On a fine morning in Bangalore in May 2008, when running had not yet become popular, a thin man in his 30s collapsed around the 4km mark of a 10K run. Fortunately, the intensive care ambulance was parked right there, manned by the best emergency doctor on the team covering the event, of which I was the medical director.
He had no pulse, and no amount of resuscitation helped. He was rushed to the hospital, which was a couple of kilometers away. Fortunately, he survived. All investigations into this medical mystery were normal. So what went wrong on that fateful day?
The participant, a taxi driver, did everything wrong. He was wearing leather shoes, formal pants and a shirt. He found out about the race that very morning and just showed up to have fun. The night before, he had been on a binge. Although he was thin, he was by no means healthy, a common fallacy. A skinny person leading an inactive lifestyle is much worse off than a chubby person despite making all the right choices, like being physically active and eating right.
As history has a habit of repeating itself, last Sunday a 32-year-old man collapsed just 200-250 meters from a half marathon, where he was looking for a finish time of less than two hours. Again, there was an ambulance right there, which took him to the hospital. Unfortunately, he did not survive. In this case, he was not new to running or being physically active. He had recently run a full marathon and was a former national level table tennis player. It was later reported that he had begun to move unsteadily from one side of the road to the other from about a kilometer earlier.
Such incidents make the front page of newspapers and go viral on social media, tarnishing the name of exercise, with claims that running and gymnastics kill, discouraging those who guard the fence and those who don’t move at all. begin.
I put together a poll on both LinkedIn and Twitter, asking people if they thought pushing hard while running or exercising was safe or not. Two-thirds of the 300 respondents thought it was unsafe. My audience, in any case, is skewed because I keep talking and talking about the role of exercise and running in having a better quality of life (otherwise I suspect it could very well be that over 90% would have thought that pushing with force is dangerous.)
This reminds me of the comments of Dr. Paul Thompson, a cardiologist who is a long-distance runner and has been studying the benefits and risks of exercise for more than four decades, especially the risk of sudden death. “Exercises, while you’re doing them, increase your risk. It is like investing in the stock market. You invest for long-term profit. You exercise to win in the long run. But when you invest, you can have a bad action. And when you exercise, some people have cardiovascular events that occur during exercise. Therefore, there is a general benefit of physical training. But (we are all) interested in small cases that have secondary effects of physical training.” This is why we should not accept the argument of well-meaning people telling us to stop exercising because of such rare cases.
But what about strenuous exercise?
Professor Timothy Noakes, a veteran sports and exercise medicine expert who for many years was the medical director of the 89km Comrades Marathon in South Africa, wrote his world-famous book know how to run which was rightfully called the bible of running for trainers and runners. He writes: “I tend to believe that he is the runner rather than the activity. The intellectual challenge begins when an autopsy fails to detect a cause. Is it concluded that there is a pathological cause that was not detected? Or that exercise caused death and the cause will not be found?
It is important to define strenuous. It is different for different people. What is crucial is to first have a solid base to move from and not to do too much too soon. When running, focus on one thing at a time, either increasing distance or increasing speed, not both at the same time. In any case, increase them gradually, week by week. Once you’ve built that foundation, you’re ready to go.
There is a consensus among experts that there is almost always an underlying cause of sudden death in people who exercise. In people over 35 years of age, it is usually a narrowing of the carotid arteries by cholesterol. This justifies screening for all marathoners and gym goers. But that can be excessive.
Dr. Thompson adds, “A lot of those people, about 30% of them, have symptoms before they attend the event. Many people ignore chest discomfort, and one of the things that is most often ignored is discomfort in the upper part of the stomach. People think they have an ulcer or heartburn. You get the point, heartburn. So we always tell people that if they have symptoms that come with exercise, but go away with rest, that’s your heart until you prove otherwise. So check with your doctor. What kills younger people is congenital conditions of the heart muscle or congenital conditions of the coronary arteries.”
Professor Noakes agrees that he has always believed that there is always an underlying undiagnosed cause. “However, I once investigated two athletes who collapsed unconscious at the finish line of distance running, presumably with cardiac arrest/ventricular fibrillation (sadly undocumented). They were resuscitated and the full cardiological evaluation found nothing.”
An overlooked condition is overhydration, which is far more fatal than dehydration in race conditions. This has been repeatedly highlighted by Professor Noakes. Most people drink too much water during the race, not knowing any better.
As race organizers, the responsibility for the safety of our participants rests with us, so we must make them aware of the signs and symptoms that could save their lives. As a race organizer, I appreciate that most people take things lightly as long as nothing goes wrong, and when something does go wrong, there’s not much to worry about.
Dr. Thompson sums it up well. “Most people should go run the marathon and have a good time and not think twice about it. The key issue in the US (worldwide now) is not too much exercise, it’s getting people out of their duffs.”
Keep walking and smiling.
Dr. Rajat Chauhan is the author of MoveMint Medicine: Your Journey to Peak Health and La Ultra: Couch to 5, 11 & 22 kms in 100 days
He writes a weekly column, exclusively for HT Premium readers, that discusses the science of movement and exercise.
The opinions expressed are personal.
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