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

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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.

Read more from Waterlogged by Timothy Noakes.

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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.

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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

https://www.youtube.com/watch?v=13Bjb2dsPxk&embed=true

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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Crawling to the Finish Line: Why do Endurance Runners Collapse?

Implications for Understanding of Mechanisms Underlying Pacing and Fatigue

• Review Article
• Published: 09 April 2013
• Volume 43 , pages 413–424, ( 2013 )

Cite this article

• Alan St Clair Gibson 1 ,
• Jos J. De Koning 2 ,
• Kevin G. Thompson 3 ,
• William O. Roberts 4 ,
• Dominic Micklewright 5 ,
• John Raglin 6 &
• Carl Foster 7  

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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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St Clair Gibson A, Noakes TD. Evidence for complex system integration and dynamic neural regulation of skeletal muscle recruitment during exercise in humans. Br J Sports Med. 2004;38:797–806.

Article   PubMed   CAS   Google Scholar  

Foster C, Schrager M, Snyder AC, et al. Pacing strategy and athletic performance. Sports Med. 1994;17:77–85.

Morgan WP, Pollock ML. Psychologic characterization of the elite distance runner. Ann NY Acad Sci. 1977;301:382–403.

De Koning JJ, Bobbert MF, Foster C. Determination of optimal pacing strategy in track cycling with an energy flow model. J Sci Med Sport. 1991;2:266–77.

Article   Google Scholar  

Atkinson G, Peacock O, St Clair Gibson A, et al. Distribution of power output during cycling. Sports Med. 2007;37:647–67.

Article   PubMed   Google Scholar  

St Clair Gibson A, Foster C. The role of self talk in the awareness of physiological state and physical performance. Sports Med. 2007;12:1029–44.

Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behaviour. New York: Plenum Press; 1985.

Book   Google Scholar  

Nicholls JG. Achievement motivation: conceptions of ability, subjective experience, task choice, and performance. Psychol Rev. 1984;91:328–46.

Maron BJ, Poliac LC, Roberts WO. Risk for sudden cardiac death associated with marathon running. J Am Coll Cardiol. 1996;28:428–31.

Futterman LK, Myerburg R. Sudden death in athletes: an update. Sports Med. 1998;26:335–50.

Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes: clinical, demographic and pathological profiles. JAMA. 1996;276:199–204.

Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol. 1998;32:1881–4.

Roberts WO. A 12-yr profile of medical injury and illness for the Twin Cities Marathon. Med Sci Sports Exerc. 2000;32:1549–55.

PubMed   CAS   Google Scholar  

Noakes TD. Reduced peripheral resistance and other factors in marathon collapses. Sports Med. 2007;37:382–5.

St Clair Gibson A, Lambert MI, Noakes TD. Neural control of force output during maximal and submaximal exercise. Sports Med. 2001;31:637–50.

Ulmer H-V. Concept of an extracellular regulation of muscular metabolic rate during heavy exercise in humans by psychophysiological feedback. Experientia. 1996;52:416–20.

St Clair Gibson A, Goedecke JH, Harley YX, et al. Metabolic setpoint control mechanisms in different physiological systems at rest and during exercise. J Theor Biol. 2005;236:60–72.

Rauch HGL, St Clair Gibson A, Lambert EV, et al. A signalling role for muscle glycogen in the regulation of pace during prolonged exercise. Br J Sports Med. 2005;39:34–8.

Paterson S, Marino FE. Effect of deception of distance on prolonged cycling performance. Percept Mot Skills. 2004;98:1017–26.

Micklewright D, Papadopoulou E, Swart J, et al. Previous experience influences pacing during 20-km time trial cycling. Br J Sports Med. 2010;44:952–60.

Renfree A, West J, Corbett M, et al. Complex interplay between determinants of pacing and performance during 20 km cycle time trials. Int J Sports Physiol Perform. 2012;7:121–9.

PubMed   Google Scholar  

Parry D, Chinnasamy C, Papadopoulou E, et al. Cognition and performance: anxiety, mood and perceived exertion among ironman triathletes. Br J Sports Med. 2010;45:1083–94.

Google Scholar  

Marcora SM, Staiano W. Mental fatigue impairs physical performance in humans. J Appl Physiol. 2009;106(3):1763–70.

Chinnasamy C, St Clair Gibson A, Micklewright D. The effect of spatial and temporal cues on athletic performance in schoolchildren. Med Sci Sports Exerc. 2013;45(2):395–402.

St Clair Gibson A, Lambert EV, Lambert MI, et al. Exercise and fatigue control mechanisms. Int Sport Med J. 2001;2(3):1–14.

St Clair Gibson A, Lambert EV, Rauch LHG, et al. The role of information processing between the brain and peripheral physiological systems in pacing and perception of effort. Sports Med. 2006;36:705–22.

Lucia A, Hoyos S, Santalla AJ, et al. Tour de France versus Vuelta a Espana: which is harder? Med Sci Sports Exerc. 2003;35:872–8.

Lambert EV, St Clair Gibson A, Noakes TD. Complex system model of fatigue: integrative homeostatic control of peripheral physiological systems during exercise in humans. Br J Sports Med. 2005;39:52–62.

Johnson BD, Joseph T, Wright G, et al. Rapidity of responding to a hypoxic challenge during exercise. Eur J Appl Physiol. 2009;106:493–9.

Burnley M, Jones AM. Oxygen uptake kinetics as a determinant of sports performance. Eur J Sports Sci. 2007;7:63–79.

Thiel C, Foster C, Banzer W, et al. Pacing in Olympic track races: competitive tactics versus best performance strategy. J Sports Sci. 2013;30(11):1107–15.

Tucker R, Bester A, Lambert EV, et al. Non-random fluctuations in power output during self-paced exercise. Br J Sports Med. 2006;40:912–7.

Atkinson G, Brunskill A. Pacing strategies during a cycling time trial with simulated headwinds and tailwinds. Ergonomics. 2000;43:1449–60.

Cangley P, Passfield L, Carter H, et al. The effect of variable gradients on pacing in cycling time trials. Int J Sports Med. 2010;32:132–6.

Swain DP. A model for optimizing cycling performance by varying power on hills and in the wind. Med Sci Sports Exerc. 1997;29:1104–8.

Rai M, Thompson PD. The definition of exertion-related cardiac events. Br J Sports Med. 2011;45:130–1.

Durakovic Z, Durakovic MM, Skavic J. Arrhythmogenic right ventricular dysplasia and sudden cardiac death in Croatians’ young athletes in 25 years. Coll Antropol. 2011;35:793–6.

Larsson E, Wesslen L, Lindquist O, et al. Sudden unexpected cardiac deaths among young Swedish orienteers: morphological changes in hearts and other organs. APMIS. 1999;107:325–36.

Sivrides E, Pavlidis P, Stamos C, et al. Sudden death after myocardial infarction in a high school athlete. J Forensic Sci. 2010;55:1378–9.

Wright JN, Salem D. Sudden cardiac death and ‘athlete’s heart’. Arch Intern Med. 1995;155:1473–80.

Kim JH, Malhotra R, Chiampas G, et al. Cardiac arrest during long-distance running. New Eng J Med. 2012;366:130–40.

Ector J, Ganame J, van der Merwe N, et al. Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment. Eur Heart J. 2007;28:345–53.

Elosua R, Arquer A, Mont L, et al. Sport practice and the risk of lone atrial fibrillation: a case study. Int J Cardiol. 2006;108(3):332–7.

Heidbuchel H, Anne W, Willems R, et al. Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter. Int J Cardiol. 2006;107:67–72.

Karjalainen J, Kujala UM, Kaprio J, et al. Lone atrial fibrillation in vigorously exercising middle aged men: case-control study. Br Med J. 1998;316:1784–5.

Article   CAS   Google Scholar  

La Gerche A, Burns AT, Mooney DJ, et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J. 2012;33:998–1006.

Benito B, Gay-Jordi G, Serrano-Mollar A, et al. Cardiac arrhythmogenic remodelling in a rat model of long-term intensive exercise training. Circulation. 2011;123:13–22.

Ruiz JR, Joyner MJ, Lucia A. Letter by Ruiz et al regarding article, “Cardiac arrhythmogenic remodelling in a rat model of long-term intensive exercise training”. Circulation. 2011;124:250.

Sheffer AL, Austen KF. Exercise-induced anaphylaxis. J Allergy Clin Immunol. 1980;66:106–11.

Roberts WO. Exercise-associated collapse care matrix in the marathon. Sports Med. 2007;37:431–3.

Hsieh M. Recommendations for treatment of hyponatraemia at endurance events. Sports Med. 2004;34:231–8.

Hiller DB, O’Toole ML, Fortress EE, et al. Medical and physiological considerations in triathlons. Am J Sports Med. 1987;15:164–8.

Kipps C, Sharma S, Pedoe DT. The incidence of exercise-associated hyponatraemia in the London Marathon. Br J Sports Med. 2011;45:14–9.

Noakes TD, Goodwin N, Rayner BL, et al. Water intoxication: a possible complication during endurance exercise. Med Sci Sports Exerc. 1985;17:370–5.

Noakes TD. A modern classification of the exercise-related heat illnesses. J Sci Med Sport. 2008;11:33–9.

Kenefick RW, Sawka MN. Heat exhaustion and dehydration as causes of marathon collapse. Sports Med. 2007;37:378–81.

American College of Sports Medicine, Armstrong LE, Casa DJ. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39:556–72.

Roberts WO. Heat and cold: what does the environment do to marathon injury? Sports Med. 2007;37:400–3.

Noakes TD, Mekler J, Pedoe DT. Jim Peters’ collapse in the 1954 Vancouver Empire Game marathon. S Afr Med J. 2008;98:596–600.

Vlak MH, Rinkel GJ, Greebe P, et al. Trigger factors and their attributable risk for rupture of intracranial aneurysms: a case crossover study. Stroke. 2011;42:1878–82.

Herbst J, Gilbert JD, Byard RW. Urinary incontinence, hyperthermia, and sudden death. J Forensic Sci. 2011;56:1062–3.

Arbefeville EF, Tebbi CK, Chrostowski L, et al. Sudden death after exercise in adolescents with hemoglobin SE. Am J Forensic Med Pathol. 2011;32:341–3.

Gioroso J Jr, Reeves M. Marfan syndrome: screening for sudden death in athletes. Curr Sports Med Rep. 2002;1:67–74.

Lobo SW, Pant S, Kharoshah MA, et al. Can rhabdomyolysis be a cause of sudden death in young athletes? Med Hypotheses. 2011;77:935.

Byard RW, James RA, Gilbert JD. Childhood sporting deaths. Am J Forensic Med Pathol. 2002;23:364–7.

Speedy DB, Noakes TD, Holtzhausen LM. Exercise-associated collapse: postural hypotension, or something deadlier? Phys Sportsmed. 2003;31:23–9.

Brennan FH, O’Connor FG. Emergency triage of collapsed endurance athletes: a stepwise approach to on-site treatment. Phys Sportsmed. 2005;33:28–35.

Childress MA, O’Connor FG, Levine BD. Exertional collapse in the runner: evaluation and management in fieldside and office-based settings. Clin Sports Med. 2010;29:459–76.

Roberts WO. Exercise associated collapse in endurance events: a classification system. Phys Sportsmed. 1989;17:49–59.

Asplund CA, O’Connor FG, Noakes TD. Exercise-associated collapse: an evidence-based review and primer for clinicians. Br J Sports Med. 2011;45:1157–62.

Chen C-Y, Bonham AC. Postexercise hypotension: central mechanisms. Exerc Sport Sci Rev. 2010;38:122–7.

Holtzhausen LM, Noakes TD. The prevalence and significance of post-exercise (postural) hypotension in ultramarathon runners. Med Sci Sports Exerc. 1995;27:1595–601.

Lucas SJE, Cotter JD, Murrell D, et al. Mechanisms of orthostatic intolerance following very prolonged exercise. J Appl Physiol. 2008;105:213–25.

Noakes TD. The forgotten Barcroft/Edholm reflex: potential role in exercise associated collapse. Br J Sports Med. 2003;37:277–8.

Privett SE, George KP, Middleton N. The effect of prolonged endurance exercise upon blood pressure regulation during a post-exercise orthostatic challenge. Br J Sports Med. 2010;44:720–4.

Willliamson JW, Querry R, McColl R, et al. Are decreases in insular regional cerebral blood flow sustained during postexercise hypotension? Med Sci Sports Exerc. 2009;41:574–80.

Holtzhausen LM, Noakes TD, Kroning B, et al. Clinical and biochemical characteristics of collapsed ultra-marathon runners. Med Sci Sports Exerc. 1994;26:1095–101.

Lind E, Welch AS, Ekkekakis P. Do mind over muscle strategies work? Examining the effects of attentional association and dissociation on exertional, affective and physiological responses to exercise. Sports Med. 2009;39:743–64.

Masters KS, Ogles BM. Associative and dissociative cognitive strategies in exercise and running: 20 years later, what do we know? Sport Psychol. 1998;12:253–70.

Stanley CT, Pargman D, Tenenbaum G. The effect of attentional coping strategies on perceived exertion in a cycling task. J Appl Sport Psychol. 2007;19:352–63.

Morgan WP, O’Connor PJ, Ellickson KA, et al. Personality structure, mood states, and performance in elite male distance runners. Int J Sport Psychol. 1988;19:247–63.

Noakes TD, Opie LH, Rose AG. Marathon running and immunity to coronary heart disease: fact versus fiction. Clin Sports Med. 1984;3:527–43.

Corrado D, Basso C, Thiene G. Sudden cardiac death in athletes: what is the role of screening? Curr Opin Cardiol. 2012;27:41–8.

Micklewright D, Angus C, Suddaby J, et al. Pacing strategy in schoolchildren differs with age and cognitive development. Med Sci Sports Exerc. 2012;44:362–9.

Foster C, Hendrickson KJ, Peyer K, et al. Pattern of developing the performance template. Br J Sports Med. 2009;43:765–9.

O’Brien J, Foster C, De Koning JJ, et al. Learning pacing strategy in relation to age. Med Sci Sports Exerc. 2011;43:1024.

Stone M, Thomas K, Wilkinson M, et al. Effect of deception on exercise performance: implications for the determinants of ‘fatigue’ in humans. Med Sci Sports Exerc. 2012;44:534–41.

Schuler J, Langens TA. Psychological crisis in marathon and the buffering effects of self-verbalizations. J Appl Soc Pysch. 2007;37:2319–44.

Driscoll DJ, Edwards WD. Sudden unexpected death in children and adolescents. J Am Coll Cardiol. 1985;5:118–21.

Noakes TD. Heart disease in marathon runners: a review. Med Sci Sports Exerc. 1987;19:187–94.

Plymire DC. Running, heart disease, and the ironic death of Jim Fixx. Res Q Exerc Sport. 2002;73:38–46.

Walshe CA. Syncope and sudden death in the adolescent. Adolesc Med. 2001;12:105–32.

Cabanac M. Sensory pleasure optimizes muscular work. Clin Invest Med. 2006;29:110–6.

Ekkekakis P, Parfitt G, Petruzzello SJ. The pleasure and displeasure people feel when they exercise at different intensities: decennial update and progress towards a tripartite rationale for exercise intensity prescription. Sports Med. 2011;41:641–71.

Duda JL. Perpetuating myths: a response to Hardy’s 1996 Coleman Griffin Addess. J Appl Sport Psych. 1997;9:303–9.

Elbourne KE, Chen J. The continuum model of obligatory exercise: a preliminary investigation. J Psychosom Res. 2007;62:73–80.

Gaudreau R, Antl S. Athlete’s broad dimensions of dispositional perfectionism: examining changes in life satisfaction and the mediating role of sport-related motivation and coping. J Sport Exerc Psychol. 2008;30:356–82.

Hulleman CS, Durik AM, Schweigert SA, et al. Task values, achievement goals, and interest: an integrative analysis. J Educ Psychol. 2008;100:398–416.

Raglin J. The psychology of the marathoner: of one mind and many. Sports Med. 2007;37:404–7.

Smith A, Ntoumanis N, Duda J. Goal striving, goal attainment, and well-being: adapting and testing the self-concordance model in sport. J Sport Exerc Psychol. 2007;29:763–82.

Solms M, Turnbull O. The brain and the inner world: an introduction to the neuroscience of subjective experience. New York: Other Press; 2002.

Blair SN, Sallis RE, Hutber A, et al. Exercise therapy: the public health message. Scand J Med Sci Sports. 2012;22(4):e24–8.

Lee IM, Sesso HD, Oguma Y, et al. The ‘weekend warrior’ and risk of mortality. Am J Epidemiol. 2004;160:636–41.

Paffenbarger RS, Hyde RT, Wing AL, et al. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 1986;314:605–13.

Paffenbarger RS, Hyde RT, Wing AL, et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med. 1993;328:538–45.

Freud S. Papers on metapsychology (1915). In: Freud S, Strachey J, editors. Standard edition of the complete psychological works of Sigmund Freud Vol XIV (1914–16): On the history of the psycho-analytic movement, papers on Metapsychology and other works. London: Vintage Press; 2001. p. 105–204.

Freud S. The Ego and the Id (1923). In: Strachey J, editor. The standard edition of the complete psychological works of Sigmund Freud Vol XIX: The Ego and the Id and other works. London: Vintage Press; 2001. p. 3–66.

Hauck ER, Blumenthal JA. Obsessive and compulsive traits in athletes. Sports Med. 1992;14:215–27.

Mondin GW, Morgan WP, Piering PN, et al. Psychological consequences of exercise deprivation in habitual users. Med Sci Sports Exerc. 1996;28:1199–203.

St Clair Gibson A, Grobler LA, Collins M, et al. Evaluation of maximal exercise performance, fatigue and depression in athletes with acquired chronic training intolerance. Clin J Sports Med. 2006;16:39–45.

Szabo A. Physical activity as a source of psychological dysfunction. In: Biddle SJG, Fox KR, Boutcher JH, editors. Physical activity and psychological wellbeing. London: Routledge; 2000. p. 130–95.

Collins M, Renault V, Grobler LA, et al. Athletes with exercise-associated fatigue have abnormally short muscle DNA telomeres. Med Sci Sports Exerc. 2003;35:1524–8.

Grobler LA, Collins M, Lambert MI, et al. Skeletal muscle pathology in endurance athletes with acquired training intolerance. Br J Sports Med. 2004;38:697–703.

Hamer M, Karageorghis CI. Psychobiological mechanisms of exercise dependence. Sports Med. 2007;37:477–84.

Raglin JS. Addiction to physical activity. In: Rippe J, editor. Encyclopedia of lifestyle medicine and health, vol 1. Thousand Oaks (CA): Sage; 2012. p. 9–11.

Winsley R, Matos N. Overtraining and elite young athletes. Med Sport Sci. 2011;56:97–105.

Morgan WP, O’Connor PJ, Sparling PB, et al. Psychological characterization of the elite female distance runner. Int J Sports Med. 1987;8:124–31.

Armstrong LE, Van Heest JL. The unknown mechanism of the overtraining syndrome: clues from depression and psychoneuroimmunology. Sports Med. 2002;32:185–209.

Pyne DB, Hopkins WG, Batterham AM, Gleeson M, Fricker PA. Characterizing the individual performance responses to mild illness in international swimmers. Brit J Sports Med. 2005;39:752–6.

Raglin JS, Kentta G. A psychological approach to understanding and preventing overtraining syndrome. In: Echemendia R, Moorman CT, editors. Praeger handbook of sports medicine and athletic health, vol. 3. Santa Barbara (CA): Praeger; 2011. p. 63–76.

Winchester R, Turner LA, Thomas K, et al. Observer effects on the rating of perceived exertion and affect during exercise in recreationally active males. Percept Mot Skills. 2012;115(1):213–27.

Baumeister RF. A self-presentational view of social phenomena. Psychol Bull. 1982;91:3–26.

You Tube. Dramatic finish at high school state cross country championship [online]. http://www.youtube.com/watch?v=2xIzuyjCcZk&NR=1&feature=fvwp . Accessed 18 March 2013.

You Tube. Crawling to the finish line [online]. http://www.youtube.com/watch?v=67nfdeSDYzU&feature=related . Accessed 18 March 2013.

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Acknowledgements

The term Foster collapse position is used in this manuscript to describe dynamic collapse ambulatory positions for what we believe are for the first time, and named in honour of Dr Carl Foster as a mark of respect for his groundbreaking work in the pacing research field over the last three decades, and because he was one of the original authors that identified these dynamic collapse positions. The concepts described in this manuscript were first described by the authors during two symposiums at the American College of Sports Medicine Annual Conference in Denver, Colorado, USA, in 2011. There are no potential conflict interests for any authors with regard to the contents of this article. Financial assistance for the development of this manuscript and presentation of the concepts at the above described conferences were supplied by the University of Northumbria Research and Development Fund.

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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

Alan St Clair Gibson

MOVE Research Institute Amsterdam, Faculty of Human Movement Studies, Vrije Universiteit, Amsterdam, The Netherlands

Jos J. De Koning

Discipline of Sport Studies, University of Canberra, Canberra, ACT, Australia

Kevin G. Thompson

Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA

William O. Roberts

School of Biological Sciences, University of Essex, Colchester, UK

Dominic Micklewright

Department of Kinesiology, University of Indiana, Bloomington, IN, USA

John Raglin

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St Clair Gibson, A., De Koning, J.J., Thompson, K.G. et al. Crawling to the Finish Line: Why do Endurance Runners Collapse?. Sports Med 43 , 413–424 (2013). https://doi.org/10.1007/s40279-013-0044-y

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

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• 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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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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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.

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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.

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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.

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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.

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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 .

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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).

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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.

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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

• View Article
• PubMed/NCBI
• Google Scholar
• 8. Hultman E, Nilsson LH. Liver glycogen in man. Effect of different diets and muscular exercise. In: Muscle metabolism during exercise. Springer; 1971. p. 143–151. https://doi.org/10.1007/978-1-4613-4609-8_14
• 22. Brooks G, Fahey T, White T, et al. Fatigue during muscular exercise. Exercise physiology: human bioenergetics and its applications. 2000; p. 800–822.
• 24. Brooks G, Fahey T, White T, Baldwin K. Cardiovascular dynamics during exercise. Exercise Physiology: Human Bioenergetics and its applications Mountain View, Ca: Mayfield Publishing Company. 2000; p. 317–339.
• 43. Haney TA Jr. Variability of pacing in marathon distance running. University of Nevada, Las Vegas; 2010.
• 48. Trubee NW. The Effects of Age, Sex, Heat Stress, and Finish Time on Pacing in the Marathon. University of Dayton; 2011.
• 56. Rooksby J, Rost M, Morrison A, Chalmers MC. Personal tracking as lived informatics. In: Proceedings of the 32nd annual ACM conference on Human factors in computing systems. ACM; 2014. p. 1163–1172.
• 59. Stawarz K, Cox AL, Blandford A. Beyond self-tracking and reminders: designing smartphone apps that support habit formation. In: Proceedings of the 33rd annual ACM conference on human factors in computing systems. ACM; 2015. p. 2653–2662.
• 61. Möller A, Scherr J, Roalter L, Diewald S, Hammerla N, Plötz T, et al. Gymskill: Mobile exercise skill assessment to support personal health and fitness. In: 9th Intl. Conf. on Pervasive Computing (Pervasive 2011), Video, San Francisco, CA, USA; 2011.
• 62. Yoganathan D, Kajanan S. Persuasive Technology for Smartphone Fitness Apps. In: Proceedings of the Pacific Asia Conference on Information Systems (PACIS); 2013. p. 185.
• 64. Smyth B. Recommender Systems: A Healthy Obsession. In: The Thirty-Third AAAI Conference on Artificial Intelligence, AAAI 2019, Honolulu, Hawaii, USA, January 27—February 1. AAAI Press; 2019. p. 9790–9794.
• 65. Smyth B, Willemsen MC. Predicting the Personal-Best Times of Speed Skaters Using Case-Based Reasoning. In: Watson I, Weber RO, editors. Case-Based Reasoning Research and Development—28th International Conference, ICCBR 2020, Salamanca, Spain, June 8-12. vol. 12311 of Lecture Notes in Computer Science. Springer; 2020. p. 112–126.
• 67. Feely C, Caulfield B, Lawlor A, Smyth B. Using Case-Based Reasoning to Predict Marathon Performance and Recommend Tailored Training Plans. In: Watson I, Weber RO, editors. Case-Based Reasoning Research and Development—28th International Conference, ICCBR 2020, Salamanca, Spain, June 8-12. vol. 12311 of Lecture Notes in Computer Science. Springer; 2020. p. 67–81.
• 68. Feely C, Caulfield B, Lawlor A, Smyth B. Providing Explainable Race-Time Predictions and Training Plan Recommendations to Marathon Runners. In: Santos RLT, Marinho LB, Daly EM, Chen L, Falk K, Koenigstein N, et al., editors. RecSys 2020: Fourteenth ACM Conference on Recommender Systems, Virtual Event, Brazil, September 22-26. ACM; 2020. p. 539–544.
• 69. Smyth B, Cunningham P. Running with Cases: A CBR Approach to Running Your Best Marathon. In: Case-Based Reasoning Research and Development—25th International Conference, ICCBR 2017, Trondheim, Norway, June 26-28, 2017, Proceedings; 2017. p. 360–374.
• 70. Smyth B, Cunningham P. An Analysis of Case Representations for Marathon Race Prediction and Planning. In: Case-Based Reasoning Research and Development—26th International Conference, ICCBR 2018, Stockholm, Sweden, July 9-12, 2018, Proceedings; 2018. p. 369–384.
• 71. Smyth B, Cunningham P. Marathon Race Planning: A Case-Based Reasoning Approach. In: Proceedings of the Twenty-Seventh International Joint Conference on Artificial Intelligence, IJCAI 2018, July 13-19, 2018, Stockholm, Sweden.; 2018. p. 5364–5368.
• 72. Berndsen J, Smyth B, Lawlor A. Fit to Run: Personalised Recommendations for Marathon Training. In: Santos RLT, Marinho LB, Daly EM, Chen L, Falk K, Koenigstein N, et al., editors. RecSys 2020: Fourteenth ACM Conference on Recommender Systems, Virtual Event, Brazil, September 22-26, 2020. ACM; 2020. p. 480–485.
• 73. Berndsen J, Smyth B, Lawlor A. Pace my race: recommendations for marathon running. In: Proceedings of the 13th ACM Conference on Recommender Systems. ACM; 2019. p. 246–250.

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!

Your team of expert coaches and fellow runners dedicated to helping you train smarter, stay healthy and run faster.

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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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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Runner collapses during the NYC Marathon. Firefighter’s quick action saves his life

It was an unseasonably warm day for the NYC Marathon this past November, but Daniel Gottesmann had been training 26.2-mile run for three months and he felt confident the heat wouldn't be a problem. As he ran, he began to feel “extremely thirsty.” At mile 11, he collapsed. Lucky for him, New York Firefighter Ryan Dillon was watching the marathon nearby.

“He started going in and out of consciousness,” Dillion, 31, of Brooklyn, tells TODAY.com. “When I saw him go out, I just immediately started pumping.” Thanks to Dillion’s quick efforts, Gottesmann survived. They two reconnected at the bar near where Gottesmann collapsed.

“Upon meeting Daniel, I was extremely nervous,” Dillon says. “You don’t really get to meet the people you make a difference in their lives.”

Unusual feeling while running leads to collapse

Last year, Gottesmann, 33, of Brooklyn ran a marathon in the Hamptons and has run several half marathons. Leading up to the NYC Marathon, which he ran with his wife, Gottesmann ran almost every day and even had some long training runs exceeding 11 miles. He felt healthy as he trained.

“I felt well,” he tells TODAY.com. “I never felt anything like I was feeling during the marathon itself.”

As Gottesmann started running he noticed it felt “a little bit tougher.”

“I felt like I’m not getting into my rhythm that I usually get after three or four miles,” he explains. “I felt like I was putting in more effort to keep the pace that I wanted to keep during the run.”

He also felt parched and wondered if the heat and the fact that he didn’t have a water bottle on him contributed to this.

“In training usually, I run with a bottle of water,” Gottesmann says. “Every water station that I got through I had to drink two cups of water. I felt extremely thirsty and felt like I’m going to need to put more effort into keeping my typical pace.”

Each mile felt harder to Gottesmann. Miles eight, nine and 10 became harder and harder for him.

“It didn’t concern me from a health perspective,” he says. “I didn’t feel like I was about to faint.”

By mile 10, Gottesmann couldn’t remember anything. He just remembers entering Williamsburg, where Dillon and his wife were watching the race outside a bar. They were looking for one of Dillion’s coworkers to run by when someone told Dillon that a runner had collapsed.

“I ran over there and I saw Daniel. They had got him in a chair, and I ran down the block to go find medical help,” Dillon says. “When I came back up the block he was in the chair, basically in and out of consciousness.”  

It looked like Gottesmann started choking on his saliva, so Dillon laid him on the ground.

“He started turning blue and I’m like, ‘Wait a minute, I think he’s choking on something,’” Dillon recalls. “I turn him over to his side and gave him a pat on the back. He throws up and he opened his eyes.”

Gottesmann soon lapsed back into unconsciousness and Dillon began CPR compressions.

“When I saw him close his eyes and go out, I just started pumping,” Dillon says. “I didn’t have any medical equipment.”

Even though Dillon is trained to help in emergencies, it felt tougher without his equipment with him. The 30 minute wait for EMS felt grueling for the firefighter.

“We kept him warm because he was a little cold because he was in shock,” Dillon says. “We just waited for EMS to show up and kept him conscious, at least somewhat.”

Gottesmann remembers none of this. He does recall waking in an ambulance and wondering what happened. He didn’t have his phone with him so he couldn’t call his wife or anyone to let them know what happened. While she was running, they were at difference paces and she was unaware he collapsed.

“I just arrived at the hospital. The first two, three, four hours, I was as weak as it gets. It didn’t feel good to move my body or open my eyes or absorb information,” Gottesmann says. “After being connected to an IV for a couple hours. I started to feel better.”

Doctors ran a slew of tests to understand what happened to Gottesmann. When his wife finished the marathon in three and a half hours, she noticed her husband hadn’t finished and called her dad. He was the couple’s emergency contact and knew that Gottesmann was in the hospital and she came to visit him. Gottesmann stayed for a week because doctors wanted to make sure that his health stabilized.

“Some of the things you can find in bloodwork or blood stream … were elevated and the doctor is wanting to see them come down,” he says. “It was mostly things involving the liver and heart.”

Doctors suspected that Gottesmann experienced rhabdomyolysis, also known simply as rhabdo, according to the U.S. Centers for Disease Control and Prevention . This potentially fatal condition occurs when damaged muscles discharge proteins and electrolytes into the blood, which can lead to kidney and heart problems. While anyone can develop rhabdo, it occurs more often when people are exercising or engaging in strenuous tasks in the heat. It often affects firefighters, military members, construction worker and athletes, according to the CDC.

The CDC says symptoms include:

• Muscle pain
• Urine that looks tea or soda colored
• Weakness or exhaustion

Doctors diagnosed it by taking a blood test to look for creatine kinase or creatine phosphokinase.

“The body needs to work extra time to get ride of those proteins mostly that were there now in the blood,” Gottesmann says. “Once the values got to a point where the doctors felt good, they sent me home.”

He’s had several follow-up appointments to make sure he’s still healthy.

“I’m feeling good today,” he says.

Meeting properly

Dillon continued watching the marathon, hoping that the paramedics effectively treated the stranger he helped. He had no idea that Gottesmann needed to spend so much time in the hospital to recover. Though, as a firefighter he often doesn’t hear what happens to people he helps.

“I didn’t specially know about Ryan until my wife and I went to the bar next to where I collapsed,” Gottesmann says. “Only then we learned that some guy helped me.”

He wanted to thank that person and asked the bartender if she could help find him.

“The bartender contacted my wife,” Dillon says. “She was like, ‘That guy from the marathon was looking for you guys. He got out of the hospital.’ We were like, ‘What?’” 

Dillon felt shocked that Gottesmann was in the hospital for so long and he agreed to meet him. The two felt anxious before the meeting.

“I was kind of nervous but more excited to meet Ryan,” Gottesmann says. “He’s so humble and such a decent good human being.”

Dillon also didn’t know what to expect.

“I did everything that I could until the actual health professionals got there and you can do everything right, medically wise, and still come out with a loss. That’s why it’s nerve wracking,” Dillon says. “The whole thing was amazing.”  

Gottesmann said this experience taught him to pay better attention to what his body’s telling him. He feels grateful for the kindness he received.  

“I certainly don’t know what would have happened to me if it hadn’t been for Ryan,” he says.

As for Dillon, he thinks anyone can do what he did.

“Just (make) an effort to try to help,” he says. “Just be a decent person. (A) human life is the most valuable thing in the world. If you see somebody struggling and you aren’t, help them out.”

Meghan Holohan is a digital health reporter for TODAY.com and covers patient-centered stories, women’s health, disability and rare diseases.