Last month, two people suffered cardiac arrests and collapsed in the final stretch of the London Marathon. While one of them, a 50-year-old who collapsed just 400m from the finish line, is still in coma, the other, a 31-year-old war veteran, whose body shut down about 4.5km short of the finish line, died a day later.

Ahead of any race, most runners focus on training and nutrition. They ignore their cardiac and physiological systems’ readiness as they chase personal records. “Runners collapsing during a strenuous run is becoming more common," says Shayamal Vallabhjee, a sports scientist and Puma running expert.

Professor Timothy Noakes from the University of Cape Town, South Africa, initially put the spotlight on this phenomenon when he researched overhydration-related deaths during the Comrades Marathon in 1984.

“Interestingly, we have also seen this trend with some of the elite marathon runners," says Vallabhjee.

So what are the potential causes of this? “Firstly, it’s based on the fact that the motivation to push harder and the physiological stress the body feels operate independently of each other. Which means that while the body cannot manage the stress physiologically, the motivation to push harder may still exist and the runner could continue. Because of this, a runner will push past performance limits, landing oneself in physiological trouble. The most common causes for this are hyperthermia or energy depletion from maintaining a pacing strategy," says Vallabhjee.

In middle-aged and older adults, acute plaque disruption is the major cause of sudden cardiac death during sport events, adds Ramakanta Panda, cardiovascular and thoracic surgeon at the Asian Heart Institute in Mumbai. Acute plaque disruption, or hardening of the arteries, is a condition in which plaque builds up inside the arteries. Plaque is made of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood). It is particularly unstable and prone to produce sudden major problems, such as a heart attack or stroke.

“Ingestion of exogenous dietary supplements, particularly ephedrine- and caffeine-containing preparations in excessive quantities, causes life-threatening arrhythmias, a condition in which the heart beats with an irregular or abnormal rhythm. As a result, the FDA (the US’ food and drug administration) has banned marketing of these substances for enhancement of athletic performance or weight loss," says Dr Panda.

According to race organizers in the country, about a million runners participate in one of the 350-plus middle- or long-distance races in India currently. Given the wide age range of both men and women who participate in these events, it is difficult to point to a particular group that is at risk of such a collapse due to running or overtraining.

“The fatalities in running are physiological and can affect any runner on the day. The best form of prevention is to use scientific training methodologies and get regular medical check-ups to ascertain your risk aversion to any specific condition. Once you know them, familiarize yourself with the signs and symptoms associated with these conditions and be cognizant of them while running," advises Vallabhjee, who is an ultra runner.

Dr Panda warns: “Old age population (especially with coronary artery diseases), diabetics, hypertensive patients, people with electrocardiographic abnormalities, obese population, smokers, those with high cholesterol levels and individuals with a history of sudden cardiac death in the family are at a greater risk of suffering collapses during a strenuous run."

Sport today has a new paradigm—participative sport, says Dilip Jayaram, chief executive officer of Procam International, which promotes four of India’s biggest races. “Proponents of this sport are actually the athletes themselves and not mere audiences. We term them ‘working athletes’—because at 5am every day, they are athletes in training while at 9am, they are professionals who go to work. This key differentiator makes participative sport more susceptible to potential health issues, created by the fact that the body is being exposed to intensive physical activity, which might bring out latent medical issues," he says.

While people pay more attention to the training regimen and food intake, they forget the basic principle of cardiovascular health screening before signing up for a race. This was also the case with Jim Fixx, an American who authored The Complete Book Of Running, a best-seller. He died of heart attack while jogging at the age of 52. “Fixx was at a high risk of heart disease because his father had died from a heart attack at a relatively young age of 43. In addition, Fixx was a reformed smoker, with markedly elevated blood cholesterol levels. An autopsy showed that Fixx had severe coronary heart disease, with near total occlusion of one coronary artery and 80% occlusion of other coronary arteries. His heart was also enlarged, suggesting the possibility of concurrent hypertrophic cardiomyopathy," says Dr Panda.

Vallabhjee recommends mandatory medical screening for races longer than 21km. “These should be done yearly and submitted to the race organizer for two reasons: First, the runner will be aware of one’s own changing health parameters and can take the appropriate precautions and, second, the organizers will have a database of all high-risk runners and the paramedic team will have vital information on hand which could save a life," says Vallabhjee. He also recommends that high-risk runners should have a special marking on the race bib which makes them identifiable to all. “This way, each one of us can be responsible in helping save a life."


Before you sign up for a race, undergo a complete health check-up. This should include:

uFasting lipid profile

uComplete blood count

uFasting and post-meal blood sugar levels

uSerum electrolytes level

uKidney function test

uLiver function test

u2D Echo and stress tests, especially for those who have a family history of ischemic heart disease, hypertension, hypercholesterolaemia and smoking.

In addition to these tests, those who have a history of ischemic heart disease should undergo a stress Echo and/or coronary angiography if indicated by the cardiologist. A familial or genetic profile of the individuals who have a history of sudden cardiac death in the family is also advisable.

—Ramakant Panda, cardiovascular and thoracic surgeon at the Asian Heart Institute in Mumbai.