Cardiac arrest deaths among marathoners have decreased, study finds
washingtonpost.com
washingtonpost.com
[1] https://www.abc.net.au/news/2025-04-07/nsw-ambulance-ecmo-tr...
[2] https://www.nsw.gov.au/media-releases/mobile-cardiac-treatme...
[3] https://www.bmj.com/content/384/bmj-2023-076019
Edit: The numbers in [3] are optimistic, as they are for in-hospital CPR, not out-of-hospital CPR.
(There are similar programs around the world with different models of care, notably in Paris, Albuquerque, the Netherlands and Regensburg, Germany).
This strikes me as either your cardiologist being wrong or you misinterpreting what they said.
Can you damage your heart doing endurance events? Most certainly. I’ve seen at least two cardiac arrests during events where the person did not survive.
Does everyone who does an event suffer heart damage? No.
There have been quite a number of studies mentioned in ultramarathon journals that contradict your claim.
Additionally, I have run so many marathons and ultramarathons I’ve lost count. I just recently had my own extensive (and expensive, despite insurance) cardiology work where they observed no such damage. I asked them whether endurance sports cause heart damage, because I’m old and thinking of starting up again and the summary of their answer was “as long as you’re training properly, you’re good”.
That said, certainly these events put short term (~weeks/~months, depending) stress on the heart.
The article mentions new medical technology and techniques as increasing survivability but I also wonder if better training and awareness is also a key. When I started running ultras particularly, it was just a bunch of nutcases. But now you have “hobbyists” like soccer moms running them (and I’m thrilled about that) and doing well at them because there are sets of extremely good training knowledge out there.
This is not what they said. Your doctor said that “as long as you’re training properly, you’re good” but I've trained with a lot of other people and most people don't know what properly means. They just go hard.
> my cardiologist said that everyone who trains hard for a marathon has some level of heart damage from the excessive training
> Does everyone who does an event suffer heart damage?
These do not mean the same thing. Everyone who trains hard for a marathon is not everyone who does a marathon.
There's no evidence I've seen that "everyone who trains hard for a marathon has some level of heart damage".
Can you point me to such evidence?
3:40 is slow by "serious layperson" marathon standards, but it was about the max I could get with my at the time 40-ish yo body and ~6 months of serious training, starting from a solid baseline.
I am slow, so my average marathon normally hovers around 4:00.
I am not fast by any measure, but I do have ridiculous endurance.
How do you observe such damage without a biopsy?
"We want you to run until you feel tired." (I forget their exact wording, but that's the spirit)
"Uhm, we're going to be here for hours."
"OK, get it up to 145bpm and then stop whenever you want."
"I never get up to 145 bpm!"
"We'll get you up to 145 bpm".
And indeed they did. An aside: their treadmill goes steeper than mine at home does. :-P
https://archive.nytimes.com/well.blogs.nytimes.com/2012/01/1...
https://www.mayoclinicproceedings.org/article/s0025-6196(16)...
Something like that seems to have the best outcomes (will it help you not die?) and it fits with how I feel. Running more than once a week always made me get worn down. My best 5k time came from running one long run a week and lifting weights the rest of the week. I was effectively just wasting my time with the other runs in the week. I don't suggest this for a real professional runner, but for weekend warrior types like me, I think it works well. And I have won my age group before in a race, so I'm not a total novice.
This is about 50 % beyond what I would normally be doing, and a couple of times after upping the volume I did get close to backing off because I felt like I was overdoing it, but after pushing through for a week I started recovering again.
The difference in my fitness is almost unbelievable. I can knock out 160+ km rides with no problem when in previous years I would have found them very difficult.
And beyond just results on the bike, I feel much better in myself, even than when I was doing 10 hours per week. I never get out of breath, hills I used to walk up with the dog I now realise I am walking up breathing through my nose the whole time, I handle heat much better, my resting heart rate is in the mid-to-high 40s, I have more energy, etc.
If your goal is to do well at the local 5 km run in the park then lower volume is probably fine, but in my personal experience I still don’t think I’ve hit my limit even at 15 hours per week.
Maybe I'm reading it wrong, but the study seems to claim that running less than the recommended amount is still good, not that running more is necessarily bad:
> ...these highest runners still had trends of lower mortality than did nonrunners and only a nonsignificant trend of higher mortality than did the lower-dose runners (P≥.05). Therefore, until we have more compelling evidence on running doses and mortality, we should emphasize that “even a little is great” rather than debating whether “more is better or worse” from a public health perspective.
Sprinting, though, 3x/wk, is very good for you.
These long events leave me feeling weary and fatigued, and sore in places no doubt, but never what I'd call in pain, and definitely not in my chest. If I ever felt pain in my chest I'd definitely get that checked out.
Your cardiologist spoke directly with you; they're a trained, accredited, licensed, and in good standing professional. Go with your interpretation of what they told you.
Additionally, lets learn how to over-come HN's own form of bro-science because I'm pissed off right now.
Step 1: go to pubmed and throw the most basic of terms in: "marathon training cardiology damage"
Step 2: Quickly review the studies listed; we want to see studies after the advent of advanced hormone and mRNA quantification--that's around 2005 to 2010 or so--or anything within the last 5-10 years.
Step 3: Read through one study especially if it appears to be well setup or specific to what we are trying to understand--we can look at the abstract if we have some knowledge in the area, or are just getting a feel for the topic.
Step 3b: take note of terms; this study is an easy one and has everything we want to see in the abstract: https://pubmed.ncbi.nlm.nih.gov/36767963/ "Effects of Long-Term Endurance Exercise on Cardiac Morphology, Function, and Injury Indicators among Amateur Marathon Runners" in the Int J Environ Res Public Health . 2023 Jan 31;20(3):2600. doi: 10.3390/ijerph20032600.
Step 3c terms:
- cardiac morphology, function, injury indicators;
- left ventricular end-diastolic volume and left ventricular end-systolic volume indicator;
- myocardial injury indicators, serum levels of cardiac troponin I, creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and N-terminal pro-b-type natriuretic peptide (NT-proBNP)
- Long-term high-intensity endurance exercise (not indicated; but "High intensity Steady State" (HISS) and similar will creep into our vocabulary)
Step 4: refine search to something like "cardiac morphology myocardial injury marathon amateur"; throw on "biological indicators", "creatine kinase"
Step 5: rinse, repeat, and read deeper into some of the studies.
Anyways, "Long-term high-intensity endurance exercise caused some damage to the hearts of amateur runners." and your cardiologist said the same. Or you can believe some rando giving medical advice on this forum. And honestly, I'm beyond irritated at the consistently bad takes on medicine, biomedicine, and exercise on YC HN.
No, his cardiologist apparently said this:
>my cardiologist said that everyone who trains hard for a marathon has some level of heart damage from the excessive training.
There is a huge difference between "some damage observed in some people that do X" and "everyone that does X has damage from doing X". They are completely different statements. They say different things.
Scaremongering about the "dangers" of exercise causes much more harm than exercise does. Even if it were true, it would still be better to have a few heart attacks from exercise than TONS of heart attacks from obesity and unfitness.
I wonder the fitness levels of the people that experienced cardiac arrests. Like were these first time runners that signed up to run a marathon?
In my understanding of what happens during sudden arrest is that after having filled the artery wall tubing with as much plaque as it could stand, instead of ruptering through the outer wall , it collapses inwards, cutting off blood supply to the heart muscle.
I read about marathon runners saying it takes a month to recover from a marathon. That can't be healthy.
I never felt healthier in my life than that year.
This is not medical advice, but the body is amazingly adaptable and can withstand some pretty high levels of stress if you build up to them slowly and are willing to back off when it tells you to.
Being in shape makes you far less likely to die or be injured by a heart attack than being a fat unhealthy pig. Anyone that refuses to accept this is living in denial.
Health matters, exercise matters, and life has random elements but is not random. Choices do have consequences.
Almost all of the deaths or mortality for young athletes (amateur or professional) are due to the genetic, for example mostly are based on the hypertrophic cardiomyopathy (HCM) [1].
Another fun fact, unlike normal CVDs, genetic based CVDs like HCM the death is totally preventable if it can be detected and treated early.
In many countries now CVDs screening including ECG is mandatory for professionsl atheletes, hopefully it can be made mandatory for amateur athelete as well e.g marathoners [2].
[1] Hypertrophic cardiomyopathy:
https://en.wikipedia.org/wiki/Hypertrophic_cardiomyopathy
[2] Periodical cardiovascular screening is mandatory for elite athletes:
Personally I'm working towards accurate non-invasive screening of HCM based on ECG for professional athletes in initial collaboration with Oxford University and local national sport institute.
[1] Radiopaedia: Hypertrophic cardiomyopathy:
https://radiopaedia.org/articles/hypertrophic-cardiomyopathy
Here is the (paywalled) JAMA article, which as far as I can tell is not on Anna's Archive etc yet
My speculation would be that these mega running nerds all wear watches that track their heart rate 24/7 now. I suspect if something is wrong then you get an earlier detection rather than only discovering it on a race day.