Are you running yourself to death?

Benefits of proper training
Before you go into full freak-out mode, there is some good news. First, proper training seems to go a long way toward protecting you from heart injury during the race. The Circulation study found that people who'd averaged at least 45 miles a week in training were significantly less likely to suffer heart damage than those who ran 35 miles a week or less. That makes sense to Dr. Siege, who notes that training is an injury-and-repair process: Your body suffers damage when you exert yourself during training but then repairs itself and becomes stronger. So runners who log lots of training miles are able to withstand more punishment during the race than those who train less.

The other piece of good news is that even among marathoners who were undertrained, heart damage didn't appear to be permanent. Within a month, all the runners in the study showed relatively normal cardiac function. "There is no data to suggest that any long-term aftereffects were caused by the changes," says Dr. Wood.

But blocking out that dose of sunshine is still a very dark cloud: During the race and for several hours afterward, the systemic inflammation significantly increases your risk of a cardiac event, particularly if you're middle-aged and have some silent coronary-artery disease. (Men in their 40s and 50s form the biggest cluster of marathon fatalities.) Two things happen: First, inflammatory mediators released during muscle injury may make the thin, fibrous plaque that lines your artery walls more likely to rupture; second, this inflammation can lead to an imbalance of coagulation factors, making blood more susceptible to clots. The result: a heart attack.

The paradox is that marathoners' training puts them at an overall lower risk of heart trouble. But when you start doing the event for which you've been training, your relative risk increases. To oversimplify: At the starting line, you're Lance Armstrong; at the finish line, you're Louie Anderson.

"Marathon running may be regarded as a dose of exercise that pushes you past the zone of cardioprotective benefit into one of enhanced risk," says Dr. Siege, who stopped running marathons more than a decade ago, partly because of the risks involved. If you want to be smart, he suggests, do all the training for a marathon... and then watch the race from the sidelines.

But, well, what fun is that, right?

A sense of accomplishment
The reason most people suffer through all those dreary training miles is for the thrill of the race. Take away that carrot, and many marathoners would be on the couch munching Pringles and watching "American Gladiators." Eliminate the risk and you inadvertently eliminate an incentive.

My motivations: I liked to run. I knew I'd be in kick-ass shape. And my buddy McDade was doing it, so I felt some camaraderie and competition. As it turns out, I'm pretty typical. A study of motivation in the Journal of Sport Behavior found that most runners have multiple reasons for participating in the sport, from improving their health to socializing to competing. "People might have started with one motivation — say, becoming fit — but when they got into it, they found all these other side benefits," says one of the study authors, Ohio University psychologist Benjamin Ogles, Ph.D.

While women were most likely to cite weight control and socializing as reasons for running marathons, men were more into achievement and competition, either with themselves or others. It is, I suppose, easy to mock this as typical lunkheaded guy behavior: Me tough guy. Me run marathon. But Ogles says there are definite mental health benefits to setting and meeting a challenge.

"Running a marathon brings a great sense of accomplishment," he says. Citing research that dates back decades, he adds, "This need for us to have success at things can be a strong motivational force. Even young kids can be motivated by successful mastery of basic skills — [researchers] talk about the gratification that comes from learning how to walk." Mastering a skill is crucial, he says: "When there are problems with self-mastery, you end up with problems like depression."

To put it another way, we seem to have an innate need to do things simply for the sake of doing them or to see if we can do them. What makes me and half a million other people want to run a marathon, even though we know it might not be good for us? Maybe it's the same things that drive people to climb Mt. Everest or drove Leo Tolstoy to write a 1,400-page epic about Russia in the time of the Napoleonic wars.

Because it's there. Because we can.

Which brings us back to the dilemma at hand: Is the satisfaction that comes from running a marathon worth the risk?

Dr. Siege hopes that studies may someday show that "drugs that undermine inflammation, such as aspirin or statins, may protect runners during the transition from low to high risk during and after races." In the meantime, if you're planning to run a marathon, you should have some respect for what you're getting yourself into. That means training properly — a minimum of 45 miles a week. It also means understanding that there is some risk involved.

"People choose all the time to do risky things, like mountain climbing and scuba diving," says Dr. Siege. "Thrill seekers are well advised to understand the risks involved to limit any adverse consequences. Marathon running is potentially dangerous for susceptible individuals. Pheidippides is still out there."

Well, actually, he isn't. He's dead. And that's a message I'm going to remember as I lace up my running shoes and start training for an event that, for some reason, I just can't seem to resist.

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