There are enormous health benefits to participating in and training for a marathon or long distance running event. However, it is also a huge physical challenge, which requires a sensible and safe approach. It is essential that you are properly prepared and that you follow a carefully structured training programme that will help you complete the race while also safeguarding your health.

We advise that you do not participate on race day unless you have achieved the recommended mileage in your training runs and urge you to take the time to understand issues surrounding hydration, fuel and any medications you might be taking.

Please make sure that you read our comprehensive guide below, ahead of taking part in the marathon.

For more information an excellent resource is: www.runnersmedicalresource.com

THE BASICS

ARE YOU FIT ENOUGH TO TAKE PART?

If you have any medical conditions such as cardiac problems, asthma or diabetes it is essential that you check with your medical advisors whether there is any medical reason why you should not run a long distance event or train for it. Your GP is the best person to discuss this with. They know the benefits of training for the event but also the effects on your body. They may advise against you running and if they do, you must take their advice.

Please remember that you may need to make adjustments to your medication or treatment when running long distances.

If your GP would like more detailed advice from the Brighton Marathon medical team then your GP can email a dedicated advice line through their NHS email account. Unfortunately, we are unable to advise runners individually because we do not know the details of your medical history; any changes to treatment must be made by your GP who is in a position to balance any risks and benefits. We will therefore only reply to GP NHS email requests with specific enquiries about Brighton Marathon or BM10k.

Your GP can email: gpadvice@brightonmarathon.co.uk

Although we cannot advise individually, please ensure you also notify us if you have a medical condition. We request that you include full details of any medical problems, medication, allergies and contact details on the back of your running number, should we need to treat you during the race.

If you have previously encountered any significant medical problems while taking part in a running event, such as heat or hydration issues, it is especially important that you check with your medical advisers and/or a sports physician whether or not you should take part in the Brighton Marathon or BM10k.

Review

Whether or not you have a medical problem, it is important that you regularly carry out your own medical risk assessment regarding your ability to train and take part. Every day you need to decide whether you are fit to train. It is essential that you do not run if you are ill or have recently been ill. For example you should not run if you have a viral infection; even a bad cold can be harmful when pushing your body.

DO NOT RUN IF YOU FEEL UNWELL

Leading up to race day, one of the bravest decisions any runner has to make is not to run if they have been unwell. If you find yourself in this dilemma, no matter how hard you have trained, despite how much money you have raised in sponsorship or how much you have been looking forward to the race, it is essential for your own health and safety and indeed for that of others, that you do not run if you are unwell or unfit in any way.

This is a very important issue and the marathon organisers are very aware of how painful a decision this might be. They have made it clear to me that should anyone withdraw for medical reasons, they will have a guaranteed place the following year. You can do this by completing a deferral form (marathon entries only) which can be found in the FAQ section of the Brighton Marathon website.

MEDICATIONS AND PAINKILLERS

You should also be very careful to avoid NSAID medications whilst training and racing. Drugs such as larger doses of aspirin, voltarol (diclofenac) and ibuprofen (e.g Nurofen) can cause kidney problems when combined with high intensity exercise, and in very rare cases can affect bowel function. If pain relief is required, please use paracetamol instead. Please discuss running the marathon with your GP if you take any of these medications regularly.

You should also consult your GP if you take any medications that can make you more susceptible to heat stroke or collapse, such as thyroxine, blood pressure medications or a number of mood stabilising drugs.

Finally, drugs to dry up runny noses, which contain drugs such as pseudoephedrine or oxymetazoline, can increase your blood pressure and interfere with the heart’s electrical circuitry and so should be avoided for a few days prior to the race and not taken whilst training. Stimulants of any kind should not be used. Again, for any questions, please consult your GP.

FUELLING UP

By now you will already be aware that you need to have adequate amounts of fuel on board to enable you to run regularly. It is essential that you pay attention to the quantity and type of fuel you use before, during and after training and especially on the day of the race. Getting the right balance, in the type and amount of fluid you drink and fuel you take in, is critical for performance and safety.

We would advise you to read the following advice: http://www.runnersmedicalresource.com/en/drinking/

There are many other good sources of information on diet, nutrition and food balance, however everyone is different and it is essential that you rehearse this during your training programme. Do not try new food or fluid the night before the event. Please also avoid caffeine and alcohol the night before the race due to their dehydrating effects.

ON THE DAY

Remember that a lot of the race will be along Brighton seafront and that the wind chill factor and weather will have a significant effect on the day. Please look out for weather forecasts in the week before the marathon and look for updates from the Brighton Marathon team on the website.

Also it is important to look out for any information about smog or air pollution, for more advice please visit: http://uk-air.defra.gov.uk/. If you suffer from respiratory conditions, this is especially important. If there are specific problems around smog or air pollution we will issue more information closer to the time.

FLUID INTAKE AND ENERGY SUPPLEMENTS

Stop for drinks and fuel as you have planned. How much and what type of fluid you drink, will depend on the weather and conditions, the speed you are running and what your body is telling you. If you are thirsty make sure you drink – water is usually adequate but it can be combined with isotonic drinks. Although there are regular drink stations, these are not in place so that you stop to drink at every one. Forcing yourself to drink too much water during a race is as dangerous as drinking too little. Taking energy supplements whilst not taking in adequate amounts of fluids is equally dangerous. Please read the advice from the manufacturers of the products you use to find out how best to use these products. It is especially important to avoid any stimulants (legal or not) as they can make you prone to heat stroke.

It is especially important to not take any legal highs or illegal drugs whist training and racing as this can impact on your health and make you more prone to heat exhaustion.

IF YOU FEEL UNWELL DURING THE RACE

If you feel yourself getting confused or too hot, or very weak, this may be a sign of heat stroke and you must stop immediately and get help from one of the medical team. Heat stroke is a very serious condition, common in runners doing marathons. Those that suffer severe consequences are those that don’t listen to their body saying stop. It is much safer to stop than push yourself and collapse before the finish line.

MEDICAL SERVICES ON RACE DAY

If you do need any of the medical services on the day we have a highly experienced medical team in place. St. John Ambulance provides the first aiders and help with issues such as Vaseline and abrasion injuries. They will also be managing the first aid tents, and ambulances. For more seriously unwell runners we have a large team of doctors, paramedics and nurses working in conjunction with the St John Ambulance Team. These are highly skilled and qualified personnel working under the direction of NHS consultants who have volunteered for the day and who are using standard drugs and equipment.

We also have physiotherapists and podiatrists in the main medical tents who are on site ready to help with any running related injuries.

Once You’ve Finished

You have just put your body through a considerable amount of exertion. It is especially important for you to be extra careful during these next few hours and days following the marathon. If you feel unwell in anyway, confused or suffer from a collapse, or have pigmented urine – please get medical help. Please avoid any anti-inflammatory medicines for the next few days and until told it is safe, please also avoid blood pressure tablets until you have been reviewed by your GP.

CHECK YOUR HYDRATION LEVELS

Simple ways to measure your need for fluids is to check your weight and keep track of how much you are urinating. It is common to lose a few pounds of water weight during the marathon and therefore it is important to know your weight just before the race.

If you have lost 2-5% (example 2% of 150lbs = 3lbs) then you have lost fluid and may be dehydrated.

If you are urinating and have no symptoms then you should continue to take sips of sports drink and water every 15-20 minutes. Once your urine is clear and you are urinating freely, stop taking sips and drink only when thirsty.

SYMPTOMS TO LOOK OUT FOR

If you have symptoms such as feeling light-headed, dizzy, nauseous, vomiting, confused, short of breath, develop muscle aches or cramps which will not go away, and you have not been able to urinate, then you should call 999 or have someone take you to the nearest A&E department and tell them you have run the marathon.

If you do not know your weight, then keep track of your urine:

Urine that looks like lemonade means that you do not need to drink any extra fluids, and so drink only if you are thirsty.
Urine that looks like apple juice is concentrated and may mean you are dehydrated
Urine which looks dark (dark orange or cola coloured) along with muscle aches or cramps that do not go away, can indicate rhabdomyolysis (muscle breakdown). This can be dangerous and you should call 999 or have someone take you to the nearest A&E department and tell them that you have run the marathon.
Much less commonly, if you have gained weight, then you may have drunk too much during the marathon. You are at risk of hyponatraemia (low salt levels).

If you have symptoms such as feeling dizzy, nauseous, vomiting, have a headache, confused, then you should call 999 or have someone take you to the nearest A&E and tell them you have run the marathon or 10k.

If you feel unwell after the race, you should also not drink alcohol.

MEDICATIONS TO AVOID AFTER YOUR MARATHON

Finally you may need to avoid some medications for several days after the marathon since they can harm your kidneys:

Do not take anti-inflammatory drugs such as ibuprofen (nurofen). Paracetamol is safe.

It should be noted that some ‘blood pressure’ medications should be stopped for a couple of days after the marathon – please ask your Doctor to advise you.

In Summary

  • Please take care and listen to your body.
  • Make sure you train properly, following a good training plan well ahead of Race Day.
  • Consult your GP if you have any medical problems or are taking medications. If you are feeling unwell before the race, DO NOT run.
  • If you become unwell during the race, stop and seek medical advice at the nearest first aid station
  • Avoid taking NSAID medications / painkillers on race day
  • Drink sensibly during the race and do not take too much or too little fluids
  • Consult the manufacturers advice on consuming energy drinks or gels
  • If you feel unwell after the race, seek advice.

Thank you for reading; have a fantastic (and safe) Brighton Marathon Weekend.

Dr. Rob Galloway (Accident and Emergency Consultant at Brighton and Sussex NHS Trust) and Brighton Marathon Medical Director.