Some vital dos and don’ts that will ensure you have a memorable marathon experience
Singapore marathon fever is upon us once again. And it is going be a momentous event for a lot of us. You probably have been training for this for the last few months with building up your weekly mileage, enduring weekly long runs, doing speed work with interval training and, last but not the least, letting your body rest and recover. By this time, you would have scaled back on your training in preparation for the big day. So how tough is it to run a 26-mile race? The first person to run the marathon, a Greek soldier called Pheidippides, collapsed and died. Currently, the best marathoners in the world are invariably the Kenyans; they run the race in a little over two hours. The main fuel to support a marathon comes from glycogen. The main storage of glycogen is in the liver and the muscles which provides enough fuel for about two hours. Hence, if you take more than two hours to run the race, you have to top up your fuel supply, usually by eating.
Fuel for a run commonly comes in the form of bananas, chocolate or energy gels. The energy gels contain carbohydrates in form of maltodextrins and glucose with potassium and sodium. Maltodextrins are long chains of glucose molecules. They are pre-digested simple carbohydrates and resemble the food that has been digested by the stomach. Hence the absorption is rapid in the intestine. These maltodextrins also serve the purpose of being isotonic with little water needed. The thing to remember is that you got to accustom yourself to drinking isotonic fluids while taking these gels on the run prior to the big race. It is recommended for an average runner to take a gel patch every 30-45 minutes in a marathon. The other important thing to consider is your hydration status. You should hydrate yourself adequately during the last week prior to race day. You should, by now, be able to gauge how much fluid you would need during the training runs in the same humidity and temperature. Hence, on race day you would know how to drink appropriately. One should not depend purely on the sensation of thirst before drinking.
Often, when you feel thirsty, the body is already dehydrated. Thirst is regulated by a centre in the brain stem which senses the concentration of the circulating blood. When the blood concentration rises, the brain stem sends a signal to the body giving you a sensation of thirst. This signal is often ignored during a run when there is too much excitement and euphoria. There is also a risk when one drinks too much. This is commonly seen in the slower runners who would be drinking more at water stations and yet sweating less. That can lead to a situation called hyponatremia, where the sodium level in the blood drops due to dilution from over-drinking. This can cause altered mental state and confusion. This brings us to the matter of a runner who collapses during the run; it could be from hyponatremia, heat disorder, low blood sugar or from a heart condition. In our hot and humid climate our major concern is heat disorder.
The temperature in the body rises from dehydration, excessive heat production due to running and the lack of heat dissipation from our warm and humid weather. Heat disorder is quite insidious and must be recognised by the paramedical and medical personnel deployed during the race. The immediate treatment is to get the collapsed heatstroke runner into a body cooling unit before evacuating him to hospital. Wearing the right shoes is important too, and for most of us, cushioning shoes are critical to buffer the constant pounding on the road. Some of us are flat-footed and need motion and stability control shoes. Some runners buy special socks; wearing light mesh clothing is useful in our climate, as well as applying Vaseline to chafing parts of our bodies. Chafing is caused by constant rubbing of the moving body parts against the running gear which causes the bruising of the skin. The common sites are the nipples, the groin and the armpits. The conditioning of the mental state is as important as the physical preparation.
The feeling of not being able to complete the race comes soon after the euphoria during the start of the race has evaporated. This is compounded by the heat, loss of stamina to complete the 26 miles, and low body fuel. Some runners listen to music to distract themselves, carry on a conversation, or merely admire the environment and the cheering crowd. Positive thinking helps tremendously to minimise the awkward feeling of not being able to complete the race. When you have completed the race, head for the medical post if you are feeling unwell. Otherwise, keep moving as there can be risk of fainting due to venous pooling when the overworked muscles suddenly become inactive. Do make sure you drink water and isotonic drinks. When you have reached home, continue to drink water and isotonic drinks and listen to your thirst. Do eat protein-laden and carbohydrate-rich food. You should continue to move around and do get rest, naps and a good sleep to let the muscles and the heart to recover quickly.
Getting yourself a sports massage may also help and do not race competitively for a fortnight or more. If you have injuries, remember to ice, rest, compress and elevate the affected limb. You can take some an anti-inflammatory medication and, if in doubt, go see your family doctor for evaluation. Finally, do go out there today and enjoy your run that you have been training for quite a while. You don’t always have to finish it if you can’t and you don’t have to run it all the way.
Just listen to your body and you will have a great, once-in-a-lifetime experience.
Dr Chong Yeh Woei
Senior Consultant Physician (Internal Medicine)
MBBS (Singapore), MRCP (UK) (Internal Medicine)
THE BUSINESS TIMES WEEKEND 30 NOVEMBER 2019