Helbredsrisici ved Marathon?

[kahlua-kalv]

Helt konkret ville jeg hører om der er nogle af jer som har kendskab til at deltagelse i Marathon løb er forbundet med nogle betydelige helbredsrisici? Fx Hjerteproblemer osv. Jeg tænker ikke på skinnebensbetændelse el. lign.

Jeg har søgt lidt på PubMed for at finde undersøgelser der kunne underbygge risikofaktorerne ved at deltage, men kan kun finde artikler om alm. skavanker i bevægeapparatet umiddelbart efter løbet.

Nogle der kan hjælpe?

[KnuD45]

Hvis du er sund og rask, kan jeg da ikke se der skulle være noget at bekymre sig over.

Edited August 5, 2007 by KnuD45

[kahlua-kalv]

Nej det mener jeg jo heller ikke selv, men der må selvfølgelig være nogle der falder om med hjerteproblemmer osv. uden at de var klar over deres helbredstilstand inden de startede løbet.

Jeg ved at hjerte-patienter har øget risiko under motions-udøvelse, men nedsat i døgnets øvrige 24 timer.

Spørgsmålet er bare om man på nogen måde kan vise øget risici i forbindelse med marathon og om det i givet fald, burde være medvirkende til at fraråde fx 50 årige at løbe så langt?

Mit eget gæt er at de positive aspekter af træningen frem mod løbet vil være overvejende gavnlige, mens selve løbet muligvis kan være skadeligt?

[mugge]

Da jeg løb mit første marathon kom jeg ind på 4.27 og lige før mig løb mand jeg ville have skudt på at være godt oppe i tredserne måske 70. Hvis du kigger på listen over dem, der gennemfører Copenhagen Marathon vil du se, at der er rigtig mange, der gennemfører i en høj alder. Hvis det var farligt for dem, ville man nok have hørt om det.

[Sortiarius]

Der er til tider folk der blot falder om med hjertestop til marathon (eller andre ekstreme idrætsaktiviteter) uden nogen tilsyneladende forklaring. Der findes mange teorier men een af de udbredte er at der hvis man presser sig selv udtalt i lang tid kan få et forhøjet niveau af elektrolytten kalium i blodet, en problematik der også nogle gange ses i trafik-traumer hos folk der samtidig får mange blodtransfusioner. Kaliumophopbningen skyldes overbelastning af den såkaldte Natrium-Kalium pumpe der pumper kalium ind og natrium ud af cellen. Et for højt kalium niveau (og til tider også et for lavt) forstyrrer hjertets depolarisering og kan resultere i spontant ventrikelflimmer (hjertestop) eller andre alvorlige arytmier. Men som sagt er det kun en teori.

[Diddley]

Der er masser af folk over 50 år, der løber marathon uden problemer. Jeg tvivler på at veltrænede løbere udsætter sig selv for nogen særlig risiko, udover de almindelige belastningsskader.

Jeg plejer at kunne nøjes med forkølelsessår og vabler

[kahlua-kalv]

Kaliumophopbningen skyldes overbelastning af den såkaldte Natrium-Kalium pumpe der pumper kalium ind og natrium ud af cellen. Et for højt kalium niveau (og til tider også et for lavt) forstyrrer hjertets depolarisering og kan resultere i spontant ventrikelflimmer (hjertestop) eller andre alvorlige arytmier.

Vil det ikke være rimeligt at antage det primært gælder personer som dybest set ikke er i form til at gennemfører et langvarigt anstrengende løb? Hvis man ofte løber længere ture burde det vel ikke kunne ske?

[Au-4ooo]

En af mine forældres bekendte løb marathon og fik vist hjertestop... Nu er han frisk nok igen, men må nøjes med halvmarathon...

[Sortiarius]

Vil det ikke være rimeligt at antage det primært gælder personer som dybest set ikke er i form til at gennemfører et langvarigt anstrengende løb? Hvis man ofte løber længere ture burde det vel ikke kunne ske?

Tilfældene opstår typisk i maraton og det må antages at de fleste der deltager der er i god form. Det ses også sjældnere hos blandt bl.a. fodboldspillere, her findes dog også en teori omkring NSAID (her især selektive COX-2 hæmmere) der er knap så velfunderet.

Så for at svare på dit spørgsmål synes det at kun ramme de fleste, i alle aldersgrupper, men det er trods alt et relativt sjældent fænomen og ikke noget jeg synes man skal bekymre sig voldsomt om.

Mig bekendt kan Na-K pumpen dog godt trænes (opreguleres)

Edited August 6, 2007 by Sortiarius

[Keyz]

Hey

Kom lige til at tænke på nogle artikler jeg har læst. Tror måske det er sådan nogle du søger efter:

Artikel fra PubMed

Boston Marathon studie

Editorial fra PubMed

Marathoner's heart

Måske lidt svære artikler, men konklusionerne burde være til at forstå

/Keyz

[Guest Slettet bruger]

Hehe... Uden at ville hagles ned vil jeg gerne her indskyde, at jeg løb mit første marathon som 15-årig i tiden 4:37 og jeg havde VIRKELIG ikke trænet. Jeg spillede fodbold en gang eller to om ugen, og i slutningen af april hørte jeg så om et lokalt hold, som skulle til Copenhagen Marathon. Jeg grublede lidt over det, købte nye løbesko og løb i dem 4-5 gange. D.1 maj løb jeg så 20 km, og da jeg synes det var herre let meldte jeg mig til.

Jeg er siden hen blevet klogere, og ja det gjorde rigtig rigtig nas at løbe de sidste 14 km.

Generelt tilslutter jeg mit idéen om de mange teorier, men ingen entydig. For de personer som drætter om har som bekendt intet tilfælles. I øvrig kan jeg foreslå at løbe Copenhagen Marathon da de aldrig har haft et dødsfald (dårlig joke)

[Guest Slettet bruger]

Top Ten Reasons not to Run Marathons

10. Marathon running damages the liver and gall bladder and alters biochemical markers adversely. HDL is lowered, LDL is increased, Red blood cell counts and white blood cell counts fall. The liver is damaged and gall bladder function is decreased. Testosterone decreases.

From Wu, Worl J Gastroenterol. 2004 Sep 15: 10 (18): 2711-4, "RESULTS: Total bilirubin (BIL-T), direct bilirubin (BIL-D), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) increased statistically significantly (P<0.05) the race. Significant declines (P<0.05) in red blood cell (RBC), hemoglobin (Hb) and hematocrit (Hct) were detected two days and nine days d after the race. 2 d after the race, total protein (TP), concentration of albumin and globulin decreased significantly. While BIL, BIL-D and ALP recovered to their original levels. High-density lipoprotein cholesterol (HDL-C) remained unchanged immediately after the race, but it was significantly decreased on the second and ninth days after the race. CONCLUSION: Ultra-marathon running is associated with a wide range of significant changes in hematological parameters, several of which are injury related. To provide appropriate health care and intervention, the man who receives athletes on high frequent training program high intensity training programs must monitor their liver and gallbladder function."

9. Marathon running causes acute and severe muscle damage. Repetitive injury causes infiltration of collagen (connective tissue) into muscle fibers.

From Warhol et al Am J Pathol. 1985 Feb: 118 (2): 331-9, "Muscle from runners showed post-race ultrastructural changes of focal fiber injury and repair: intra- and extracellular edema with endothelial injury; myofibrillar lysis, dilation and disruption of the T-tubule system, and focal mitochondrial degeneration without inflammatory infiltrate (1-3 days). The mitochondrial and myofibrillar damage showed progressive repair by 3-4 weeks. Late biopsies showed central nuclei and satellite cells characteristic of the regenerative response (8-12 weeks). Muscle from veteran runners showed intercellular collagen deposition suggestive of a fibrotic response to repetitive injury. Control tissue from nonrunners showed none of these findings."

8. Marathon running induces kidney disfunction (renal abnormalities).

From Neyiackas and Bauer, South Med J. 1981 Dec; 74 (12): 1457-60, "All postrace urinalyses were grossly abnormal...We conclude that renal function abnormalities occur in marathon runners and that the severity of the abnormality is temperature-dependent."

7. Marathon running causes acute microthrombosis in the vascular system.

From Fagerhol et al Scan J Clin Invest. 2005; 65 (3): 211-20, "During the marathon, half-marathon, the 30-km run, the ranger-training course and the VO2max exercise, calprotectin levels increased 96.3-fold, 13.3-fold, 20.1-fold, 7.5-fold and 3.4-fold, respectively. These changes may reflect damage to the tissues or vascular endothelium, causing microthrombi with subsequent activation of neutrophils."

6. Marathon running elevates markers of cancer. S100beta is one of these markers. Tumor necrosis factor, TNF-alpha, is another.

From Deichmann et al in Melanoma Res. 2001 June; 11 (3): 291-6. "In metastatic melanoma S100beta as well as melanoma inhibitory activity (MIA) are elevated in the serum in the majority of patients. Elevation has been found to correlate with shorter survival, and changes in these parameters in the serum during therapy were recently reported to predict therapeutic outcome in advanced disease."

From Santos et al Life Sci. 2004 September: 75 (16): 1917:24, "After the test (a 30km run), athletes from the control group presented an increase in plasma CK (4.4-fold), LDH (43%), PGE2 6.6-fold) and TNF-alpha (2.34-fold) concentrations, indicating a high level of cell injury and inflammation."

5. Marathon running damages your brain. The damage resembles acute brain trauma. Marathon runners have elevated S100beta, a marker of brain damage and blood brain barrier disfunction. There is S100beta again, a marker of cancer and of brain damage.

From Marchi, et al Restor Neurol Neurosci, 2003; 21 (3-4): 109-21, "S100beta in serum is an early marker of BBB openings that may precede neuronal damage and may influence therapeutic strategies. Secondary, massive elevations in S100beta are indicators of prior brain damage and bear clinical significance as predictors of poor outcome or diagnostic means to differentiate extensive damage from minor, transient impairment."

Other studies indicate confusion in post-event marathon runners.

4. Marathons damage your heart. From Whyte, et al Med Sci Sports Ecerc, 2001 May, 33 (5) 850-1, "Echocardiographic studies report cardiac dysfunction following ultra-endurance exercise in trained individuals. Ironman and half-Ironman competition resulted in reversible abnormalities in resting left ventricular diastolic and systolic function. Results suggest that myocardial damage may be, in part, responsible for cardiac dysfunction, although the mechanisms responsible for this cardiac damage remain to be fully elucidated."

3. Endurance athletes have more spine degeneration.

From Schmitt et al Int J Sports Med. 2005 Jul; 26 (6): 457-63, "The aim of this study was to assess bone mineral density (BMD) and degenerative changes in the lumbar spine in male former elite athletes participating in different track and field disciplines and to determine the influence of body composition and degenerative changes on BMD. One hundred and fifty-nine former male elite athletes (40 throwers, 97 jumpers, 22 endurance athletes) were studied. ...Throwers had a higher body mass index than jumpers and endurance athletes. Throwers and jumpers had higher BMD (T-LWS) than endurance athletes. Bivariate analysis revealed a negative correlation of BMD (T-score) with age and a positive correlation with BMD and Kellgren score (p < 0.05). Even after multiple adjustment for confounders lumbar spine BMD is significantly higher in throwers, pole vaulters, and long- and triple jumpers than in marathon athletes."

The number two reason not to run marathons,

2. At least four particiants of the Boston Marathon have died of brain cancer in the past 10 years. Purely anecdotal, but consistent with the elevated S100beta counts and TKN-alpha measures. Perhaps also connected to the microthrombi of the endothelium found in marathoners.

And now ladies and gentlemen the number one reason not to run marathons,

1. The first marathon runner, Phidippides, collapsed and died at the finish of his race. [ Jaworski, Curr Sports Med Rep. 1005 June; 4 (3), 137-43.]

link

[mugge]

Top Ten Reasons not to Run Marathons

10. Marathon running damages the liver and gall bladder and alters biochemical markers adversely. HDL is lowered, LDL is increased, Red blood cell counts and white blood cell counts fall. The liver is damaged and gall bladder function is decreased. Testosterone decreases.

From Wu, Worl J Gastroenterol. 2004 Sep 15: 10 (18): 2711-4, "RESULTS: Total bilirubin (BIL-T), direct bilirubin (BIL-D), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) increased statistically significantly (P<0.05) the race. Significant declines (P<0.05) in red blood cell (RBC), hemoglobin (Hb) and hematocrit (Hct) were detected two days and nine days d after the race. 2 d after the race, total protein (TP), concentration of albumin and globulin decreased significantly. While BIL, BIL-D and ALP recovered to their original levels. High-density lipoprotein cholesterol (HDL-C) remained unchanged immediately after the race, but it was significantly decreased on the second and ninth days after the race. CONCLUSION: Ultra-marathon running is associated with a wide range of significant changes in hematological parameters, several of which are injury related. To provide appropriate health care and intervention, the man who receives athletes on high frequent training program high intensity training programs must monitor their liver and gallbladder function."

9. Marathon running causes acute and severe muscle damage. Repetitive injury causes infiltration of collagen (connective tissue) into muscle fibers.

From Warhol et al Am J Pathol. 1985 Feb: 118 (2): 331-9, "Muscle from runners showed post-race ultrastructural changes of focal fiber injury and repair: intra- and extracellular edema with endothelial injury; myofibrillar lysis, dilation and disruption of the T-tubule system, and focal mitochondrial degeneration without inflammatory infiltrate (1-3 days). The mitochondrial and myofibrillar damage showed progressive repair by 3-4 weeks. Late biopsies showed central nuclei and satellite cells characteristic of the regenerative response (8-12 weeks). Muscle from veteran runners showed intercellular collagen deposition suggestive of a fibrotic response to repetitive injury. Control tissue from nonrunners showed none of these findings."

8. Marathon running induces kidney disfunction (renal abnormalities).

From Neyiackas and Bauer, South Med J. 1981 Dec; 74 (12): 1457-60, "All postrace urinalyses were grossly abnormal...We conclude that renal function abnormalities occur in marathon runners and that the severity of the abnormality is temperature-dependent."

7. Marathon running causes acute microthrombosis in the vascular system.

From Fagerhol et al Scan J Clin Invest. 2005; 65 (3): 211-20, "During the marathon, half-marathon, the 30-km run, the ranger-training course and the VO2max exercise, calprotectin levels increased 96.3-fold, 13.3-fold, 20.1-fold, 7.5-fold and 3.4-fold, respectively. These changes may reflect damage to the tissues or vascular endothelium, causing microthrombi with subsequent activation of neutrophils."

6. Marathon running elevates markers of cancer. S100beta is one of these markers. Tumor necrosis factor, TNF-alpha, is another.

From Deichmann et al in Melanoma Res. 2001 June; 11 (3): 291-6. "In metastatic melanoma S100beta as well as melanoma inhibitory activity (MIA) are elevated in the serum in the majority of patients. Elevation has been found to correlate with shorter survival, and changes in these parameters in the serum during therapy were recently reported to predict therapeutic outcome in advanced disease."

From Santos et al Life Sci. 2004 September: 75 (16): 1917:24, "After the test (a 30km run), athletes from the control group presented an increase in plasma CK (4.4-fold), LDH (43%), PGE2 6.6-fold) and TNF-alpha (2.34-fold) concentrations, indicating a high level of cell injury and inflammation."

5. Marathon running damages your brain. The damage resembles acute brain trauma. Marathon runners have elevated S100beta, a marker of brain damage and blood brain barrier disfunction. There is S100beta again, a marker of cancer and of brain damage.

From Marchi, et al Restor Neurol Neurosci, 2003; 21 (3-4): 109-21, "S100beta in serum is an early marker of BBB openings that may precede neuronal damage and may influence therapeutic strategies. Secondary, massive elevations in S100beta are indicators of prior brain damage and bear clinical significance as predictors of poor outcome or diagnostic means to differentiate extensive damage from minor, transient impairment."

Other studies indicate confusion in post-event marathon runners.

4. Marathons damage your heart. From Whyte, et al Med Sci Sports Ecerc, 2001 May, 33 (5) 850-1, "Echocardiographic studies report cardiac dysfunction following ultra-endurance exercise in trained individuals. Ironman and half-Ironman competition resulted in reversible abnormalities in resting left ventricular diastolic and systolic function. Results suggest that myocardial damage may be, in part, responsible for cardiac dysfunction, although the mechanisms responsible for this cardiac damage remain to be fully elucidated."

3. Endurance athletes have more spine degeneration.

From Schmitt et al Int J Sports Med. 2005 Jul; 26 (6): 457-63, "The aim of this study was to assess bone mineral density (BMD) and degenerative changes in the lumbar spine in male former elite athletes participating in different track and field disciplines and to determine the influence of body composition and degenerative changes on BMD. One hundred and fifty-nine former male elite athletes (40 throwers, 97 jumpers, 22 endurance athletes) were studied. ...Throwers had a higher body mass index than jumpers and endurance athletes. Throwers and jumpers had higher BMD (T-LWS) than endurance athletes. Bivariate analysis revealed a negative correlation of BMD (T-score) with age and a positive correlation with BMD and Kellgren score (p < 0.05). Even after multiple adjustment for confounders lumbar spine BMD is significantly higher in throwers, pole vaulters, and long- and triple jumpers than in marathon athletes."

The number two reason not to run marathons,

2. At least four particiants of the Boston Marathon have died of brain cancer in the past 10 years. Purely anecdotal, but consistent with the elevated S100beta counts and TKN-alpha measures. Perhaps also connected to the microthrombi of the endothelium found in marathoners.

And now ladies and gentlemen the number one reason not to run marathons,

1. The first marathon runner, Phidippides, collapsed and died at the finish of his race. [ Jaworski, Curr Sports Med Rep. 1005 June; 4 (3), 137-43.]

link

Hvis det er rigtigt, så må elite matathonløbere, der vel løber adskilige løb om året have en markant overdødelighed. Nogen der ved noget om det. ?

[Guest Slettet bruger]

Hvis det er rigtigt, så må elite matathonløbere, der vel løber adskilige løb om året have en markant overdødelighed. Nogen der ved noget om det. ?

Arthur De Vany skriver som oftest om når marathonløbere dør - den sidste i rækken var "Brian Maxwell" som opfandt powerbaren. Han døde som 51 årig og var en meget kendt marathonløber. Arthur har en kategori på hans blog der hedder "Endurance Training: Death, Injury, and Risk" hvor han skriver rigtig meget om det.

[kahlua-kalv]

Artikel fra PubMed

Boston Marathon studie Spændende, men selv om den stiller spørgsmålstegn ved udvalgte parametre er den overordnede konklusion jo at det er fornuftigt at løbe, især hvis man har trænet fornuftigt frem mod løbet

Editorial fra PubMed

Marathoner's heart Den kan jeg desværre ikke få adgang til... Har du den på fil?

Måske lidt svære artikler, men konklusionerne burde være til at forstå Ja, men det gik lige...

/Keyz

[kahlua-kalv]

Top Ten Reasons not to Run Marathons

10. Marathon running damages the liver and gall bladder and alters biochemical markers adversely. HDL is lowered, LDL is increased, Red blood cell counts and white blood cell counts fall. The liver is damaged and gall bladder function is decreased. Testosterone decreases.

From Wu, Worl J Gastroenterol. 2004 Sep 15: 10 (18): 2711-4, "RESULTS: Total bilirubin (BIL-T), direct bilirubin (BIL-D), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) increased statistically significantly (P<0.05) the race. Significant declines (P<0.05) in red blood cell (RBC), hemoglobin (Hb) and hematocrit (Hct) were detected two days and nine days d after the race. 2 d after the race, total protein (TP), concentration of albumin and globulin decreased significantly. While BIL, BIL-D and ALP recovered to their original levels. High-density lipoprotein cholesterol (HDL-C) remained unchanged immediately after the race, but it was significantly decreased on the second and ninth days after the race. CONCLUSION: Ultra-marathon running is associated with a wide range of significant changes in hematological parameters, several of which are injury related. To provide appropriate health care and intervention, the man who receives athletes on high frequent training program high intensity training programs must monitor their liver and gallbladder function."

9. Marathon running causes acute and severe muscle damage. Repetitive injury causes infiltration of collagen (connective tissue) into muscle fibers.

From Warhol et al Am J Pathol. 1985 Feb: 118 (2): 331-9, "Muscle from runners showed post-race ultrastructural changes of focal fiber injury and repair: intra- and extracellular edema with endothelial injury; myofibrillar lysis, dilation and disruption of the T-tubule system, and focal mitochondrial degeneration without inflammatory infiltrate (1-3 days). The mitochondrial and myofibrillar damage showed progressive repair by 3-4 weeks. Late biopsies showed central nuclei and satellite cells characteristic of the regenerative response (8-12 weeks). Muscle from veteran runners showed intercellular collagen deposition suggestive of a fibrotic response to repetitive injury. Control tissue from nonrunners showed none of these findings."

8. Marathon running induces kidney disfunction (renal abnormalities).

From Neyiackas and Bauer, South Med J. 1981 Dec; 74 (12): 1457-60, "All postrace urinalyses were grossly abnormal...We conclude that renal function abnormalities occur in marathon runners and that the severity of the abnormality is temperature-dependent."

7. Marathon running causes acute microthrombosis in the vascular system.

From Fagerhol et al Scan J Clin Invest. 2005; 65 (3): 211-20, "During the marathon, half-marathon, the 30-km run, the ranger-training course and the VO2max exercise, calprotectin levels increased 96.3-fold, 13.3-fold, 20.1-fold, 7.5-fold and 3.4-fold, respectively. These changes may reflect damage to the tissues or vascular endothelium, causing microthrombi with subsequent activation of neutrophils."

6. Marathon running elevates markers of cancer. S100beta is one of these markers. Tumor necrosis factor, TNF-alpha, is another.

From Deichmann et al in Melanoma Res. 2001 June; 11 (3): 291-6. "In metastatic melanoma S100beta as well as melanoma inhibitory activity (MIA) are elevated in the serum in the majority of patients. Elevation has been found to correlate with shorter survival, and changes in these parameters in the serum during therapy were recently reported to predict therapeutic outcome in advanced disease."

From Santos et al Life Sci. 2004 September: 75 (16): 1917:24, "After the test (a 30km run), athletes from the control group presented an increase in plasma CK (4.4-fold), LDH (43%), PGE2 6.6-fold) and TNF-alpha (2.34-fold) concentrations, indicating a high level of cell injury and inflammation."

5. Marathon running damages your brain. The damage resembles acute brain trauma. Marathon runners have elevated S100beta, a marker of brain damage and blood brain barrier disfunction. There is S100beta again, a marker of cancer and of brain damage.

From Marchi, et al Restor Neurol Neurosci, 2003; 21 (3-4): 109-21, "S100beta in serum is an early marker of BBB openings that may precede neuronal damage and may influence therapeutic strategies. Secondary, massive elevations in S100beta are indicators of prior brain damage and bear clinical significance as predictors of poor outcome or diagnostic means to differentiate extensive damage from minor, transient impairment."

Other studies indicate confusion in post-event marathon runners.

4. Marathons damage your heart. From Whyte, et al Med Sci Sports Ecerc, 2001 May, 33 (5) 850-1, "Echocardiographic studies report cardiac dysfunction following ultra-endurance exercise in trained individuals. Ironman and half-Ironman competition resulted in reversible abnormalities in resting left ventricular diastolic and systolic function. Results suggest that myocardial damage may be, in part, responsible for cardiac dysfunction, although the mechanisms responsible for this cardiac damage remain to be fully elucidated."

3. Endurance athletes have more spine degeneration.

From Schmitt et al Int J Sports Med. 2005 Jul; 26 (6): 457-63, "The aim of this study was to assess bone mineral density (BMD) and degenerative changes in the lumbar spine in male former elite athletes participating in different track and field disciplines and to determine the influence of body composition and degenerative changes on BMD. One hundred and fifty-nine former male elite athletes (40 throwers, 97 jumpers, 22 endurance athletes) were studied. ...Throwers had a higher body mass index than jumpers and endurance athletes. Throwers and jumpers had higher BMD (T-LWS) than endurance athletes. Bivariate analysis revealed a negative correlation of BMD (T-score) with age and a positive correlation with BMD and Kellgren score (p < 0.05). Even after multiple adjustment for confounders lumbar spine BMD is significantly higher in throwers, pole vaulters, and long- and triple jumpers than in marathon athletes."

The number two reason not to run marathons,

2. At least four particiants of the Boston Marathon have died of brain cancer in the past 10 years. Purely anecdotal, but consistent with the elevated S100beta counts and TKN-alpha measures. Perhaps also connected to the microthrombi of the endothelium found in marathoners.

And now ladies and gentlemen the number one reason not to run marathons,

1. The first marathon runner, Phidippides, collapsed and died at the finish of his race. [ Jaworski, Curr Sports Med Rep. 1005 June; 4 (3), 137-43.]

link

Jeg har ikke fået tjekket alle kilderne, men nogen af grundende er sku for langt ude (nr. 1, 2 og 3) og 4 handler ikke om marathon, men endnu hårdere og længere belastninger...

Tror jeg vil tjekke lidt op på 6 og 7