'll risk doing a road marathon again... my 2p: the marathon in itself was probably not too unhealthy... the absence of time to recover from it, yes!

Marathon Princess said...

I think a lot depends on the conditions of the marathon, what you do before/during/after and overall training that affect us. Just like training runs, some go really well and others make us wonder why we even try. The key is listening to your body to know what to do about running, this is a lesson I never followed myself.

The best thing I think I did for my running was to run a marathon pregnant this past spring. I felt the best I have ever felt during and after a race and still finished with a sub 4. My attitude changed away from racing and to just enjoy the run and I hope to continue that in my post-partum racing this upcoming year.

sea legs girl said...

Wow. What great comments everyone! Thank you.

Brooke, my big secret is using photos that other people have taken :). I usually only manage to get my camera out after the race or on training runs.

Jan, great to hear you will be at Transalpine 2010. Our attendance is unlikely, but not impossible. I would love to do it again.

Marie-Aline, that is an absolutely amazing and terrible story. You are absolutely right about the real dangerous time being days to weeks after the race. Sounds like a good topic for a blog post...

Marathon Princess, Awesome!! A sub 4 pregnant. There is something so wonderful about racing pregnant since we don't push ourselves beyond what is reasonable. Anyway, you should be having that little one any day now, right?

olga said...

Nothing is too unhealthy if you train right. I do marathons every weekend, come to think about it, and more. 56 marathons and over a year is something quite a few of my friends accomplished (my highest tally for the year is 24 official races 26.2M and above, including 4x100M and not including training runs in the same range). Recovery shortens with experience. Also, right foods and drinks help (as I learnt with time). The post-race blues are like postpartum ones (we call them PRD as opposed to PPD) - drop in adrenaline, lasts between 1 to 4 days tops. Once you know it's coming - you're good.

Anonymous said...

All you ladies are making me feel more motivated to run my first marathon!

skhx said...

it's impt to definitely get the refueling process started post race asap... under 15min, if you can... any type of calorie helps... whatever the stomach will tolerate. this will help with the whole recovery including brain function... with ultras, there have been some studies about the endocrine system taking up to several weeks to completely normalize (post 100mi) but no long term detrimental effects all other things being equal.
but truly, like olga said... with any big event you get excited for, there's always a bit of a let down after... til we regroup and focus on the next goal.
as to your particular race, didn't you write that you only had 3-4h sleep prior? perhaps that explains the post-race brain funk more than the race itself. :) how many of us mothers long for those lovely 8-10hr occasional uninterrupted nights' sleeps! maybe in another 20yrs... :) THANKS FOR THE GREAT CD'S!!!!!!!