Deccan Chronicle

Gasping For Breath

Deccan Chronicle.| Swati Sharma

Published on: August 26, 2023 | Updated on: August 26, 2023

Long-distance races make headlines for the wrong reasons when a runner collapses or dies during the event. Why does this happen?

News reports of young runners who appear to be in good health dying after marathons are frightening.

News reports of young runners who appear to be in good health dying after marathons are frightening.

Dominic Fusco, a certified personal trainer and nutrition coach with 53K Instagram followers, collapsed on the track after suffering a cardiac arrest. He had earlier completed two marathons, an ultramarathon and many long runs, and crushed numerous hard track workouts.

Dominic, who survived the crisis, still can’t believe that it happened! "I have no history of heart problems. I like to think of myself as pretty darn healthy. I exercise every freaking day. I’m very particular about what I put into my body and basically, I’m trying to optimize my health," the 24-year-old runner said on his Pure Ambition podcast.

M Dinesh Kumar, a 20-year-old college student, was not as fortunate as Dominic. He died of a cardiac arrest after participating in a marathon in Madurai last month. Last year, Raj Krantilal Patel, a 32-year-old expert athlete and international badminton player, collapsed and died a few metres from the finish line during a 21-kilometer (half marathon) run in Mumbai.

News reports of young runners who appear to be in good health dying after marathons are frightening. Why do marathon runners collapse and die? Is it true that a healthy lifestyle does not necessarily protect you from risk factors?

Pay attention to your body

Cardiologists emphasise the importance of listening to one’s body and learning about risk factors and potential warning signs. "There are some heart conditions, such as hypertrophic cardiomyopathy, that do not show any symptoms in everyday life but can cause sudden death while participating in a race or event, as we see so frequently among police recruits," says orthopaedic surgeon and marathoner Dr Chandrasekhar Ramini.

"Exercise and a healthy diet have a lot of benefits," adds Dr Chandrasekhar. "But there are many risk factors for which they may not suffice."

Is genetics to blame?

"When we talk about fitness, we fix our minds on looks and being well-built. Fitness, an ideal body condition, is never understood in a holistic  manner," says Dr Srikanth Pilli, MD (Homeo) and Ironman finisher.

Genetics is frequently the cause of apparently healthy young runners – in their twenties and thirties – developing coronary issues without warning. "You can be extremely healthy and still have a heart attack. You can reduce your risk of heart disease by not smoking, staying physically fit, and eating healthy, but you can’t ignore your genes or family history of cholesterol and blood pressure. Individual risk factors are important," he cautions.

Exercise & activity

Our days are mostly spent seated – at the computer, in front of the television, and on the way to and from work, says Dr Pilli. "Even if you exercise every day, all that sitting can have a negative impact on your heart health. A brief period of exercise cannot compensate for a lack of activity throughout the day. Exercise and activity are not the same thing.

Exercise-Associated Collapse

Athletes who collapse following endurance events develop extremely low blood pressure only when standing (exercise-associated postural hypertension, or EAPH). This results in insufficient blood supply to the brain (cerebral ischemia), which could cause dizziness, nausea and possibly vomiting, as well as a brief loss of consciousness (fainting). These symptoms will last until an increase in blood pressure restores blood flow to the brain. EAPH This usually happens when the athlete lies flat on the ground, redirecting a large volume of blood from the legs (and intestines) to the centre of the body. This sudden return of blood to the heart improves heart function and returns blood pressure to pre-exercise levels.

Any deliberate effort to raise your heart rate, strengthen your muscles and increase your flexibility is referred to as exercise. In contrast, activity refers to how much you move throughout the day. Sedentary behaviour all day, according to research, can increase the risk of developing heart disease, diabetes and even cancer. To meet your goal, it is preferable to spread out your activity throughout the day and take steps every  hour."

Don’t overdo it

Excessive exercise in a short period of time can cause an increase in blood pressure or heart rate. "If a person has underlying coronary artery disease, high blood pressure or weak heart muscles, they are more likely to have a heart attack or stroke, or develop an arrhythmia. Exercise, like all medicines, is poison if taken at the wrong time and in the wrong dose. It is critical to have yourself evaluated before engaging in strenuous exercise," says Dr Srikanth Pilli.

Don’t push your limits

"Having a cardiologist or physician check you out before you start exercising helps to reduce the occurrence of unfortunate events. But there’s also the growing popularity of endurance races like marathons. People are drawn to the idea of running 42 /21/10 kms, which requires extensive training and ongoing motivation," says Dr. Chandrasekhar. While injuries are common among runners, the majority of them are avoidable. "Warm up before you run, and make sure your cool-down routine includes plenty of slow and sustained stretches. Runners should have an annual physical examination, regardless of how young or healthy they appear, to rule out hidden heart ailments. Running, like all endurance sports, is physically demanding on the body, which has to undergo a  recovery process. If proper recovery is not achieved, the body will deteriorate rather than improve. Unfortunately, we frequently lack comprehensive awareness of the precise internal dynamics of the body, causing athletes to inadvertently push themselves beyond reasonable limits," Sai Harsha Kalburge, Chief Human Resources Officer and marathoner, notes.

Silent killers

"Bad weather during a race can cause electrolyte imbalances and tip the already enlarged heart. Hypovolemia caused by insufficient hydration and overhydration can also stress the heart. Other dangers include dehydration, increased body temperature, impaired kidney function, and electrolyte imbalance, all of which push the heart, which is constantly beating, to work at a faster rate, which could result in a heart attack," warns Dr Chandrasekhar.

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