[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-433926-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-433926-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","running-preparation-for-cardiac-safety-and-improved-performance","Running preparation for cardiac safety and improved performance","","Marathon participation has grown worldwide, raising the average age of runners and increasing concern for late-race sudden events. For middle-aged and older men, the main causes of sudden death are cardiac diseases, especially coronary artery disease and acute myocardial infarction, which can be triggered by acute cardiovascular stress during high-intensity endurance. Structured progressive training, adequate hydration, and individualized pacing can mitigate risk. Cardiac screening is recommended for individuals with asymptomatic coronary disease or known risk factors, with attention to dehydration versus exercise-associated hyponatremia.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/running-preparation-for-cardiac-safety-and-improved-performance/433926/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/running-preparation-for-cardiac-safety-and-improved-performance/433926.png","ImageObject",300,407,{"name":42,"@type":43},"Miles","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",14,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is pre-race cardiac screening recommended for some marathon participants?","Question",{"text":63,"@type":64},"Because individuals with asymptomatic coronary artery disease or other risk factors can face sudden cardiac death triggered by acute cardiovascular stress during marathon running. Screening helps identify latent disease before high-intensity effort.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What type of training plan is suggested before entering a marathon?",{"text":68,"@type":64},"A structured, progressive training program of at least 16 weeks is recommended. For untrained middle-aged men, completing a marathon after a 16-week program has been associated with transient cardiac changes that return to baseline within 4 weeks.",{"name":70,"@type":61,"acceptedAnswer":71},"How should hydration be managed to balance performance and safety?",{"text":72,"@type":64},"Avoid exceeding about 2% body-mass loss from dehydration and drink roughly 400–800 mL per hour guided by thirst. Also avoid total intake above about 3 L during the event to reduce the risk of exercise-associated hyponatremia.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},433926,1790762901,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":30,"preview_page_count":4},13056703019404,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Editorial  \n[https://doi.org/10.12965/jer.2550774.387](https://doi.org/10.12965/jer.2550774.387) Journal of Exercise Rehabilitation 2025;21(6):259-259  \nRunning preparation for cardiac safety and improved performance  \nJunga Lee  [https://orcid.org/0000-0002-9221-0405](https://orcid.org/0000-0002-9221-0405)  \nMarathon participation has increased worldwide in recent years. As more middle‑aged and older adults have taken part, the average participant age has risen, and the middle‑aged cohort now represents the largest share. Although fatal events are rare among male mar‑ athoners, cases often occur late in the race or near the finish line. For individuals with asymptomatic coronary artery disease or oth‑ er risk factors, pre‑race cardiac screening is recommended.  \nAmong middle‑aged male marathon participants, the leading causes of sudden death are cardiac diseases, particularly coronary artery disease and acute myocardial infarction. Vigorous exercise such as marathon running imposes acute cardiovascular stress, which can precipitate sudden cardiac death in those with latent disease. Prolonged high‑intensity efforts may also be associated with ele‑ vated blood pressure, transient ventricular remodeling, and increased vascular stiffness. Less commonly, congenital heart disease, con‑ duction abnormalities, dehydration, electrolyte imbalance, and excessive intake of caffeine or stimulants can contribute.  \nUntrained runners carry a markedly higher risk compared with trained runners. Repeated training confers cardioprotection and substantially reduces the likelihood of adverse events. Most docu‑ mented sudden deaths occur in runners with underlying cardio‑ vascular disease or baseline risks.  \nBefore entering a marathon, individuals should complete a struc‑ tured, progressive training program of at least 16 weeks. In un‑ trained middle‑aged men, completing a marathon after a 16‑week program has been associated with transient cardiac changes, with all measured parameters returning to baseline within 4 weeks. Longer‑term training (e.g., 8 months) can improve blood pressure, reduce body fat, and favorably modify cardiovascular risk factors. A practical target is four to five sessions per week of approximately one hour each, with gradual increases in distance and intensity.  \nHydration is essential for performance, health maintenance, and safe completion. Key considerations include appropriate fluid in‑ take, dehydration thresholds, and the risk of overhydration that can lead to exercise‑associated hyponatremia. A body‑mass loss of about 2% from dehydration is commonly cited as a threshold at which performance and cardiovascular strain may worsen; howev‑ er, training adaptations and individual variability are substantial, and some well‑trained athletes complete races with greater fluid deficits. Elite marathoners typically ingest roughly 200–800 mL of fluid per hour, whereas untrained runners tend to drink more frequently and in larger volumes.  \nBecause dehydration depends on temperature, humidity, pace, and sweat rate, timing and degree vary widely. Exercise‑associated muscle cramps appear more closely linked to muscle damage than to isolated fluid or electrolyte loss. Water, sports drinks, and elec‑ trolyte supplements show minimal differences for routine dehy‑ dration recovery in most situations. Practical guidance is to avoid exceeding about 2% body‑mass loss, drink approximately 400– 800 mL per hour guided by thirst, and avoid a total intake above roughly 3 L during the event to reduce the risk of hyponatremia. Individuals with known genetic or clinical risk factors for heart disease should undergo cardiac screening before participating.  \nCONFLICT OF INTEREST  \nNo potential conflict of interest relevant to this article was re‑ ported.  \nGraduate School of Physical Education, Sports Medicine and Science,  \nKyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin 17104, Korea [Email: jalee@khu.ac.kr](Email: jalee@khu.ac.kr) ","cbCaiedwcmD6pg5H","https://ap.wps.com/l/cbCaiedwcmD6pg5H","pdf",57404,"English","# Running preparation for cardiac safety and improved performance\n## Sudden death risk in middle-aged and older marathoners\n## Training duration, progression, and cardioprotection\n## Hydration strategies and hyponatremia prevention\n## Cardiac screening and practical safety guidance","[{\"question\":\"Why is pre-race cardiac screening recommended for some marathon participants?\",\"answer\":\"Because individuals with asymptomatic coronary artery disease or other risk factors can face sudden cardiac death triggered by acute cardiovascular stress during marathon running. Screening helps identify latent disease before high-intensity effort.\"},{\"question\":\"What type of training plan is suggested before entering a marathon?\",\"answer\":\"A structured, progressive training program of at least 16 weeks is recommended. For untrained middle-aged men, completing a marathon after a 16-week program has been associated with transient cardiac changes that return to baseline within 4 weeks.\"},{\"question\":\"How should hydration be managed to balance performance and safety?\",\"answer\":\"Avoid exceeding about 2% body-mass loss from dehydration and drink roughly 400–800 mL per hour guided by thirst. Also avoid total intake above about 3 L during the event to reduce the risk of exercise-associated hyponatremia.\"}]","Running preparation for cardiac safety and improved performance | PDF",1790666230]