Marathon medical advice from the medical director
Medical problems
Discuss any medical problems with your general practitioner
(GP). This advice supplements anything he or she says. See
your GP if you have a problem that makes it a risk to run
in a marathon. We are happy for people with serious medical
conditions to run, but only with your GP’s agreement
and if you send me details of your condition and the treatment
you are undergoing. Please send these to me and quote your
running number when you know it. Address the envelope to me,
mark it ‘Confidential’ and send it to:
Flora London Marathon office, PO Box 1234, London SE1 8RZ.
If you have a medical problem that may lead to you having
a blackout, such as fits or diabetes, put a cross on the front
of your number and write the details, especially your medication,
on the reverse of the number.
Cardiac events and screening
Over the past 20 years, more than 430,000 runners have successfully
completed the London marathon, but we have experienced five
fatalities from heart disease (four from severe coronary heart
disease) in runners apparently unaware that they had a problem.
Their condition would have been detected if medical advice
had been sought and relevant tests carried out. A ‘fitness
test’ is not sufficient to detect these problems.
If you have a family history of heart disease or sudden death,
or you have symptoms of heart disease ie chest pain or discomfort
on exertion, sudden shortness of breath or rapid palpitations,
see your GP who can arrange for you to have a proper cardiac
assessment. As a cardiologist, I am aware that such an assessment
may not be instantly available, but continuing to run with
these symptoms may shorten your running career catastrophically!
Training
Muscular aches and pains occur most commonly after an increase
in training. Training should be increased gradually so that
you do not suffer prolonged exhaustion and intersperse days
of heavy mileage with one or two days of lighter training,
so that your body can replace its fuel (muscle glycogen).
Rest days are also important.
If you have flu, a feverish cold or a tummy bug, do not train
until you have fully recovered. Then start gently and build
up gradually. Do not attempt to catch up on lost mileage after
illness or injury — this may cause further damage or
illness. To reduce injury risk, train on soft surfaces when
you can, especially on easy training days. Vary routes; do
not always use the same shoes and run on differing cambers,
hills, etc. Always face oncoming traffic, especially in the
dark.
Note: if you cannot run 15 miles comfortably one month before
the marathon, you will not manage it in safety or enjoy it.
Please do not run on this occasion.
Fluids
Fluids lost in sweat must be replaced otherwise your body
becomes dehydrated and less efficient. Alcoholic drinks are
dehydrating. A pint of beer produces more than a pint of urine;
spirits have a worse effect. Take plenty of non-alcoholic
drinks, especially before the race and in hot weather. Thirst
is a poor guide to how much you need. Drink enough to keep
your urine copious and a pale straw colour. Drink plenty of
liquids after training, especially long runs, and drink during
races, especially in the first half of a marathon. Practice
drinking during longer training runs. Drink plenty of fluids
and reduce alcohol intake in the two days before the race.
Diet
Eat what suits you! Large doses of supplementary vitamins
and minerals (such as iron) are not essential and produce
no benefit if you are on a good mixed diet, but additional
vitamin C in small doses is reasonable when fresh fruit and
vegetables are in short supply.
Training helps you to sustain a high level of muscle glycogen
if you eat a lot of carbohydrate. If you can, eat within two
hours of your long runs and the marathon. This helps replace
the muscle glycogen quickly and speeds recovery.
Carbo loading
Do not change your normal diet drastically in the last week
before the marathon, but decrease your intake of protein (meat)
and increase your intake of carbohydrate (pasta, bread, potatoes,
cereals, rice and sweet things), especially for the last three
days when you should also be markedly reducing your training.
This loads the muscle with glycogen. Unless y ou reduce your
protein intake you will not eat enough carbohydrate. (Not
all runners are helped by first depleting carbohydrate with
a long run and low carbo diet and then loading — this
can make your muscles very heavy.)
Clothing
When training in the dark, be seen. Wear white clothing and
reflective flashes or bandoliers.
In a recent London marathon, at least 50 people sought medical
treatment for blisters at the start. They had either been
training too hard in the final two weeks with ill-fitting
shoes, or they had worn a new pair of shoes for the last long
training run. Use shoes you know from experience will not
give you blisters.
On the day
Do not run if you feel unwell or have just been unwell, even
if you are raising money for charity. Most medical emergencies
occur in people who have been unwell but do not wish to miss
the event. If you feel feverish, have been vomiting, have
had severe diarrhoea or any chest pains, or otherwise feel
unwell, it is unfair to you, your family, your sponsoring
charity and the marathon support staff to risk serious illness
and become a medical emergency. You are unlikely to do yourself
justice. There are many other marathons.
Wear appropriate clothes for the weather. On a cold, wet
day you can become very cold if you reduce your running pace
or walk. A hat and gloves will prevent heat loss and are easily
carried. If it is hot, wear loose mesh clothing, start slowly
and, if possible, run in the shade.
Do not be greedy and pour bottles of drinking water over
yourself; you may be depriving slower runners of much needed
drinks. If it is hot, extra water will be provided and showers
set up on the course use these to cool yourself.
Start the race well hydrated (urine looks pale) and drink
whenever you can, especially in the first half of the race
when you may not feel thirsty, as you lose a lot of fluid
insensibly. This will help you feel better late in the race
and may prevent cramp. Cramp is most common in runners who
have not trained sufficiently or are dehydrated. Do not gulp
large volumes of liquid during or after the race. It is possible
to become ill from drinking too much, too quickly.
At the finish
Do not stand about getting cold. Keep walking, especially
if you feel dizzy, and drinking to replace lost liquid. Go
to the baggage area as soon as you can, use the baggage system,
change into warm, dry clothing, and then go to the reunion
area. Foil blankets will not stop you from becoming cold.
Keep on drinking and have something to eat. Some runners
feel faint more than half-an-hour after finishing the race,
often because they have taken insufficient fluid at the finish
and/or not eaten anything.
And finally....
Train sensibly. Follow this simple advice and you will probably
not need medical aid. St John medical aid posts are located
about 50-100 m past the drink stations and after the finish
line. If you drop out, go to an aid station or to the nearest
underground station — you can travel free to the finish
if you show your running number.
Keep this advice and refer to it nearer the day and on marathon
eve.
Dr Dan Tunstall Pedoe FRCP DPhil
Race medical director
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