This article was originally published Oct. 17, 2011
A 27-year-old man died on Sunday in the Toronto Marathon. A 35-year-old man died in the Chicago Marathon on Oct. 9. A 32-year-old man died in the Montreal Marathon on Sept. 25. Three high-profile deaths by cardiac arrest in seemingly healthy men during mass-participation events in less than a month.
How long will it before there are calls to ban marathons or demands that participants undergo mandatory medical testing before they can run?
As tragic as these deaths are, a knee-jerk response to restrict these type of events would be a mistake. The solution, while counterintuitive, is to encourage a lot more people to lace 'em up and hit the streets. The benefits far outweigh the risks – regardless of the impression you may get from the newspaper headlines.
Those who think that marathons are deadly dangerous are grossly misinformed: They don't understand statistics and science – or, at the very least, choose to not do so to reinforce their prejudices.
About 50,000 Canadians suffer heart attacks each year. Almost 40 per cent of them are fatal, meaning 20,000 deaths. On average, two marathoners a year die during races. Yet they garner more media attention that the other 20,000 or so deaths combined.
Put it down to the man-bites-dog syndrome: The media have a penchant for the unusual, particularly when it occurs in a public venue.
Nobody is counting or cataloguing the La-Z-Boy deaths – the thousands of people who die while watching TV or another sedentary activity. The science is unequivocal: The sedentary – the 50 per cent plus of Canadians who barely move each day – are at greatest risk.
Being active – including running – dramatically decreases your risk of death, particularly from heart disease (which has just been edged out by cancer as the country's No. 1 killer). People who are fit have 50 per cent fewer heart attacks than those who are sedentary. They also have a lower risk of stroke, diabetes, cancer and dementia.
Being fit does not require feats of super-athleticism. It means upping your heart rate – maybe even working up a sweat – for 30 to 60 minutes a day. That's the equivalent of running (or jogging slowly) about five kilometres for most people.
You don't have to run a marathon to be fit. And you don't have to be Kenyan-marathoner-thin to run either. More than 61 per cent of Canadians are overweight or obese and spectators at any big city race know that there are marathoners in those ranks.
But running – and more important training for a marathon – can make you fitter. It can even offset the risks of being overweight to a large extent. The research shows that more activity is better for your health. Those whose activity levels surpass the minimum recommended norms tend to have a healthier body weight, lower blood pressure and better cholesterol readings and, over all, they tend to eat better. (Never mind that many marathoners have a voracious appetite and a sweet tooth to boot.) Yes, runners get injured, but their bones are actually stronger and their injuries pale in comparison with those suffered by the obese and the frail.
There are intangibles as well. Marathon and half-marathon participation has exploded in recent years because running is the social activity of choice for many. It is no coincidence that the new runners are predominantly in their 30s and 40s – when the fat starts to accumulate around the middle and the prospect of hanging out in bars to make friends becomes overly depressing. Running is not about vanity, it is about being part of a community and being good to oneself.
Public policy should encourage Canadians to be active. Building running trails, bike paths and sidewalks is one of the best investments in health promotion we can make. So, too, is promoting marathons, bike tours, inline-skating races and whatnot – even if it does inconvenience car drivers occasionally.
It would be a shame if the legions of Canadians who are joining running groups at the YMCA, the Running Room and countless other spots were misled into thinking that running is deadly. And it would be downright tragic to slap them with dissuasive measures such as pre-race screening or medical tests. Doing so would be expensive, intrusive and ineffective.
The reality is that about 95 per cent of those who die during marathons have underlying heart problems – either genetic or lifestyle-related.
A surprisingly high number of people have heart abnormalities, but most are benign. Detection does not lessen the risk of death, except in some specific instances. As for the lifestyle-related problems – high blood pressure and high cholesterol – these conditions are commonplace and runners are no exception. Hey, that's why a lot of them run in the first place. But predicting the risk of a heart attack during a specific activity is almost impossible.
Paradoxically, if you're going to have a heart attack, a marathon is one of the best places to have one because paramedics and defibrillators are nearby. About 75 per cent of people whose heart stops at a race survive; in everyday life, it's about 15 per cent.
Ultimately, runners and non-runners alike owe it to themselves to go beyond the headlines and retain the important data.
Donald Redelmeier, a professor of medicine at the University of Toronto, examined records from marathons where there were 3.3 million participants over a 30-year period. There were 26 deaths. That's a death rate of one in 126,000 – roughly the same as the death rate in the general population. Stated plainly, people die of heart disease, not running. (And, to repeat, being fit reduces the risk of heart disease substantially.)
It is well known that Jim Fixx, whose seminal work, The Complete Book of Running, is credited with sparking the running craze in the 1970s, died of a heart attack while running. Less well known is that he had an underlying heart condition. Doctors estimate that he would have died a decade earlier had he not been fit.
Mr. Fixx would no doubt be bemused by the current debate about the safety of marathons. But his philosophy still holds true today: "I don't know if running adds years to your life, but it adds life to your years."