The completely unexpected death of a man running for charity in the London Marathon in 2014 cast a shadow over a remarkable event. Forty-two-year-old Robert Berry collapsed shortly after crossing the finishing line. It may not have caused as much widespread devastation as the bombing at the Boston Marathon the year before, but the tragedy is every bit as personal.
How safe is marathon running?
Marathon running has become something of a national pastime. Spurred on by the wish to reach a personal goal, or often to raise money for a needy charity close to their hearts, thousands of ordinary Britons dust off their sports shoes every year and get into training. For the first few weeks they ache in muscles they never knew they had, but gradually their bodies respond and their stamina builds. Then they really start to believe they can do the race itself. The first few miles, they hear, are a doddle - then they'll hit 'the wall'. But if they push on through, the sense of achievement, and the jubilation and sense of community at the finish line, is heady. I've never run a marathon, but I have cycled over 300 miles from London to Paris for charity, and stood at the finish line to support contestants running the London Marathon for HEART UK. The latter was inspiring - but doing it myself, was a buzz I had never imagined. Dropping dead was never on the agenda.
How common is sudden cardiac death (SCD)?
Every so often we hear about sportsmen injured or even killed through head and spine injuries, but when someone drops dead for no apparent reason while they're exercising, it's usually due to their heart - SCD, or sudden cardiac death . (1) It's very public and obviously it makes the headlines, but it's actually very rare. It occurs in the region of one in 280,000 men under 30 (2) and the figure is even lower in women. (3)
In young, healthy people, almost one in two cases is caused by hypertrophic cardiomyopathy (HCM) . (4) It's often inherited, and 60% of people diagnosed with HCM have a brother, sister, parent or child who has it too. The problem is that while it can often be detected by a heart murmur or on an ECG heart tracing, it usually causes no symptoms before sudden death. Another cause is abnormal positioning of the coronary arteries, which supply blood to the heart muscle. In this case, examination, ECG and even exercise ECG testing are normal, but people who have this condition are more likely to have symptoms. The warning symptoms include chest pain, unusual shortness of breath, dizziness and fainting during exercise. A third possible cause, especially in older patients, is heart attack due to the 'traditional' risk factors for atherosclerosis , or furring up of the arteries.
Whether or not everyone participating in marathons should have a full medical beforehand has been hotly debated by the medical community for years. Huge numbers would need to be screened, and many people worried and put through invasive tests unnecessarily, to identify the one person where sudden cardiac death could be predicted. One study estimates the cost would be $10 million per life saved. (5) But two things are undisputed. Firstly, defibrillators save lives, and they should always be available at sporting events like these. Secondly, for the overall population, the risk of early death from failing to exercise is hugely outweighed by the benefits to health of regular exercise ..
If someone in your family has died suddenly and unexpectedly (especially before the age of 50 while exercising), it's well worth getting your heart checked out. But whatever you do, don't let these stories put you off putting on your running shoes. The next Bank Holiday, when the sun is shining and you have a break from work, might just be the perfect time to start.
1) Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes: clinical, demographic, and pathological profiles. JAMA. 1996;276:199-204
2) Ragosta M, Crabtree J, Sturner WQ, Thompson PD. Death during recreational exercise in the State of Rhode Island. Med Sci Sports Exerc. 1984;16:339-342.
3) Van Camp SP, Bloor CM, Mueller FO, Cantu RC, Olson HG. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc. 1995;27:641-647.
4) Koester M. J Athl Train. 2001 Apr-Jun; 36(2): 197-204.