Premarathon Evaluations: Is There a Role for Runner Prerace Medical Screening and Education to Reduce the Risk of Medical Complications?

Abstract

There is irrefutable evidence that regular participation in physical activity has substantial health benefits, and as such participation in mass community-based sports events should be supported. However, with the promotion of physical activity comes the potential risk of medical complications during an acute exercise session, with this risk varying according to the risk factor profile of an individual and the nature of the event. The demographics of marathon race entrants changed over the past two to three decades, and currently about 50% of runners are older than 40 yr. A consolidated view of previously published research shows that in a marathon with a field of 50,000 runners for example, the medical staff will, on average, encounter a sudden death every 2 to 3 yr, a sudden cardiac arrest every year, 25 runners that present with a serious medical complication requiring specialized management or hospitalization, and 1000 runners that require medical attention. Runners may have several intrinsic risk factors that can predispose them to serious acute cardiovascular or other serious noncardiac medical complications on race day. This intrinsic risk can be exacerbated by several extrinsic risk factors as well. As health care professionals, we are obliged to give the best medical advice to individuals who wish to participate in moderate- and high-intensity endurance activities, and at the same time reduce their risk of a medical complication during exercise. Preliminary data indicate that an online prerace medical screening and targeted educational intervention program can be successfully implemented and is effective in reducing the risk of acute medical complications during a race.

Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants—SAFER Study VI

“…1,[4][5][6][7] Not surprisingly, in the last 2-3 decades, participation in mass community-based endurance sports events (running, cycling, swimming and triathlons) has seen a steady growth worldwide 8 with notable increases in older participants. 9 Recreational distance running remains one of the most popular forms of endurance exercise, and since 1976 there is a reported increase of >12 fold in overall participation numbers in distance races such as the marathon (http://www.runningusa.org/annual-reports -accessed on 1 February 2018).…”

“…10,11 These complications include serious cardiac incidents [12][13][14][15][16] and non-cardiac complications typically related to severe fluid and electrolyte abnormalities (mainly hyponatraemia) [17][18][19] , acute kidney injury and renal failure [20][21][22][23] , exertional heat stroke [24][25][26][27][28] and gastrointestinal bleeding. 29 Risk factors associated with acute medical complications (cardiac and non-cardiac) were recently reviewed 9 , and one of the risk factors is the use of medication, immediately before or during races . 9 The most common type of medication used by athletes is prescription and over-the-counter (OTC) analgesic and / or anti-inflammatory medication (AAIM).…”

“…29 Risk factors associated with acute medical complications (cardiac and non-cardiac) were recently reviewed 9 , and one of the risk factors is the use of medication, immediately before or during races . 9 The most common type of medication used by athletes is prescription and over-the-counter (OTC) analgesic and / or anti-inflammatory medication (AAIM). 30 AAIM use during training, competition and recovery is common practice in many athletes including Olympic athletes 31 32 , Paralympic athletes 33 , elite track and field athletes 34 , football (soccer) players [35][36][37][38] , athletes participating in multi-coded sports events 39 , college athletes 40 and athletes participating in triathlon 41,42 and endurance cycling.…”

A comparison of two pre‐race medical screening tools in 5771 running race entrants—SAFER XXVIII

“…Paradoxically, moderate‐ to high‐intensity physical exercise is associated with an increased risk for serious life‐threatening medical encounters (MEs) including cardiac events (sudden cardiac arrest and sudden cardiac death), exertional heatstroke, acute kidney injury and serum electrolyte abnormalities e.g. hyponatraemia 6 . Individuals at higher risk of MEs should be identified and are usually older male athletes with underlying cardiovascular disease 2,6–8 and other chronic diseases 9,10 .…”

“…hyponatraemia. 6 Individuals at higher risk of MEs should be identified and are usually older male athletes with underlying cardiovascular disease 2 , 6 , 7 , 8 and other chronic diseases. 9 , 10 In most mass community‐based endurance sports events, male entrants still predominate and over the past 2–3 decades the number of older participants has increased.…”