The past weekend was again marred by the death of a runner. On this occasion it was Neil van Niekerk of the Westville club who passed away during the Chatsworth 52km Freedom Marathon.

 Although in his sixties van Niekerk was focusing on Comrades this year and had put in substantial distance work before collapsing along the route in the challenging ultra event.

There seems to have been an increase in such deaths over the past months not just in South Africa but also around the world.

From a statisticians view point this is not surprising. After all with the increase in numbers running and the greater percentage of lifestyle runners there is likely to be more people subject to medical risks.

However the increase has prompted the International Marathon Medical Directors Association to produce a set of recommendations for marathoners and distance runners.

Although the marathon and ultra marathon expose runners to longer term physical exertion, in many instances the intensity of shorter events create even greater risk.  


Since the death of early running guru Jim Fix, it has often been said that the death of committed runners can be related to an underlying heart problem. It has been speculated that some of these runners would have died earlier if it had not been for the health benefits they gained from running over the years.

While the guidelines attempt to reduce these unfortunate instances, each one of these deaths highlights the reason for and substantiates the rules forbidding the swapping of race numbers or entries without going through a formal process with race organizers.

The effect of informal number swapping was highlighted in the Two Oceans this year.

A runner who found out a couple of weeks before the race that he would be unable to compete, put out a general appeal to runners to take over his number. Since he had been raising funds through sponsorship he wanted the new runner to continue to run under his name.

Putting aside the potential fraudulent nature of collecting money on the basis of having completed a marathon you did not even run, the end result on the day was even more serious. The new runner unfortunately collapsed after crossing the line, and was taken to hospital but passed away.

However there were moments of confusion as the race number was linked to incorrect runner details. The number was still linked to an International runner instead of the local SA runner, who was actually lying in the Intensive Care Unit under medical supervision.

Consider all the potential miss information of this situation. Consider the potential anxiety and anguish of the families and next of kin of both runners. Most importantly did the failure to do an official substitution contribute in any way to delay, or cause incorrect treatment, that may have saved a life?

Yes rules sometimes feel bureaucratic or incur cost but generally they are implemented for very good reason… ensuring the correct runner participates with the correct number and details is vital. Don’t only abide by the rules yourself but also convince others of the need to abide by such rules – it could be a life or death decision.

How to protect your runners from Sudden Death

At a scientific meeting held in Barcelona on 20 March the International Marathon Medical Directors’ Association (IMMDA) considered how risks can at least partly be offset through understanding and respecting the distance.

Exercise can increase the risk of cardiac incidents, including heart attack and death, but the risk is reduced by regular exercise and above all by exercise honed into a specific training programme.

In races runners strive to surpass their current established fitness level and this may bring various mechanisms into play that can have a seriously adverse effect.

According to the IMMDA these include:

  1. the release of muscle enzymes which may activate platelets and produce a clot and less oxygenated blood blow to cardiac muscle.
  2. risks associated with increased caffeine consumption (above 200mg) during endurance exercise.
  3. leaching of sodium from the body (Hyponatremia). This is preventable if runners take sports drinks and salt, and do not take non steroidal anti-inflammatories while running.
  4. a significantly increased effort over the last mile; this may increase adrenaline levels and take a susceptible cardiac muscle into an abnormal rhythm.

To reduce risks, IMMDA suggests that runners should:

  1. Adjust their ambitions to their preparedness; not only be sufficiently trained, but also define a personal goal and a corresponding race plan that is appropriate for their level of training and fitness.
  2. Undergo a yearly medical examination in which exercise, plans, goals are fully discussed.
  3. Consume one 81mg aspirin on the morning of a long run or walk of 10km or more, if there is no medical contra-indication.
  4. Consume less than 200mg caffeine before and during a race of 10km or more.
  5. Only drink a sports drink or its equivalent during a workout of 10km or more.
  6. Drink only for thirst
  7. Not take a non steroidal anti-inflammatory during a run or walk of 10km or more.
  8. Consume some salt (if no medical contra-indication) during a run or walk of 10km or more.
  9. During the last mile, maintain pace and avoid sprinting the last part of the race.

Food for thought for all runners!

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