Safety in endurance sports: Know your limits

By Kimberly Kwek


Last month, 42-year-old Stephen Begley died from cardiorespiratory failure during the swim leg of the Singapore International Triathlon (SIT). The Briton was a former professional rugby player with no known medical conditions.

This was the second fatality at the SIT after the death of a Singaporean man in 2009, who also faced difficulties at the swim leg.

There have been six other deaths at endurance events in Singapore in the past 10 years.

Endurance events such as marathons and triathlons are sports activities that require one’s use of key muscles over a prolonged period. A marathon is a 42.195-kilometre long run, while a triathlon consists of a 1.5km swim, 40km bike ride and 10km run.

Despite these incidents, deaths at such events are rare. A 2012 study by the New England Journal of Medicine showed that the risk of death when participating in a marathon is 1 in 256,000.

Training sufficiently

Dr Govindasamy Balasekaran, head of physical education and sports science (PESS) at National Institute of Education (NIE), said current safety precautions by organisers are sufficient and participants have to honestly evaluate their readiness for these events.

“The organisers can’t prevent these accidents. They can’t detect these kind of unknown underlying causes. People always think they have no problems so what they have to do is clear themselves medically and ask themselves if they are ready for the run,” he said.

He also stressed the importance of preparing sufficiently for such events, and recommended at least six months of training for people with a few years of experience in long-distance running.

Dr Govindasamy, a former national runner who has represented Singapore in 5,000 and 10,000 metre track events, also emphasised the inclusion of interval training, strength conditioning and neuromuscular coordination when training for marathons.

“People think that marathon is only about going for long runs, but that doesn’t cut it. You have to have strength,” said Dr Govindasamy, who coaches national runners in long-distance running events.

He warned seasoned runners against being complacent and to know their limits.

“They think that they’re seasoned marathoners and they want to break their own personal best. So what happens is that when they start off, they go at a very high intensity, which is not according to their pace,” he said.

Runners start burning carbohydrates instead of fats when they run at a high intensity. Forcing themselves to run without having enough glycogen in their body can cause dizziness, and in more fatal cases, heart failure.

Evaluating your health

According to Associate Professor Fabian Lim from the Lee Kong Chian School of Medicine, heart conditions are one of the main reasons why people die while doing endurance sports.

Dr Lim, who specialises in exercise physiology, said those who die of heart conditions are either younger runners who are affected by undetected abnormalities in their hearts, which may trigger cardiac arrests, or older people who are likelier to get heart attacks at that stage of their lives.  

NTU’s aquathlon team captain Samuel Choong, 23, raised the importance of listening to one’s body and to avoid going for such events if one is feeling unwell.

The second-year Nanyang Business School (NBS) student also mentioned that going on runs of similar distances is critical.

“A lot of people do it (marathons) because they think that they can walk but at the end of day, the fact is that your body isn’t prepared and you don’t know what will happen,” he said.

Apart from sufficient training, Dr Govindasamy recommends going for a basic electrocardiogram (ECG) to help uncover any undetected blockages or issues.

“Sometimes when you stress your heart, the (blood) load increases, then you realise the blockages are there,” he said.

The Physical Activities Readiness Questionnaire (PAR-Q) can also act as a checklist for people intending to participate in endurance sports. It is an online self-screening tool that assesses the need for a medical screening before participating in any strenuous activities.

Dizziness, breathlessness, chest pains, drowsiness, typical cardiac symptoms like discomfort or tingling sensations in the arms are tell-tale signs of exhaustion.

But Dr Lim said relying on physiological signs could be too late, and preventive measures should be taken beforehand.

He added: “The idea is to recognise that you’re not in form on that day and to either slow down, stop and reduce the expectation before it gets to the state where you’re feeling drowsy or you collapse.”

Dr Lim feels more can be done to educate the public on the importance of assessing the readiness of their bodies before taking part in such events.

“A great opportunity to educate the people is at the point of registration. They can even insist on having everyone fill up a PAR-Q and for those who fail the PAR-Q, they need to insist on having the medical clearance before they accept their registration,” said Dr Lim.

Carrying on with the run

Still, most remain undeterred by these risks and still sign up for long-distance running events.

“It doesn’t affect me. These things are just a one-off thing. If you see a population and see the statistics, it’s just a small percentage out of the whole population,” said NTU Runners Club member Kleeve Hoi, 22, a second-year student from the School of Physical and Mathematical Sciences.

Some enjoy the challenge and experience that these events offer.

“We just want to push ourselves and try something new,” said Alison Chiang, 19, who will run her first half-marathon at the Great Eastern Women’s Run this month.

The first-year NBS student added: “We just need to make sure that we’re well-prepared for the run. Especially since we have not run 21km before, we need to season our bodies to be able to withstand the stress of running at least one and a half or two hours.”