The human body is a fragile instrument, and when it shuts down — as it does, tragically, for thousands of athletes each year — there is nothing that can be done. It often doesn't matter if trained medical personnel are nearby, or that the athlete was in peak physical condition.
But the death of a marathon runner grabs our attention in a unique way. When it happens — and it happens every year — media attention follows. There are often questions about whether the human heart was made to hold up to the strain of running 26.2 miles, or suggestions that marathons on days when the temperature is unexpectedly warm be postponed.
When 23-year-old Princeton graduate Peter Curtin died last year while running the Baltimore Marathon, it was the second death in the 9-year history of the event, which has had at least 2,100 participants per year in its main race since it was founded. In 2001, the first year the race was run, a 29-year-old female died of a brain aneurysm.
More than 22,000 runners will compete in this year's Baltimore Running Festival, which includes six different races of varying distances and difficulties, and caps its marathon field at 5,000 runners.
Even though, statistically, the odds are good that every runner will make it home safely, Lee Corrigan of Corrigan Sports, the event's organizer, says it will be hard for him to relax until every runner is alive and accounted for at the end of the day.
"I'm always going to be nervous," Corrigan said. "You just try to prepare the best you can. We have over 250 medical volunteers on the course. Last year, we did everything we could to save [Curtin's] life. We were right there when he went down. But you learn that it's a percentage game. Even though the odds are in your favor, and it might be one runner out of 100,000, eventually, your number is going to come up."
But research — including a study that examined the number of deaths in the London Marathon, the biggest in the world, over a 20 year period — tends to show that marathon running is no more dangerous than most athletic activities. The study, done by Dan Tunstall Pedoe, the medical director of the London Marathon, found a death rate of one in every 67,414 runners over a 20 year period, or one death for every 2 million miles run. Heart related illnesses, often undiagnosed, were the most common cause of death.
Another study, done in 2007 by a doctor at the University of Toronto, examined 26 marathons over a 30-year period and came up with a ratio of one death per 126,000 participants.
The Baltimore Running Festival asks that every runner fill out the back of their bib with any pertinent medical information prior to the race, and in partnership with Union Memorial Medical Hospital and MedStar Health, it offers free seminars in the weeks and months prior to the race about proper training and fitness. Approximately 17,000 gallons of water, 20,000 granola bars and 6,000 apples will be passed out to runners during the day.
But it doesn't have any fitness-related screening requirements.
Runners must be at least 16 years old, and they must finish in less than seven hours, but their level of fitness is in their own hands.
That's one reason why many medical experts, such as Dr. Theodore Abraham, an associate professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, recommends athletes, especially young athletes who might not show symptoms of hidden problems, undergo both an echocardiogram (which measures heart size and pumping function and checks for faulty heart valves) and electrocardiogram (which assesses the heart's electrical rhythms) prior to competition.
Sudden cardiac death due to heart rhythm disturbances is blamed for more than 3,000 deaths a year in young people, according to Abraham.
Dr. Dorianne Feldman, a faculty member in the Department of Physical Medicine and Rehabilitation at Johns Hopkins, said in addition to evaluating a runner's medical history, she'd advise a runner preparing for a marathon that their training regimen should begin nearly six months in advance, and that it gradually increase in intensity until 15 to 20 mile runs are a baseline.
In addition to wearing proper dress and evaluating the weather, it's important to keep an eye on potential warning signs that could be indicators of a hidden problem, Feldman said. Fainting, heartburn, stomach problems, and fatigue are common ones. Stress at work can also be a big factor in heart-related illness.
"But sometimes you may not have a warning sign," Feldman said. "Those are just things that, if they do happen, you need to get them checked out. These kind of deaths are rare, but they do happen. Running a marathon is a very vigorous activity and there is a risk in this.
"There is no real strategy that is scientifically proven to decrease these events. You have to be cautious when you're exercising because when you're running, it does create stress on a lot of different organs. You have to listen to your body."