John E. Delzell Jr., MD, MSPH, MBA, FAAFP
I still remember the first time I crossed the finish line
of a marathon.
It was hot. We were in Orlando (the Disney Marathon). My legs were toast. The
crowds were cheering. I definitely cried in those final few meters. Finishing
26.2 miles doesn’t just test your body. It tests your commitment, your mind,
your pain threshold, and sometimes your relationship with your toenails.
I’ve run a lot of races since then. Some were fast. Some were slow. Some were
surprisingly fun. Others… let’s just say I was glad they ended. But each one
taught me something—not just about pacing or hydration, but about myself. About
resilience. About joy. About being present in motion.
So, when I recently came across two very different—but equally
important—articles on running, I felt compelled to dig a little deeper.
Why We Run (And Why I Still Do)
Let’s start with the why. In 2021, Hugo Vieira Pereira and colleagues (1)
published a systematic review in Frontiers in Psychology that asked a simple
but profound question: What drives people to run for fun?
Not surprisingly, it’s not about weight loss or physical
health—although those show up plenty. They found that psychological and
behavioral factors play just as large a role, especially for recreational
runners. Things like stress relief, mood elevation, a sense of achievement, or
just the pure enjoyment of the run itself. I do enjoy the bling, nothing like
posting that picture of your finisher medal on your favorite social media site,
but there is much more to the joy of running than a medal. Interestingly,
runners with more experience tend to internalize the joy—shifting away from
extrinsic motivations (like medals or fitness) toward more intrinsic ones (like
emotional well-being or identity).
I get that. Running has long been a reset button. It’s where I process tough
days, pray, think, unwind. It’s where I go when I need space, and oddly enough,
also where I go when I need community. The running community is incredibly
supportive. Long runs with friends have a way of cutting through small talk.
You learn a lot about someone at mile 16.
The Pereira review also highlights how consistent runners tend to have high
self-regulation skills—planning, goal-setting, time management, and the ability
to push through discomfort. That sounds right. You don’t finish a marathon on
motivation alone. You finish it because you ran all the invisible miles in the
dark before sunrise, when no one was cheering.
The Hidden Risk No One Talks About on Race Day
But running isn’t all runner’s highs and finish-line photos. Every time I pin
on a bib number, especially at marathons or halfs, I know I’m also assuming a
small—but real—risk. And that brings us to the second article. Published in 2025 in JAMA, the study by Kim
et al (2) tackled the sobering topic of cardiac arrest during long-distance
running races. The researchers reviewed over a decade’s worth of data and
identified several critical insights:
- Cardiac arrest during organized races is really rare—occurring in about 1 per
100,000 participants—but considering the number of race participants (>23M) not
negligible.
- Most cases occurred during marathons (not shorter distances), and more often
near the end of the race.
- Interestingly, the incidence of cardiac arrest is stable (compared to
2000-2009) but there has been a significant decline in mortality
- Bystander CPR and the presence of automated external defibrillators (AEDs)
significantly improved survival.
As a physician, I’ve always known running carries cardiovascular risk,
especially if there’s underlying heart disease, electrolyte imbalances, or
unrecognized genetic issues like hypertrophic cardiomyopathy. But reading this
paper hit me a little differently—because it’s about my people. My tribe.
Ordinary folks pushing themselves to extraordinary limits. As a runner, it
reminded me that health screening and preparation matter—even when you’re
“fit.” It’s easy to assume that crossing the start line means you're healthy
enough. But racing is different from running. The adrenaline, the intensity,
the heat, the dehydration—all of it combines into a stress test with real
consequences.
Running Smarter, Running Longer
So how do I reconcile the joy of running with the risk it carries? Honestly, it’s the same way I’ve practiced
medicine for 30 years: with a clear-eyed look at the data and a respect for
human experience.
First, I take precautions seriously. Regular checkups. Listening to my body.
Hydration. Electrolytes. And yes, even slowing down when needed. No PR is worth
collapsing for.
Second, I keep running for the same reasons that I started running. I’m not
chasing record times anymore. I’m chasing clarity. Fellowship. Flow. Those long
runs that leave your muscles sore but your spirit full.
And third, I encourage others, especially new runners, to train smart and
listen to their body. Get checked out by your primary care doctor if you are
over 40 and new to endurance sports. Don’t ignore chest discomfort, dizziness,
or feeling “off” on race day. Carry ID. Know where the aid stations and AEDs
are. Be the person who knows CPR.
The truth is, running can be one of the most powerful mental and physical
health interventions we have—when done right.
My Finish Lines and What They Taught Me
Each marathon I’ve run has carried its own story. The one where it rained the
whole time. The one where I cramped at mile 18. The one I ran with my best
friend from high school cheering me at the finish line. Each race reminded me
that finishing isn’t about being fast—it’s about being faithful to the
training, the effort, the journey.
I’ve been lucky. I’ve stayed healthy, mostly. I’ve never DNF’d. But I’ve seen
people collapse. In our first half marathon, a man collapsed and got bystander chest
compressions on the course (he lived!). I’ve slowed down to walk someone to the
medical tent. And I’ve always been thankful to cross the line—upright, tired,
and deeply grateful.
Final Thoughts
Whether you’re finishing first or finishing last, there’s something sacred
about committing your body and mind to something hard and seeing it through.
Something human. Running, like life,
holds both joy and risk. We run to feel alive, to cope, to connect, to
challenge ourselves. And while the road can be unpredictable—especially over
26.2 miles—it’s also where I’ve found some of my clearest moments.
So yes, I’ll keep lacing up. I’ll keep being smart. I’ll keep showing up.
The finish line may only last a few seconds, but the lessons from the road last
a lifetime.
References
(1) Pereira
HV, et al. Systematic Review of Psychological and Behavioral Correlates of
Recreational Running. Front. Psychol., 06 May 2021; Volume 12
https://doi.org/10.3389/fpsyg.2021.624783
(2) Kim
JH, Rim AJ, Miller JT, et al. Cardiac Arrest During Long-Distance Running
Races. JAMA. 2025;333(19):1699–1707. doi:10.1001/jama.2025.3026
No comments:
Post a Comment