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The Art and Science of Fitness | Can running or exercising kill you?

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On a pleasant morning in May 2008 in Bengaluru, when running had yet to become popular, a skinny man in his thirties collapsed about 4 km from a 10 km run. Fortunately, the intensive care ambulance was parked right there, led by the best emergency doctor on the team covering the event, of which I was the medical director.

He had no pulse and no amount of resuscitation helped. He was rushed to hospital, which was a few miles away. Fortunately, he survived. All inquiries into this medical mystery were normal. So what happened on that fateful day?

The participant, a taxi driver, did everything wrong. He wore leather shoes, dress pants and a shirt. He heard about the race that morning and just showed up for fun. The night before, he had had a drinking binge. Although he was thin, he was by no means healthy – a common mistake. A thin person who leads an inactive life is much worse than a chubby person despite having made all the right choices, such as being physically active and eating well.

As history is wont to repeat, last Sunday a 32-year-old man collapsed just 200-250 meters from a half marathon, where he was aiming for a finish time of less than two hours. Again, there was an ambulance right there, which rushed him to the hospital. Unfortunately, he did not survive. In this case, he was not new to running or physical activity. He had recently run a full marathon and was a former national level table tennis player. It was later reported that he had started moving unsteadily from one side of the road to the other about a mile before.

Such incidents make headlines and go viral on social media, tarnishing the name of the exercise, with allegations of deadly running and gymnastics, discouraging fence keepers and non-movements from taking the plunge.

I ran a poll on LinkedIn and Twitter, asking people if they thought pushing hard while running or exercising was safe or not. Two-thirds of the 300 respondents thought it was dangerous. My audience, in any case, is biased because I keep talking about the role of exercise and running in a better quality of life (otherwise I’d suspect over 90% would have thought that pushing hard is dangerous.)

It reminds me of the comments of Dr. Paul Thompson, a cardiologist who is a distance runner, and for more than four decades has studied the benefits and risks of exercise, particularly the risk of sudden death. “Exercises, while you are doing them, increase your risk. It’s like investing in the stock market. You are investing for long-term gain. You are training for long term gain. But when you invest, you can have a bad stock. And when you exercise, some people have cardiovascular events that occur during exercise. Thus, there is an overall benefit of physical training. But we (all) are interested in small cases that have side effects of physical training. This is why we should not accept the argument of well-meaning people who tell us to stop exercising because of such rare cases.

But what about intense exercise?

Professor Timothy Noakes, a veteran sports and exercise medicine expert who for many years was the Medical Director of the 89km long Comrades Marathon held in South Africa, has written his acclaimed book world know how to run which was aptly called the Running Bible by coaches and runners. He writes, “I tend to think it’s the runner rather than the activity. The intellectual challenge begins when an autopsy does not detect a cause. Do we conclude that there is a pathological cause that has not been detected? Or that exercise caused death and no cause will be found?

It is important to define intense. It is different for different people. What is crucial is first to have a solid base to move on and not to do too much too soon. In running, focus on one thing at a time, whether it’s increasing distance or increasing speed, not both at the same time. In any case, increase them gradually, week after week. Once you’ve built this base, you’re good to go.

There is consensus among experts that there is almost always an underlying cause of sudden death in people who exercise. In people over 35, it is usually a narrowing of the carotid arteries due to cholesterol. This argues for all marathon runners and gym goers to get tested. But that may be overkill.

Dr Thompson adds: “Many of these people, around 30% of them, show symptoms before they go to the event. Chest discomfort is overlooked by many people, and one of the things most often overlooked is upper stomach discomfort. People think they have an ulcer or they have heartburn. Get the point, heartburn. So we always tell people if they have exercise-related symptoms, but go with rest, it’s your heart’s content until you prove otherwise. So check with your doctor. What kills younger people is congenital heart muscle disease or congenital coronary artery disease.

Professor Noakes agrees that he always believed there was always an undiagnosed underlying cause. “However, I once researched two athletes who collapsed unconscious at the finish line of distance races, presumably with cardiac arrest/ventricular fibrillation (unfortunately undocumented). They were resuscitated and a full cardiological evaluation found nothing.

One overlooked condition is overhydration, which is far more deadly in racing conditions than dehydration. This has been repeatedly emphasized by Professor Noakes. Most people drink way too much water while running, without realizing it.

As race organizers, the responsibility for the safety of our participants lies with us, so we need to make them more aware of the signs and symptoms that could save their lives. As a race organizer, I appreciate that most people take things lightly as long as nothing goes wrong, and when something does go wrong, there’s not much to worry about.

Dr. Thompson sums it up nicely. “Most people should go run the marathon and have a good time and not think twice about it. The key issue in the US (globally now) isn’t too much exercise, it’s getting people out of their duffs (backs).

Keep smiling and smiling.

Dr. Rajat Chauhan is the author of MoveMint Medicine: Your Journey to Peak Health and La Ultra: cOuch to 5, 11 & 22 kms in 100 days

He writes a weekly column, exclusively for HT Premium readers, that breaks down the science of movement and exercise.

Opinions expressed are personal