According to Noakes(1), one of the earliest reports on the association between running and cardiac risk was published in 1909 by five eminent British doctors in the Times Magazine. It claimed that school cross country races over one mile for boys below the age of nineteen were totally inappropriate and that the associated stress will cause damage in the heart and other organs. At the time of publishing of the report, doctors claimed that the heart would beat at a certain rate and raising the heart rate beyond this particular number would lead to premature aging. These arguments have subsequently been shown to be obsolete in the last century.
The Sudden Death of Jim Fixx
Since then, the most talked about event featured the association between running and sudden cardiac death of James Fixx (better known as Jim Fixx) during a work-out. Fixx wrote and published his best selling book on running entitled The Complete Book of Running (published by Random House 1977). The book took the world by storm and fueled the rapid propagation of the running sport at that time. The book listed Fixx's personal experiences of improving his own health remarkably through running and the health benefits of the sport. One can understand the shock his readers and runners in general experienced when Fixx collapsed and died a sudden death on July 20 1984, at the age of 52. Shortly after, it was revealed that Fixx's father had died of a heart attack at the age of 43. Furthermore, when Fixx started running in 1967, at the age of 35, he weighed 214 pounds and smoked two packets of cigarettes daily. When The Complete Book of Running was published 10 years later, he had shed 60 pounds and given up smoking.
Jim Fixx's Post-Mortem Report
His post-mortem report showed that Fixx had severe occlusion of his coronary arteries. The most serious occlusion was measured at 95%, the other two occlusions measured 80% and 50%. In conclusion, his death was more attributed to his medical illness and strong family history of heart disease, than to running. It was also highlighted that Fixx actually lived nine years longer than his father did, probably related to the change in his life style(2).
How Risky is Running a Distance Race
The London Marathon is one of the most popular marathons. Since 1998, the number of runners has consistently exceeded 30000. According to Pedoe(3), there were seven cardiovascular deaths from 1981 to 2003. Five of these were caused by coronary heart disease and two were caused by cardiomyopathies. There were also five successfully resuscitated cardiac events. Overall, over the span of 23 years, the mortality rate was one out of sixty-seven thousand runners, or one death per two million miles run. Pedoe and co-workers (4) also looked at the New York City Marathon, another marathon run by a huge number of runners. A total of three sudden deaths were found amongst the 400,000 entries over the years they looked at. Frere and co-workers(5) studied the risk of death in the other distance events. They collected data from America's largest twenty 10 km, ten 12 km, twelve 15 km and twenty half-marathon races. They found that, amongst the 1,636,720 race finishers, there were a total of five cases of sudden death. Four of these were from the 10km races and the remaining one from a half-marathon. The mortality risk was one out of three hundred twenty three thousand, or 0.0003%. Frere and co-workers concluded that the mortality risk associated with the shorter races was significantly lower than that associated with the marathons (14 / one million people). They detected no significant difference in the mortality risks between the shorter races of different distances. They also noted that all the deaths were caused by coronary artery disease.
Conclusion: The Risk of Sudden Death Associated with Running is Very Low
Based on the above data, the risk of sudden death in a healthy individual during a running work-out or a distance race is very low. However, some individuals with severe cardiovascular disease could have silent disease without symptoms. Therefore, a medical exam prior to commencement of an intense training program can be life-saving in preventing some (but not all) of the sudden cardiac deaths.
References:
1. Noakes, TD (1998). Sudden death and exercise. Sportscience, 2 (4).
2. Higdon, H. (2004). The legacy of Jim Fixx, from http://www.halhigdon.com/Articles/Fixx.htm.
3. Pedoe, DT (nd). London Marathon: lines, damned lines and statistics: what we know about the incidence of injury, illness and death in the London Marathon. Peak Performance (Online).
4. Pedoe, DT (2000). Sudden cardiac death in sport--spectre or preventable risk? British Journal of Sports Medicine, 34 , 137-140.
5. Frere, JA, Maharam, LG, & Van Camp, SP (2004). The risk of death in running road races. The Physician and Sportsmedicine, 32,6.
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