askST: How can runners complete a marathon safely?

SINGAPORE – A participant died after crossing the line at the Standard Chartered Singapore Marathon (SCSM) on Dec 1. 

This marked the

third death in the history of the 23-year-old event.

Organisers did not disclose the details of the participant, who was taking part in the 42km run, or the cause of death. 

Two men in their 20s died – both of cardiac causes – after finishing the half-marathon in 2011 and 2016.  

The Straits Times speaks to runners, coaches and doctors to find out how runners should safely prepare for a race.

Q: Should you opt for a health screening before a marathon?

A: Everyone should have their health checked, even those who are physically fit, said Professor Roger Foo, senior consultant at the cardiology department at the National University Heart Centre, Singapore.

“Physical fitness does not equate to being healthy or disease-free,” he said. “Often, diseases are hidden and silent, and do not display any signs.” 

Men above 35 years old and women above 45 years old are advised to get cardiac screenings as they face a higher risk of developing coronary heart diseases, said Dr Soon Chao Yang, senior cardiologist at The Heart Doctors Clinic at Mount Alvernia Hospital. 

Those who have existing cardiovascular risk factors such as diabetes, hypertension or high cholesterol, as well as individuals with a family history of cardiac deaths or hereditary heart conditions, should also consider undergoing screening. 

Q: What are the available options for cardiac tests?

A: Basic heart screening options include electrocardiography (ECG), exercise stress test and transthoracic echocardiography (TTE), said Dr Soon. 

ECG is a non-invasive and pain-free procedure which records the heart’s rhythm and rate by placing electrodes – sticky patches – onto one’s arms, legs and chest. This test is the most cost-effective, said Dr Soon. Checks show that it costs from about $50 to $80. 

An exercise stress test assesses one’s heart response to an increased demand for blood, and how much physical strain one can take. It is conducted by recording one’s ECG while on a treadmill machine, and costs anywhere from $200 to $500. 

TTE is an ultrasound test which assesses the pumping function of one’s heart by recording images of its structure. It detects abnormalities, such as a hole in the heart or fluid around it, and may also reveal heart defects from birth. It costs from about $400 to $1,000.

It is worth doing all three tests as they serve different purposes, said Prof Foo, who added that TTE reveals the structure of the heart most clearly.

For those with moderate to high risks of heart problems, undergoing CT coronary angiography may be warranted, said Dr Soon. 

An angiogram, conducted by taking images of the heart with a CT scan, can detect narrowing or blocked blood vessels in the heart. Based on checks, the test costs from about $1,200 to $2,500.

“Screening is not absolutely fool-proof, but it is still what we can do for now, and it is key,” said Prof Foo.

Q: How long does it take to train for a marathon? 

A: This can range from six months to a year for someone who just started hitting the road, said marathoner Soh Rui Yong.

Soh,

who won his fifth consecutive national title

at this year’s SCSM, advised those looking to start their marathon journey to get a coach to guide them through race preparation and execution. 

Those gearing up for a full marathon (42.195km) should be clocking three or four training sessions a week, and covering distances of at least 20km regularly, said veteran running coach Steven Quek. 

Those who do not manage to get sufficient training should opt for shorter races such as the 10km run or half-marathon, he added. 

“These distances provide a rewarding enough challenge and help build the fitness necessary for marathon training later,” said Quek.

“Jumping into marathon preparation without a proper foundation of regular training could lead to problems.”

If one is travelling abroad to run a marathon, he or she is advised to reach the host country early to acclimatise to the weather, said Dr Dinesh Sirisena, consultant in sports and exercise medicine at Auspicium Orthopaedic Clinic.

“If someone is coming from a very cold place to Singapore, coming a few days or a week before the race and getting used to the weather is important,” he said. “But the most important thing is to train progressively over a period of time and increase your cardio capacity.”

Q: How do you know if you are fit enough for a marathon? 

A: Being able to consistently run for two to three hours at least once a week is a marker that one is fit enough to do a marathon, said national record holder Soh. 

“You don’t have to run a full marathon in training, but you do need to be able to run for a reasonably long time,” he said.

Quek said one should be able to run a distance of at least 35km.

“If a participant hasn’t trained consistently and reached this milestone, they are likely not sufficiently well prepared for the physical demands of running a marathon.”

Q: How can you keep healthy during the race?

A: Staying hydrated throughout the run is crucial, especially in Singapore’s hot and humid climate, said national runners. 

Runners should drink water or take electrolytes, refuelling at the hydration stations along the race or with their own supplies, said national distance runner Vanessa Lee. 

“Many choose to ignore this aspect in favour of saving time early on, but it can bite you after,” said Soh, citing the example of former American long-distance runner Alberto Salazar. 

Salazar famously barely drank any water throughout the 1982 Boston Marathon, and collapsed after finishing first. He was given emergency treatment and 6 litres of saline solution through an intravenous drip. 

“Even the best athletes are not spared,” said Soh. 

During the race, one should be aware of one’s limits, added Lee, who claimed the women’s national title in the half-marathon at the SCSM. “It’s perfectly okay to miss your target time or even stop to walk if needed.”

Q: What are some signs that you should stop running? 

A: Chest discomfort, shortness of breath, giddiness and faintness, and heart palpitations are some of the symptoms one should not ignore before or during a strenuous workout, said Dr Soon.

Runners should also be on the lookout for signs of heat stress, such as cramps, disorientation and agitation. 

Pushing through heat stress and beyond one’s ability may lead to issues such as heatstroke, which can be fatal, said Professor Jason Lee, director of the Heat Resilience and Performance Centre at NUS.“Heat stress can also impose additional stress on the heart and increase the risk for cardiac arrest,” he added.

Physical exertion on hot days may also lead to over-hydrating, which will dilute one’s blood sodium concentration and cause water intoxication, said Prof Lee. “While rare, severe water intoxication can cause seizures and even deaths.”

While there has been much debate about the optimal level of hydration while running, Dr Dinesh advises runners to “drink to thirst – when your body tells you it needs hydration”. “You don’t necessarily have to drink when someone offers you one.”