Thinking about running a marathon for the first time? Dr. E. Lee Rice has some words of advice.
If you're not an experienced runner, what are the first steps you should take?
If you're not comfortable running or not a normal runner, you should have a basic medical evaluation where the physician can ask questions to find out whether you're at risk or not. The first thing I would do is evaluate medical risk based on family history or personal history of any symptoms. Then I would run certain tests, like a treadmill test or an electrocardiogram, to make sure you're safe.
When is someone not fit to run a marathon?
The biggest problem I see is not people who are at risk of cardiac issues, it's overweight people who are not physically fit and want to run a marathon to lose weight or honor somebody else in a fund-raising event, that kind of thing. Honestly, they have no business running a marathon ... You can look at people who don't have a normal smooth, trained running style and the load forces on the knees, hips, back, ankles are significant over a 26-mile course — not to mention the training for a 26-mile run. That's a lot of stress to put on the body and a lot of degenerative changes that can occur.
As far as cardiac issues, if we did an electrocardiogram and saw extra beats we would want to know why. If the patient had any signs of (heart) chamber-size enlargement or any electrical conduction that was abnormal on the EKG, those would be things that wouldn't necessarily exclude someone from running, but they would be things where we would say, "You shouldn't run unless you have a further evaluation."
If we did a treadmill evaluation to measure their fitness level and if we see an abnormal response of heart rate or blood pressure, or if their recovery is not as smooth, those are all symptoms that would need further evaluation. Abnormalities that occur in the first minute of recovery after peak exercise are more important than abnormalities that occur during exercise.
Lastly, if they've had any family history of sudden cardiac death, any personal history with fainting, chest-pain, shortness of breath — those things all necessitate further evaluation before they're cleared.
And once you've passed your medical evaluation and you're fit to run, what is the next step?
Then you need to get information about proper training. That can come from the Web, there are legitimate sources on the Web about training for marathons, there are organizations that offer training courses for people, there are also personal trainers. If someone is going to get a personal trainer, I would advise them to have somebody that's ACE certified (American Council on Exercise). I think knowing how to train properly and having someone monitor your condition as you're training is helpful. That way, if you're not doing it right, those signs are recognized, and you can modify your training to make it more appropriate for you.
What is some advice you can give to runners training for a marathon to keep them safe?
Our bodies are our own best indicator of whether we're safe or whether we're getting into some sort of a danger zone. My belief is that people don't know what to look for — or don't know what to monitor — and we tend to deny any symptoms that may arise.
Unfortunately, men are worse than women when it comes to this. They don't want to ask for help and they don't like to admit that there's a problem. The signs are everything from light-headedness, to headache, unusual fatigue, any kind of dizziness, visual changes, shortness of breath, wheezing, or just feeling not quite right. Sometimes you can't define the feeling.
Athletes have to learn how to tune into their own body and record what it feels like on a normal run, when they feel healthy, and any variation from that is a touch on the shoulder that says, "Pay attention." Anything that doesn't feel right, that doesn't go away, especially if it gets worse, should be a sign for you to stop running until you feel normal again. Or, if you're in a race, stop at a medical station and make sure you're OK.
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