This Is Why It's So Dangerous To Race If You're Sick

This Is Why It’s So Dangerous To Race If You’re Sick

South African men are pushing themselves to the limits. But are we risking too much?

by Men's Health

March 4, 2014

black and white photo of people running a marathon dangerous to race

One sweltering February afternoon, the life of a 15-year-old boy named Ross Tucker changed. School had finished, and he and his athletics team had joined the local running club for their weekly time trial. It was an eight-kilometre route – long enough to showcase speed, short enough to maintain conditioning. Ross remembers running with a middle-aged man in the group who he caught up with about two kilometres from the finish line. “He said he was having a tough day,” says Tucker. “We had a few words of encouragement for each other and I ran with him for a kilometre before I left him.” After finishing the run, Tucker walked over to his schoolmates to do stretching exercises. When they returned, the man – who was last seen sitting on the pavement – had stopped breathing. Twenty minutes later – despite the efforts of defibrillation and CPR – he was pronounced dead.

“It was a seminal moment in my life,” says Tucker, who now has a PhD in exercise science and is a consultant scientist at the Sports Science Institute of South Africa (SSISA). As a runner and an expert in running, he’s become familiar with this recurring cause of death. “He had flu the week before and he’d come out thinking he was okay to run again but he was too early,” he says. “His heart failure was put down to running with a virus and as a result I’m very cautious with such things.”

Over the years, several South African sports events have yielded a body count from populations of people who would have considered themselves healthy. People such as 28-year-old Kevin Staessen, an operations manager from Johannesburg, and Berton Bosman a 36-year-old chartered accountant from Pretoria, who both took part in their first Ironman competition in 2013. Halfway through the 1.9 km swim in the waters of East London’s Orient Beach both athletes suffered cardiac respiratory events and were taken to the medical tents for resuscitation. Later, they were both pronounced dead in St Dominic’s Hospital. They were the first athletes to die in the 10-year existence of the South African Ironman.

Staessen was reportedly on antibiotics before the race. Dr Jeremy Boulter, medical director of the Comrades Marathon, who’s treated countless athletes stretchered into his medical tents, says to run sick is to tempt fate. “A significant number have been sick before Comrades, and they shouldn’t have run.”

Recently, evidence has shown that medication may be more dangerous than expected. Painkillers such as the common paracetamol may affect the heart muscle, says Boulter. He adds that anti-inflammatories can bring serious consequences to your kidneys. “They reduce the bloodflow of the kidney so you don’t get rid of waste products, and there is danger of acute renal failure when you combine that with dehydration.”

Despite doctors’ orders, logic and gut feelings, the preparation that precedes a challenge influences the decision to choose to grin and bear it. “When the event comes around and you think that you might not be able to take part in it after having put in all that effort – there’s huge pressure on you,” says Boulter. And far too often, South African males think it’s not dangerous to race and sacrifice caution for the sake of competition.

Challenge Accepted

Men aren’t only choosing regulated events to measure themselves; there seems to be a Choose Your Own Adventure approach to physical challenges – South African men are kayaking around Iceland, running the length of the Great Wall of China, summiting Mount Kilimanjaro barefoot and paddling up the Amazon.

We’ve always been up for a challenge, it’s just easier to brag about it nowadays. “With social media, all those feats are much better publicised,” says Tim Goodenough, author of Raising Talent and mental conditioning coach at the Prime Human Performance Institute in Durban. It may seem like this is a new trend, but it’s likely this has always happened. “There might have been all this unbelievable, daring madness 100 years ago but we didn’t know too much about it because you only heard one in 10 of the stories.”

All it takes is one story though. “Everyone realises these are just ordinary guys who are doing extraordinary things, and it creates a generation of people saying, ‘Hmmm… I could do that.’”

Goodenough describes his clientele at the Prime Human Performance Institute as usually either elite performers or people with an “elite appetite”. Nowadays, the latter can expect elite-level support thanks to a combination of social attention and access to world-class sports science. “This creates a perfect storm that fuels the adventurous part of men – it’s the modern, healthier version of the mid-life crisis.”

Successful men are often promoted away from their passion and primary skill-set, says Goodenough. “They’ll often lack a level of meaningfulness in their life and start to look to find ways to get it.”

As far as mid-life crises go, being active carries a lot more benefits than a budget sportscar or an office affair. “There’s a lot of great pay-offs,” says Goodenough. “Guys are getting into shape, they’re getting outdoors and in touch with their adventurous side.” But you’ve got to do it for the right reason, he stresses.

Professional athletes are generally more cautious when compared to enthusiastic weekend warriors. “When an athlete’s livelihood depends on their health, they are far more prudent about taking risks,” says Tucker.

Those with an athletic sense of ambition but without athletic sensibilities are at risk. “They try to push processes too quickly and they go beyond what an elite athlete would be able to do, whether for pride or commitment or passion,” says Goodenough. “That’s where the wheels sometimes fall off.”

If you’ve got underlying health and stress issues, you’re putting yourself at risk, Goodenough says. “You might have an elite appetite but if you’re 45 and you haven’t really been in shape for a long period of time, you’re going to get found out.”

You don’t need to take part in events with Herculean levels of difficulty to get found out. Tucker says there is no specific correlation between incidents and the duration of an event. “It’s just how well you want to do in comparison with other people and how close you’re willing to take yourself to the limits of what you’re capable of doing.”

Even 10km races can break an unprepared man. Tucker cites the notorious Falmouth Road Race that takes place in the US. “It often starts in temperatures of 25 degrees Celsius or hotter. A lot of people aren’t trained for that, and because it’s 10km they go so much faster and run themselves into quite serious heat issues, and they have a super high prevalence of medical incidents.”

“That’s a 10km – most people in this country would think of a 10km as a fun run,” says Tucker. “A lot depends on what you want to get out of it – any athlete will tell you a hard 10km can be harder than a marathon because of the intensity.”

Underestimating Risk

The danger, says Tucker, doesn’t lie in the enormity of the event but in misjudging the risk involved. “People underestimate the severity of the risk and not its probability – so they probably know that there’s a risk but they don’t think it’s that serious. They think the worst that can happen is a bad day out – they’ll struggle along and finish slower than expected.”

“Driving a car is not risky if you stick to the speed limit, don’t accelerate fast and give yourself a following distance,” he explains. “But if you drive 120km per hour through a residential area, you’re looking for risk because you’re pushing boundaries.”

AJ Calitz, one of South Africa’s top trail runners, recounts his first ever trail run – where he discovered how deceptively demanding trail running is. He considered himself well equipped for the challenge – he’d ticked off the Ironman and the Comrades. On paper, the distance seemed easy. On the slippery rocks and jagged slopes, it wasn’t. “Never having run a trail run before, I got the fright of my life after 40km with nothing left in the tank and I still had another 15 to go.”

He had what the running community refers to as “bonking”. “You can have a great run and, all of a sudden, hit the wall – you can be top of the pops to bottom of the barrel in five minutes,” he says.

Calitz managed to finish the race, and left with a lesson in sizing up challenge. One of the reasons people struggle with trail running is because they’re too cocky, says Calitz. “It has an unbelieving ability of humbling you. You think, ‘Ag, it’s only 20km.’ It takes you two and a half hours to do those 20km.”

“I thought I was fit and strong, and I was sorely mistaken. I had to go back to the drawing board and say: ‘New challenge – I accept’.”

A Culture Of Overachievers

We live in a country with an embedded aspirational culture for physical challenges, says Tucker. South Africa hosts more mass-participatory sports events than most countries. “To people overseas, running a marathon is a big deal. If you run a marathon in the States, you’re seen as a pretty serious, hardcore runner. We have a bit of laissez-faire attitude to them; in this country they’re seen as tune-up events – we run them almost fortnightly. The rest of the world doesn’t say, ‘It’s just a marathon’, they say, ‘Wow, a marathon!’” The consequence of this, Tucker explains, is that a hefty proportion of South African men waiting at the starting lines are less trained than they should be.

This attitude towards challenges is not reserved for first-timers. Surprisingly, the more experienced you are, the more likely you are to underestimate the consequences, says Boulter. A few years ago, Boulter was in charge of a particularly tough edition of the Comrades – there were high numbers of runners in the medical tent and admitted to hospital. There were also an increased number of novices that year. As he did his rounds he checked to see if there was any correlation. “I thought that the patients would be novices, but the majority of runners were between their third and their seventh Comrades.”

Generally, novices are more cautious and it’s the old hands that risk becoming complacent and careless, says Boulter. “The novices are nervous about it so they’ll put in the hours, but the ones that have done a couple get a bit blasé about it. If you ran Comrades this year and you finished within the time limit, you qualify for next year’s Comrades so it means you don’t have to put in the hours needed and it’s easy to let your fitness levels slip a little bit. You might take a week off in your training, thinking, ‘Nah, I’ll be fine.’ But actually you won’t be.”

Genetic Threat

“Deaths that happen in exercise seem to be increasingly related to an underlying genetic risk. There are a number of different genetic faults where people carry a gene that predisposes them to sudden cardiac arrest,” says Tucker.

“Several studies have shown that people who regularly participated in endurance-type exercise and are well-trained overall have a lower risk of sudden cardiac death than people who do not,” says Tucker. “You don’t eliminate it but you lower the risk.” There’s an ironic twist, though. “The fine print is our overall risk is lower but if you’re at risk of sudden cardiac death it’s more likely to happen when you exercise.” Boulter’s medical team has teamed up with the University of the Witwatersrand for a study investigating sudden cardiac arrests and sudden cardiac deaths in athletes. Boulter mentions the incident last year in an FA Cup match where Bolton Wanderers midfielder Fabrice Muamba collapsed on the pitch. “He collapsed on the field and the spent about 75 minutes before they got his heart going on the field – he had an underlying heart problem that hadn’t been previously diagnosed.”

Healthy Competition

Along with the Y-chromosome comes competitiveness and man’s Darwinian desire to prove himself. “People look for that surge that very few can get without some sort of extreme event,” says Goodenough. It doesn’t matter whether you’re enduring a challenge to set a PB or proving a point or because you heard a guy in worse shape than you did it.

“I don’t want to make it sound like you take your life into your own hands every time you go out and exercise but there’s no question that a lot of people who do these events could train better for them”. These are the ones who put on their shoes too late. “They get themselves into the bare minimum shape and then they stress their bodies out massively for 12 hours and then they don’t do it again for nine months – that’s the mindset,” says Tucker.

However, the thinking athlete can measure himself and extend his life without knowing what the inside of a medical tent looks like. Exercise can be dangerous but it’s still more dangerous to sit in car. When cities close roads for marathons, the death toll is much lower, says Tucker “There are fewer deaths on those days because the car accident rate is higher than the death rate for marathons. The safest day in London is the marathon day.”

“Most people aren’t taught how to create their own meaning so we need an event, an experience, a situation to create meaning for us,” says Goodenough.

There’s a right way to train for an event, and there’s a right reason to want to do one in the first place. Before you choose your adventure, check your reasons, he advises. “Don’t do it so that some people can look up to you. Do it so you can look up to you.”