RISK OF DEATH DURING MARATHON RUNNING

Legend has is that a Greek soldier by the name of Pheidippides, ran from the plains of Marathon to Athens, to announce that the Greeks had just defeated the Persians, in 490 BC.  The distance he ran was 42.2 kilometers, which has then become the official distance of a ‘marathon’.  Legend also has it that after announcing the victory, he collapsed and died.  2500 years later on February 24, 2013 a brave citizen of Bombay ran the half marathon in Thane, and at the end of the race he proudly collected his medal.  After receiving his coveted prize, like Pheidippides, he too collapsed and died, despite intense efforts to revive him by the doctors present there.

Historians contested this version of Pheidippides, and in fact later discovered that he had run well over 450 km, over a ten day spell and was instrumental in saving the battle for the Greeks.  Unfortunately, for our Bombay Braveheart (I am not naming him, in respect for privacy), and his family his death is undisputed, and I extend my deepest sympathies to his family and friends.

As is to be expected, this running death has created grave concern within the running fraternity of Mumbai, of which I consider myself an integral part (both, as a runner and as the Medical Director of the Standard Chartered Mumbai Marathon).  In the media, and in the running community I have encountered polarized views on the risks of long distance running.  One view is that exercise in general, and running in particular is extremely healthy, and therefore cannot be harmful by any means.  The opposite view is that running is dangerous and if one wants to exercise, nothing beats a leisurely walk.  In my opinion, neither of these views is absolutely true, since this is a complex topic and needs a deeper understanding rather than knee-jerk one-liners.  The purpose of this article is to try and shed some more light on the risk associated with marathon running.

Before we begin, I would like to clarify that this article is not about the benefits and risk of exercise in general.  The health benefits of exercise have been unequivocally established, and these benefits very clearly outweigh the risks.  Also, this article deals with running  half and full marathons, and not distances beyond that.  There is new literature emerging on the cardiovascular effects of ultramarathons, which can be discussed separately.

DEATH DURING LONG DISTANCE RACES: THE NUMBERS

In 2012, a study was published in the New England Journal of Medicine, titled ‘Cardiac Arrest during Long-Distance Running Races’. This looked at the incidence of cardiac arrests in marathon and half-marathon races in the United States from 2000 to 2010, and included 10.9 million runners.  In that entire period there were 59 sudden cardiac arrests, of which 42 were fatal.

Sudden cardiac arrest occurs when the heart suddenly and unexpectedly stops beating. When this happens, blood flow to the brain and other vital organs stops, and can lead to death if not treated within minutes.  In fact, this year at the SCMM marathon we had a sudden cardiac arrest, and due to a combination of luck and medical preparedness we were able to save the runner (for more on that, read here: http://drcontractor.blogspot.in/2013/01/a-miracle-on-race-day.html).

The following is the information we learned from the Cardiac Arrest study:

1. Cardiovascular disease accounted for the majority of these cardiac arrests and deaths
2. The incidence of arrests was significantly higher during full-marathons than half-marathons, and was higher among men than women
3. The incidence rate of cardiac arrest during half and full marathons was 1 per 184,00 runners
4. The incidence rate of death during half and full marathons was 1 per 259,000 runners
5. The commonest cause of death was hypertrophic cardiomyopathy

According to official figures, about 10 deaths take place on the Mumbai suburban railway network each day, and approximately 7 million commuters travel each day. This translates into 1 death per 700,000 commuters. In other words, the risk of dying during marathon running is a little more than double that of taking a ride on the Mumbai local trains!  I know this is not a fair or scientific comparison, and I do not mean to trivialize even a single death, but the idea is to put the risk in perspective, which in absolute terms is very low.

 

WHAT CAUSES THESE ARRESTS AND DEATHS?

The two most common causes of death found during this study, as well as others looking at exercise and acute cardiovascular events were:

1. Hypertrophic cardiomyopathy
2. Atherosclerotic coronary artery diseases (blockages in the arteries)

Hypertrophic cardiomyopathy (HCM) has been defined as a primary disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause (source: Wikipedia).

It has been well established that among young individuals, less than 30 years of age, HCM and other birth related (congenital) abnormalities are the main cause of cardiovascular events.

It was also thought that in athletes over the age of 30, atherosclerotic coronary artery disease (which is just the scientific way of saying ‘blockages in the heart arteries’) is the most frequent cause of cardiac arrest and death.  Vigorous exertion was thought to lead to rupture of the blockage, leading to clot formation, which leads to an abnormal heart rhythm knows as ventricular fibrillation and ultimately death.

The surprising finding in the New England study was that HCM was also the leading cause of death in the population studied during the ten years of marathon running, including the older runners.  Several of the deaths were due to a combination of HCM and blockages in the arteries.

OTHER CAUSES OF DEATH:

Besides the cardiovascular causes, hyponatremia (low sodium level in the blood), and hyperthermia accounted for a total of about 10 percent of the deaths.  These remain important concerns during long distance running but are not common causes of death.

WHAT CAN BE DONE TO REDUCE RISK?

This is clearly the most important question at the end of it all.  In my opinion, risk can be reduced by taking care of the following:

1. Pre-participation health check
2. Paying heed to warning signs
3. Sensible and appropriate training programs
4. Medical facilities available during races

Pre-Participation health check:

Before you read any further, it is important to acknowledge that the human body is an extremely complex organism.  There is no definite testing protocol which can completely rule out risk, which is why you occasionally have the scenario of someone suffering an attack, even though they recently passed their medical evaluation with flying colours. Having said that, these are the tests I recommend, and the reason for each:

1. ECG: this is certainly not a perfect test, but is a great starting point to give a basic indication of your heart function. It’s a great test to pick up HCM
2. Fasting sugar, lipid profile, blood pressure, body mass index and weight circumference: all of these will give an indication of your ‘cardiac risk profile’.
3. Stress test: one can debate the necessity of a stress test, but I would recommend it for two reasons.  It’s a great indicator of your cardiovascular fitness, if nothing else and may indicate the presence of blockages in your arteries.  One can criticize it for two reasons too: blockages show up on the stress test only when they reach a certain size and are ‘obstructive’ to the flow of blood. Often, there are smaller plaques which are the ones that actually rupture and cause the attack. Also, stress tests often show up ‘false positive’ tests, wherein no abnormality exists even though the test is abnormal (for some strange reason, doctors call it ‘positive’ when it is abnormal).  Let the physician conducting the test know that you are a marathon runner and to allow you to carry out the test till you reach maximal fatigue.
4. 2 D- echo: this is a great test to assess  heart valve functioning, and the pumping capacity of your heart muscles. It’s also a great test to rule out HCM. It is relatively expensive, and if you are younger and asymptomatic I guess it would be fine to just do a simple ECG.

The most important part of the evaluation is to consult with a physician who ‘understands’ exercise and the kind of program you hope to embark upon.  In addition to the above tests, your medical and family history is vital.  Data from individual tests do not have as much meaning as the combined risk profile.

Warning Signs:

Several studies have shown that individuals who experienced cardiac events during exercise, often had mild warning signs and symptoms, which they or their physician chose to ignore.  The most common of these, which occurred a week before their arrest were (as reported by friends and families):

1. Chest pain
2. Increasing fatigue
3. Indigestion / heartburn /gastrointestinal symptoms
4. Excessive breathlessness
5. Ear or neck pain

Appropriate training programs:

All exercise programs should be progressed gradually.  Most arrests and deaths occur in individuals who participate without adequate preparation or those who ramp up their training exponentially.  At the end of vigorous physical exertion it is important to cool down appropriately (something which most of us, including myself do not do), since reduced blood supply to the heart may be exacerbated by abrupt cessation of activity.  This is the reason that runners often collapse immediately after finishing an intense race.

Medical facilities on race day:

It goes without saying that adequate medical facilities should be available during long distance runs, especially those exceeding 10 km.  In addition to medical facilities, I personally feel that every runner should take it upon himself or herself to learn the technique of CPR (cardiopulmonary resuscitation). In the event of a cardiac arrest, good CPR can be life-saving.

TAKE-HOME MESSAGE:

Long distance running can be a safe and enjoyable sport with considerable health benefits.  There is a small amount of risk involved which can be kept to a  minimum by making sure you undergo a ‘running-specific’ health check, train sensibly and pay heed to warning signs and symptoms should they occur.

References:

1. Cardiac Arrest Duing Long-distance Running Races. Kim et al, NEJM 2012;366:130-140

2. Exercise and Acute Cardiovascular Events: American Heart Association Scientific Statement: Circulation 2007;115:2358-2368

Straight from the heart: Personal accounts of the Bravehearts who ran the 2013 Standard Chartered Mumbai Marathon

There is an inexplicable sweetness in setting a lofty goal for yourself and achieving it.  After all the accolades of your family, friends and peers have settled down what remains with you is the quite sense of achievement. But what happens, when you are not able to achieve the goal you have set, even after trying with all your heart?
The first few moments, and even the first few days after your 'disappointment' can drag you down, and in spite of all the consolatory comments of the same band of supporters, it is hard to shake off that losing feeling.  However, after all the dust has settled down, and you sit down and analyze the course of events, you may end up realizing that the adversity that you went through has made you even stronger, and considering the situation, you ended up a winner.

Here are the stories of a few of our Bravehearts from the Cardiac Health and Rehabilitation Center at the Asian Heart Institute (Mumbai), all of whom have heart disease and ran the half marathon in the 2013 Standard Chartered Mumbai Marathon.  Most of them tell a tale of heroic courage in the face of great pain, and all of them are looking forward to take a crack at the run in 2014.

My Run and Pain: How I confronted and conquered it

The day finally dawned after a year of hard training and injury. Woke up at 3.45 am to a warm morning. Had a steaming coffee, cleared my mind and told myself to give the race all I have as the next few hours was what the whole year was about.

The run started, with me doing the 80/20 ratio (run:walk) and maintaining a good speed. At 8 km my watch read 58m instead of 61m as per my practice time, felt good! There was a crowd cheering when we got off the sea link. Makes you feel that you are a hero and the world has come out for you, a great uplifting feeling. Of which I saw the result at 10 km when the watch read 73m, little did I realize what was in store! At Worli dairy the pain came up, I stopped running and walked and prayed for the pain to go away. Tried running after a while, the pain became excruciating. Knew I could not run and would have to walk the balance distance. A painful decision when you gave this day your whole year. When pushed the heart and mind can work like there is no tomorrow. Got myself to a resolve that I will not give up inspite of the pain and started walking like I have never done before. A few times I actually overtook people who were jogging! Now the cheers of Run Mumbai run were hurting me, but, kept my mind focused on what lay in front of me and how I had to conquer the same with severe limitations. At Babulnath the African pack thundered past me on the opposite side, maybe someday I will like them, but today it was a difficult and different challenge. I was walking at a good pace, alone with my pain and fears and finally could barely run past the finish line at 2h 41m 30s a full four minutes less than last year. I was hurting physically and demoralized. It took me a full 24 hours to realize that considering what I was up against the outcome was pretty good. I was proud the way I faced and dealt with it and finished faster than last year.  

The race has left me braver and wiser to the point that Life is going to throw tough challenges at me but will have to rise above them, I did on Sunday, and will try to do so always.

SUKEN MEHTA:

I did manage to complete the marathon but this will be the 5th one but the worst one till now . I have injured my knee during last week’s badminton game, for which I had taken pain killers and applied ice.  I even did 30 minutes running in treadmill on the 17th ,that was before the marathon and nothing happened then.  So I took the challenge and participated in the marathon ,which I think has been a mistake on hindsight . I ran the marathon for more than 9 /10 kms but after that my knee gave way and ended up in severe pain, everytime I took a running step .

I walked the distance after that and completed and hence took nearly 3 hrs 40 minutes !!!

I am ashamed of my timing when i was sure of doing better than the last marathon timings and have my garmin records to prove ....it was not  to  be !!!

 Now I am determined to get the knee examined and try to run the 21 kms within a month or two. Of course all will depend on the reports ..

I thank You, Dr Kiran and Dr Priyanka for all the help and support

 SUBRAMANIUM ESHWAR

Before the start of the Race my target was to finish within 2 Hours and I had decided to stick to the group of 2-Hour Bus. When we started at 5.40 AM, it was pleasant, and the air was cool. Keeping earlier year’s experience in mind, I was carrying Half ltr. bottle of electral to avoid dehydration. I was feeling quite comfortable till the Jaslok Hospital incline. My left ankle started giving me trouble around that time. I slowed down a bit, walked for 1-2 minutes and again continued my run. But that point onwards I could not catch up with the group running with 2 Hour-Bus. Due to ankle pain I could not dare to increase my speed beyond certain level. Ultimately I finished my race in 122.34 minutes. Since I was not carrying Stop Watch, I thought my timing was 121 minutes. Maybe next year I will finish it within 2 Hours.

I must thank Team AHIRC for their continued support and encouragement without which it would have been difficult for people like us, ex-Heart Patients, to get over traumatic experience of earlier years and become physically Fit. That is the reason I prefer to run with Team AHIRC rather than with my Bank’s Team which also participates in Mumbai Marathon. I hope to continue my association with AHIRC for ever.

BHUSHAN BAGWE

Thanks for the encouragement and guidance, due which I could attempt and complete, for the first time in my life, a half marathon.  I could not practice as much as I wanted to due to sciatica in my right leg and pain in left knee which surfaced after the 21km practice run at BKC, on 15Dec. Subsequently, I did manage 3 bouts of 10km, including the Powai Marathon on 02Jan, apart from shorter ones, but this was not enough strengthening, as I found myself tiring out and loosing steam around the 15 km mark on the slopes of Pedder Rd.

My target was to keep it below 3h, but lost out by 3mt and 29 sec.  I could not attain my target of 8km in the first hr due to to bunching up on the sea link. And then I missed Mr Venkat’s 3 hr bus as we exited onto Marine Drive.  Positives are that there was  no injury, undue pain and I am back to running, after a days rest. Now I know that I need to be regular thru out the year and will be aiming for 2:45hr in 2014.

Congratulations to ALL !!

CAPT. SANJIV BHALLA

As decided earlier I was going to walk with my wife Malini entire Marathon. IT was cool on marathon day. This year as marathon was to start early it was nice and pleasant early in the morning. Though previous day was cold. I was walking casually and Malini was on speed walk she has to pace with me. On sea link we over took one physically handicapped person. He had Jaipur leg. He was with one companion. He used to fast walk some distance and than slow down and walk slowly. This gave malini boost that when his man can do it even I can complete. This was there till Lotus and after that we were ahead of them. Even on sea link visually blind man ran past us. He too was with one companion. I was enjoying my walk along. At worli we were greeted by Mr. Vikas Desai. Crowd on the way were cheering  participants offering biscuits, oranges, sweets, home made soft drinks and glasses of mineral water. On the way Asian Heart staff at respective medical camp were very helpful and were cheering participants. After crossing furnishing line I hugged Malini that she has finished without any injury though she has injury on her right shoulder. It was great moment for us.

SHAILESH PATEL

Tks a lot for your and your teams support. Ours was one of the few teams, where all happily finished.

I started a bit slow to avoid crowd. It was nice cool climate  so sea link was v. Enjoyable. Till lotus cinema, I was with the 2.30hr bus but then slipped may be due to wet/uneven surface. I continued slow jogging till cadbury house. As the home run approached I became a bit more confident & started fast up pedder rd slope and  that was mistake, and I  slowed & started walking, and a angel tapped from the back saying, “run run”. Gathered breath started jog till wilson collage. Slight pain started in right knee so slowed(walk/jog) till jazz by bay where used pain killer spray got boost from my respected trainer. I continued slowly till the finish enjoying my run as I understood that I was behind my planed timing with little pain in my knee which was damaged in early 90s due to my bike stunts. Last 2 runs I never had right knee pain don't know where it came from but today its gone. Went for a nice walk this morning enjoying cool Bombay climate which is GODs gift for  runners.

SUNIL FADIA

(The angel who tapped fm behind was non but our own Roshni fm AH family)

Weight-Loss Myths Refuted in New Review

No topic in the world of health and fitness excites as much comment or discussion as weight loss. Consequently, most of us have several firm beliefs in our head on 'what works' and what does not. However, as you will read below, many of these beliefs are only half-truths and often are downright false. A special article published in one of the most respected medical journals, was published a few days back which debunked many of the myths. These myths are listed below, and I have added 'my take' to each of them, for what its worth!

The findings were published online January 31 in a special article in the New England Journal of Medicine. Here is a link to the article, but you need to be a member to read the whole article:

http://www.nejm.org/doi/full/10.1056/NEJMsa1208051?query=featured_home


The below article on the subject has been pasted from theheart.org, and the full link for the article is below.

http://www.theheart.org/article/1501837.doutm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Theheartorg+(theheart.org)

The authors discuss a total of 7 myths, along with refuting evidence. Here are some examples:

Small changes in food intake and/or exercise will produce large, long term weight changes — This idea was based on the old idea that 3500 kcal equals 1 pound of weight. But it does not take into account the fact that energy requirements change as body mass changes over time. So, as weight is lost, it takes increasingly more exercise and reduced intake to perpetuate the loss.

My take: In other words, as you begin losing weight you will need to curb your caloric intake further and / or increase your caloric output to continue losing weight at the same pace.


Realistic weight-loss goals will keep people motivated — This idea seems reasonable, but it is not supported by evidence. In fact, several studies have shown that people with very ambitious goals lose more weight (eg, TV's The Biggest Loser).

My take: Actually, I used to believe in realistic and gradual weight loss goals too, and still do, but with a caveat. I have realized that for those who are very heavy (say, at least 30 kg above ideal body weight), gradual weight loss does not work. One of the reasons, in my opinion, is that a 6-8 kg weight loss (which may take a few months, when done 'sensibly') usually, does not show on the person, and no one notices. I feel, that positive feedback and 'wow' comments from near and dear ones go a long way in keeping up motivation, and often gradual weight loss does not lead to that.


Slow, gradual weight loss is best for long-term success — Actually, a meta-analysis of randomized, controlled weight-loss trials found that rapid weight loss via very-low-calorie diets resulted in significantly more weight loss (16% vs 10% of body weight) at 6 months, and differences in weight loss persisted up to 18 months (Int J Behav Med. 2010;17:161-167).

My take: I am surprised to know that the weight loss persisted up to 18 months. Will need to read the entire article to be satisfied on this one.


A bout of sexual activity burns 100 to 300 kcal per person — With intense sexual activity, a 154-pound man burns approximately 3.5 kcal per minute. However, given that the average amount of time spent during one stimulation and orgasm session is about 6 minutes, this man might expend about 21 kcal total. But, he would burn about 7 kcal per minute just lying on the couch, so that amount has to be subtracted, which gives a grand total of 14 kcals of energy expended.

My take: So much for all the 'studs' who thought they were getting a great workout between the sheets.

The article also explores 6 "presumptions," or widely accepted beliefs that are neither proven nor disproven. Among them:


Eating breakfast prevents obesity — Actually, 2 studies showed no effect of eating vs skipping breakfast.


Adding fruits and vegetables to the diet results in weight loss — Adding more calories of any type without making any other changes is likely to cause weight gain. Eating fruits and vegetables is healthful, however.


Weight cycling, aka "yoyo dieting," increases mortality — The data are from observational studies and likely confounded by health status.

Finally, the authors offer 9 facts about obesity and weight loss that are supported by data, among them:

Moderate environmental changes can promote as much weight loss as even the best weight-loss drugs.

Diets do produce weight loss, but attempting to diet and telling someone to diet are not necessarily the same thing.

Physical activity does help in promoting weight loss and has health benefits even in the absence of weight loss.

For overweight children, involving the family and home environment in weight-loss efforts is ideal.

Providing actual meals or meal replacements works better for weight loss than does general advice about food choices.

Both weight-loss drugs and bariatric surgery can help achieve long-term weight loss in some individuals.

Sugary Drinks and Post-meal Walks: Weekly News Round Up

Jan 28, 2013

In the past week, two studies were released, which are of interest, though they only reinforced knowledge we already have. I will present the studies, followed by 'My take (-home message) on it'

The first looked at sugary drinks, what we commonly refer to as 'cold or soft drinks'.

New meta-analysis on sugar sparks old debate

Cutting consumption of sugar produces a small but significant reduction in body weight for adults, a new meta-analysis concludes. The study found was published by Dr Lisa Te Morenga (University of Otago, Dunedin, New Zealand) and colleagues in their paper published online January 15, 2013 in BMJ.
The review is accompanied by an editorial by Dr Walter C Willett (Harvard School of Public Health, Boston, MA) and Dr David S Ludwig (New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, MA), which concludes that the tide is beginning to turn against sugar, with evidence continuing to accumulate that it is indeed deleterious to health.

"It's clear that sugar does have adverse effects, particularly in liquid form as sugar-sweetened drinks," Willett told heartwire. "This study addresses a piece of the picture, the effect on weight gain. There is also a strong body of evidence showing that sugar-sweetened beverages are related to type 2 diabetes.  But the question remains as to what is a desirable limit, they note. Current intake of added sugar in the US and UK is about 15% of total energy, so the 2003 World Health Organization (WHO) aim of limiting intake to 10% "could be viewed as a realistic and practical goal." However, the American Heart Association (AHA) suggests a limit of 5% of energy, "which would be more consistent with a goal for optimal health," they point out.

This information was taken from theheart.org. The full article can be accessed by clicking on the link below.

http://www.theheart.org/article/1496039.do?utm_medium=email&utm_source=20130116_heartwire&utm_campaign=newsletter

My Take-home message:

Sugary drinks, be it soft drinks, such as colas, or sweetened juices, do not really have any health benefits. At best, they are empty calories, and at worst they are agents promoting overweight and diabetes.  Luckily in India, the soft-drink culture has not yet invaded the country to the extent it has in the west. A recent survey in the US showed that the average daily consumption was more than a drink a day (about 400-500 ml) 

(http://www.gallup.com/poll/156116/nearly-half-americans-drink-soda-daily.aspx).

Growing up in the 70's (now I am dating myself), a soft drink was a special treat, and I think we need to go back to viewing it as such.  

Light exercise can reduce postprandial triglycerides

Brisk walking followed by some resistance training an hour after eating can suppress the postprandial elevation in triglyceride levels, research suggests. When compared with the elevated levels that occur following a meal, triglyceride levels decreased 72% after a combined exercise program of walking and light resistance training, report investigators.

In contrast, brisk walking and resistance training prior to eating decreased triglyceride levels 25%.

Authors:  Dr Wataru Aoi (Kyoto Prefectural University, Kyoto, Japan) and colleagues in the February 2013 issue of Medicine & Science in Sports & Exercise.

This information was taken from theheart.org. The full article can be accessed by clicking on the link below.

http://www.theheart.org/article/1498383.do?utm_medium=email&utm_source=20130123_heartwire&utm_campaign=newsletter

My Take-home message:

An after-meal walk has many benefits, and reducing triglycerides is one of them.  However, the regimen used in this study- a 2-km walk followed by squats, shoulder presses, push-ups, and leg raises, among other resistance exercises- is certainly not a practical or sustainable solution.  I would recommend sticking to your usual exercise routine, and not changing it based on this information.  The post-walk meal can be a leisurely 10-15 minute stroll, which will aid digestion and help burn a small amount of calories.

 

A Miracle on Race Day

Usually, when you read the term 'miracle' in one of my posts, it's natural to think that I am talking about one more inspiring run by one more person, under extreme circumstances.  Many of these inspiring runs did take place on Sunday, 20th January, during the tenth running of the Standard Chartered Mumbai Marathon, but on that day something much more miraculous took place- a runner survived a cardiac arrest!

At around 8:15 am, I was running alongside the venerable Fauja Singh as medical support (and I mean RUNNING, not jogging or walking), when I got the dreaded call on my walkie talkie.  A runner had been 'picked up' around Babulnath mandir, and was in cardiac arrest.  In all my time as the Race Medical Director, these are the words that haunt me the most.  In simple language, a cardiac arrest is a 'death rhythm' and unless the person gets advanced medical care very very quickly, there are very few chances of survival.  Thanks to the very quick reaction time of our ambulance doctor, who started CPR on the spot, the runner reached Jaslok Hospital alive.  By the time he reached, he had already received advanced CPR, a tube was put down his throat to his lungs, and he was give intravenous emergency medication.  At the hospital another of our doctors received him and along with the Jaslok team, continued with the emergency medical care.  I was at the hospital, and must give credit to all for working in perfect unison.  In no time the on-call cardiologist arrived and the runner was taken up for an emergency angiography.  He made it through the procedure and was then shifted to the ICU for observation and treatment.

Medical Base Camp

As of this morning (thursday) he was fine and in complete recovery mode.  It is very rare to rescue a cardiac arrest, especially in the middle of a crowded event, and for that I am grateful to the Asian Heart Institute medical team and God.....I am sure the deity of Babulnath mandir was watching over us all that morning.

Great Weather for the Marathon, but Take Care

I am writing this on Saturday morning, a day before the 10th Standard Chartered Mumbai Marathon, and the weather is perfect. I was on Marine Drive at 10 am, with two living legends of distance running, Haile Gebrselassie and Fauja Singh and was surprised by how cool it was.  It's perfect running weather and let's hope it lasts for at least 24 hours more.
However, since its unusually cold for our city, I thought I would thrown in a few points which runners should be aware of:

1. Plan to carry something to warm you up, before you leave home, and as you wait at the start line. Two great options are an old t-shirt or a large garbage bag, with appropriate cut-offs for your arms.  Both, can be discarded after a few km of running, probably after the sea-link for half marathoners, and after marine drive for the full. (please, please don't throw the garbage (pun intended) on the road, but in a trash can).

2. While this weather is great to attempt a personal best, don't get carried away at the start. Stick to your pacing plan (trust you have one ready by now).  If you are feeling great, you can always accelerate once you hit the home stretch at Marine Drive. That still gives you plenty of time to put in a better than expected performance.

3. Don't ignore hydration. Your thirst cues may be a bit off, due to cooler weather, but I suggest you stick to your usual hydration and nutrition plan (again, I trust and hope you have a plan).

4. Have fun and have a great race.

Why does India fare so poorly at the Olympics?

Let me begin with a confession. I have spent the better part of the last two weeks with my eyes glued to the TV screen and my buttocks glued to the couch. It's an irony that the Olympics which embody the zenith of physical activity have turned me into a couch potato. Thanks to the non-stop coverage on 4 different channels, and my newly acquired toy, the HD-recording TataSky setbox, I have been able to record the Games on two different channels, while simultaneously watching an earlier recording on a third channel. And thanks to watching only recorded versions, I have been able to fast forward the deeply regressive and offensive Hero motorcycle commercials (the ones where the women are called 'chidiyas') and the annoying Tata docomo ads (to be fair to them, even the best ad when repeated a zillion times can be annoying).

As the games progressed, it became quite clear that India was not going to drastically improve its performance over the previous years, and before you pounce on me and point out that we have doubled our medal haul, let me remind you that its a double of three. It's the same 'low-base' effect that affect most of our national calculations, including economic growth. Six medals for a large nation is a pathetic showing by any standard, and here I am not even getting into our exact population, since I understand that that is not entirely fair given the circumstances in which a large number of people live. Having said that, I have the deepest respect and admiration for all the medal winners and all the other athletes who fought valiantly on the international stage. A special mention must be made of OGQ (Olympic Gold Quest), and their efforts. I have met Viren Resquniha and the dedication he and his team have is amazing.

So, to get back to the original question of our perennial poor performance, let me try and answer it with a little bit of science and a lot of my own thoughts, for whatever they are worth. Let me preface it with the disclaimer that at the end of all my thoughts, you may be more confused than when you started.

The Nature Vs Nurture Debate:

In a lot of human endeavour and human health, scientists have forever tried to answer the question of how much of what happens to us is due to genes, versus the environment. There is no doubt that there are genetic factors at play which influence sporting performance. The most stark examples of that are the Jamaicans and the East Africans. Jamaica has a population of 2.8 million people (about one fifth of Mumbai- sorry, I could not resist that), and has had a monopoly on both the men and women's short sprint distances, over the recent past, and East Africans have had that same monopoly over middle and long distance running. Our muscles are divided into three different fiber types; 1, 2a and 2b. Type 1 are also called slow twitch muscle fibers, and as the name implies they are designed for distance rather than speed. Type 2 are fast twitch muscle fibers, of which type 2 b are essential for explosive speed, the kind needed to ace the short distance sprints. The percentage of fiber types is largely genetic, and world-class sprinters are born with a large amount of type 2 b muscle fibers. It would be scientifically accurate to say that if you did not have a significant amount of these, there is no way you could be a world class sprinter. Clearly the Jamaicans have an abundance of these, though they were 'discovered' only recently. I think it was Merlene Ottey, the great woman sprinter who threw open the doors of possibility in the 1984 Olympics (incidentally, Merlene is still competing at the international level, at the unbelievable age of 52, but for the Czech Republic now). Ever since the floodgates have been opened, the Jamaicans have dominated. Similarly the East Africans have dominated long distance running, over the past few decades, and they are blessed with an abundance of Type 1 muscle fibers which are fatigue resistant and allow them to glide like gazelles over long distances. The Jamaican and East Africans have been 'discovered', but there are several other parts of the world, which are just discovering their potential, such as The Bahamas in sprinting, and Uganda in distance running.

Both long and short distance running, as well as several track and field events at the Games require a large amount of 'genetic gift'. But, most of the other events at the Olympics don't. You don't need to be born talented to excel at fencing, or badminton, or table tennis, or synchronized swimming. Yes, talent will help, but will not be the deciding factor in success, unlike the sprint events. The point I am trying to make is two-fold.

1. Genetic talent or the nature part of the nature vs nurture argument, cannot justify our poor showing at the Olympics, since very few sports are heavily dependent on raw genetic talent.

2. India is a very vast country, consisting of varied ethnic groups. I am sure a dedicated search will unearth several groups who have the right muscle fiber structure needed for track and field events. One group that comes to mind are the folk who live in the high mountains, and have a superior ability to utilize oxygen and therefore perform well in long distance events.

The 'lack of interest' debate:

Culturally, I do not think that sport has ever been a priority for Indians. A recent worldwide study showed that Indians are a relatively active group, compared to several other countries, though I doubt that. My feeling is that this included the country as a whole, and as we know a large part of the country is under-served by road and mechanized transportation, making physical activity necessary for survival, as opposed to something done voluntarily for health benefits. Besides cricket we really don't give a damn about sports, and even in cricket our performance is at best lukewarm, considering that our population is more than all the cricket playing nations put together. We have always viewed sports as something that children do in school, and that too for a limited period of time, so that their academic prowess is not marred. In whichever city you live in, look around at the scores of billboards advertising 'coaching classes', and think about when was the last time you saw a hoarding which promised to make your child the best runner or tennis player. However, in spite of the lack of overall interest, we do know that there are parts of the country, which are crazy about football, such as Bengal and Goa. Put together, their population is far in excess of nations which excel at the game, but still we feature nowhere. I really don't have a convincing explanation for that.

The killer instinct:

There is a theory that we are good at sport, but lack the 'killer instinct' which is necessary for winning at the highest level. In my opinion, there is some truth to that. Take tennis for instance; over the last few decades we have had some fabulously talented players, but the one who made it to the top was Leander Paes. In pure strokeplay, Leander was clearly not the best of his generation (and I have had the good fortune of having played with most of them), but what set him apart was his strong mental strength. His lack of strokes was made up by agility of mind and foot, and I am willing to gamble that had he the strokes to match, he would certainly have been in the top ten in the world in singles. As a nation we seem to have taken that old saying to heart, 'its not the winning that counts, but the taking part'. This seems to reflect clearly in our approach. If you heard the commentary or read the news articles, it was apparent that we thought that being in the quarterfinals or semis was 'good enough' and we were not expected to ever challenge the top few seeds, especially in badminton, boxing, or wrestling. Why ? Most of our athletes in those sport were in the top 20 in the world, and therefore should be expected to win at the highest level, rather than have an attitude of 'reaching this far is good enough'. When pitted against the best in the world our media and athletes are satisfied with putting up a good fight, which often means winning a few points. Contrast that with the killer mindset, which has guided American sport in the recent past with the dictum, 'winning is not everything.....its the only thing'.

However, amidst all this gloom, the silver lining is that we have won more medals than ever, and that should spur on a whole new generation to perform better. Mary Kom, Yogeshwar Dutt and others will serve as heroes to the country, especially those in their hometown, who will know that it can be done, and in human endeavour that's often all that is needed for success. Much like the 4 minute mile barrier which stood for decades, but once Sir Roger Bannister broke it, it was broken repeatedly in that same year. Our medal winnners this Olympics will serve as the Bannisters of their generation, or closer home, they will serve as Tenzing Norgay did to a whole generation of Sherpas to reach the highest point in the world. And when they do so, cynics like myself will have to start blogging about why Indians are so great at sport.