Research at INFS, Research Review

Does Marathon Running Pose Health Risks? – An INFS Research Review

Regular Physical Activity (PA) is considered an essential part of a lifestyle in the promotion of cardiovascular (CV) health [1]. Marathon running has both positive and negative effects on health. On the one hand, marathon training and completion can improve cardiovascular fitness and overall endurance, and the rigorous training regimen in preparing for a marathon can help to strengthen the heart and lungs, increase lung capacity, and improve blood circulation. Additionally, regular exercise, such as marathon running, has been linked to reduced risk of chronic diseases such as heart disease, diabetes, and certain types of cancer.

On the other hand, marathon running also poses potential health risks. The extreme physical demands of running 26.2 miles or 42 km can result in various injuries, such as sprains, strains, stress fractures, and muscle damage. Also, overtraining can lead to excessive wear and tear on the body, increasing the risk of long-term damage. Moreover, the intense physical and mental stress of marathon running can compromise the immune system, making runners more susceptible to illness and infection.

Read on to know the conditions where marathon running is a blessing and the conditions when marathon running is a blight.

Evidential Effects of Marathon Running on Health

Mental Health

A self-reported enrolment data of a longitudinal observational study among 1,212 active ultramarathon runners, the conclusion was compared with the general population, and ultramarathon runners appeared healthier. The prevalence of all chronic diseases and mental health disorders appeared to be lower in the ultramarathon runners. It was also reported only a very few ultramarathon runners missed work or school days due to illness or injury [2-4].

Cardiac Health

In a retrospective cohort study among male and female urban participants who have completed 42 km marathons from 1982 to 2009, it was reported that the incidence of Sudden Cardiac Arrest (SCA) and Sudden Cardiac Death (SCD) for the entire cohort was one in 39,000 and one in 78,000 finishers, respectively. Among these, for male finishers, the SCA and SCD incidence was one in 29,000 and one in 60,000 for the 28-year cohort, and there has been an increase of one in 22,000 and one in 50,000 in the last decade. The increased incidence in men was especially over the age of 40 years [5]. The prevalence of sudden cardiac death among marathon runners from the USA is relatively low, with a rate of 1 in 45,000 runners [6]. Whereas among the general population, the incidence of sudden cardiac death ranges from 30 to 100 cases per 100,000 people occurring worldwide [7-9].

Globally, it is estimated that the annual burden of sudden cardiac death would be in the range of four to five million cases per year in the world (total population approx. 6,540,000,000) [10].

Bone Health

A comparative study conducted on 68 marathoners and 40 normal controls reported that there was a higher level of a biochemical marker reflecting the bone formation and blood osteocalcin among the marathon group than the control. However, there was no significant difference in bone resorption markers [11], so future studies are required in this aspect. Not only physical activity but also age and genetic variations affect the bone mineral density of an individual [12].

Respiratory Functions

Many studies have assessed the impact of marathon and ultra-marathon running on pulmonary function and respiratory muscle fatigue. These studies have used spirometry to evaluate the pulmonary function and maximal static mouth-pressure manoeuvres to indirectly measure respiratory muscle fatigue. Both events caused a drop in pulmonary function in the range of 10 to 15% (regardless of airway obstruction) and respiratory muscle fatigue in the range of 15 to 25%. These post-race decreases in pulmonary function rarely attain clinical significance (still, the values tend to remain within the lower limits of normal), but the implications might be severe for individuals with pre-existing respiratory disorders or below-average baseline function [13].

A higher prevalence of asthma and allergies was observed among marathon runners than among the general population [2]. Moreover, marathon runners are prone to having runny noses. This could be because during marathon running, the participant would breathe more, which makes the nose hyperactive, and the mucous membranes within the nose produce mucous, often accompanied by a watery discharge.

Immunity

During the marathon, there are tremendous changes in an individual’s immune mechanism. The various compartments of the immune system and body change, including the skin, upper respiratory tract, mucosal tissue, lung, peritoneal cavity, blood, and muscle. The natural killer cells (NK), neutrophils, and macrophages of the innate immune system are the immune cells that experience the most significant changes in terms of numbers and functions. Multiple mechanisms might be involved, such as exercise-induced changes in stress hormone and cytokine concentrations, changes in body temperature, increases in blood flow, and dehydration. During this ‘open window’ of immune dysfunction, which may usually last between three to 72 hours, depending on the immune measure, viruses, and bacteria may gain a foothold, leading to the increased risk of subclinical and clinical infection [14].

Running Related Injuries

Ultramarathon runners, when compared with shorter-distance runners, have a similar annual incidence of exercise-related injuries but a higher proportion of stress fractures involving the foot, and it is the younger and the less experienced ultramarathoners who are prone to the most risk for injury. Research on running-related injuries among marathon runners has consistently found a high incidence of lower limb injuries, particularly in the knee [15]. Marathon runners’ most common lower extremity injuries include knee pain, ankle sprains, Achilles tendinopathy, and medial tibial stress syndrome [16].

Hormonal Changes

A prospective longitudinal study for above one year observed that endurance training can
modify hormonal profiles among males quantitatively and qualitatively while doing long-distance running [17]. Among non-elite, middle-aged marathon runners, running resulted in acute hormonal changes, with increased cortisol and prolactin levels immediately after the race and a significant decrease in testosterone levels one hour after the race (3.4 ng/ml) compared to the baseline level (4.85 ng/ml) returning to baseline after a week (4.85 ng/ml) [18]. Among female runners, there was an increased frequency of menstrual cycles of <24 days, shorter duration of bleeding (4.79 vs. 5.27 days), and an increased frequency of painless menstruation (23.96% vs. 7.69%) when compared with non-runners [19].

Like a coin, marathon running also has both pros and cons. Based on an individual’s existing health conditions, one must decide to participate in the marathon. Also, please follow the recommendations.

Recommendations for Marathon Runners

  1. Prerace Medical Screening [20]
  2. Access to a Qualified Trainer [21]
  3. Take Professional Help for Diet [22]
  4. Stay Hydrated [23]
  5. Have Proper Rest and Sleep [24]
  6. Wear Compression Clothing [25]
  7. Taper Before the Race [26]

Conclusion

In conclusion, marathon running produces mixed effects on health. On the one hand, it can enhance cardiovascular fitness, bone health, and mental well-being while reducing the risk of chronic diseases. On the other hand, it also carries the potential for injuries, hormonal changes, and temporary immune suppression. It’s essential for individuals to weigh these factors against their existing health conditions before deciding to participate in a marathon. Following carefully weighed recommendations such as pre-race medical screening, professional training, proper hydration, and adequate rest can help mitigate risks and maximize the benefits of marathon running.

Author – Dr. Shunmukha Priya (Research Supervisor and Faculty, INFS)

References

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26] Smyth, B., and Lawlor, A. (2021). Longer Disciplined Tapers Improve Marathon Performance for Recreational Runners. Frontiers in sports and active living, 3, 735220. https://doi.org/10.3389/fspor.2021.735220

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