What health care professionals need to know about marathons

An increasing number of people in the United States are hoping to complete a marathon. Since 1990, the number of marathon finishers per year has more than doubled, and the number of marathons with over a thousand finishers has nearly quadrupled.1 Marathons attract a large community of runners and athletes seeking out longer races and new recreational challenges as well as people hoping to get in shape. Non-traditional running events and half marathons have seen a significant increase in participation as well.2 Both full- and half-marathons require months of training that mandate perseverance, healthy eating, consistent training and a lot of motivation. Health care professionals, for example a certified medical assistant, need to be prepared to aid patients that may have concerns about tackling such a massive undertaking. People looking to run their first marathon will likely have questions about diet, injury and general health.

A marathon’s effect on the heart

The heart undergoes significant stress when training for a marathon due to the intensive cardiovascular regimen needed to properly train, along with actually running the race itself. Regular exercise is considered essential to a healthy lifestyle, however, endurance exercise can overuse the heart muscle and increase the risk of arrhythmias, a condition that causes the heart to beat irregularly.3 Arrhythmia can mean the heart is beating too slow, too fast or erratically. Several studies suggest that the heart can weaken due to too much exercise overall.4 Other evidence suggests endurance running puts participants at risk of myocardial damage.5 In addition, running a marathon can put people with heart conditionsat risk of additional injury.6 A Swedish study conducted by the Department of Cardiology at the Karolinska Institute found that an extreme amount of exercise as well as a notable lack of exercise raises the risk of atrial fibrillation.7 This study found that men who exercised regularly in moderation had a lower risk of atrial fibrillation than those that either neglected to exercise or exercise everyday. Doctors and other health care professionals can utilize this information to alert patients and help them understand the potential risks of running a full-length marathon.

Eating right for a marathon

Running a marathon necessitates a long-term change in diet to accommodate for the overall changes in levels of endurance exercise and calorie consumption. Many first-time marathon runners might not be prepared to alter their eating habits to fit their new workout plan. Health care professionals can assist in this process by recommending foods that not only complement heavy exercise, but also prepare runners for the physiological and psychological challenges of running for hours on end. A good training diet is heavy in nutrients, carbohydrates and protein. Daily calorie and nutrient consumption should be monitored and aligned with each day’s running schedule. Learning how to properly fuel up helps prevent muscle fatigue, which in turn can reduce risk of injury.8 A healthy marathon diet can further benefit runners by strengthening the immune system and restoring muscle tissue more efficiently.9 Each person has individual nutritional needs.As such, discussing and tracking one’s diet can be an effective way to help marathon runners perform their best. A great way to help patients with their marathon diet is to encourage them to maintain a food log, giving them a detailed profile of their daily caloric intake.

Training safely and avoiding injury

Another question most first-time marathon runners will probably have regards the risk of injury. Marathons are associated with chronic injuries such as runner’s knee, patellofemoral pain syndrome, and iliotibial band friction syndrome.10 Other possible conditions include shin splints, plantar fasciitis and stress fractures. Helping protect runners from these type of injuries means, first and foremost, encouraging them to voice any pains they experience, as these could potentially lead to more harmful, long term problems. Health care professionals should talk to patients interested in running marathons about the importance of properly resting and icing sore muscles, stretching, and investing in proper footwear.11 Finding the right running shoes can limit risk of injury, so being able to recommend a local running store or specialist can assist patients. When runners try to push their bodies beyond what they are capable of, they are putting themselves in jeopardy of sustaining a serious injury.

For medical personnel, working with first-time marathon runners and endurance race veterans alike requires cooperation to form individual goals and workout plans. Seasoned runners are exposed to higher risk of chronic injuries that can require continual attention. Helping any runner properly prepare and understand the limitations of their body will help to avoid damaging effects to the heart and various joints. Health care professionals should consider what a patient is capable of physically accomplishing and help them achieve those goals safely.

1“Annual Reports” Running USA. March 23, 2014. http://www.runningusa.org/annual-reports

2“Annual Reports” Running USA. March 23, 2014. http://www.runningusa.org/annual-reports

3“Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study”  Kasper Andersen1,*,Bahman Farahmand2,3, Anders Ahlbom2, Claes Held1, Sverker Ljunghall1, Karl Michaëlsson4 and Johan Sundström1. European Heart Journal. December 14, 2013. http://eurheartj.oxfordjournals.org/content/early/2013/06/10/eurheartj.eht188.full

4“Atrial fibrillation is associated with different levels of physical activity levels at different ages in men Press Release” Nikola Drca1, Alicja Wolk2, Mats Jensen-Urstad1, Susanna C Larsson2. Heart. May 14, 2014 http://heart.bmj.com/content/early/2014/03/25/heartjnl-2013-305304

5“Marathoner’s Heart?” Paul D. Thompson, MD; Fred S. Apple, PhD; Alan Wu, PhD. Circulation. http://circ.ahajournals.org/content/114/22/2306.full

6“Marathoner’s Heart?” Paul D. Thompson, MD; Fred S. Apple, PhD; Alan Wu, PhD. Circulation. http://circ.ahajournals.org/content/114/22/2306.full

7“Atrial fibrillation is associated with different levels of physical activity levels at different ages in men Press Release” Nikola Drca1, Alicja Wolk2, Mats Jensen-Urstad1, Susanna C Larsson2. Heart. May 14, 2014 http://heart.bmj.com/content/early/2014/03/25/heartjnl-2013-305304

8“How to avoid running injuries” Sarah Phillips. The Guardian. February 19, 2012. http://www.theguardian.com/lifeandstyle/2012/feb/19/how-to-avoid-running-injuries

9“How to avoid running injuries” Sarah Phillips. The Guardian. February 19, 2012. http://www.theguardian.com/lifeandstyle/2012/feb/19/how-to-avoid-running-injuries

10“How to avoid running injuries” Sarah Phillips. The Guardian. February 19, 2012. http://www.theguardian.com/lifeandstyle/2012/feb/19/how-to-avoid-running-injuries

11“How to avoid running injuries” Sarah Phillips. The Guardian. February 19, 2012. http://www.theguardian.com/lifeandstyle/2012/feb/19/how-to-avoid-running-injuries