Lack of Awareness of Fluid Needs Among Participants at a Midwest Marathon
Brown S, Chiampas G, Jaworski C, & Passe D (2011). Lack of Awareness of Fluid Needs Among Participants at a Midwest Marathon Sports Health: A Multidisciplinary Approach, 3 (5), 451-454.
Participation in marathons has increased from 25,000 runners in 1976 to 425,000 runners in 2008. This growth in popularity has attracted runners with various levels of experience, fitness, and knowledge about potential complications of marathon running. Brown et al. examined the experience of the typical marathon participant in the 2007 Chicago Marathon regarding the potential complications of running a marathon and hydration status. Surveys were completed by 419 runners during the Marathon Expo held two days before the marathon. The survey asked about demographics, number of previous marathons, extent of training for this marathon, history of injuries, previous use of medical tents at marathons, and hydration preferences. 34% of the runners reported never running a marathon before and 17% had a history of one marathon. 153 (37%) of the runners that completed the survey reported a history of at least one injury during the current running season (78% were defined as minor). Among the 278 participants who completed a previous marathon, 54 (19%) reported needing the medical tent: 17 (32%) runners for dehydration, 10 (19%) runners for cramping, 6 (11%) runners for musculoskeletal injuries, and the remainder for various health issues (i.e., vomiting, bleeding, heat- or cold-related illnesses, and hyponatremia). Overall, 55% and 64% of participants reported that they were not concerned with musculoskeletal injuries or hyponatremia; respectively. 89% reported no knowledge of their sweat rate and 68% reported that they did not weight themselves to assess hydration status. Over 81% of participants reported not having a method to address hydration status. The authors concluded that “most participants were inexperienced, lacked concern for injury or hyponatremia, and were not using methods of hydration assessment.”
This study is important because it clarifies the level of experience, knowledge, and perceptions among marathon runners. A few decades ago, marathon runners were primarily elite athletes but participants are becoming more diverse. This inexperience may lead to an increased burden on medical teams. The 2007 Chicago Marathon had 48,463 registrants (according to the article) but only about 29,000 participants finished the race. Furthermore, despite new record times in 2011, the average finish time has increased from 4:20:22 (2000 to 2002) to 4:37:14 (2009 to 2011; data verified here) in less than a decade. It would be interesting to see how this study’s data compares to other marathons or how the perceptions of runners relate to who utilizes the medical tents at that marathon. As a medical community that emphasizes injury prevention, we need to play a more active role in educating this population about proper hydration, training, and injury prevention. This may require us to be more proactive by promoting sound advice and guidelines in trade magazines, injury prevention workshops, and attending marathon expos. While marathons may be a once a year event for the medical community that serves a marathon, we should engage the running population all year. This could be a great opportunity for sports medicine to influence a large physically active and highly motived community before they come in with stress fractures, tendinitis, heat-related illness, or other conditions. I know when I talk to a runner they often have questions or stories. When was the last time you spoke to a recreational long-distance runner (that didn’t attend the school you worked at)?
Written by: Jeffrey Driban
Reviewed by: Kyle Harris
As marathons become more mainstreamed, the the number of hobbyist runners increases and running a marathon becomes less of an elitist event. Endurance running is not for everybody physiologically speaking, as is demonstrated through the steady rise in finishing times and dropout rates. However, if people want to push past the genetics and run as well as they are able, they should be made aware of the finer points of proper safety. Too many people are ignorant of safety concerns and prudent practice concerning endurance racing. Preventative education is a great idea and should be presented through various sources.
Thanks for the comment Justin. I think the next questions is how can we engage this population to help educate them about proper training, injuries, and proper hydration.
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It is funny when you talk to a recreational runner and they will often times think that they should drink at every water station, because they are there for a reason. It appears that education needs to cover BOTH ends of the hydration spectrum. What is really interesting to me is the "other" 11% including hyponatremia. Drinking too much water during a race leads to this possibly deadly condition. And the misconception of drinking water at every station could lead to this less recognized issue.
Nicole: You just reminded me that the Washington Post had this article recently: "Marathon runners who drink too much water are at risk of a deadly condition"
The same issues exist in the collegiate running population. The balance of electrolytes in the body is so important to performance and especially recovery. I have worked with a few runners who have chronically aching lower limbs. When they have labs done, it is discovered their electrolytes are all over the board. Most of them think it is adequate have a sports drink after their run and water the rest of the day. When in reality, they need to be drinking fluids with substance (i.e milk, sports drinks, juice) all day long, especially during peak training times. I imagine the same can be said for runners training for and competing in marathons.
Thanks for the comment Natalie. Have you had any educational sessions with your runners to address proper hydration strategies? If so, do you think those could be introduced to a wider audience (e.g., recreational runners)?
I think it is awesome that so many people are becoming more recreationally active and taking part in these races (of all distances) that are open to the public. I know a handful of people right now who are training for 1/2 marathons or marathons. While these people are experienced runners, there are a great deal of people who are novice and just want to mark another thing off their "Bucket List." In 2010 the IMMDA came out with recommendations for runners competing or training in any race over a 10k. These recommendations include being sufficiently trained, what types of drinks to consume, consuming salt, having a yearly physical, and more. Having a handout/email for each runner when they sign up for the race and maybe sending out other emails in the time leading up to the race may reach a few more people. They would at least have the information on what should be done, even if they choose not to read/abide by it. All we can do is put the information out there and hope that someone listens.
Thanks for the comment Whitney. It's a great idea to mail the runners information as the marathon approaches.
Are you referring to the IMMDA fluid recommendations? https://aimsworldrunning.org/articles/IMMDA_Updated_Fluid_Recommendation.pdf
If not, do you have link to the recommendations you mentioned?
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