Grave Concerns
If running is so good for you, why do people drop dead during marathons every year? A lifelong runner, with help from the experts, finds the encouraging truth behind the scary headlines.
By Amby Burfoot
Deaths During Marathons
In the mid-1970s a California pathologist named Thomas J. Bassler, M.D., advanced the alluring theory that marathon runners might develop a sort of immunity from heart disease. He likened marathoners to the Masai warriors of Kenya and the Tarahumara Indians of Mexico-groups with little or no heart disease. "Marathon runners have much in common with these primitive populations," Bassler wrote. Runners everywhere repeated Bassler's tale to friends and skeptics alike. Then a trickle of case studies proved Bassler wrong, and the party was over.
Since the mid-1970s, three independent groups have collected data on heart-attack deaths during marathons. When the results are pooled together, we're looking at more than 4.5 million marathoners over the last 30 years. Of these, 41 runners died of heart attacks, a rate of one in every 110,476 marathoners. However, the two best of the three marathon studies have produced death rates somewhat higher than this average.
Family doctor and University of Minnesota Medical School professor Bill Roberts, M.D., has been medical director of the Twin Cities Marathon since 1985. Along with Barry Maron, M.D., a sudden-cardiac-death specialist also from Minneapolis, Roberts has gathered death statistics on both the Twin Cities and Marine Corps marathons going back to 1976. During that time, the combined marathons have had 525,700 finishers and seven cardiac deaths, an average of one death per 75,000 runners. Roberts and Maron have also found that this rate is declining, no doubt due to the increased availability of portable defibrillators. At Twin Cities, Roberts has established a goal of reaching any fallen runner with a defibrillator within five minutes. "If you're going to have a heart attack, a marathon is a great place to have one," he says. "Your chance of surviving is about 50 to 75 percent, versus five to 15 percent anywhere else on the streets."
In London, cardiologist Daniel Tunstall Pedoe served as London Marathon medical director from the inaugural 1981 marathon, which he ran in 3:19, through the 2007 event. Pedoe has studied marathoner deaths during all 27 London Marathons. Almost 712,000 runners have completed the race, with eight dying from heart attacks, a rate of one in every 89,000. The eight London deaths included five attributed to artery disease (cholesterol deposits) and three to structural heart abnormalities such as those that killed Ryan Shay and Chad Schieber. The deaths have occurred all along the course-at miles six, 10, 11, 12, 18, 19, 24, and in the finish chute. "Marathon running has a comparatively low, but not negligible, risk, and it's not surprising that people are frightened when they hear about a marathon death," says Pedoe. "That's why we have to keep educating everyone about the lifetime benefits of exercise."
Last December, barely a month after the deaths of Chad Schieber, Ryan Shay, and Matthew Hardy, the British Medical Journal published the biggest-by-far study of deaths during marathons. It was less definitive than the other two, however, since it relied on a search of newspaper articles to determine marathon-related deaths. Nonetheless, the BMJ study, conducted by Donald Redelmeier, M.D., from the Department of Medicine at the University of Toronto, surveyed 750 separate marathon days that were taken from 26 marathons over 30 years. The total number of runners in these races was 3,292,268, and Redelmeier found newspaper articles noting 26 heart-attack deaths. Hence, his ratio is one death in 126,000 runners. Redelmeier's most striking finding was that nearly half of all deaths occurred in the last mile of the race, or after the finish. This conclusion led Redelmeier to advise runners not to sprint at the end. In fact, in his one marathon, he deliberately jogged over the finish in 4:17. "I just tried to finish with a smile," he says.
Overall, Redelmeier concluded: "Clinicians interested in preventing sudden cardiac death might be surprised by the low risk associated with marathon running. [It's about] the same as the baseline hourly risk of death for a middle-aged man."
