write a hypothesis that explains why the marathon runners are collapsing and possibly dying

Why Do Marathon Runners Collapse?

Here, we’ll explore why do marathon runners collapse—or even suffer cardiac arrest —during marathons and other endurance events. 

• 1 Running A Marathon: What the Body Endures
• 2 Cardiac Arrest And Underlying Heart Disease
• 3 Electrolyte Imbalance
• 4 Heat Stroke
• 5 Hypertrophic Cardiomyopathy
• 6 After The Event: Postural Hypotension
• 7 Staying Safe
• 8 Final Word on Why Do Marathon Runners Collapse
• 9.1 Is it common to collapse during a race?
• 9.2 What should I do if I think I’m going to collapse during a race?

Running A Marathon: What the Body Endures

For both aspiring and seasoned triathlon, marathon, and half marathon athletes, it’s hard to ignore the thought of becoming one of the runners who collapse on the sidelines, needing medical attention. Most runners who have participated in an endurance event have witnessed other runners needing to visit the medical tent.

It can be scary to see runners struggling, and it’s smart to learn what causes a runner to collapse during long-distance races. There are several reasons endurance athletes may experience an inability to continue during endurance races.

Here, we’ll explore some of the most common issues that result in a collapsed athlete, including cardiac arrest and heart disease, hyponatremia (electrolyte imbalance), heatstroke, hypertrophic cardiomyopathy (underlying, typically unknown cardiac abnormalities), as well as postural hypotension, which can cause serious health issues or death after the endurance event is complete. 

Cardiac Arrest And Underlying Heart Disease

Cardiac arrest doesn’t happen often (less than one percent of half marathon and marathon endurance athletes experience cardiac arrest), but when it does happen, it’s often deadly.

Cardiac arrest occurs when there’s a misfiring in the electrical signals that keep the heart beating properly, resulting in a loss of blood flow to the heart. This misfiring (also known as cardiac arrhythmia) causes the heart to stop beating. 

About 70% of the athletes who experience cardiac arrest pass away due to cardiac death. Sudden cardiac arrest can be related to underlying heart disease or previously unknown heart defects. Some runners who survive cardiac arrest are eventually able to return to their normal running schedule without health issues.

Electrolyte Imbalance

Taking on a new challenge — such as a marathon or half marathon — can surprise even a seasoned endurance athlete, no matter how high their level of cardio fitness. Changes in body temperature, changes in mental status, and fluctuating sodium levels due to new levels of physical exertion may cause some runners to overhydrate. 

This does far more than just create an uncomfortable bloated feeling — it can result in hyponatremia, a serious condition in which the sodium levels in the blood are dangerously low. If a collapsed runner is treated quickly (without intravenous fluids), it’s possible that their sodium levels can return to normal. The incidence of hyponatremia is especially high among female ultramarathon runners. 

Heat Stroke

Most runners have been there: it’s time for a huge race that marks the end of months of training , but running conditions aren’t ideal. When you run, your heat production multiplies by twenty — and when you’re running in conditions that are hotter than what you’re used to, the result can be disastrous. 

Interestingly, a study by Dr. Timothy Noakes revealed that marathoners are less likely to suffer from heat stroke than 5K runners. In a long-distance race, the brain communicates with the body when temperatures are rising too high, too fast, and forces the body to slow down.

The problem: this communication takes time. In a shorter race, runners who are psyched to get to the finish line may work faster than their brain’s warning systems can handle, increasing the likelihood of heatstroke. 

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is a genetic disorder that causes an unusual thickness of the left wall of the heart. Intense physical exercise can increase the thickness of the walls of the heart in a person without this condition.

Athletes who have hypertrophic cardiomyopathy are at increased risk for sudden cardiac death. If you’ve had a family member pass away suddenly, it’s possible that they had undiagnosed hypertrophic cardiomyopathy, and it’s more likely that the same could happen to you. 

Often, an athlete’s hypertrophic cardiomyopathy is not known until after they pass away due to a sudden cardiovascular event. If an athlete knows that they have the condition, or have a family history of the condition, it’s important to talk with a physician about how to exercise and compete in a way that makes sense for their health. 

After The Event: Postural Hypotension

Many runners feel that they’re in the clear after they cross the finish line, but this isn’t necessarily the case. Postural hypotension is a dangerous condition that can occur after the race is over when finishers are ready to recover. 

Postural hypotension is marked by the pooling of blood in the legs. Treatment is simple: runners simply need to lie down with their head and pelvis elevated. The biggest concern with postural hypotension isn’t death (the body will faint long before serious damage occurs) — it’s falling and getting hurt. 

Staying Safe

If you’re training for a new distance or making serious changes to your training routine, it’s smart to talk with your doctor to ensure that you’re making the right moves to lower your risk of exercise-associated collapse. 

While many common causes (such as running during excessive heat or overhydrating) occur on race day, always been on the lookout for over-exertional symptoms during training. Let someone know where you’ll be when you’re training, keep an eye on your heart rate and hydration levels, and stop running if something feels off.

If you start to feel not quite like yourself during a race, be sure to alert nearby sports medicine personnel. 

Final Word on Why Do Marathon Runners Collapse

There are many reasons for runner collapse, ranging from benign (postural hypotension) to more severe issues, such as cardiac arrest. If you experience a running-related collapse, be sure to talk with a sports medicine specialist before you resume training. 

You might also be interested in our explainer on why do runners get shin splints .

FAQs About Why Do Marathon Runners Collapse

Is it common to collapse during a race.

Not at all. Most runners never experience a collapse while competing. That being said, up to 85% of athlete collapse issues happen after a race is finished ( Sallis 2004 ), so be sure to follow the above instructions on avoiding postural hypotension, and seek medical attention if something doesn’t feel right 

What should I do if I think I’m going to collapse during a race?

Recognize warning signs that collapse is imminent (changes to heart rate, chest pain, feeling faint), and flag down a sports med specialist. If you can, move to the side of the course to get medical attention.

About The Author

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Why Runners Collapse During or After a Race

At this year’s New York City Half Marathon, reigning Olympic 5km and 10km champion Mo Farah of the United Kingdom took on Geoffrey Mutai, one of the best marathoners in the world.

Though Mutai bested Farah by a good 17 seconds, that wasn’t the biggest story of the day.

Moments after the finish, Mo Farah collapsed to the ground . He was immediately tended to by medical staff at the race and reappeared in good health not too long after at the post-race press conference to allay any fears, but it was still a nerve-racking incident.

As any veteran of endurance races knows, runners collapsing either during or after a race is not unheard of.  If you’ve been to enough races, you’ve probably seen this happen first-hand.

There are a number of reasons why athletes collapse on race day; some are relatively benign, while others are very serious. In today’s article, we’re going to explore some of those reasons so you can help prevent them and ease any fears a situation like this might have caused.

Causes of runners collapsing during and after races

A 2011 scientific paper by Chad Asplund, Francis O’Connor, and Timothy Noakes, three researchers and medical doctors from the United States and South Africa, investigated the various reasons runners collapse during and after races.

Heat stroke

Heat stroke is one potential cause—when you run hard, your body generates a large amount of heat, and if you can’t get rid of it effectively, this will result in an abnormally high body temperature. This in turn causes massive, body-wide problems, which manifest as confusion, dizziness, vomiting, and collapse.

Dehydration can increase your risk of heat stroke, but it is not the only cause. Outside temperature and a rise it internal body temperature from working hard can also cause heat stroke. And while heatstroke is more common on very hot days, it can happen even on days with moderate weather.

Here are 6 helpful strategies for how to perform well and race safely in the heat.

Hyponatremia

Hyponatremia, a drop in the sodium that circulates in your blood, is another possible cause of collapse.

Typically, this occurs in runners who drink far too much water during a race, which dilutes the sodium in their blood so much that it disrupts their body’s normal biochemistry. Hyponatremic runners also commonly vomit, become confused, and collapse.

Athletes at greatest risk are novice runners or slower runners who may take 4-5 hours or more to finish a marathon and who are drinking mainly water. These runners often have an easier time drinking while running at a slower pace and also have more time and opportunities to fill up on fluids.

As the marathon and other long-distance races become more popular, especially among newer recreational runners, more athletes are likely to be at risk for hyponatremia.

For a more in-depth look at hyponutremia and how you can prevent it, here’s a great article written by our nutritionist Emily Brown and based on the work of Dr. Tim Noakes. You can also check out our podcast with Dr. Noakes himself .

Heart conditions

Traditional heart disease can lead to a heart attack during a race, even in apparently healthy middle-aged runners, and many young runners train and race with undetected congenital heart conditions.

One study done in Italy, which requires all young people to undergo cardiac testing before participation in sports, found that 2% of all young athletes had potentially dangerous heart abnormalities. Every year, a handful of high school and college athletes suffer sudden cardiac arrest during athletic events.

One well-known case occurred in 2008, when professional runner Ryan Shay collapsed and died only five miles into the Olympic Trials Marathon.

It’s always advised to consult your doctor before jumping into a training program, especially if you haven’t been exercising regularly before starting.

Postural hypotension (the most likely cause)

As worrying as the three conditions above are, there is some good news

Asplund, O’Connor, and Noakes point out that the majority (though not all ) of runners who collapse after reaching the finish line of a race are likely suffering from a relatively benign condition called postural hypotension.

This happens in part because you’ve stopped running.

• During an all-out effort, like a race, your heart rate is sky-high, and as a result, so is your blood pressure. 
• Additionally, the rapid, rhythmic contractions of your muscles while you run provide a strong pump-like effect on your blood vessels, encouraging blood to circulate back from your legs.

Once you hit the finish line, both of these mechanisms cease.

The result is a sudden drop in blood pressure, which produces dizziness, fainting, and collapse, much like when you stand up too fast after sitting or lying down for a while.

Collapse from postural hypotension still needs medical attention, and Asplund, O’Connor, and Noakes provide guidelines for medical personnel treating collapsed runners. But it’s easily treated with leg elevation and oral rehydration, and it’s not a life-threatening condition.

News stories report that this is exactly what happened to Mo Farah after his half marathon.

Final message

To be sure, there are several very serious life-threatening medical problems that can cause a runner to collapse, even after crossing the finish line. But research suggests the runners who are most likely suffering from a serious problem tend to collapse during the race, and most of the runners who make it to the finish line before collapsing are going to be okay.

Still, any collapsed runner needs medical attention right away.

Knowing the various reasons why a runner might collapse in or after a race could save a life, so it’s worth learning!

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We love running and want to spread our expertise and passion to inspire, motivate, and help you achieve your running goals.

1. Asplund, C. A.; O'Connor, F. G.; Noakes, T. D., Exercise-associated collapse: an evidence-based review and primer for clinicians. British Journal of Sports Medicine 2011, 45 (14), 1157-1162. 2. Armstrong, L. E.; Epstein, Y.; Greenleaf, J. E.; Haymes, E. M.; Hubbard, R. W.; Roberts, W. O.; Thompson, P. D., Heat and cold illnesses during distance running: ACSM position stand. 1995. 3. Noakes, T. D., Hydration in the marathon: using thirst to gauge safe fluid replacement. Sports Medicine 2007, 37 (4-5), 463-466. 4. Noakes, T. D., Lore of Running. 4th ed.; Human Kinetics: Cape Town, 2001. 5. Corrado, D.; Basso, C.; Pavei, A.; Michieli, P.; Schiavon, M.; Thiene, G., Trends in Sudden Cardiovascular Death in Young Competitive Athletes After Implementation of a Preparticipation Screening Program. Journal of the American Medical Association 2006, 296 (13), 1593-1601.

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4 Responses

Just want to know how does VO2 max work and how do I use it my running correctly I have seeing in the articles on runners connect it talk about persentages of VO2 max being used while running I just want a better understanding of VO2 max and how do I apply it in running?

Great.. Remember if you’re running a long-distance race, medical aids should be available throughout the course; seek help when you need it.

I just ran a half marathon after a day of being sick, I collasped afterwards and was taken to the er. My blood pressure had dropped to 70/30, After being treated I was just left with a headache.I will never run a race again if I am not feeling well. I think we all dont take not feeling well serious enough before setting out to run. Listen to your body.

Hi Susan, thanks for sharing. Sorry you had to go through that, but you are exactly right. Now that you have learned your lesson, you will appreciate your training so much more in the future. For now rest up, and feel better!

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Crawling to the finish line: why do endurance runners collapse? Implications for understanding of mechanisms underlying pacing and fatigue

Affiliation.

• 1 Department of Sport and Exercise Sciences, Sport, Exercise and Wellbeing Research Centre, Faculty of Health and Life Sciences, Northumbria University, Northumberland Road, Newcastle upon Tyne, NE1 8ST, UK. [email protected]
• PMID: 23568375
• DOI: 10.1007/s40279-013-0044-y

Effective regulation of pace enables the majority of runners to complete competitive endurance events without mishap. However, some runners do experience exercise-induced collapse associated with postural hypotension, which in rare cases results from life-threatening conditions such as cardiac disorders, cerebral events, heat stroke and hyponatraemia. Despite the experience of either catastrophic system failure or extreme peripheral muscle fatigue, some runners persist in attempting to reach the finish line, and this often results in a sequence of dynamic changes in posture and gait that we have termed the 'Foster collapse positions'. The initial stage involves an unstable gait and the runner assumes the 'Early Foster' collapse position with hips slightly flexed and their head lowered. This unstable gait further degrades into a shuffle referred to as the 'Half Foster' collapse position characterized by hip flexion of approximately 90° with the trunk and head parallel to the ground. At this point, the muscles of postural support and the co-ordination of propulsion begin to be compromised. If the condition worsens, the runner will fall to the ground and assume the 'Full Foster' collapse position, which involves crawling forwards on knees and elbows towards the finish line, with their trunk angled such that the head is at a lower angle than the hips. Upon reaching the finish line, or sometimes before that, the runner may collapse and remain prone until recovering either with or without assistance or medical treatment. The Foster collapse positions are indicative of a final, likely primordial, protective mechanism designed to attenuate postural hypotension, cardiac 'pump' insufficiency or cerebral blood flow deficiency. Continuing to attempt to reach the finish line in this impaired state is also perhaps indicative of a high psychological drive or a variety of neurological and psychological pathologies such as diminished sensitivity to interoceptive feedback, unrealistic situational appraisal or extreme motivational drives. A better understanding of the physiological, neurological and psychological antecedents of the Foster collapse sequence remains an important issue with practical implications for runner safety and theoretical understanding of collapses during exercise.

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Home > Misc > Featured > Why Did The Marathon Runner Collapse

Why Did The Marathon Runner Collapse

Modified: January 22, 2024

Discover the shocking reasons why the featured marathon runner collapsed and learn how to prevent such incidents in the future. Uncover crucial insights now.

(Many of the links in this article redirect to a specific reviewed product. Your purchase of these products through affiliate links helps to generate commission for Runningshorts.com, at no extra cost.)

Introduction

Welcome to the thrilling world of marathon running, an endurance sport that pushes the limits of human capabilities. Witnessing athletes conquer incredible distances, it’s easy to be inspired by their determination and commitment. However, alongside the triumphs, we occasionally hear stories of marathon runners collapsing during races, leaving us bewildered and concerned.

So, why do marathon runners collapse? Is it a result of a lack of preparation, or are there other factors at play? In this article, we will explore the various reasons why marathon runners sometimes experience collapses, shedding light on the physical demands of the sport and the potential dangers that can arise.

It’s important to note that collapsing during a marathon is relatively rare, as most runners are well-prepared and take necessary precautions. Nevertheless, understanding the potential causes of collapses can help us appreciate the importance of proper training, nutrition, and race day strategies in preventing such incidents.

To gain a comprehensive understanding of why marathon runners may collapse, we’ll delve into the physical demands of long-distance running and the factors that can contribute to collapses. We’ll also examine the impact of heat stress, dehydration, overexertion, fatigue, and pre-existing medical conditions on a runner’s performance and well-being. Additionally, we’ll explore the role of training, preparation, and environmental factors in ensuring a successful race experience.

By the end of this article, you’ll have a wealth of knowledge to better comprehend the reasons behind marathon collapses and the measures that can be taken to minimize the risk. So, lace up your running shoes and let’s embark on this enlightening journey into the world of marathon running .

Understanding Marathon Running

Marathon running is an iconic sporting event that involves covering a distance of 26.2 miles (42.195 kilometers) in a single race. It is a test of physical and mental endurance, requiring months of dedicated training and preparation. The marathon traces its roots back to ancient Greece, where the legendary messenger Pheidippides ran from the city of Marathon to Athens to deliver news of a military victory.

Today, marathons attract thousands of participants from around the world, ranging from elite athletes aiming for record-breaking times to recreational runners seeking personal achievements. The event is renowned for its electrifying atmosphere, with crowds cheering and encouraging runners every step of the way.

Running a marathon demands a high level of aerobic fitness, as the body needs to efficiently utilize oxygen to sustain prolonged physical exertion. The cardiovascular and respiratory systems work in tandem to supply oxygen to the muscles, allowing them to generate energy and maintain a steady pace. Endurance training plays a crucial role in enhancing these systems, enabling runners to sustain effort over long distances.

In addition to the physical aspect, marathon running also requires mental strength and resilience. Distances of such magnitude can be mentally challenging, with runners having to battle through fatigue, self-doubt, and the temptation to slow down or quit. Mental preparation is just as important as physical training, helping runners maintain focus and motivation throughout the race.

Marathon runners often follow training programs that gradually increase the duration and intensity of their runs, allowing their bodies to adapt and build endurance. Long runs help condition the muscles and cardiovascular system, while speed workouts improve running efficiency and stamina. Additionally, incorporating strength and flexibility exercises into training routines helps prevent injuries and maintain overall fitness.

While completing a marathon is an incredible achievement, it’s important to recognize that each runner’s journey is unique. Some may prioritize finishing the race within a certain time frame, while others may focus solely on the accomplishment of crossing the finish line. Regardless of individual goals, marathon running fosters a sense of camaraderie and personal growth, with participants often describing it as a life-changing experience.

Now that we have a basic understanding of marathon running, let’s explore the physical demands this sport entails and how they can contribute to collapses during races.

The Physical Demands of a Marathon

Running a marathon is a grueling endeavor that places significant demands on the body. The distance, duration, and intensity of the race require well-trained muscles, a robust cardiovascular system, and mental fortitude. Understanding these physical demands helps us comprehend why marathon runners may occasionally face challenges and potential collapses.

First and foremost, let’s acknowledge the sheer distance of a marathon. Covering 26.2 miles (42.195 kilometers) in a single race requires remarkable endurance and stamina. The muscles responsible for propulsion, such as the quadriceps, hamstrings, and calves, endure continuous strain throughout the entire distance. Overcoming this challenge demands extensive training to condition the muscles to withstand such prolonged exertion.

In addition to muscular endurance, marathon running requires efficient cardiovascular function. The heart plays a vital role in supplying oxygen-rich blood to the working muscles, ensuring they receive the necessary nutrients and energy to sustain the demanding pace. Regular cardiovascular training, such as long runs and interval workouts, strengthens the heart muscle, increases its stroke volume, and improves blood circulation.

The respiratory system also plays a pivotal role in marathon running. The lungs must provide an adequate supply of oxygen to meet the increased demands during intense physical activity. Through regular endurance training, runners improve their lung capacity, enabling them to take in larger volumes of oxygen and expel carbon dioxide more efficiently.

Maintaining proper form and technique is essential during a marathon. Efficient running mechanics help minimize energy expenditure and reduce the risk of injuries. Proper foot strike, stride length, cadence, and upper body posture all contribute to running efficiency. Runners who have developed good running mechanics through training will have a higher chance of performing well and enduring the physical stresses of the race.

Lastly, mental resilience is a fundamental component of marathon running. As the race progresses, runners may experience mental fatigue, self-doubt, and the temptation to slow down or quit. The ability to maintain focus, stay motivated, and push through discomfort is crucial for success. Mental training techniques, such as visualization, positive self-talk, and mindfulness, can help runners overcome these challenges and maintain a strong mindset throughout the race.

To summarize, marathon running places significant physical demands on the body. Endurance, muscular strength, cardiovascular fitness, respiratory capacity, and mental fortitude all play crucial roles in a runner’s ability to complete the race successfully. In the next section, we will delve into specific factors that can contribute to collapses during marathons, shedding light on the potential dangers that runners may face on race day.

Factors Contributing to Collapses

Collapses during marathons can occur due to various factors, ranging from physical exertion to environmental conditions. It’s important to understand these factors to prevent and mitigate the risks associated with collapsing during a race.

One of the primary factors contributing to collapses is heat stress and dehydration. Running a marathon in hot and humid conditions can lead to excessive sweating, which can result in fluid and electrolyte imbalance. When the body loses more fluids than it takes in, dehydration sets in, impacting performance and increasing the risk of collapse. Heat stress further worsens the situation, as the body struggles to regulate its temperature. This highlights the importance of proper hydration strategies and taking precautions in hot weather conditions.

Overexertion and fatigue are also significant factors in marathon collapses. Pushing the body to its limits without adequate training or pacing can lead to excessive fatigue, making it difficult to maintain a steady pace and balance energy reserves. Overexertion can result in muscle cramps, exhaustion, and a decreased ability to regulate body temperature, increasing the risk of collapse.

Nutrition plays a crucial role in marathon running, and inadequate fueling can contribute to collapses. Consuming an insufficient amount of carbohydrates, which are the body’s primary source of energy during endurance exercise, can lead to depletion of glycogen stores, resulting in fatigue and a decline in performance. Failing to replenish energy levels during a race can increase the risk of collapsing, especially during the later stages when glycogen stores are depleted.

Pre-existing medical conditions can also make individuals more susceptible to collapsing during a marathon. Conditions such as heart problems, asthma, or heat-related disorders can increase the risk of experiencing a medical emergency during the race. It is crucial for individuals with underlying health issues to consult with medical professionals and take the necessary precautions before undertaking such intense physical activity.

Training and preparation significantly impact a runner’s ability to avoid collapsing during a marathon. Insufficient training, inadequate rest, or a lack of acclimatization to environmental conditions can contribute to collapses. Properly designed training plans that gradually increase mileage and intensity are essential in preparing the body for the demands of a marathon, while allowing for sufficient rest and recovery periods.

Environmental factors, such as extreme temperatures, high altitude, or poor air quality, can also increase the risk of collapses. These conditions place additional stress on the body, impacting performance and increasing the chances of overheating or experiencing respiratory difficulties.

By understanding and addressing these factors, marathon runners can take proactive measures to prevent collapses during races. In the next sections, we will explore specific strategies and precautions that can be taken to mitigate these risks and ensure a safe and successful marathon experience.

Heat Stress and Dehydration

Heat stress and dehydration are significant factors that can contribute to collapses during marathons, particularly in hot and humid environments. As the body engages in intense physical activity, it generates heat, which must be dissipated to maintain a stable internal temperature. However, when the external temperature and humidity are high, the body’s cooling mechanisms can be overwhelmed, leading to heat-related issues.

When the body sweats, it loses both water and electrolytes, such as sodium and potassium, which are essential for proper muscle function and hydration. As dehydration sets in, blood volume decreases, making it more difficult for the heart to pump blood to the muscles and other vital organs. This can result in decreased performance, fatigue, dizziness, confusion, and an increased risk of collapsing.

To prevent dehydration and minimize the risk of heat-related issues during a marathon, it is crucial for runners to prioritize proper hydration strategies. Here are some key considerations to keep in mind:

• Pre-hydration: Hydration should begin well before the race starts. Ensure you are adequately hydrated in the days leading up to the marathon by consuming enough fluids, including water and electrolyte-rich beverages.
• During the race: Aim to drink fluids at regular intervals throughout the race. This may involve utilizing aid stations along the course or carrying a hydration pack or belt. Water and sports drinks containing electrolytes are recommended options to replenish fluids and restore electrolyte balance.
• Listen to your body: Pay attention to your body’s signals and drink when you feel thirsty. Thirst is an indication that you are already mildly dehydrated, so proactive hydration is essential.
• Monitor urine color: Monitoring the color of your urine can provide insights into your hydration status. A pale yellow or straw-colored urine indicates adequate hydration, while a dark yellow or amber color may suggest dehydration.
• Recovery hydration: After completing a marathon, it’s important to continue hydrating to replenish fluids lost during the race. Consuming water, sports drinks, or electrolyte-rich fluids alongside balanced meals can aid in the recovery process.

Additionally, it is recommended to adjust running pace and exertion levels in hot and humid conditions to minimize the risk of heat stress and dehydration. Slowing down and taking walk breaks can help conserve energy and prevent excessive overheating. Wearing lightweight, breathable clothing and a hat can also aid in temperature regulation by allowing sweat to evaporate more effectively.

By understanding the impact of heat stress and dehydration on marathon running, and implementing appropriate hydration strategies, runners can minimize the risk of collapsing and ensure a safer and more enjoyable race experience.

Overexertion and Fatigue

Overexertion and fatigue are common factors that can contribute to collapses during marathons. Pushing the body beyond its limits without adequate training, pacing, and rest can lead to a significant decline in performance and an increased risk of physical and mental exhaustion.

During a marathon, runners continuously exert themselves, maintaining a steady pace for an extended period. This sustained effort places tremendous strain on the muscles and depletes energy reserves. Without proper training and conditioning, the body may not be prepared to handle the demands of the race, leading to premature fatigue and difficulty maintaining form and performance.

The risk of overexertion and fatigue can be mitigated by following some key strategies:

• Gradual training progression: Proper training programs gradually increase mileage and intensity, allowing the body to adapt and build endurance over time. Incremental increases in mileage and the incorporation of rest days help prevent overexertion and minimize the risk of fatigue.
• Pacing and race strategy: Setting a realistic pace and sticking to it is crucial. Starting too fast can result in early fatigue, while conserving energy in the beginning allows runners to maintain a steady pace throughout the race. It’s important to resist the temptation to sprint or keep up with faster runners to avoid overexertion.
• Proper fueling and nutrition: Consuming a balanced diet and ensuring adequate nutrient intake before, during, and after a marathon is essential. Carbohydrates provide the primary source of energy, while adequate protein intake aids in muscle recovery. Refueling with energy gels, sports drinks, and simple carbohydrates during the race can help maintain energy levels and stave off fatigue.
• Listening to your body: Pay attention to physical and mental cues that indicate fatigue. Pushing through extreme exhaustion can lead to injury or collapse. If the body feels excessively fatigued or if dizziness, nausea, or extreme muscle soreness occur, it may be necessary to slow down, walk, or seek medical assistance.
• Rest and recovery: Adequate rest and recovery are crucial components of marathon training. Allowing the body to repair and replenish energy stores enhances overall performance and reduces the risk of injury. Building recovery periods into training plans and getting enough sleep are vital for managing fatigue.

Additionally, mental resilience plays a crucial role in counteracting fatigue during a marathon. Staying focused, maintaining a positive mindset, and practicing mental strategies, such as visualization and positive self-talk, can help overcome mental fatigue and keep runners motivated and determined.

By implementing these strategies and understanding the importance of pacing, nutrition, rest, and mental resilience, marathon runners can reduce the risk of overexertion and fatigue, enhancing their chances of completing the race successfully without collapsing.

Nutrition and Hydration Strategies

Nutrition and hydration are crucial components in marathon running, as they directly impact performance, energy levels, and the overall well-being of runners. Proper fueling and hydration strategies before, during, and after the race are essential in preventing collapses and optimizing race performance.

Prior to the marathon, it’s important to focus on consuming a well-balanced diet that includes a variety of whole foods. Carbohydrates should be emphasized, as they are the primary fuel source for endurance exercise. Whole grains, fruits, vegetables, and legumes are excellent sources of complex carbohydrates that provide sustained energy. Adequate protein intake supports muscle repair and recovery, while healthy fats provide essential nutrients and help satisfy hunger.

Leading up to the race, it’s recommended to increase carbohydrate intake to build glycogen stores in the muscles and liver. This process, known as carb-loading, typically involves consuming around 2-4 grams of carbohydrates per pound of body weight in the days leading up to the race.

During the marathon, fueling becomes critical to sustain energy levels and prevent depletion. Runners often rely on carbohydrates in the form of energy gels, sports drinks, or easily digestible snacks to provide a quick source of fuel. Consuming carbohydrates at regular intervals, typically every 45 minutes to an hour, helps maintain blood glucose levels and stave off fatigue.

Hydration is equally important during a marathon to prevent dehydration and maintain performance. Runners should aim to drink fluids at regular intervals, taking advantage of aid stations along the course. Water is essential for hydration, while sports drinks containing electrolytes aid in replenishing the body’s electrolyte balance. The amount of fluid needed varies based on factors such as temperature, humidity, and individual sweat rate.

It’s crucial to develop a personalized nutrition and hydration plan during training to understand what works best for your body. Experimenting with different foods, fluids, and timing can help identify the optimal strategy for fueling and hydrating during the marathon. Keep in mind that everyone’s digestive system responds differently, so it’s important to test your plan during long training runs to ensure it works well for you.

Post-marathon nutrition is vital for recovery and replenishing depleted energy stores. Consuming a balanced meal or snack within the first 30 to 60 minutes after the race is recommended to kickstart the recovery process. It should include carbohydrates for glycogen replenishment, protein for muscle repair, and fluids to rehydrate the body.

By prioritizing proper nutrition and hydration before, during, and after the marathon, runners can optimize their performance, reduce the risk of collapsing, and ensure a successful and enjoyable race experience.

Pre-existing Medical Conditions

Pre-existing medical conditions can significantly impact a runner’s risk of collapsing during a marathon. Conditions such as heart problems, asthma, heat-related disorders, and others require special considerations and precautions to minimize potential risks and ensure the safety of the runner.

It is essential for individuals with pre-existing medical conditions to consult with their healthcare providers before participating in a marathon. The healthcare professional can assess the individual’s medical history, perform necessary tests, and provide guidance on whether it is safe to engage in such intense physical activity.

Heart problems, including arrhythmias, coronary artery disease, and valve abnormalities, pose a significant risk during a marathon. Intense exercise places an increased workload on the heart, which may exacerbate existing heart conditions. Runners with known heart problems should undergo thorough cardiovascular evaluations and receive clearance from their cardiologists before participating in a marathon.

Asthma, a chronic respiratory condition characterized by inflammation and narrowing of the airways, can also impact a runner’s performance and increase the risk of complications during a marathon. Individuals with asthma should work closely with their healthcare providers to manage their condition effectively and ensure that their medications are optimized for exercise.

Heat-related disorders, such as heat stroke and heat exhaustion, can be life-threatening and are of particular concern in hot and humid environments. Those who have a history of heat-related illness should be cautious when participating in marathons and take proper precautions to prevent overheating. Acclimatization, proper hydration, and monitoring body temperature during the race are essential strategies to reduce the risk of heat-related complications.

Other conditions, such as diabetes, epilepsy, and chronic musculoskeletal injuries, require special attention and management during a marathon. Individuals with these conditions should work with their healthcare providers or specialists to develop a personalized plan that addresses their specific needs and minimizes the risk of complications.

In some cases, individuals with pre-existing medical conditions may be advised against participating in a marathon. However, for individuals who are cleared to participate, it’s crucial to take extra precautions and be aware of warning signs that may indicate a medical emergency. These signs may include chest pain or pressure, difficulty breathing, dizziness, confusion, severe headache, or any other unusual symptoms.

Ultimately, the decision to participate in a marathon with a pre-existing medical condition should be made in consultation with healthcare professionals. Their guidance, expertise, and individualized advice will help ensure that runners with medical conditions can safely participate and enjoy the benefits of marathon running.

Training and Preparation

Training and preparation are integral components of marathon running. Adequate preparation not only enhances physical fitness but also reduces the risk of collapsing during a race. Following a well-designed training plan, incorporating specific workouts, and allowing for proper rest and recovery are essential for a successful marathon experience.

Training for a marathon typically spans several months and involves progressively increasing mileage and intensity to build endurance. A structured training plan helps runners gradually adapt to the demands of long-distance running, preventing overexertion and reducing the risk of fatigue and injury.

Key elements of marathon training include:

• Base Building: Starting with a foundation of aerobic fitness, runners gradually increase their weekly mileage to develop a strong endurance base. This phase typically involves predominantly easy-paced runs and is crucial for preparing the body for the more demanding aspects of training.
• Long Runs: Integrating long runs into the training plan is vital for building cardiovascular fitness and mental resilience. These runs should progressively increase in distance to simulate the marathon distance and allow the body to acclimate to sustained efforts.
• Speed Workouts: Interval training and tempo runs are incorporated to improve aerobic capacity, running efficiency, and speed. These workouts help the body adapt to running at faster paces while providing valuable opportunities for practicing race pace.
• Rest and Recovery: Scheduling rest days and incorporating lighter training weeks throughout the training plan is essential for allowing the body to rest, repair, and adapt to the increased training load. Recovery practices, such as foam rolling, stretching, and adequate sleep, also promote overall well-being and reduce the risk of injuries.

Gradually increasing mileage, incorporating speed work, and allowing for adequate recovery periods are key strategies in preventing overexertion and fatigue. Proper pacing during training runs is crucial to avoid burnout and to develop a better understanding of personal limits and race-day goals.

In addition to physical training, it’s important to prepare mentally for the challenges of the marathon. Developing strategies to manage the mental demands of long-distance running, such as visualization, positive self-talk, and goal-setting, can help runners stay focused and motivated during the race.

Preparing for a marathon also involves paying attention to logistical details. This includes selecting appropriate race attire and footwear, familiarizing oneself with the race course, and understanding the aid stations and water locations. Having a race-day plan, including strategies for hydration, fueling, and pacing, is essential for optimizing performance and minimizing the risk of collapsing.

By following a well-structured training plan, incorporating rest and recovery, and preparing both physically and mentally for the challenges of a marathon, runners can increase their chances of completing the race successfully and enjoying the entire experience.

Environmental Factors

Environmental factors play a significant role in marathon running and can greatly impact a runner’s performance and well-being. Factors such as temperature, humidity, altitude, air quality, and even the course terrain can pose challenges and increase the risk of collapses during a marathon.

One of the most influential environmental factors is temperature. Running in hot weather conditions can lead to increased body temperature and additional stress on the cardiovascular system. High temperatures can also exacerbate dehydration and increase the risk of heat-related illnesses.

Humidity is another crucial factor to consider. High humidity impairs the body’s ability to cool itself through sweat evaporation, making it difficult to regulate body temperature. The combination of high temperature and humidity creates an even greater challenge for marathon runners, increasing the risk of heat stress and collapsing.

Altitude can also impact marathon performance and can be particularly demanding for runners who are not acclimatized to high elevations. At higher altitudes, the air is thinner, resulting in lower oxygen levels. This can lead to decreased aerobic capacity, increased heart rate, and a higher risk of fatigue and collapsing.

Air quality is another environmental factor that should not be overlooked. Poor air quality due to pollution or smog can negatively affect respiratory function, making it harder for runners to breathe and causing discomfort during the marathon. Runners with pre-existing respiratory conditions should be especially cautious and may need to modify their race plans in areas with poor air quality.

The course terrain can also present challenges during a marathon. Hilly courses place additional stress on the leg muscles, requiring more effort and potentially increasing the risk of fatigue. Runners should familiarize themselves with the course’s elevation profile and adjust their race strategy accordingly.

Taking into account these environmental factors, runners can implement strategies to mitigate their impact and reduce the risk of collapsing during a marathon. Here are some key considerations:

• Monitoring weather conditions: Stay informed about the weather forecast leading up to the race and on race day. Adjust your race strategy and pace accordingly to accommodate for extreme temperatures, high humidity, or other adverse weather conditions.
• Hydration and cooling strategies: Increase fluid intake before and during the race to compensate for dehydration caused by heat and humidity. Utilize cooling techniques such as pouring water over the head and neck or using ice packs to cool down during the race.
• Acclimatization: If running at high altitudes, spend time acclimatizing to the elevation before the race. Gradually increase the intensity and duration of training at higher altitudes to allow the body to adjust to the reduced oxygen levels.
• Course familiarization: Study the course map and terrain profile to mentally prepare for any challenges. Adjust your race plan accordingly, conserving energy for uphill sections and capitalizing on downhill portions.
• Pay attention to air quality: Check the air quality index in the area where the marathon will take place. If levels are poor, consider modifying your race strategy, using a face mask, or seeking an alternative race location with better air quality.

By understanding and addressing the environmental factors that can affect a marathon, runners can make informed decisions and take appropriate measures to optimize their performance and minimize the risk of collapsing.

Race Day Strategies

Race day is the culmination of months of training and preparation, and executing the right strategies can greatly impact a runner’s performance and ability to avoid collapsing during a marathon. Here are some key race day strategies to consider:

• Arrive Early: Arriving at the race venue with ample time allows for a smooth check-in process, warm-up routines, and mentally preparing for the race. It also helps avoid unnecessary stress and rushing, ensuring a calm and focused mindset.
• Stick to Your Plan: It’s crucial to stick to your race plan and pacing strategy. Avoid getting caught up in the excitement and energy of the start, which can lead to starting too fast and potentially causing early fatigue or collapsing later in the race.
• Hydration and Fueling: Be mindful of your hydration and fueling needs during the race. Utilize aid stations along the course and carry any necessary nutrition supplements with you. Drink fluids at regular intervals, and consume carbohydrates to maintain energy levels and prevent depletion.
• Monitor Effort and Pace: Monitor your effort and maintain a consistent pace throughout the race. Pay attention to your perceived level of exertion and use it as a guide to avoid pushing beyond your limits and risking overexertion or fatigue.
• Stay Mentally Strong: Keep a positive and focused mindset during the race. Break the marathon into smaller, manageable sections, and celebrate mini-milestones along the way. Use visualization, positive self-talk, and mantras to keep motivation high and push through challenging moments.
• Adapt to Course Conditions: Adjust your race strategy based on the course terrain and environmental conditions. Be prepared for inclines, declines, or any specific challenges the course may present. This includes adjusting your pace, conserving energy on uphill sections, and capitalizing on downhill portions.
• Listen to Your Body: Tune into your body’s signals and be aware of warning signs of fatigue, dehydration, or other health concerns. If you start experiencing dizziness, extreme muscle soreness, or any concerning symptoms, be prepared to adjust your strategy, seek medical assistance, or consider stopping if necessary.
• Fuel Up for the Finish: In the final miles of the marathon, when glycogen stores may be depleted, fuel up with any remaining nutrition supplements or energy gels to maintain energy levels and prevent collapsing before the finish line.
• Celebrate and Recover: After crossing the finish line, take the time to celebrate your accomplishment and reflect on your journey. Rehydrate with water or sports drinks, consume a balanced recovery meal, and engage in active recovery methods such as light stretching or walking to aid in the recovery process.

Remember, every marathon is a unique experience, and what works for one runner may not work for another. Be adaptable and make adjustments based on your own needs and conditions. By implementing effective race day strategies, you can optimize your performance, minimize the risk of collapsing, and create a memorable and rewarding marathon experience.

Recognizing Warning Signs

Recognizing warning signs of potential distress during a marathon is crucial for maintaining the safety and well-being of runners. Being aware of these signs allows for prompt action and can help prevent serious health complications or collapsing. While each individual may exhibit different warning signs, here are some common indicators to watch out for:

• Extreme Fatigue: Feeling an overwhelming sense of exhaustion or heaviness in the legs that persists and significantly impacts running form and pace can be a warning sign of impending collapse. It’s important to listen to your body and adjust your pace or seek medical attention if necessary.
• Dizziness or Lightheadedness: Feeling dizzy or lightheaded during a marathon could be a sign of dehydration, low blood sugar, or poor circulation. It’s crucial to slow down, take a walk break, and rehydrate to prevent further complications.
• Confusion or Disorientation: A sudden onset of confusion, difficulty concentrating, or disorientation may indicate heat stroke, dehydration, or other medical conditions. These signs should be taken seriously, and immediate medical attention should be sought.
• Severe Muscle Cramps: While muscle cramps can be common during a marathon, if they become severe and are accompanied by intense pain or immobility, it may indicate an electrolyte imbalance or muscle injury. Stopping, stretching, and seeking medical assistance can help alleviate the cramps and prevent further complications.
• Persistent Nausea or Vomiting: Continuous feelings of nausea or vomiting during a race could be a sign of dehydration, electrolyte imbalance, or heat exhaustion. It’s important to take small sips of water or an electrolyte beverage to rehydrate and seek medical aid if the symptoms worsen.
• Chest Pain or Discomfort: Chest pain or discomfort during a marathon should never be ignored. It could be a sign of a potentially serious cardiac event, such as a heart attack. Stopping immediately and seeking immediate medical attention is crucial in such instances.
• Unresponsiveness or Loss of Consciousness: If a runner becomes unresponsive or loses consciousness during a race, it is a medical emergency. Calling for immediate medical assistance and seeking help from nearby race volunteers or spectators is essential in these situations.

It’s important for runners to educate themselves about these warning signs before the race and to communicate their concerns to friends, family, or fellow runners who can help monitor their condition. Equally important is understanding the importance of looking out for one another during a marathon and seeking help if someone exhibits any of these warning signs.

Race organizers, volunteers, and medical personnel along the course are there to assist runners in cases of distress. If you witness a fellow runner experiencing any of these warning signs, alert nearby race officials or medical personnel immediately. Prompt and appropriate action can make a significant difference in preventing serious complications and ensuring the safety of all participants.

Immediate Response and Medical Treatment

In the event of a collapse or any other medical emergency during a marathon, an immediate and coordinated response is crucial. Knowing how to respond and having access to medical assistance can make a significant difference in ensuring the well-being of the runner. Here are key steps to take in the event of a collapse:

• Assess the Situation: If you witness a collapse, quickly assess the scene for any immediate danger or potential risks. Ensure your own safety and the safety of those around you before moving forward.
• Call for Help: Dial emergency services or alert nearby race officials, volunteers, or medical personnel to summon immediate medical assistance. Provide clear and accurate information about the location and nature of the emergency.
• Check Responsiveness: Assess the responsiveness of the collapsed individual by gently shaking or tapping their shoulder and asking if they are okay. If there is no response, assume they are unconscious and require immediate medical attention.
• Open Airways: If the collapsed runner is unresponsive or not breathing normally, open their airway by tilting their head back slightly and lifting the chin. Check for any obstructions in the mouth or throat and remove them if possible.
• Perform CPR if Trained: If you are trained in CPR (cardiopulmonary resuscitation), start chest compressions and rescue breaths following the appropriate guidelines. Continue until medical professionals arrive or until the person shows signs of recovery.
• Monitor Vital Signs: While waiting for medical assistance, monitor the collapsed runner’s vital signs, such as pulse and breathing. Provide comfort and reassurance, and keep them as stable as possible.
• Follow Medical Advice: When medical professionals arrive on the scene, follow their instructions and provide them with any relevant information about the collapsed individual, such as pre-existing medical conditions or medications taken.
• Offer Support to the Runner: After the immediate medical response, be compassionate and offer support to the runner’s family or friends who may be present. Assist with gathering belongings and providing any necessary information to medical personnel.

It’s important to remember that each medical emergency is unique, and the steps taken may vary depending on the specific situation. Therefore, it is highly recommended for runners and spectators to familiarize themselves with basic first aid and CPR training to better respond to emergencies during a marathon.

Race organizers, medical personnel, and volunteers are present along the marathon route to provide necessary aid and support during emergencies. They are trained to handle various situations and should be relied upon for their expertise.

By taking immediate and appropriate actions, and working together with medical professionals and race officials, we can ensure the prompt and adequate treatment of collapsed runners, minimizing the impact of such incidents during a marathon.

Post-Collapse Care and Recovery

After a collapse or medical emergency during a marathon, it is essential to provide proper care and support for the individual’s recovery. Post-collapse care focuses on ensuring the well-being of the runner and assisting in their physical and emotional recovery.

Here are important steps to consider for post-collapse care and recovery:

• Medical Evaluation: Following a collapse, the individual should undergo a thorough medical evaluation to determine the cause of the incident and to ensure there are no underlying health issues requiring further attention or treatment.
• Hydration and Nutrition: Replenishing fluids and nourishing the body is crucial for recovery. Encourage the runner to drink water or sports drinks to rehydrate and consume a balanced meal or snack to replenish energy stores and aid in muscle recovery.
• Rest and Observation: Allow the runner to rest and gradually regain their strength. Monitor their vital signs, including heart rate and blood pressure, as well as any recurring symptoms. If there are concerns or a change in condition, seek medical attention promptly.
• Emotional Support: Collapsing during a marathon can be a traumatic experience, and emotional support is vital during the recovery period. Offer reassurance, listen empathetically, and provide a safe space for the runner to express their feelings and concerns.
• Gradual Return to Activity: It is important for the individual to gradually return to physical activity after a collapse. Following medical clearance, they can engage in light physical activity, such as gentle stretching, walking, or low-impact exercises, to promote circulation and aid in the recovery process.
• Review and Reflect: After the incident, it may be helpful for the runner to reflect on the circumstances that led to the collapse and assess their training, nutrition, and hydration strategies. This reflection can guide adjustments for future races and improve overall preparedness.
• Seek Professional Guidance: For runners who have experienced a collapse, it is beneficial to consult with a healthcare professional, such as a sports medicine physician or a registered dietitian, to address any concerns, receive guidance on preventing future incidents, and develop a personalized recovery plan.

It’s important to remember that each individual’s recovery process and timeline may vary. Some runners may require more rest and time before returning to full activity, while others may recover more quickly. Patience, understanding, and flexibility are key as they navigate their post-collapse recovery journey.

Moving forward, it is essential for the runner to adjust their training and race strategies based on the information gained from the collapse incident. Working closely with healthcare professionals and knowledgeable coaches can help identify potential areas for improvement and ensure a safer, more successful marathon experience in the future.

Participating in a marathon is an incredible endeavor that requires physical endurance, mental resilience, and careful preparation. Understanding the factors that can contribute to collapses during a marathon is crucial for maintaining the safety and well-being of runners. Factors such as heat stress, dehydration, overexertion, pre-existing medical conditions, and environmental factors can significantly impact a runner’s performance and increase the risk of collapsing.

By implementing strategies such as proper hydration, nutrition, and pacing, runners can mitigate these risks and optimize their performance. Attention to warning signs, assessing the situation, and seeking immediate medical assistance in case of a collapse are vital in ensuring the well-being of the individual. Post-collapse care and recovery should focus on medical evaluation, rehydration, nutrition, rest, emotional support, gradual return to activity, and seeking professional guidance when necessary.

It is essential for both runners and race organizers to prioritize the safety and well-being of participants. Adequate planning, provision of medical support along the race route, and educating runners and spectators about recognizing and responding to emergencies are crucial elements of a well-organized marathon event.

Participating in a marathon is an extraordinary accomplishment that can transform lives and inspire others. By understanding the risks associated with collapses, implementing appropriate strategies, and fostering a supportive and inclusive marathon environment, runners can enhance their race experiences and continue to pursue their passion for long-distance running.

Ultimately, the journey of a marathon encompasses much more than just crossing the finish line. It is a testament to the human spirit, resilience, and determination. By staying informed, prepared, and attentive, participants can minimize the risks and maximize the rewards of this incredible endurance sport.

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Unraveling the Mystery: Why Do Runners Collapse?

Page Contents

The Dehydration Dilemma: A Common Culprit

Fueling the body: the importance of nutrition, overexertion and heat stress: pushing the limits, medical conditions and individual factors: an unpredictable element, preventing collapse: strategies for a safe and successful run, conclusion: running safely and strongly.

Running, the exhilarating sport that challenges both our bodies and spirits, is a journey filled with triumphs and challenges. While the finish line often brings a sense of accomplishment, there are moments when the body’s limits are pushed to the edge, leading to a phenomenon that has puzzled many: runners collapsing. In this exploration, we delve into the various factors that can contribute to runners collapsing and shed light on how to minimize the risk.

Dehydration stands as one of the most common factors leading to runners collapsing during races or training. As we pound the pavement, we lose valuable fluids through sweat, and failing to replenish them adequately can result in decreased blood volume and potential collapse. A study published in the Journal of Athletic Training revealed that runners who experienced dehydration were at a higher risk of heat-related illnesses, including collapse.

To mitigate this risk, hydration should be a top priority before, during, and after your run. Ensuring that you’re adequately hydrated, and consuming fluids that contain electrolytes, can help maintain your body’s fluid balance and reduce the likelihood of collapsing due to dehydration.

Nutrition plays a pivotal role in a runner’s ability to sustain their energy levels and prevent collapse. Inadequate fueling before or during a run can lead to depletion of glycogen stores, which are essential for maintaining muscle function and overall performance. A study published in the Journal of the International Society of Sports Nutrition highlighted the connection between proper carbohydrate intake and endurance exercise.

To avoid collapsing due to nutritional deficiencies, prioritize a balanced diet rich in carbohydrates, protein, and healthy fats. Additionally, consider consuming energy gels or snacks during longer runs to replenish glycogen stores and maintain stable blood sugar levels.

Pushing our bodies to the limit is often a hallmark of dedicated runners, but there’s a fine line between a challenging workout and overexertion. Excessive physical strain, especially in hot and humid conditions, can lead to heat stress and, in severe cases, collapse. A study published in the Journal of Science and Medicine in Sport explored the impact of heat stress on runners, emphasizing the importance of heat acclimatization and proper training in hot environments.

To reduce the risk of collapsing due to overexertion and heat stress, pay attention to your body’s signals. Be cautious when training in extreme weather conditions and adjust your pace or intensity accordingly. Gradually acclimate yourself to hot conditions and prioritize rest and recovery to allow your body to adapt.

While dehydration, nutrition, and exertion are common factors, it’s important to acknowledge that individual differences and underlying medical conditions can also contribute to runners collapsing. Conditions such as heat stroke, exercise-induced asthma, and cardiac issues can increase the risk of collapse during a run. A study published in the British Journal of Sports Medicine highlighted the significance of recognizing medical factors that can impact runners’ health and safety.

To address this unpredictable element, it’s crucial to undergo regular medical check-ups, especially if you have pre-existing conditions. Listen to your body, and if you experience symptoms such as dizziness, nausea, or extreme fatigue during a run, it’s essential to stop and seek medical attention if needed.

As runners, our passion for the sport often propels us to explore new boundaries and achieve personal milestones. While the thrill of reaching these goals is undeniable, it’s equally important to ensure that our running endeavors are approached with caution and care. In this segment, we’ll delve into effective strategies that can help prevent the occurrence of collapsing during your runs and promote a safer, more enjoyable experience.

1. Stay Hydrated: The Ultimate Key Hydration remains a cornerstone of preventing collapse while running. Begin your run well-hydrated and continue to drink water or electrolyte-rich beverages throughout your session, especially in hot weather. Remember that thirst is not always an accurate indicator of hydration levels, so make a conscious effort to sip fluids regularly.

2. Fuel Wisely: Energize Your Body Prioritize proper nutrition to fuel your runs. Consume a balanced meal or snack containing carbohydrates, protein, and healthy fats before heading out. If you’re embarking on a long run, bring along energy gels or snacks to maintain your energy levels and prevent glycogen depletion. Adequate fueling supports your muscles, enhances endurance, and reduces the risk of collapsing due to low energy reserves.

3. Gradual Progression: Build Stamina Safely When aiming to improve your running performance, gradual progression is key. Avoid suddenly increasing your mileage, pace, or intensity, as this can lead to overexertion and potential collapse. Follow a structured training plan that incorporates progressive increases in distance and intensity, allowing your body to adapt and minimize the risk of pushing yourself too far.

4. Temperature Awareness: Beat the Heat Running in hot and humid conditions requires extra precautions. Acclimate yourself to high temperatures gradually, allowing your body to adjust. Opt for early morning or late evening runs when the sun’s intensity is lower. Dress in lightweight, moisture-wicking clothing and wear a hat or visor to shield your face from direct sunlight. Additionally, listen to your body’s cues – if you start feeling dizzy, fatigued, or excessively overheated, it’s time to stop and cool down.

5. Rest and Recovery: Prioritize Well-Being Rest and recovery are essential components of a successful running routine. Integrate rest days into your training plan to give your body the opportunity to repair and rejuvenate. Engage in activities that promote relaxation, such as stretching, yoga, or meditation. Prioritizing adequate sleep also plays a crucial role in preventing collapse and maintaining overall well-being.

6. Seek Professional Guidance: Know Your Limits If you have a pre-existing medical condition or are new to running, consider consulting a healthcare professional before embarking on a rigorous training regimen. They can provide valuable insights into your individual health and help you establish safe running parameters.

The phenomenon of runners collapsing is a reminder of the incredible demands we place on our bodies during the pursuit of our running goals. By understanding the factors that can contribute to collapse – from dehydration and nutrition to overexertion and individual factors – we empower ourselves to run safely and make informed decisions about our training.

Remember, running is a journey that encompasses not only physical endurance but also mindful self-care. Prioritize hydration, fueling, and proper training techniques to ensure that you’re equipped to face the challenges of the road while minimizing the risk of collapse. By striking a balance between pushing your limits and respecting your body’s needs, you’ll be well on your way to conquering miles with strength, resilience, and the joy of a successful run.

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Making sense of why runners collapse

This is an excerpt from waterlogged by timothy noakes..

Why Runners Collapse

Why would anyone expect the symptom of thirst to be present in collapsed runners? Thirst is such a powerful urge that any thirsty marathon runner suffering from dehydration during a race will simply stop at the next refreshment station and drink until her thirst is slaked. Simple.

The basis for the belief that collapsed runners were suffering from dehydration began with the explosive growth in the number of marathon runners after 1976 (figure 2 a , page xv). This produced a massive increase in the number of runners requiring medical care at the finish of those races. Logically, the collapse of an athlete after rather than during a sporting event cannot be due to dehydration, since dehydration, which allegedly impairs circulation, must cause the athlete to collapse during the race when the strain on the heart and circulation is the greatest. This cannot happen immediately after the exercise terminates when any stress on the heart and circulation is falling. But this simple logic was ignored. Instead, it was concluded that all these collapsed athletes were suffering from dehydration, and their symptoms were caused by that dreaded disease.

But the truth is that athletes who collapsed after endurance events develop very low blood pressure only when standing (exercise-associated postural hypertension, or EAPH). This is caused by physiological changes that begin the moment the athlete stops running or walking after exercise and to which dehydration does not contribute. We know this because the moment these collapsed athletes lie flat, or better, with their legs and pelvis elevated above the level of the heart (“head down”), their symptoms instantly disappear. 4 Thus, if the symptoms occur in athletes who are not thirsty and can be reversed instantly without fluid ingestion, the condition cannot be due to dehydration. Rather, EAPH must be due to the relocation of a large volume of blood from the veins in the chest and neck (which fill the heart and ensure its proper functioning) to the veins of the lower legs (which lie below the level of the heart) and therefore fill whenever an athlete stands.

One of the physiological costs of bipedalism is that it made it more difficult for exercising humans to regulate blood pressure when standing, because more than 60% of the blood in circulation is contained in large veins that are situated below the level of the heart. If this volume increases abruptly at any time, especially on cessation of exercise, it will cause EAPH to develop. Two factors cause this translocation immediately after the exercise terminates. First, the muscles in the calf, the contraction of which empties blood from the leg veins pumping it toward the heart, stop working. As a result, the action of this “second heart” is lost, causing blood to pool in the legs. Second, exercise impairs the bodily responses to any sudden reduction in blood pressure. This response requires the rapid activation of the sympathetic nervous system, which raises the blood pressure by increasing the resistance to blood flow in many organs, including the muscles of the legs. But endurance training reduces the sensitivity of the sympathetic nervous system to respond to such sudden stresses.

Those athletes who do not develop EAPH are able to prevent this relocation of blood volume from the center of the body to the legs, which begins the moment exercise terminates, in part because they activate an appropriate response of their sympathetic nervous system the moment they stop exercising.

The symptoms of EAPH are caused by this sudden onset of a falling blood pressure, which results in an inadequate blood supply to the brain (cerebral ischemia). The symptoms of cerebral ischemia are dizziness, nausea leading perhaps to vomiting, and a transient loss of consciousness (fainting). These symptoms persist until the blood flow to the brain is restored by an increase in blood pressure. Usually this occurs when the athlete falls to the ground and lies flat, thereby relocating a large volume of blood from the legs (and intestine) back to the center of the body. This sudden return of blood to the heart rapidly improves heart function and restores blood pressure to the appropriate postexercise value ( 100 to 120 / 60 to 80 mmHg), which is usually slightly lower than the accepted normal ( 110 to 140 / 60 to 90 mmHg) for resting humans who have not recently exercised.

The point is that dizziness, fainting, and nausea are the symptoms not of dehydration but of an inadequate blood supply to the brain. People who die from profound fluid loss when they are lost in the desert for three or more days without water also become confused. But this is not because of an inadequate blood supply to the brain—one of the body's most protected physiological functions—but because they develop multiple organ failure, including heart, kidney, and liver failure. The heart failure reduces blood flow to the brain, while kidney failure and liver failure cause the accumulation of certain toxic chemicals in the body that interfere with brain functioning, causing confusion and ultimately coma and death.

Experienced sport physicians are unable to determine the extent of dehydration (or volume of depletion) on the basis of the methods taught in medical school, that is, by examining the turgor of the skin, the state of hydration of the mucous membranes in the mouth, the presence of “sunken eyes,” the ability to spit, and the sensations of thirst (McGarvey, Thompson, et al., 2010). The only way accurately to determine the level of an athlete's state of hydration after prolonged exercise is to measure the body weight before and after exercise and, better, to measure the change in body water. The use of urine color, much promoted by some scientists, is of no value (Cheuvront, Ely, et al., 2010), because it is a measure of the brain and kidneys' response to changes in blood osmolality. It does not tell us exactly what the blood osmolality is and whether it is raised, lowered, or normal. As we will show, athletes with EAH typically excrete a dark urine even though they are severely overhydrated with blood osmolalities that are greatly reduced.

While serving as medical consultant at the 1998 Ironman Hawaii Triathlon, I attempted to introduce the concept of elevating the base of the bed to treat the low blood pressure (postural hypotension) that, in my opinion, is by far the most common cause of postrace collapse in athletes. Lifting the base of the bed cures the symptoms of postural hypotension and reduces the need to give intravenous fluids (inappropriately) for this condition.

This I showed at least to my own satisfaction in one elderly (>70-year-old) finisher whom I was called to see because he was deathly pale. The attending doctor could not detect a measurable pulse or blood pressure. I immediately lifted the base of the bed. Within seconds the patient's pulse became palpable, color returned to his face, and he was miraculously “cured.”

Years later, scientific papers written by some of the doctors I had interacted with showed that some lessons had been learned. Dr. Robert Sallis, who had been my close companion in the medical tent in 1998, wrote an article on the GSSI website acknowledging the value of this simple intervention. In that article he wrote, “The most common benign cause of collapse is low blood pressure due to blood pooling in the legs after cessation of exercise (as in postural hypotension, heat exhaustion, or syncope). This condition is treated by elevating the feet and pelvis until symptoms improve” (Sallis, 2004, p. 1). In the article, Dr. Sallis lists dehydration as a “non-serious” cause of collapse in athletes, which seems to conflict with the message of both the ACSM and the GSSI.

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• DOI: 10.1007/s40279-013-0044-y
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Crawling to the Finish Line: Why do Endurance Runners Collapse?

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• Published in Sports Medicine 9 April 2013

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Recurrent heat stroke in a runner: race simulation testing for return to activity., the ergogenic effect of elastic therapeutic tape on stride and step length in fatigued runners., exercise-associated collapse, evolutionary pattern of improved 1-mile running performance., pacing and perceived exertion in endurance performance in exercise therapy and health sports.

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Research Article

How recreational marathon runners hit the wall: A large-scale data analysis of late-race pacing collapse in the marathon

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Insight SFI Research Centre for Data Analytics, School of Computer Science, University College Dublin, Dublin, Ireland

• Barry Smyth

• Published: May 19, 2021
• https://doi.org/10.1371/journal.pone.0251513
• Reader Comments

Introduction

In the marathon, how runners pace and fuel their race can have a major impact on race outcome. The phenomenon known as hitting the wall (HTW) refers to the iconic hazard of the marathon distance, in which runners experience a significant slowing of pace late in the race, typically after the 20-mile mark, and usually because of a depletion of the body’s energy stores.

This work investigates the occurrence of significant late-race slowing among recreational marathoners, as a proxy for runners hitting the wall, to better understand the likelihood and nature of such slowdowns, and their effect on race performance.

Using pacing data from more than 4 million race records, we develop a pacing-based definition of hitting the wall, by identifying runners who experience a sustained period of slowing during the latter stages of the marathon. We calculate the cost of these slowdowns relative to estimates of the recent personal-best times of runners and compare slowdowns according to runner sex, age, and ability.

We find male runners more likely to slow significantly (hit the wall) than female runners; 28% of male runners hit the wall compared with 17% of female runners, χ 2 (1, N = 1, 928, 813) = 27, 693.35, p < 0.01, OR = 1.43. Such slowdowns are more frequent in the 3 years immediately before and after a recent personal-best (PB) time; for example, 36% of all runners hit the wall in the 3 years before a recent PB compared with just 23% in earlier years, χ 2 (1, N = 509, 444) = 8, 120.74, p < 0.01, OR = 1.31. When runners hit the wall, males slow more than females: a relative slowdown of 0.40 vs. 0.37 is noted, for male and female runners, when comparing their pace when they hit the wall to their earlier race (5km-20km) pace, with t (475, 199) = 60.19, p < 0.01, d = 0.15. And male runners slow over longer distances than female runners: 10.7km vs. 9.6km, respectively, t (475, 199) = 68.44, p < 0.01, d = 0.17. Although, notably the effect size of these differences is small. We also find the finish-time costs of hitting the wall (lost minutes) to increase with ability; r 2 (7) = 0.91, p < 0.01 r 2 (7) = 0.81, p < 0.01 for male and female runners, respectively.

Conclusions

While the findings from this study are consistent with qualitative results from earlier single-race or smaller-scale studies, the new insights into the risk and nature of slowdowns, based on the runner sex, age, and ability, have the potential to help runners and coaches to better understand and calibrate the risk/reward trade-offs that exist as they plan for future races.

Citation: Smyth B (2021) How recreational marathon runners hit the wall: A large-scale data analysis of late-race pacing collapse in the marathon. PLoS ONE 16(5): e0251513. https://doi.org/10.1371/journal.pone.0251513

Editor: Maria Francesca Piacentini, University of Rome, ITALY

Received: December 1, 2020; Accepted: April 28, 2021; Published: May 19, 2021

Copyright: © 2021 Barry Smyth. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All of the data used in this research is publicly available on marathon websites. The data has been collected from a variety of different marathon result archives, the URLs of which have been provided as a table in the Supporting information .

Funding: BS is supported by Science Foundation Ireland under grant 12/RC/2289P2. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

In the marathon, terms such as “hitting the wall” (HTW), “bonking”, or “blowing up” refer to the sudden onset of debilitating fatigue that can occur late in the race. At best, this can temporarily slow even the most accomplished and experienced runners, but it can also render a runner unable to muster much more than a walking pace for the remainder of the race and may prevent some from finishing. While most marathon runners are familiar with the notion of hitting the wall—many even claim to have experienced it in person [ 1 , 2 ]—it should be recognised that truly hitting the wall is not the same as the feeling of generalized fatigue and discomfort that is part and parcel of running the marathon distance [ 3 – 5 ]. The conventional wisdom is that runners hit the wall when their glycogen stores become depleted, usually as a result of poor race nutrition [ 6 – 9 ], which can be exacerbated by aggressive pacing [ 7 , 10 , 11 ], and there is thought to be an important cognitive component too [ 12 , 13 ]. While experienced marathoners understand how to avoid hitting the wall, it remains a significant risk among recreational marathoners, especially novices and first-timers.

The central objective of this work is to explore the nature of these slowdowns by analysing more that 4 million race-day records; the scale of this study distinguishes it from much of the work on hitting the wall that has come before [ 1 , 2 , 11 , 14 , 15 ]. We identify runners who suffer significant and sustained slowing during the latter stages of the marathon, and examine the characteristics of these slowdowns (frequency, start, duration, degree, finish-time cost) in relation to sex, age, and ability.

We find male runners to be much more likely than female runners to hit the wall [ 11 , 14 ], regardless of age or ability, and we find that slowdowns occur more frequently in the years immediately before and after a recent personal best. Moreover, when males hit the wall, they slow more than female runners, and over longer distances. Although the costs of these slowdowns (lost minutes) are broadly similar between males and females, they tend to increase with ability, with faster runners experiencing a greater finish-time cost than slower runners.

Related work

The phenomenon of hitting the wall is perhaps the most iconic hazard of the marathon distance, but a similar effect can be found in other endurance events too, including ultra-marathons, adventure races, cycling and the triathlon. Fortunately, the most catastrophic examples of hitting the wall remain relatively rare, but the phenomenon continues to impede many marathoners, especially less experienced recreational runners. And despite the significance of the phenomenon, consensus has yet to be reached on a precise conceptual or operational definition; see [ 15 , 16 ]. It is usually framed as a fatigue and fueling problem [ 7 , 17 , 18 ]: simply put, if an athlete runs out of the energy they need to fuel their remaining race, then they will have to slow or even stop. However, the relationship between fatigue and performance is not a straightforward one, and the topic continues to be a source of debate in the literature. In what follows, we review related work on fatigue, pacing and performance, as it relates to the phenomenon of hitting the wall in the marathon, in order to frame the work presented in this study.

Fatigue & fueling

Historically, fatigue can mean different things to different disciplines [ 17 , 18 ]: a physiologist might view fatigue as the failure of a specific physiological system [ 19 ]; biomechanists may view it in terms of a decrease in the force output of muscles [ 20 , 21 ]; while a sports psychologist will typically view fatigue as the ‘feeling’ of tiredness [ 22 , 23 ]. It is not surprising, therefore, that research into fatigue-induced changes in exercise performance involves several different disciplines and perspectives, and has led to the development of several different models to explain the fatigue response that arises from prolonged exercise.

For example, Noakes [ 17 ] and Green [ 19 ] discuss how the cardiovascular/anaerobic model assumes that fatigue occurs when the cardiovascular system is no longer able to supply the necessary oxygen to, or remove waste products from, the working muscles; see also [ 24 ]. A related model is the energy supply/energy depletion model [ 17 , 19 , 25 ], which proposes that fatigue is the result of two mechanisms: (1) a failure to provide sufficient ATP to the working muscles, via the various metabolic pathways; and (2) a fueling problem, due to the depletion of fuel substrates, namely muscle and liver glycogen, blood glucose and phosphocreatine [ 8 , 9 ].

Alternatively, the neuromuscular fatigue model links fatigue with a diminished muscular response to electrical stimulus as a result of prolonged exercise [ 17 , 20 , 25 – 27 ], while the muscle trauma model proposes that fatigue is a consequence of the type of muscle damage [ 28 , 29 ] that commonly occurs during prolonged exercise (muscle swelling and stiffness, or the tearing of muscle fibres etc.). The motivational model of fatigue is based on a lack of interest in exercise performance, akin to losing the will to perform [ 22 , 30 , 31 ]. While it is often incorporated into the neromuscular model of fatigue and the central governor model (see below), the motivational model uniquely holds that neuromuscular function is intentionally down-regulated, rather than subconsciously altered.

In the central governor model Noakes [ 32 ], Noakes et al. [ 33 ], and Ulmer [ 34 ] argue that exercise performance is controlled by a governor located in the central nervous system, which uses signals and feedback from muscles and other organs to regulate exercise performance, in order to protect vital organs from injury or damage. More recently, Lambert et al. [ 13 ] and Gibson & Noakes [ 35 ] have extended the central governor model by proposing the complex systems model of fatigue. This model integrates a variety of peripheral signals and sources of feedback, in a non-linear manner, in order to regulate activity to allow for the completion of a given bout of exercise. Accordingly, fatigue is a subconscious sensation that reflects the underlying state of this integrative process.

In marathon running, the phenomenon of hitting the wall is associated with the rapid onset of debilitating fatigue and, as the above viewpoints suggest, it may arise from a combination of factors including inadequate fueling, a lack of training, or a diminished intentional state. Recently Rapoport’s energy model [ 7 ] has been developed with marathon running in mind, and it offers an opportunity to predict when a runner will become fatigued based on their energy stores and pace. The model is based on the premise that it takes approximately 1 calorie to move a runner per kilo of body mass and per kilometer of running, regardless of pace [ 36 , 37 ]. Rapoport’s model extends this by considering: (a) the source of energy—fat vs. carbohydrates—with per-km energy expenditure varying, not by pace, but by the source of the energy; and (b) the amount of carbohydrates available. Romijn et al. [ 38 ] discuss how faster runs are fueled by a greater proportion of carbohydrates than fat. Whether a runner will hit the wall depends on how quickly their glycogen stores deplete, which Rapaport found depends on a combination of a runner’s aerobic capacity (or VO 2 max ), the density of muscle glycogen, and the relative mass of their leg musculature. Hagen et al. [ 39 ] report that a higher aerobic capacity leads to a faster marathon, provided there are adequate glycogen stores, while Fairchild et al. [ 40 ] note that larger leg muscles, relative to body mass, are associated with a higher percentage of VO 2 max that can be sustained, because a lower body mass means a lower running energy cost, and larger leg muscles mean more room to store glycogen. The utility of this model is that it can be used to estimate the distance at which runners will exhaust their glycogen stores as a function of pace, thereby providing a basis for optimising the performance of endurance runners and predicting mid-race fueling needs.

In conclusion, fatigue is an inevitable consequence of the marathon distance, and the need for in-race fueling is a necessary response to the natural limits of the human body’s energy stores. Together, fatigue and depleting energy reserves can conspire to dramatically slow even the swiftest runner, when they hit the wall, and, in what follows, we will consider the further implications of this for pacing and performance.

Pacing and performance

Pacing in endurance events is an important research topic, particularly when it comes to understanding the optimal pacing strategy for a given event type. For example, Tucker et al. [ 41 ] examined the pacing strategies of male runners in world-record performances to show how pacing strategies varied with distance. Shorter events were characterised by fast starts, followed by progressive slowing, while 5,000m and 10,000m events were associated with fast starts and fast finishes, with a period of slower running during the middle of the race. March et al. [ 42 ] conclude that more even pacing tends to be associated with faster finish-times in the marathon, with females associated with more consistent pacing than males, even when the effects of ability and age were controlled for [ 43 – 46 ]. Tucker & Noakes [ 47 ] emphasise how pacing can be impacted by many different factors. For instance, the work of Trubee [ 48 ] found that pacing difference between the sexes increased with temperature; see also the work of Cuk et al. [ 49 ].

Smyth [ 10 ] examined more than one million marathon race records, of mostly recreational runners, to explore the relationship between starting and finishing paces, and overall race performance, in the marathon. The conventional wisdom is that starting too fast can create pacing problems later in the race—including hitting the wall—but, equally, finishing too fast may signal that a runner has paced too conservatively. Starting or finishing too fast was found to be associated with slower overall finish-times, as partly predicted by Denison [ 50 ]. Indeed, fast starts were found to be especially injurious to performance, in part because they increased the likelihood that a runner would go on to hit the wall later in the race.

More recently, the work of Oficial-Casado et al. [ 51 ] considered differences in pacing profiles in four big-city marathons (Valencia, Chicago, London, and Tokyo) to find that differences between corresponding sections of these races tended to increase with finish-time increases. In particular, the pacing of the first 5km of the races analysed differed significantly, with London having the fastest first 5km and also the greatest difference in relative speed between the first and second half of the race. These results, underscore pacing differences that can exist between races and highlight the importance of accounting for race pacing characteristics when selecting a marathon and a suitable pacing strategy.

On the psychology & phenomenology of hitting the wall

Despite what is known about how runners pace their races, the related phenomenon of hitting the wall appears to be less well understood. One reason for this might be because the phenomenon remains relatively rare among elite runners—the usual targets of performance studies—even though many recreational marathoners do confront it at some stage in their marathon history [ 1 , 2 , 12 ].

Some of the literature that does exist focuses on the perceptions, expectations, and cognitive orientations of runners who hit the wall. For example, one early study by Summers et al. [ 2 ] surveyed 363 middle-aged, recreational, first-time marathoners to evaluate their reasons for attempting the marathon, their perceived outcomes from the event, and their experiences during the race. Overall, 56% of respondents reported hitting the wall, with just over 73% of them experiencing it after the 19 mile (30km) mark. In related work by Stevinson & Biddle [ 1 ], the focus was on the relationship between a recreational runner’s cognitive orientation and hitting the wall. The 66 participants (56 males and 10 females) in this study were all entrants into the 1996 London marathon, and the sample included 35 marathon first-timers. Of the 53% who reported hitting the wall—more males than females—they were much more likely to adopt a cognitive orientation of ‘inward distraction’ and a sense of internal disassociation as they attempted to distance themselves from the task at hand.

Buman et al. [ 11 ] produced a more in-depth study of the phenomenologcial characteristics of hitting the wall, based on a survey of 315 runners, to assess whether they felt they had hit the wall and, if so, their perceptions of 24 different characteristics linked to the experience. Once again, a high proportion (43%) of respondents reported hitting the wall and the study concluded that four characteristics—generalised fatigue, unintentional slowing, a desire to walk, and a shifting focus on survival—were especially salient. However, surprisingly, only 70% of those who reported hitting the wall also reported a concomitant slowdown. In related work, Buman et al. [ 14 ] looked at the relationship between the risk profile of runners and when they are likely to hit the wall, in order to describe the overall functional form of risk over the course of a marathon. The sex of a runner, their training volume, and their race expectations were found to play important roles in predicting whether someone would be likely to hit the wall, with the risk peaking at mile 21 followed by a steep subsequent decline; see also [ 1 , 12 ].

These studies provide useful reference rates for hitting the wall among recreational runners, although it seems unwise to conclude that more than 40–50% of all recreational runners will actually hit the wall in a given race, in practice. It is more likely that the methodology used by these studies might elicit an over-reporting of the phenomenon, especially if many less experienced runners conflated the usual late-race feelings of fatigue, and a natural slowdown, with the idea of hitting the wall. If there was no material deterioration in pace for up to 30% of those who claimed to have hit the wall as per Buman et al. [ 11 ], then it seems doubtful that they actually did experience the phenomenon. Indeed, if hitting the wall is seen as a rite of passage for marathoners, then using the phenomenon to justify a disappointing performance may prove to be all too tempting and common. An alternative explanation for the lack of a reported slowdown could be that some respondents simply did not report the unintentional slowing of pace as a major factor, even though it did occur. Either way, the potential objectivity shortcomings of these self-reporting studies speak to the additional value that may be provided by a more evidence-based pacing study, such as the one presented here.

Data & methodology

This study is based on an original dataset of marathon race records. All of the data is publicly available from the corresponding marathon websites and a complete list of URLs of these web-sites is provided in S1 Table in the supporting information to this article. The research was approved as being exempt from a full ethical review by the Human Research Ethics Committee (Sciences) at University College Dublin on the grounds that it involves the anonymous analysis of public data. This section describes this dataset in detail, explains the approach used to determine when a runner hits the wall, and discusses how this can be used to compare runners who hit the wall based on their sex, age, and ability.

The data for this study was incrementally collected between 2015 and 2019. The resulting dataset includes 4,183,362 race records for an estimated 2,743,322 unique runners, from 270 races that took place in 38 cities during the period from 2005 to 2019. Each race record is associated with a runner name, age information, and an indication of whether a runner was male or female. We refer to this as the original dataset. For reasons discussed below, the main analysis in this study is conducted on a subset of this original dataset, by focusing on runners who are associated with multiple race records. We refer to these as repeat runners and to their data subset as the repeaters dataset. This subset contains 2,179,221 race records (approximately 52% of the race records from the original dataset) for 717,940 unique runners (approximately 26% of the original dataset’s unique runners).

The original dataset.

The original dataset includes marathons that provide timing data for 5km race segments (0–5km, 5–10km, …, 35–40km, plus the final 40–42.195km segment); the requirement for 5km segments is based on the need to track changes in pacing during different stages of the marathon. Note that we refer to each 5km segment by its end-point, thus the 10–15km segment is the 15km segment; the exception is the shorter 40–42.195km segment, which is called the final segment. This means that each complete race record includes 9 separate segment times.

The type of age information provided varies from marathon to marathon. Sometimes precise age (or year of birth) information is included, but often it is limited to age ranges or categories. To maximise the availability of age information across the entire dataset, in this study we rely on the following age ranges, 20–39, 40–44, 45–49, 50–54, 55–59, 60+, which are either directly available from, or can be derived for, all of the race records in the original dataset.

Summary details of this original dataset are presented in Table 1 for each marathon, showing the number of participants, the percentage of female participation, the mean and standard deviation of finish-times (mins), and the percentage of participants who are deemed to have hit the wall, based on the definition developed below. In addition, a further summary table is provided by Table 2 showing similar data based on age group.

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https://doi.org/10.1371/journal.pone.0251513.t001

https://doi.org/10.1371/journal.pone.0251513.t002

The repeaters dataset.

The repeaters dataset is summarised in a similar manner in Table 3 . It includes runners with more than one race record in the original dataset. The reason for this is that our analysis of how runners hit the wall relies on an estimate of their ability and we use an estimate of their recent personal-best time for this. As above, Table 4 shows these statistics based on age group.

https://doi.org/10.1371/journal.pone.0251513.t003

https://doi.org/10.1371/journal.pone.0251513.t004

We identify repeaters by matching race records based on a combination of a runner’s name identifier, sex, and age. Precise age information (or year of birth) is used when available, otherwise age ranges are used. Infrequently, this approach incorrectly matches runners with the same name, age, and sex, who are competing in a single race and such ambiguous matches are excluded. This approach is estimated to be sufficient to identify a large fraction of legitimate repeaters from the original dataset.

An operational definition of hitting the wall

For the purpose of this study, we determine a runner to have hit the wall if they experience significant slowing for an extended period during the second half of the race; this is similar to the pacing-based definition of hitting the wall developed by Berndsen et al. [ 15 ]. Obviously, this is an imperfect measure of whether a runner truly hits the wall. It will both overestimate and underestimate the true number who hit the wall; for example, some runners will slow due to injury or lack of training/fitness, rather than because they genuinely hit the wall, while others may hit the wall too late in the race to be identified. Nevertheless, this approach should be sufficient to provide an estimate that is good enough to use at scale in this analysis.

To better understand the relationship between the fraction of runners hitting the wall, according to this definition, and the DoS and LoS thresholds, we conduct a sensitivity analysis to evaluate different ranges for these parameters. We use the full original dataset for this particular analysis, since it does not rely on repeat runners, and the results inform the selection of suitable DoS and LoS values to use in the remainder of our analysis.

Runner ability & the cost of hitting the wall

It is important to note that this estimate of a runner’s recent PB time may not be their true recent PB time, if their PB race is missing from our dataset; we discuss this further when we consider the limitations of this study. These recent PB times are also used to estimate the cost of hitting the wall ( Eq 6 ), by calculating the difference between a runner’s finish-time, when they hit the wall ( HTW Time ), and their recent PB Time ; see Eq 5 . For example, if a runner achieves a finish-time of 275 minutes when they hit the wall, and if their recent PB is 235 minutes, then we estimate the cost of hitting the wall to be 40 minutes, or a relative cost of 0.17 indicating a 17% finish-time loss; see Eq 7 .

Research questions

Using the repeaters dataset, we compare runners based on their sex, age range, and ability level (estimated PB time in 30-minute intervals), to answer the following research questions, using the metrics defined above:

• What proportion of runners hit the wall ( HTW Proportion ) in a given race? We do this by calculating the proportion of male and female runners who hit the wall (based on Eq 1 ) for each age range and ability level.
• How does the proportion of runners hitting the wall vary in the years before and after a runner achieves a PB? We answer this by calculating the proportion of male and female runners hitting the wall based on the number of years before and after achieving their overall fastest finish-time (estimated PB).
• If a runner hits the wall, then when does their slowdown begin ( HTW Start ), how long is it sustained for ( HTW Distance ), and by how much do they slow ( HTW Slowdown )? We answer this by calculating the average HTW Start , HTW Distance , and HTW Slowdown metrics for male and female runners who hit the wall for each age group and ability level.
• What is the finish-time cost ( HTW Cost ) when a runner hits the wall, relative to their recent PB time? We evaluate this by calculating the average HTW Cost and Relative HTW Cost for each age group and ability level.

Statistical analysis

We use a combination of unequal variance t tests and χ 2 tests of proportions to evaluate the significance of the differences observed between male and female runners (within a given age group or ability level) and to evaluate the significance of the differences observed for male and female runners for successive age groups and ability levels. In each case a significance threshold of p < 0.01 is used to determine significance with Cohen’s d used to measure effect size for t tests and the odds ratio ( OR ) for χ 2 tests. Where relevant, we will also use a Wald test with t-distribution as the test statistic, to evaluate if the slope of a linear regression line is different from 0—to evaluate a trend—using a significance threshold of p < 0.01 with r 2 as the corresponding effect size. In Figs 2–6 the statistical significance of the results is encoded in the following ways:

• In each graph we show the mean values for male and female runners as horizontal lines. If the difference between these overall means is statistically significant, then these lines are displayed as solid lines, otherwise they are displayed as dashed lines.
• Significant differences between corresponding results for male versus female runners are indicated by filled markers in each result graph. For example, in Fig 2, all of the differences between males and females are judged to be significant (based on a χ 2 test of proportions) for p < 0.01, regardless of age or ability; all of the individual markers are filled. In contrast, there is no significant difference between the average HTW Start experienced by males and females who are 60 years or older, as indicated by the corresponding unfilled markers in Fig 5(a).
• A solid line connecting two markers on a graph indicates that the (within-sex) difference is statistically significant. For example, in Fig 2(b), the HTW Proportions between the 330 and 360-minute ability groups are not statistically significant, for females, as indicated by the dotted line connecting these markers.

The raw data for each result graph and the corresponding statistical analysis results are available as S1 Datasets .

Sensitivity analysis

The sensitivity analysis results in Fig 1 show how the proportion of runners hitting the wall changes in a predictable manner for different DoS and LoS thresholds. As expected, larger slowdowns over longer distances correspond to smaller proportions of runners hitting the wall. For the purpose of this study we define hitting the wall using a slowdown ( DoS ) threshold of 0.25 and a minimum distance ( LoS ) threshold of 5km—that is, runners must slow by at least 25% for at least 5km—which corresponds to 34% of runners in the original dataset hitting the wall, as indicated in Fig 1 . These thresholds are comparable with similar thresholds reported by Berndsen et al. [ 15 ] where slowdowns of approximately 17% over more than 5km were proposed to identify runners hitting the wall.

https://doi.org/10.1371/journal.pone.0251513.g001

This proportion of runners hitting the wall also conforms with reasonable expectations about how many marathoners hit the wall in practice. Although this is lower than the proportions (40–50%) reported by [ 1 , 2 , 11 ] using self-reported, post-hoc surveys of runners, as we shall see in the following section, the proportion of runners hitting the wall depends on ability and more than 40% of male runners with slower PBs do hit the wall based on the definition used here.

Finally, it is worth noting that minor changes in these thresholds do not substantially change the nature of the results. Later, in a discussion of the limitations of this analysis, we will discuss this aspect in more detail and supporting evidence is available in S1 – S14 Figs.

The proportion of runners hitting the wall

Fig 2 shows the proportion of runners hitting the wall based on sex, age group, and ability level. Overall 28% of male runners hit the wall compared with only 17% of female runners, χ 2 (1, N = 1, 928, 813) = 27, 693.34, p < 0.01, OR = 1.43, and while ability level clearly influences the proportion hitting the wall, age plays a more modest role.

https://doi.org/10.1371/journal.pone.0251513.g002

In Fig 2(a) there is evidence that younger runners are more likely to hit the wall, with HTW Proportions reaching a low-point for the 45–49 age group. The effect size associated with the differences between males and females remain high for each age group, 1.79 ≤ OR ≤ 2.0, while the effect size between successive age groups for males and females is more modest, 0.93 ≤ OR ≤ 1.17.

Fig 2(b) shows how the proportion of runners hitting the wall increases steadily with recent PB times between 3 and 5–5.5 hours. All of the differences between males and females, for each ability level, are significant with p < 0.01 and 1.9 ≤ OR ≤ 3.14 and a majority of the differences between successive (within-sex) ability levels are also statistically significant with p < 0.01 and 0.61 ≤ OR ≤ 1.69 for males and 0.65 ≤ OR ≤ 1.38 for females.

The likelihood of hitting the wall based on PB year

It is also interesting to see how HTW proportions vary in the years before and after a runner achieves their overall PB; note, here we are using a runner’s overall fastest finish-time in our dataset, rather than the recent (3-year) PB, used to determine current ability. In Fig 3(a) , races are aligned so that runners achieve their (overall) PB in year 0 and then we calculate the HTW proportions for up to 9 years before and after this PB year; there are of course fewer runners available the farther we move from their PB year, and some runners with more distant races (>9 years from PB) are obviously not included. The results indicate that, in the three years before or after a runner achieves their PB, they are significantly more likely to hit the wall, compared with earlier or later years, respectively.

https://doi.org/10.1371/journal.pone.0251513.g003

This is summarised in Fig 3(b) , as the aggregate proportion of male and female runners hitting the wall in the 3 years before and after a PB, compared to 4–9 years before and after a PB. For example, 1–3 years before achieving an overall PB, 40% of male runners hit the wall, compared to just under 26% in the 4–9 year period before achieving the PB, χ 2 (1, N = 338, 057) = 6, 165.03, p < 0.01, OR = 1.25. Likewise, 28% of female runners hit the wall in the 3 years before a PB compared with 16% in earlier years, χ 2 (1, N = 171, 387) = 2, 503.39, p < 0.01, OR = 1.50. A similar result is observed for male and female runners in the years after achieving a PB too.

It is also worth noting that the differences between the proportions of male or female runners who hit the wall in the 1–3 years before their PB (40% and 28% for males and females, respectively) is significantly larger that the corresponding proportion of runners hitting the wall in the 1–3 years after their PB (32% and 21% for males and females, respectively) with χ 2 (1, N = 494, 211) = 3, 626.53, p < 0.01, OR = 1.10 for males and χ 2 (1, N = 260, 747) = 1, 835.09, p < 0.01, OR = 1.22 for females.

Thus, proximity to a PB represents a significant risk factor in terms of hitting the wall for male and female runners, and the risk is higher just before achieving a PB than it is just after a PB. This is likely due to more runners adopting more aggressive pacing as they attempt to secure a new PB and we will consider this further in the discussion section of this paper.

For completeness, Fig 4 groups runners based on their age (<40 vs. ≥40) and overall PB times (<4 hours vs. ≥4 hours), to explore whether there is an age or ability effect, when it comes to HTW risk in the years before and after a PB. Similar spikes in HTW Proportion are evident in all 4 groupings. Younger (<40 years-old) and slower (≥4 hour finishes) runners are the most at risk in close proximity to a PB; for example, more than 50% of younger and slower male runners hit the wall the year before their PB as per Fig 4(c) . On the other hand, older (≥40 years-old) runners with <4 hour finish-times are the least at risk, with the proportion of HTWs peaking at just over 30% for males; see Fig 4(b) . Once again we observe a similar pattern of statistically significant differences: (i) a greater proportion of males hit the wall than females in each cohort; (ii) the proportion of runners hitting the wall increases significantly in proximity to a PB; and (iii) the proportion of runners hitting the wall is higher in the 3 years before a PB than in the 3 years after. The full dataset for these results is available in S1 Datasets .

https://doi.org/10.1371/journal.pone.0251513.g004

The dimensions of the wall

Fig 5a–5f show the dimensions of the wall in terms of the start of the slowdown ( HTW Start ), the duration or distance ( HTW Distance ) of the slowdown, and degree of the slowdown ( HTW Slowdown ), and how they relate to age and ability for male and female runners. On average male runners begin their slowdown slightly later (29.6km) than female runners (29.3km), t (475, 199) = 20.03, p <.01, d = 0.05. Males sustain their slowdown for longer than females (10.72km vs. 9.61km, respectively), t (475, 199) = 68.44, p <.01, d = 0.17. And, and on average the degree of slowdown for males is 0.40 compared with 0.37 for females, t (475, 199) = 60.20, p <.01, d = 0.15. However, although these are statistically significant differences the effect size is modest ( d < 0.2).

HTW Start refers to the average distance at which runners begin the slowdown that corresponds to their hitting the wall. HTW Distance refers to the length of this slowdown and HTW Slowdown refers to the degree of this slowdown, relative to their base-pace (that is, their average pace during the 5–20km portion of the marathon).

https://doi.org/10.1371/journal.pone.0251513.g005

Fig 5a, 5c and 5e show that age plays a very minor role in terms of the start, distance, and degree of slowdown, but there is a stronger relationship between these metrics and ability. A Wald test confirms a non-zero slope of the regression line between these metrics and estimated PB time, for male and female runners, r 2 (7)>0.69, p < 0.01, except in the case of the degree of slowdown of female runners ( p = 0.31). The differences between male and female runners for each ability level are, generally speaking, statistically significant based on Welch’s t test ( p < 0.01) but the mean effect size for HTW Start is very small ( d = 0.10±0.11) compared with d = 0.35±0.09 for HTW Distance and d = 0.20±0.08 for HTW Slowdown .

Thus, we can conclude that while a runner’s ability and sex influences how they hit the wall (the start, duration, and degree of slowdown) the differences observed are generally small, with males slowing by a little more, and for slightly longer distances, than females. It is worth noting that this longer distance for males implies that females are more likely to recover from their slowdown before the end of the race, which is consistent with results reported by Smyth [ 10 ] showing that females are more likely to finish faster than their mean race-pace than males.

While it is straightforward to evaluate the finish-time of a runner when they hit the wall, it is less clear what their finish-time would have been had they not. We cannot replay the race without them hitting the wall, for example, but we can at least estimate their lost minutes ( HTW Cost ) by calculating the difference between their finish-times when they do hit the wall ( HTW Time ) and their recent estimated PB times, as in Eqs 6 and 7 .

Not surprisingly, the mean HTW Time of males (277.44 minutes) is significantly faster than for females (307.28 minutes), as indicated by the horizontal mean lines in Fig 6a and 6b ; t (475, 199) = −179.76, p < 0.01, d = 0.44. In Fig 6(a) we can see that this difference is preserved across all age groups ( d = 0.65±.08 for these age groups) and how HTW Time tends to increase with age, and more noticeably for older runners.

HTW Time refers to the finish-time in minutes when a runner hits the wall. HTW Cost refers to the difference between a runner’s HTW Time and their estimated PB time. Rel HTW Cost refers to a runner’s HTW Cost as a fraction of their PB time.

https://doi.org/10.1371/journal.pone.0251513.g006

However, these sex differences are less apparent when we group runners by ability (recent PB times) as shown in Fig 6(b) ; note how the slower mean finish-times of females is accounted for by an increasing number of runners in the slower PB ranges. As expected, HTW times increase monotonically with recent PB times and runners of a given ability tend to experience a similar HTW time when they hit the wall; there continues to be a modest but statistically significant difference between males and females, for each ability level, but the effect size is trivial, d = 0.09±0.11.

The cost implications of hitting the wall are shown in Fig 6c–6f . Overall, males suffer from a smaller average finish-time cost than females, 31.50 minutes vs 33.20 minutes, respectively— t (475, 199) = −19.78, p < 0.01, d = 0.05 —but the effect size is clearly very small. However, there is a strong linear relationship between HTW Cost and ability; see Fig 6(d) . Using a Wald test to confirm a non-zero slope for the linear regression lines we find r 2 (7) = 0.91, p < 0.01 for males and r 2 (7) = 0.81, p < 0.01 for females. The relationship is even stronger when we account for the cost of hitting the wall as a fraction of PB time in Fig 6(f) , r 2 (7) = 0.93, p < 0.01 for males and r 2 (7) = 0.99, p < 0.01 for females.

Thus, faster runners tend to experience a greater finish-time cost than slower runners. However, it must be recognised that this does not mean that faster runners slow by more or for longer than slower runners when they hit the wall. We know from the previous section that slower runners tend to begin slowing earlier and for longer than faster runners, and they slow down by a greater degree too. Thus, the greater finish-time cost experienced by faster runners is due to their proportionally faster PB races, compared with the PBs of slower runners.

It is also worth remarking on the fact that male runners experience a greater relative cost than female runners, for a given age group— Fig 6(e) —yet this is not the case when we compare them based on ability, as in Fig 6(f) . This is likely due to physiological differences between male and female runners, which are responsible for faster finish-times for the former. It means, for example, that a female runner with a 3-hour PB time is not equivalent to a male runner with a 3-hour PB time; all other things being equal the female runner will be achieving a higher level of relative performance than the male runner. In the past, some researchers have compensated for this by reducing female finish-times [ 46 ]. When we apply a 30-minute adjustment—that is, by reducing female times by 30 minutes—then the relative HTW costs for females drop below those of males, as indicated by the dashed line in Fig 6(f) ; the differences between males and these adjusted female values remain statistically significant. Thus, while there is some evidence to suggest that females experience a greater finish-time cost than males, when they hit the wall, the effect size is very small and complicated by confounding physiological differences between male and female runners.

The results presented here show that male runners are significantly more at risk of hitting the wall than females. This is consistent with the existing literature on pacing differences between male and female runners [ 43 , 45 , 52 ] and on the literature about hitting the wall itself [ 1 , 14 ]. It can be explained, in part at least, by the tendency of males to take more pacing risks; see for example recent work by Hubble et al. [ 53 ], in which male runners were found to consistently overestimate their marathon abilities, leading to more aggressive and risky pacing strategies.

The finding that runners are much more likely to hit the wall in the years directly before a PB appears to be a novel one, and may also be explained by risk-taking behaviour and sub-optimal pacing decisions when runners are chasing a PB . This is also consistent with the similar spike in the proportion of runners hitting the wall in the 3 years directly after achieving a PB, as some runners continue to try to improve their PB time, perhaps encouraged by their recent PB success. However, the fact that the post-PB spike is significantly less than the pre-PB spike suggests that at least some runners are satisfied to return to safer pacing patterns having achieved a new PB. This highlights the delicate balance that exists between racing hard (to secure a PB) and avoiding pacing problems later in a race, and is consistent with other work on the risks associated with starting a marathon too fast, as reported by Smyth [ 10 ], and recent work by Deaner et al. [ 54 ] showing aggressive pacing to be a strong predictor of subsequent slowing. That the increased risk of hitting the wall, in the years before and after a PB is greater among male runners is also consistent with the tendency of males to engage in more risky pacing as reported by Hubble et al. [ 53 ]. Of course pacing may also be impacted by the topology and conditions of a particular course and event. Recent work by Oficial-Casado et al. [ 51 ] shows that the pacing profiles associated with different marathons differ based on finish-time categories and it is plausible to conclude that some courses may be more susceptible to runners hitting the wall than others.

A second novel contribution of this work concerns the finish-time costs associated with hitting the wall. The existing literature remains largely silent on this feature of the phenomenon, perhaps because of the difficultly in determining what might have been a reasonable finish-time for a runner had they not hit the wall. Also, many past studies have focused on incidents of hitting the wall in isolated races or a small set of races [ 1 , 11 , 14 , 16 ], rather than by tracking the performance of runners over an extended series of races. The scale of the dataset used in this study makes it feasible to consider a runner’s (partial) marathon history and, as such, provides an opportunity to use an estimate of runner’s recent PB as a benchmark against which to evaluate the cost of their hitting the wall. Finding that faster runners experience a greater HTW Cost is surprising at first, because it suggests faster runners slow more when they hit the wall. However, since HTW Distance and HTW Slowdown increase with PB time ( Fig 5d and 5f ), this means that the higher HTW costs for faster runners must be due to proportionally faster PB times rather than slower HTW times. This is consistent with research highlighting sub-optimal pacing by slower runners [ 42 ] in general, and may indicate that, all other things being equal, the PBs of slower runners are less optimal than the PBs of faster runners, even allowing for ability differences.

Although this paper highlights a well-known disparity between the proportion of male and female runners hitting the wall, the results also show that, when runners hit the wall, they do so in a broadly similar manner with similar consequences. This of course speaks to a common mechanism underpinning the phenomenon, while the different proportions of male and females hitting the wall emphasises critical differences in their risk-taking behaviours, when it comes to pacing. In this regard at least, runners and coaches have the potential impose some level of control on whether a runner will hit the wall, by focusing on making better pacing decisions and by being aware of the increased pacing risk that exists, for males in particular, and for all runners when they are pursing a PB.

Limitations

As with any study of this nature, there are a number of assumptions and limitations worth discussing. First and foremost, this work relies on a particular definition of hitting the wall that is purely based on in-race pacing. In reality, hitting the wall is a multi-factorial phenomenon, which reflects a complex set of interactions between training, fitness, pacing, nutrition, and race-day conditions, and, as such, the model used here cannot capture the full complexity of the phenomenon. Nevertheless, we propose that it is reasonable and useful to consider significant late-race slowing as a proxy for hitting the wall, as others have done [ 15 ]. Although not every single slowdown can be explained by the runner hitting the wall (e.g. under-training, injury, or simply “giving up” can provide alternative explanations), runners who do hit the wall can be expected to slow significantly. Certainly, this model can be improved by incorporating additional sources of data, such as heart-rate data, for example, which may facilitate more accurate judgements about whether a runner has hit the wall. Although such data was not available in our dataset, the increasingly widespread adoption of mobile devices, smart-watches, and wearable sensors [ 55 , 56 ] has the capacity to generate large volumes of additional data (heart-rate, cadence, and power), which may be useful in this regard in the future [ 57 , 58 ]. Already, the availability of such diverse sources of data is enabling several new types of health and fitness applications [ 59 – 63 ] and the emergence of powerful new machine learning techniques has been used to support a variety of related prediction and planning tasks in several sporting domains [ 64 – 73 ]

It is also worth noting that the model of the wall analysed here is defined by a pair of parameters—degree of slowdown and length of slowdown—with specific values—0.25 and 5km, respectively—and it is reasonable to question whether the results would be different if different values had been chosen. We have considered several alternative sets of values and, within reasonable levels of tolerance, there is no material change to the nature of the results as presented. These additional results are available as S1 – S14 Figs.

Another limitation of the approach is that, although we have collected a large corpus of race records, it does not provide a complete account of the marathon history for many, if not most, runners. This undermines our estimation of runner ability, because it relies on the fastest available finish-time for a runner during a recent race as their recent PB time estimate. Their true recent PB time may be associated with a race that is not in our dataset and thus we can expect our PB estimates to underestimate (be slower than) a runner’s true PB. Thus our estimates of the cost of hitting the wall may also underestimate the true cost of hitting the wall. However, because the dataset used in this study is based on many of the largest marathons in the world we propose that it is likely to provide a reasonably accurate estimate of the PB times of runners, because runners are more likely to train for, target, and achieve PBs at these landmark races. Even if the PBs used here are not always true PBs, it is likely that they will correlate closely with true PBs and, as such, the trends observed, and the relative differences found, can be expected to be reasonable.

The dataset is also limited in terms of the pacing precision that it provides. For instance, the availability of 5km segment times/pacing limits the granularity with which we can explore the nature of the wall. Using more fine-grained pacing data, such as that collected by smartwatches or GPS apps, it will be possible to provide much more fine-grained insights into what it means when runners hit the wall; see for example [ 15 ]. A similar lack of precision exists for much of the age data that is provided. Although some marathons provide access to precise age (or year of birth) data, most use age ranges. This limits the precision of our age-related analyses. Nevertheless, the results suggest that, when it comes to hitting the wall, age is less important than sex or ability and, as such, it is unlikely that more fine-grained age data would reveal results that are significantly different from those reported.

We have described the results of a large-scale data analysis, focused on the marathon race records of recreational runners in big-city marathons, in order to better understand when and how runners hit the wall. The key findings include:

• A greater proportion of male runners hit the wall, compared with female runners, and the likelihood of hitting the wall is strongly correlated with the PB times of runners in the 180–300 minute range.
• The likelihood of hitting the wall increases in the years directly before and after a runner achieves a new personal-best time, regardless of age or ability.
• When runners hit the wall they tend to do so in a broadly similar manner, although male runners slow for slightly longer, and by more, than female runners.
• The finish-time cost of hitting the wall, relative to PB times, is greater for faster runners, primarily because they achieve relatively faster PB times, compared to slower runners.

Despite the limitations inherent in this work—a purely pacing-based definition of the wall with limited pacing precision (5km splits) and age precision (age ranges) and a finite and incomplete dataset of race records—the work is expected to be of interest to sport scientists, coaches, and runners alike, especially in the area of recreational marathon running.

Supporting information

S1 table. list of marathon data sources..

A table containing all of the URLs of the marathon web-sites used as a source of data for this study. Typically marathons maintain an archive of past race results either accessible directly via a web interface linked to from the main marathon website, or accessible via the websites of third-party timing services. A minority of marathons provide access to data which can be downloaded in bulk, while a majority provide access to their results via a search-based interface and in a page-based format. The data obtained used in this study were obtained directly from result archives between 2015 to 2019.

https://doi.org/10.1371/journal.pone.0251513.s001

S1 Datasets. The raw datasets and statistics for each analysis result graph.

Each individual result graph is associated with 4 different comma-separated files: (i) Raw —the (anonymised) raw data behind the means and standard deviations used for a particular result graph; (ii) Paired —the paired statistical significance results; (iii) Successive Male —the statistical significance results to compare successive groups (age and ability) for male runners; and (iv) Successive Female —the corresponding results for the statistical significance tests to compare successive groups (age and ability) of female runners.

https://doi.org/10.1371/journal.pone.0251513.s002

S1 Fig. HTW proportions for male and female runners by age range.

https://doi.org/10.1371/journal.pone.0251513.s003

S2 Fig. HTW proportions for male and female runners by ability level.

https://doi.org/10.1371/journal.pone.0251513.s004

S3 Fig. HTW start (km) for male and female runners by age range.

https://doi.org/10.1371/journal.pone.0251513.s005

S4 Fig. HTW start (km) for male and female runners by ability level.

https://doi.org/10.1371/journal.pone.0251513.s006

S5 Fig. HTW distance (km) for male and female runners by age range.

https://doi.org/10.1371/journal.pone.0251513.s007

S6 Fig. HTW distance (km) for male and female runners by ability level.

https://doi.org/10.1371/journal.pone.0251513.s008

S7 Fig. HTW slowdown for male and female runners by age range.

https://doi.org/10.1371/journal.pone.0251513.s009

S8 Fig. HTW slowdown for male and female runners by ability level.

https://doi.org/10.1371/journal.pone.0251513.s010

S9 Fig. HTW time (mins) for male and female runners by age range.

https://doi.org/10.1371/journal.pone.0251513.s011

S10 Fig. HTW time (mins) for male and female runners by ability level.

https://doi.org/10.1371/journal.pone.0251513.s012

S11 Fig. HTW cost (mins) for male and female runners by age range.

https://doi.org/10.1371/journal.pone.0251513.s013

S12 Fig. HTW cost (mins) for male and female runners by ability level.

https://doi.org/10.1371/journal.pone.0251513.s014

S13 Fig. Relative HTW cost (mins) for male and female runners by age range.

https://doi.org/10.1371/journal.pone.0251513.s015

S14 Fig. Relative HTW cost (mins) for male and female runners by ability level.

https://doi.org/10.1371/journal.pone.0251513.s016

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Profiling Collapsing Half Marathon Runners—Emerging Risk Factors: Results from Gothenburg Half Marathon

Amir khorram-manesh.

1 Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden

2 Research and Development Unit, Swedish Armed Forces Defense Medicine Centre, 426 05 Gothenburg, Sweden

Therese Löf

3 Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden

Mats Börjesson

4 Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden

5 Department of Food, Nutrition and Sport Science, Sahlgrenska University Hospital, 405 30 Gothenburg, Sweden

Finn Nilson

6 Department of Environmental and Life Sciences, Karlstad University, 651 88 Karlstad, Sweden

Sofia Thorsson

7 Department of Earth Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden

Fredrik Lindberg

Eric carlström.

8 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden

9 School of Business, University of Southeast Norway, 3679 Notodden, Norway

Associated Data

Among several serious medical conditions, arrhythmia and heat stroke are two important causes of death during endurance races. Clinically, collapsing might be the first sign of these serious conditions and may mimic the more common and benign exercise-associated collapse. Several risk factors have been reported in the literature. We aimed to conduct a qualitative study to find a perceived risk profile among runners who collapsed and who were transported by ambulances to the nearest hospital during Gothenburg’s half marathon (2010–2017). Collapsing runners seem to lack the ability to make a decision to withdraw from the contest despite being exhausted. They feel the pain, but are unable to put meaning to their feeling, to adjust their pacing, and to handle other influences. Consequently, they do not overcome the problem or assess the situation. These individual mental characteristics may indicate a unique profile for collapsing runners. Pre-race health control and educational initiatives aiming at mental preparedness and information before endurance races might be a necessary step to avoid life-threatening complications.

1. Introduction

Although most people begin running to improve their physical fitness, personal challenges have proven to be the main reason for taking part in a running contest [ 1 , 2 ]. Running a half or full marathon can be enjoyable and raises the feeling of self-satisfaction; however, it may also contribute to medical encounters with adverse outcomes [ 2 , 3 , 4 , 5 ]. Among many serious and life-threatening medical complications such as ischemic heart disease; serious metabolic complications; serious heat-related disorders; and serious fluid, electrolyte or acid–base abnormalities, arrhythmia and heat stroke are two less common causes of death during endurance races [ 3 , 4 , 5 ]. Clinically, collapsing might be the first sign of these serious conditions and may mimic the more common and benign exercise-associated collapse (EAC) [ 3 , 5 ], which is believed to be the result of a combination of postural hypotension and blunted reflex activity [ 6 ]. Several individual or environmental factors can influence EAC.

1.1. Individual Factors

Running technique or pacing is the ability of the athletes to distribute their energy equally throughout the long-distance race and can vary depending on the individual [ 7 , 8 ]. Previous studies have shown that this ability is more developed among the experienced athletes, who can also adjust their energy use before their body temperature rises to high levels [ 8 , 9 , 10 ]. Many factors such as knowledge about the length of the race, ambient air temperature, and topography can influence runners’ pacing and consequently the energy distribution. Wrong pacing can result in a collapse [ 10 , 11 ]. Another component of the running technique is training load. Previous studies have shown that at least 30 km training load per week before a marathon race decreases the risk for injuries [ 11 ]. There is, however, no information about the amount of training load needed to avoid a collapse.

Health conditions such as chronic diseases and viral infections influence the individual runner’s ability to complete a race [ 12 , 13 , 14 , 15 ]. Coxsackievirus with cold symptoms can result in myocarditis [ 16 , 17 ]. Rhinovirus influences the runner’s step, making the steps longer and slower and probably increases the risks for injuries, but it has not proven to affect the lung capacity and runners’ performance [ 12 , 13 , 14 , 15 ].

Several publications emphasize the importance of nutrition and carbohydrates intake days before endurance races and an extra load 2–4 h before the race to increase the performance [ 18 , 19 , 20 , 21 ]. Fluids, on the other hand, are necessary to compensate for the losses due to perspiration [ 19 , 21 , 22 , 23 , 24 ]. Many factors may influence the perspiration mechanism such as genetic predisposition, the ability to adjust to the heat, the intensity of physical activity, and the temperature itself [ 20 , 23 ]. Some studies recommend substitution of up to 50–80% of the total loss due to sweat [ 20 ]. However, intake of a more considerable amount of fluids may also have side effects such as gastrointestinal issues, and hypo- or hypernatremia [ 23 , 24 ].

1.2. Environmental Factors

Recent studies from Gothenburg show a significant correlation between air temperature and number of collapses, number of ambulance transportations due to collapses, and the number of runners who could not finish the race (Non-finishers = NF). These studies used a “physiologic equivalent temperature (PET)” index to estimate the impact of heat [ 25 , 26 , 27 ]. The PET index models the thermal conditions of the human body in a physiologically relevant way and includes all meteorological variables relevant for heat exchange between the body and its environment, i.e., air temperature, wind speed, atmospheric pressure, and mean radiant temperature. The latter describes the environmental radiative load on a person and is one of the essential meteorological variables governing the human energy balance and thermal comfort [ 25 , 26 , 27 , 28 ]. An increase in PET of one degree is correlated with an increase in the number of collapses of 1.8 times and the number of NF with 66% [ 25 ]. Another recent study indicated the possibility of predicting the location of collapses, based on the grade of exhaustion experienced by runners. The localization of ambulance pickups was correlated with the areas where runners experienced maximal exhaustion and collapsed [ 29 ].

Although several partly unexplained risk factors have been associated with EAC, qualitative studies dealing with this issue are scarce. Defining a runner profile or identifying specific risk factors may prevent medical encounters, and open up new research fields, thus contributing to a better understanding of collapses during endurance races; furthermore, it can enable future pre-race tests and education. We aimed to conduct a qualitative study to find a perceived risk profile among runners who collapsed and who were transported by ambulance to the nearest hospital during Gothenburg’s half marathon (2010–2017).

2. Materials and Methods

2.1. general information.

Gothenburg’s half marathon (Göteborgsvarvet = GV), is the world’s largest half marathon with over 45,000 competitors [ 29 ]. Although the number of participants may vary, around 450 to 2250 medical encounters can be expected during the contest, with the variation strongly dependent on weather-related factors. Most of these medical encounters (>90%) are moderate and can be treated on-site by the organizer’s medical crew. Around 59–85% of these cases are EACs, which typically occur once the athlete stops running. However, 2–4% of all medical cases requires ambulance transportation and care at the hospitals due to their serious nature [ 30 , 31 ].

2.2. Participants from Gothenburg Half-Marathon 2010–2017

The Gothenburg Ambulance Journal was used to identify all runners picked up by ambulance due to collapse (n = 164) [ 32 ]. Runners with incomplete journals, wrong address, or information were excluded (n = 80). Remaining 84 received the template by post, but only 30 answered. Of 54 who did not reply, 40% were unknown to the local post office, 40% have moved to other areas without leaving a forwarding address, and in 20%, no reason was found. Two out of 30 individuals were excluded later since their participation was confirmed to be before the study period. The remaining 28 were included and analyzed in this study. The results of the questionnaire were completed with semi-structured telephone interviews. Of 28 participants, 15 were excluded due to sickness or unwillingness to participate in the interview. Remaining 13 participants were interviewed.

2.3. Review and Development of the Questionnaire

A questionnaire was developed using the following keywords in a literature study: marathon, half marathon, risk factors, medical encounters, collapses, runners’ profiles, requiring ambulance. A group of multidisciplinary professionals (n = 7) with medical (sports medicine, surgery, prehospital care and physiotherapist) and non-medical backgrounds (urban climate, human thermal comfort, and crowd management) evaluated and edited the questionnaire. Free comments were allowed and categorized under the main topics. The final version of the questionnaire was approved and was sent out to all included participants. It included the following parts ( Supplementary material ):

• General information: age, gender, education, profession.
• Preparation: Number of earlier contests. Average km ran in one year and 3–4 weeks before the actual contest. Factors negatively influencing the actual contest. Feeling over-confidence. Studying the map and test running the track before the contest. Checking the weather and comfortable temperature to run. Optimal dress and the color of choice. Aimed finishing time. Food and drink taken before the contest.
• Health information: Any actual diseases. Any disease in the family. ADHD diagnostic criteria for adults [ 33 ]. Collapse during physical activity. Physical condition last three weeks before the contest. Alcohol intake (number of occasions and glasses).
• Contest: Planned vs. actual finishing time. Intake of water before the collapse.
• Incident: Marking on the map (incident, ambulance pickup, when it started to be tough). Three critical factors influencing the collapse. Intrinsic factors and experiencing symptoms before collapse (stress, inner demand, nervousness, hunger, thirst, tiredness, cramps, dizziness, confusion, nausea, visual disorder, headache, strange thoughts, others). Extrinsic factors experienced before the collapse (public behavior, crowding, relatives, public cheers, uphill slope, uneven track, warmth, cold, upwind, rain, other). Potential measures to prevent collapsing.
• Post-incident: Any help while waiting for ambulance. Hospital admission and sick leave. Running after the incident and new contests. Other comments?
• Future contact: Available for new contact by email or mobile number.

2.4. Interviews

In order to compensate for potential shortcomings in the questionnaire, to evaluate the response given by each participant, and to obtain spoken accounts, each responding runner was asked to take part in an interview. Exclusion criteria for interviews were (1) severe ongoing disease (defined as a medical condition that does not allow the patients to participate in an interview (one person with psychological disorder, and one with brain damage after cardiac arrest)); or (2) refusal to participate. The obtained information was transcribed and analyzed verbatim. The process of analysis was based on systematic text condensation and divided into two parts: analysis of the incident and analysis of influencing factors [ 34 ].

2.5. Ethical Approval

The ethical committee approved the study (No. 177-16). Each participant received information regarding the study, its aims, and the use of data upon participation. All participants signed a letter of consent before the interviews. They also received verbal information. In both cases, they were informed that their participation was voluntary and withdrawal from the study was possible whenever they desired.

3.1. The Results of the Questionnaire

3.1.1. personal information.

• The average age of the respondents was 41 years (n = 28, 71% men and 29% women). Around 60% had an undergraduate/graduate degree from a university (average in the Swedish population, 42%).

Convenient training air temperature for each runner (n = 28).

• Sixteen runners (57%) reported no previous diseases, while four had pulmonary diseases, including asthma. One suffered from Reynaud’s disease; two runners had high blood pressure; two were allergic; one had diabetes; one cardiovascular disease; one suffered from depression; and one runner reported kidney disease and hypotension.
• Ten participants (36%) reported previous collapses during contests and one during exercises.

Shows the frequency and percent of hereditary diseases in the investigated population.

3.1.2. Preparation before the Contest

• Nineteen of 28 participants (68%) had taken part in GV or equivalent races in the last five years before the collapse (Ran 1 to 17 times, an average of 4.2 + 3.9 times).
• Eighteen runners (64%) had run GV before, of whom 15 could report their running time (ran 80 to 141 min, average 107 + 18 min). None of the remaining 10 test ran the track before the contest.
• The respondents prepared themselves with running 19.7 km on average per week, within 12 months before the actual contest, with an increase to an average of 26.7 km 3–4 weeks pre-contest.
• Thirteen of 28 runners (46%) reported one or two factors with a possible negative impact on their result within one month before the contest. These factors were: (1) infections/flu; (2) stress/high workload; (3) sleeping problem the week before the collapse; (4) change of weather/high temperature; (5) chronic disease (depression and arrhythmia); (6) festivities and (7) pain.
• Eleven of 28 participants (39%) reported being over-confident in themselves and their performance.
• Nineteen participants (68%) did not study the race map before the start.
• Nineteen runners (68%) checked the weather report, days to hours before the contest.
• Only two (7%) respondents believed that they did not have an optimal running outfit. One reported being overdressed and the other had black clothes. The remaining respondents who reported optimal dressing had a different mix of light and dark colors.
• Regarding nutrition, the amount of the food and the time it was taken varied from a sandwich to a complete breakfast a few hours to minutes before the contest. Some did not have breakfast, and some had only lunch. Others had no lunch but breakfast. Some drank water, tea, or coffee, and others had energy drinks.

3.1.3. During the Contest

• Twenty-five runners (89%) predetermined their running time, while two did not. One runner did not reply to the question. Seventeen runners (61%) ran as they planned, while nine reported slower speeds, and three faster speeds.
• Twenty-two runners (79%) reported intake of fluid on predesignated water stations. Four did not take water, and two did not reply.
• The most common intrinsic factors before collapsing were symptom/feelings experienced by runners: tiredness (60.7%), followed by dizziness (50%), and intense inner demands (42.9%). Six runners (21%) experienced all these three symptoms/feelings, and 10 of 28 runners (35.7%) experienced tiredness and dizziness in combination. Other essential symptoms were: nausea, confusion, visual disorder, thirst, cramps, nervousness and headache.
• The most common extrinsic factor before collapsing was high temperature, followed by uphill slope, public cheers, public behavior, narrow track, crowding, and relative bystanders.
• Twenty-two runners believed they could prevent their collapses, while two could not, and two were not sure. Two runners did not reply. The following measures were perceived as preventive to avoid a collapse: Slower tempo/do not put pressure on yourself/Have fewer demands on yourself/Listen to your body; Do not run at all/Stop running; Take in more fluids; Eat more; Take more salt; Exercise more; Test the track before; Wear less clothes and Exercise in high temperature.
• Six runners (21%) did not remember who helped them after collapsing, while the remaining participants mentioned organizers, healthcare staff and spectators.

3.1.4. Post-Collapsing Period

Six of 28 runners (21%) were transported and hospitalized. Two runners stayed one night and three stayed two nights at the hospital. Four of these runners had a sick leave of 2 to 3 days. One 30-year old runner suffered a cardiac arrest and brain injury and was treated at the intensive care unit followed by long-term neuro-rehabilitation. Two runners did not answer the question.

3.2. The Results of the Interviews

The interviews aimed to get a broader insight into some of the statements from the questionnaire. The runners had the opportunity to expand their narratives and report more in detail about their experiences. Each interview took around 40 min. The results were categorized as: the incident, runners’ characteristics and the perceived influencing factors leading to collapses ( Figure 2 ). Thirteen runners were included in the interviews, whose age, gender, and education were comparable with the larger population who replied to our questionnaire.

Shows most important factors influencing collapses, based on the questionnaire and interviews.

Incident and Individual Characteristics

• Three of the interviewees collapsed more than once during the study period, but only on one occasion did they need ambulance transportation to the hospital. Two of interviewees collapsed long after finishing the race and while on public transportation, but still needed ambulances. In total, these 13 runners suffered 16 collapses of which 11 took place during the years with the highest air temperature and highest PET.
• All interviewees exercised regularly 3.4 h per week before the contest. The most common type of exercise was running; however, rarely over 15 km per training session.
• Most of the participants had an extra intake of carbohydrates weeks before the contest and until the contest day. Most participants had a large breakfast, but ten runners skipped the lunch. Most of those reporting less intake of food could not schedule their nutritional intake on time. Three runners did not eat due to being nervous. Five runners had proper fluid intake before the contest but did not drink during the contest. Others reported sufficient control over their fluid intake.
• Few runners experienced immense stress to get to the race on time. One person could not sleep but still took part in the race since he believed that he was experienced enough to handle that.
• Besides medical conditions mentioned in the questionnaire, some runners claimed to have orthopaedic injuries before the contest (included in the health issues, Figure 2 ).
• Despite the collapses, few runners reported previous collapses as a favorable factor, contributing to useful knowledge and understanding of their body and a better ability to pace themselves.
• All interviewees described themselves as stubborn, ambitious and disciplined persons. Most of them measured their performance based on figures such as the number of kilometers, pulse, or time. They emphasized that these characteristics were the primary motivation for training, but even possibly the major reason for the collapse. Some reported the importance of pacing and ability to adjust their performance based on the actual circumstances. However, sometimes, the inner demands, pressure from other runners, and the comparison of last year results to the actual contest influenced their running behavior, and they continued running even though their body signaled exhaustion.
• The most remarkable post-contest experience for many of the runners was the inability to remember crucial details such as names, numbers, addresses, etc. after the event. Some believed they had a nervous breakdown and cerebrovascular insult. Many had experienced fear and anxiety, and many emphasized that the event had had an impact on their lives and training routines.

4. Discussion

We aimed to conduct a qualitative study to find a perceived risk profile among runners, who collapsed, and who were transported by ambulance to the nearest hospital during Gothenburg’s half marathon (2010–2017). The most important influencing factors found in this study were mental status and the high demands on individual performance placed on each collapsed runner. Another result was the number of participants (36%) who had experienced collapses during running contests before the study and the number of participants (43%) who reported hereditary issues.

Runners’ tendency to collapse might indicate other mechanisms behind collapses than diseases and physical conditions. The interviewed participants claimed they continued the contest although their body signaled exhaustion. Although most of the runners who collapsed in our study were amateurs, they all had experiences of running contests. Most of them were well educated and highly confident about their capabilities. This population is similar to another study documenting the characteristics of 161 km ultra-marathoners, in which participants were mostly well- educated, middle-aged, married men who rarely missed work due to illness or injury, generally used vitamins and or supplements, and maintained appropriate body mass with ageing [ 35 ]. The participants described themselves similarly as stubborn, ambitious, disciplined and performance-oriented.

In another published study from 2016, ten runners volunteered to describe their experiences of withdrawal during an ultra-trail race underwent interviews to share common individual characteristics leading to withdrawal. Seven representative sequences were identified: feeling pain; putting meaning to those feelings; adjusting one’s running style; attempting to overcome the problem; other runners’ influences; assessing the situation; and deciding to withdraw [ 36 ]. Consequently, our results, as well as those represented in Hoffman’s reports, may indicate that runners with specific characteristics may lack the control mechanism to maintain these representative sequences. Thus, they feel the pain and have symptoms such as tiredness and dizziness, but cannot put meaning to the feeling, and have difficulties to adjust their running style (pacing), while trying to overcome their problems. Influenced by other factors such as other runners’ performance while passing by, and magnified by extrinsic factors such as public cheers and behavior, and air temperature and humidity [ 25 , 26 , 27 , 29 , 37 , 38 ], they may have difficulties in assessing the situation, continuing to run instead of quitting the race, and collapse [ 29 , 35 , 36 ].

Endurance races are still associated with morbidity and mortality [ 4 , 39 , 40 , 41 , 42 ]. Although the absolute risk of sudden death for the participants in an endurance race is low (0.5–1.5 cases/100,000 runners), the tragedy itself is magnified due to the involvement of younger runners [ 3 , 4 , 5 ]. In a study published in 2012, the median age among deaths was 41.5 years. Half of the deaths (14/28) occurred in runners under the age of 45. The most common cause of death was cardiac arrest due to inherited/congenital heart disease [ 40 ]. The main reasons for death among runners older than 45 years (93%) was myocardial infarction (n = 13) and atherosclerotic heart disease (n = 14). In our study, over 40% of participants had high blood pressure with or without medication, and an additional 25% had Cerebrovascular Disease (CVD). This constitutes a significant risk factor and higher morbidity and mortality rate since history of CVD together with other possible risk factors such as chronic diseases, chronic prescription medication, and history of collapse during a race, have all proven to be alarming signals. Consequently, the idea of risk assessment and pre-participations’ screening has emerged to capture runners view on their health condition [ 43 , 44 ].

Runners’ views on their symptoms and their medical history are important factors in preventing medical encounters in endurance races [ 29 , 45 ]. In one study, the authors evaluated the efficacy and feasibility of an online pre-race medical screening and an educational intervention program to reduce medical complications in long-distance races. They found that all medical encounters (including life-threatening encounters) were significantly lower after the introduction of the program, which also was feasible to perform [ 45 ]. Educational interventions do not necessarily need to deal with medical information. Knowledge about other factors such as the impacts of diseases, personal characteristics at risk, as presented in our study may be part of intervention programs in order to reduce medical complications. Existing and hereditary diseases, and unexpected medical conditions, found in our study, despite its size, are in accordance with earlier reports and confirm the need for a pre-race screening test before endurance contests.

It is shown that with an increasing air temperature above an optimum, performance decreases. The optimal air temperature can vary between runners due to the level of physical readiness. Higher air temperature has shown to be associated with a higher rate of runners withdrawing from the race and increased medical complications. The acceptable upper limit for many races is based on WBGT (wet bulb globe temperature) of 28 °C; however, the WBGT is an empirically-based index, which does not provide any detailed examination of the meteorological variables contributing to thermal stress and is consequently of limited diagnostic value [ 21 , 22 ].

Limitations

One main limitation of this study was the low response rate in the questionnaire study, which was due to wrong or incomplete information. We have, however, been informed that registered runners can offer their start positions to other participants if they cannot take part in the race due to sickness or other private reasons. This change should be reported to the organizers at least 48 hours before the contest. Missing this mandatory task may result in names with no address or addresses with no names; an organizational problem that should be addressed.

Nevertheless, as an effect of the low response rate to the questionnaire and the qualitative characteristics of the study, no statistically significant data can be reported. There is a need for larger number of participants, ideally compared to a control group to determine the relative importance of a range of risk factors. The study, however, opens up new research fields and confirms the need for both quantitative and qualitative studies in this field.

Qualitative studies have the shortcoming of not being able to generalize to a population, but the results may be transferable and can provide researchers with new angles in front of a quantitative study. Considering the scale of the studied half-marathon (45,000 competitors and six years of data but only 164 runners picked up by ambulance due to collapse) a quantitative study will be extensive. It may benefit from tentative results provided by studies such as this one to verify or falsify

5. Conclusions

Collapsing might be the first sign of severe medical conditions and clinically mimic the more common and benign exercise-associated collapse. Several risk factors associated with severe collapses have been reported. However, other individual and mental characteristics may indicate a unique profile for runners who collapse. Pre-race health check-ups and educational initiatives aiming at mental evaluation, preparedness and information before endurance races might be a necessary step to avoid life threatening complications.

Supplementary Materials

The following are available online at https://www.mdpi.com/2075-4663/8/1/2/s1 , Swedish questionnaire.

Author Contributions

All authors were involved in planning of the study. A.K.-M., T.L. and E.C. collected data for this study. All authors read and analyzed the data and contributed to the conclusions. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

Why Marathon Runners and Triathletes Collapse: Risks and Prevention Tips

If you’re a marathon runner or triathlete, you’ve likely heard stories of athletes collapsing during races. This can be a scary experience, both for the athlete and for those around them. But why does it happen, and how can it be prevented?

Understanding Athlete Collapse There are a number of factors that can contribute to athlete collapse during a marathon or triathlon. These include dehydration, electrolyte imbalances, heat stroke, and cardiac events. In some cases, the collapse may be caused by a combination of these factors.

Risk Factors and Prevention There are steps you can take to reduce your risk of collapsing during a race. These include staying hydrated, monitoring your electrolyte levels, and acclimating to the heat if you’re racing in a warmer climate. It’s also important to pay attention to your body and listen to any warning signs, such as feeling lightheaded or dizzy. If you do experience a collapse, prompt medical intervention and care can be critical.

Key Takeaways

• Athlete collapse during marathons and triathlons can be caused by a variety of factors, including dehydration, electrolyte imbalances, heat stroke, and cardiac events.
• To reduce your risk of collapse, it’s important to stay hydrated, monitor your electrolyte levels, and acclimate to the heat if you’re racing in a warmer climate.
• If you do experience a collapse, prompt medical intervention and care can be critical in preventing serious complications.

Understanding Athlete Collapse

As an athlete, you understand the importance of pushing your limits. However, pushing your limits can sometimes lead to a collapse. Collapsing during a marathon or triathlon can be a frightening experience, and it’s important to understand the causes and symptoms of athlete collapse to prevent it from happening to you.

Causes of Collapse in Endurance Athletes

There are several causes of collapse in endurance athletes, including dehydration, heatstroke, hyponatremia, cardiac arrest, and sudden cardiac death. Dehydration occurs when your body loses more fluids than it takes in, leading to an electrolyte imbalance. Heatstroke occurs when your body overheats, and you are unable to cool down. Hyponatremia occurs when your body has too little sodium, leading to nausea, vomiting, dizziness, confusion, loss of consciousness, and altered mental status. Cardiac arrest and sudden cardiac death can occur when your heart is unable to keep up with the demands of exercise.

Recognizing the Symptoms

Recognizing the symptoms of collapse in endurance athletes is crucial to preventing it from happening to you. Symptoms of dehydration include thirst, dry mouth, fatigue, and dark urine. Symptoms of heatstroke include headache, dizziness, nausea, vomiting, and confusion. Symptoms of hyponatremia include nausea, vomiting, headache, confusion, seizures, and coma. Symptoms of cardiac arrest and sudden cardiac death include chest pain, shortness of breath, and loss of consciousness.

To prevent athlete collapse, it’s important to stay hydrated, take breaks when necessary, and listen to your body. If you experience any symptoms of collapse, seek medical attention immediately. With proper preparation and awareness, you can push your limits without putting yourself at risk of collapse.

Risk Factors and Prevention

https://www.youtube.com/watch?v=eakmeWlzlhs&embed=true

When it comes to endurance event s like marathons and triathlons , there are several risk factors that can cause athletes to collapse. However, with proper training, preparation, and race day strategies, you can minimize these risks and safely push your limits.

Age and Health Considerations

Age and health are important factors to consider before participating in an endurance event. If you have a history of heart problems or high blood pressure, it’s important to consult with your doctor before training for a marathon or triathlon. Additionally, as you age, your body may not be able to handle the same level of physical stress as it did in your younger years. Make sure to adjust your training and race day strategies accordingly.

Training and Preparation

Proper training and preparation are crucial to preventing collapse during an endurance event. Gradually increase your endurance and balance your training with rest days to prevent overexertion. Nutrition and hydration are also important factors to consider. Make sure to consume enough carbohydrates for energy and stay hydrated with fluids and electrolytes. Oral rehydration solutions can be helpful during training and on race day.

Race Day Strategies

On race day, pacing and fluid intake are key factors in preventing collapse. Start off at a comfortable pace and gradually increase your speed as you progress through the event. Make sure to drink enough fluids and replenish your electrolytes with energy drinks. If you start to feel fatigued or experience symptoms like dizziness or confusion, slow down and seek medical attention if necessary. In some cases, intravenous fluids may be necessary to prevent collapse.

By taking these risk factors and prevention strategies into consideration, you can safely challenge yourself and push your limits during an endurance event like a marathon or triathlon.

Medical Intervention and Care

https://www.youtube.com/watch?v=54bg4NQmc24&embed=true

If you or someone you know collapses during a marathon or triathlon, it is important to seek medical attention immediately. On-site medical attention is critical in identifying and treating serious conditions such as sudden cardiac arrest or chest pain.

Medical tents are often set up along the course to provide access to medicine and medical attention. If you are experiencing symptoms such as dizziness, shortness of breath, or chest pain, seek medical attention immediately. The medical staff will perform an examination and may administer medication or other treatment as needed.

Post-collapse recovery is also important. After receiving medical care, it is important to rest and allow your body time to recover. Monitoring your symptoms and following up with medical care as needed is also important for a full recovery.

In some cases, follow-up care may include additional testing or monitoring to ensure that there are no underlying medical conditions that contributed to the collapse. It is important to take any recommended follow-up care seriously to prevent future incidents.

Remember, collapsing during a marathon or triathlon can be a serious medical emergency. Seek medical attention immediately and follow all recommended medical care and follow-up instructions for a full recovery.

Nutrition and Hydration Management

https://www.youtube.com/watch?v=TN-Yo21xdCA&embed=true

As a marathon runner or triathlete, your nutrition and hydration management is crucial to your performance and overall health. In this section, we’ll discuss some important aspects of nutrition and hydration management that you should keep in mind.

Understanding Fluid and Electrolyte Needs

Fluid and electrolyte balance is essential for optimal performance and recovery. Electrolytes are minerals in your body that help regulate fluid balance, muscle function, and other important bodily processes. When you sweat, you lose both fluids and electrolytes, which can lead to dehydration and electrolyte imbalances.

To maintain proper fluid and electrolyte balance, it’s important to drink fluids regularly throughout the day and during exercise. You should aim to drink enough fluids to maintain urine output and prevent dehydration. The amount of fluid you need depends on several factors, including your body weight, the intensity and duration of your exercise, and the temperature and humidity of your environment.

Dietary Strategies for Endurance Athletes

As an endurance athlete , your diet should be rich in carbohydrates , which are the primary fuel source for your muscles during exercise. You should aim to consume at least 3-5 grams of carbohydrates per pound of body weight per day. Good sources of carbohydrates include fruits, vegetables, whole grains, and sports drinks.

In addition to carbohydrates, you should also consume adequate amounts of protein to support muscle growth and repair. Aim to consume 0.5-0.7 grams of protein per pound of body weight per day. Good sources of protein include lean meats, dairy products, and plant-based sources such as beans, nuts, and soy products.

Energy drinks can also be a useful tool for endurance athletes, as they can provide both carbohydrates and electrolytes. However, be sure to read the labels carefully and avoid energy drinks that are high in sugar or caffeine.

By following these dietary strategies and staying on top of your hydration needs, you can help prevent dehydration, electrolyte imbalances, and other issues that can lead to collapse during a marathon or triathlon.

Equipment and External Factors

Choosing the Right Gear

Choosing the right gear is essential for preventing collapse during a marathon or triathlon. Your shoes and clothing should be comfortable and appropriate for the weather conditions. Make sure to wear breathable clothing that wicks away sweat and keeps you cool. Avoid wearing cotton as it retains moisture and can cause chafing.

Your shoes should fit well and provide adequate support for your feet. Make sure to break them in before the race to avoid blisters and discomfort. Consider wearing compression socks or sleeves to improve circulation and reduce muscle fatigue.

Environmental Considerations

Environmental factors such as heat and humidity can increase the risk of collapse during a marathon or triathlon. Make sure to check the weather forecast before the race and adjust your clothing and gear accordingly. If the weather is hot, wear light-colored clothing and a hat to protect your head from the sun.

Stay hydrated by drinking water or sports drinks before, during, and after the race. Avoid drinking alcohol or caffeine, as they can dehydrate you. If you feel dizzy or lightheaded, stop running and seek medical attention.

Keep an eye on your body temperature by monitoring your core body temperature or rectal temperature. If your body temperature rises above 104°F (40°C), you may be at risk of heat stroke. Symptoms of heat stroke include confusion, seizures, and loss of consciousness. Seek medical attention immediately if you experience any of these symptoms.

In summary, choosing the right gear and being aware of environmental factors can help prevent collapse during a marathon or triathlon. Stay hydrated, monitor your body temperature, and seek medical attention if necessary.

Frequently Asked Questions

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What are common reasons for athletes collapsing during a race?

Athletes may collapse during a race due to several reasons, including heat exhaustion, dehydration, hyponatremia, and cardiac issues. These conditions can be exacerbated by factors such as overexertion, poor nutrition, and inadequate training.

How can a runner tell if they’re at risk of collapsing due to poor glucose regulation?

Runners who experience symptoms such as dizziness, confusion, weakness, or fatigue during a race may be at risk of collapsing due to poor glucose regulation. Monitoring blood sugar levels and consuming carbohydrates before and during the race can help prevent this.

What immediate steps should be taken if a runner collapses during a marathon?

If a runner collapses during a marathon, it is essential to seek medical attention immediately. Call for help and provide basic first aid, such as checking the person’s airway, breathing, and pulse. Do not give the person anything to eat or drink until medical professionals arrive.

Can dehydration alone cause marathon runners to collapse, even if they are well-hydrated?

Dehydration can cause marathon runners to collapse, even if they are well-hydrated. This is because dehydration can lead to electrolyte imbalances, such as hyponatremia, which can be life-threatening.

What are the symptoms indicating a runner might be about to collapse?

A runner who is about to collapse may experience symptoms such as dizziness, lightheadedness, confusion, nausea, vomiting, or muscle weakness. It is important to pay attention to these symptoms and take appropriate action to prevent collapse.

How can marathon runners prevent collapse due to exercise-associated conditions?

Marathon runners can prevent collapse due to exercise-associated conditions by staying hydrated, consuming carbohydrates before and during the race, and avoiding overexertion. It is also essential to train adequately and be aware of any underlying medical conditions that may increase the risk of collapse.

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Unit Overview: Marathon Runner Problem Performance Task

In this performance task, students apply their knowledge of the different ways that the body maintains homeostasis, in order to determine the cause for a marathon runner's collapse.

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Case 26 The collapsed marathon runner

• Published: March 2015
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This chapter provides a discussion of the specific challenges facing the emergency physician dealing with a patient presenting with a collapse after marathon running. It describes an overview of the range of heat-related presentations, the monitoring required, and the subsequent electrolyte disturbances and the acute management strategies required.

It examines the evidence base for three key clinical questions:a consideration of whether standard tympanic temperature measurement is accurate and adequate; an analysis of how patients with exertional heat stroke should be best cooled; and discussion around whether standard antipyretic treatments have a role in lowering temperatures and alleviating symptoms.

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