Are you more likely to die from heart failure by running a road race than if you didn’t? An article in yesterday morning’s New York Times1 discusses the death of 24-year old Sean O’Neill at the Boilermaker 15k. It explores whether or not race directors do enough to prevent fatalities at their events. Sean’s death was the fourth in the history of the race, but all three of the other fatalities over the past 30 years involved men who were over twice his age. In my experience, I believe that most race directors do more than enough to provide a safe environment for their runners.

Robert Ingalls, the race director for the Boilermaker, said in a telephone interview that racers in Utica cannot run more than half a mile without passing medical personnel. Ingalls said an emergency medical technician arrived at O’Neill’s side within a minute of the call for help. An advanced unit of emergency medical technicians was on the scene within five minutes of the call, and O’Neill had reached a hospital about a half-mile away within 13 minutes of the call, Ingalls said. “I can tell you with conviction that I was absolutely elated with the response,” Ingalls said.1

A response like that is definitely something to be elated about. The biggest danger for a runner from a race director’s perspective is vehicular traffic, followed by other road hazards that can physically injure a runner. I think that it should fall upon the individual runners to make sure that they are able to safely run the race and to have gotten a physical from their doctor before beginning an exercise program to prepare for a race.

Requiring a heart screen before a race is a waste of effort. The percentage of runners who suffer from a medical condition and die during a road race are infinitesimally small. The most easily obtainable data relates to the mortality rate amongst marathoners, which most likely means that the numbers would be even smaller if you included data from the thousands of races with shorter distances.

In 1996, a study in the Journal of the American College of Cardiology2 found that deaths during or immediately after a marathon were fewer than 1 in 50,000. A 0.002% chance of cardiac arrest during a marathon is about 1/100th of the annual risk for an average person, with or without a history of heart disease.

A smaller study by the American Heart Association3 in 2006 measured the damage to the heart during and after a marathon in 60 participants of the Boston Marathon. For those who had trained well and averaged over 45 miles per week, there was almost no damage evident. For those who ran less than 35 miles per week, there was an increased risk of heart damage.

An annual physical is always a good idea as a lifestyle choice. I firmly believe that discussing any changes in your exercise habits with your doctor is a good idea. If you are going to run a long race like a marathon, then I think that it is important to train properly and to physically prepare for the race before running it. I do not believe that it is a race director’s responsibility to keep you safe from a medical condition that you may not be aware that you have, nor that the race director should be responsible for predicting that medical condition. What the race director is responsible for is ensuring that traffic is controlled and does not interfere with your race, and to try to keep hazards such as potholes and trees from hurting you.

The advantages of getting in shape, obtaining and maintaining a healthy weight, and the enjoyment that running and other forms of exercise and racing provide far outweigh the minimal risk of having a heart attack while running. If you are less likely to have a heart attack during a marathon than you are during an average year no matter how at risk you are for heart disease, then I think that it is something that is not worth worrying about.

I think that racing is an inherently healthy activity. I am quite elated that road racing in general and marathoning specifically has been growing by leaps and bounds in this country over the past 5 or 6 years4. While it is sad that some people do die when engaging in physical activity every year, I don’t think that this is something that we need to worry about. Far more people die of heart attacks that are not physically active, and many of those that are active after their first heart attack are able to live longer and fuller lives because of changes that they made to their lifestyle than would have been otherwise possible.

(References: 1 New York Times2 Science Direct3 American Heart Association4