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IN EARLY 2024, marathon runner Madison DiBattista was in the midst of training for her first Ironman race when she started experiencing alarming symptoms, like shortness of breath, chest pain, and episodes of passing out, among others. After running for over 11 years without any major problems, the 24-year-old wrote off her symptoms as anxiety or overworking while building her running gear company, Sprints<\/a>. Soon, however, she realized she wasn\u2019t getting any stronger amid rigorous training. \u201cIf anything, I was making my body so much weaker,\u201d she says. \u201cThere were a couple of weeks where I tried to get myself to run and just couldn’t.\u201d<\/p>\n Her dad shared her symptoms with a cardiothoracic surgeon friend who advised she see a doctor immediately. And yet, the doctors she saw initially wrote her off as healthy. \u201cMy primary care physician at the time looked me up and down and said, \u2018if you had heart disease, we would know by looking at you\u2019\u2014and I think that’s an easy box for athletes to be put into, because they’re healthy people. But heart disease can take a lot of different shapes.\u201d<\/p>\n After DiBattista\u2019s symptoms worsened (extreme weight loss, an abnormally high heart rate, etc.), doctors conducted additional tests and discovered she had a rare congenital heart defect\u2014so rare, in fact, that it had never been diagnosed or identified in a living adult, only through autopsies.<\/p>\n She had surgery in August of 2024, and shared one clear request for the surgeon: \u201cI want an Olympic-level heart,\u201d she says. \u201cI don’t want to get to the other side of this and have restrictions.\u201d She waited six weeks and six days before lacing up her sneakers again\u2014and now, she\u2019s working her way back up to racing, slowly but surely.<\/p>\n DiBattista\u2019s story is alarming, but it\u2019s certainly not an isolated case. There are a number of nerve-racking stories out there about runners<\/a> who thought they were in perfect health, only to discover heart issues while training for marathons or other endurance running events. And, in some instances, mid-race cardiac complications arise for people without any underlying conditions at all.<\/p>\n While cardiac arrests during races are very rare (a recent study estimates just 0.54 per 100,000 participants in the U.S., with cardiac deaths only accounting for 0.20 per 100,000) it is nevertheless alarming. In fact, some physicians even advise their patients against running longer endurance races to eliminate the possibility of excess strain on the heart.<\/p>\n With the numbers so low (for context, you\u2019re statistically more likely to die in a car accident than while running a marathon), completely abstaining from running marathons may seem overzealous. After all, isn\u2019t running supposed to be one of the best things you can do for your heart health?<\/p>\n But even with minimal marathon incidents, it does beg the question: Are marathon races really safe? Are they net positive or negative when it comes to cardiac health? And is it worth the potential risks?<\/p>\n What We Know\u2014and Don\u2019t\u2014About How Distance Running Impacts the Heart First off, let\u2019s get one thing clear: According to all of the experts we interviewed, running is good for your health\u2014and for your heart. \u201cRunning, similar to any exercise, is helpful from both the cellular and macro physiological level,\u201d says Tamanna Singh, MD<\/a>, clinical cardiologist and director of the Sports Cardiology Center at the Cleveland Clinic.<\/p>\n Running helps to increase your mitochondrial density, increase the myoglobin in your muscles, and grow new blood vessels\u2014all of which helps increase the amount of oxygen and energy available to use, she says. What\u2019s more, as with most exercise, it reduces blood pressure, helps with cholesterol and blood sugar management. \u201cIt’s one of the reasons why we have people do cardiac rehab after a heart attack. We want to get that heart working efficiently,\u201d Dr. Singh says.<\/p>\n And the list of perks certainly doesn\u2019t end there. \u201cCardio respiratory fitness also is strongly associated with longevity, decreased mortality<\/a>, decreased cardiovascular events, decreased mental health issues, cancer risk, etc.\u201d says Jonathan Drezner, MD, a family medicine physician who specializes in sports medicine and sports cardiology.<\/p>\n So logic holds: Choosing to go out for a run is ultimately a positive choice for overall health.<\/p>\n However, running does put physiological strain on the heart, particularly when it comes to higher volume and intensity. No matter how well-conditioned an athlete is, plenty of research suggests that following a marathon, individuals experience an increase in inflammatory<\/a> and abnormal cardiac biomarkers<\/a>, says Sean Swearington, MD<\/a>, a cardiologist at Rush, whose research focuses on the cardiovascular effects of intense prolonged exercise.<\/p>\n One biomarker that\u2019s garnered the most attention is the cardiac enzyme troponin<\/a>\u2014typically associated with heart damage\u2014that is often released into the bloodstream following a marathon, says Dr. Singh.<\/p>\n What\u2019s more, \u201cwe’ll typically see some form of strain on the right side of the heart, which has a thinner wall structure. It’s not meant to handle higher pressure loads like the left side of the heart, which is more muscular, and the one responsible for pushing the blood to the rest of your body,\u201d she says.<\/p>\n However, Dr. Singh points out that for individuals with a healthy heart, these effects tend to be transient, meaning \u201cwe typically see resolution of that within about 24 to 48 hours.\u201d<\/p>\n The issues tend to arise when people have heart disease, heart failure, or other underlying heart conditions\u2014as those individuals may not be able to sustain the effort required during endurance events, and may become symptomatic as a result, she explains (more on this later). \u201cThere is one disease entity where higher volume, higher intensity exercise can actually increase the risk of sudden cardiac arrest and death, and that’s arrhythmogenic cardiomyopathy [an inherited disease characterized by dangerous, irregular heart rhythms]\u2014but it’s rare.\u201d<\/p>\n There\u2019s also some debate over whether or not long-term endurance exercise increases the risk of developing scar tissue<\/a> buildup in the heart (clinically referred to as myocardial fibrosis). \u201cThere [have] been some studies using cardiac MRI<\/a> that look at lifetime marathoners compared to non-marathoners or the general population, and in lifetime marathoners, there are some areas of the heart that look like they have a little bit of fibrosis in the heart muscle,\u201d says Dr. Drezner, \u201cbut there’s absolutely no clinical correlation. There’s no higher risk of arrhythmias or sudden death, or anything in those individuals. And so we don’t know what it means.\u201d<\/p>\n Another potential topic of concern is the occurrence of atrial fibrillation (irregular and often rapid heart rhythm, commonly referred to as AFib) in endurance athletes. AFib can lead to symptoms like palpitations, shortness of breath, and fatigue\u2014or it could be totally asymptomatic. Left untreated, AFib can increase the risk of stroke, heart failure, or other serious complications. \u201cAtrial fibrillation occurs in the general population and occurs in other medical conditions like heart failure,\u201d Dr. Drezner says, \u201cbut it is more common in athletes, and specifically endurance athletes.\u201d<\/p>\n He notes that some experts believe this is because, as we exercise, the heart chamber gets larger and stronger; as a result, it dilates with more blood, which can then obstruct the smaller chamber of the atria. \u201cThat stretch may throw off the electrical signal of the heart a little bit and increase someone’s predisposition to developing atrial fibrillation,\u201d Dr. Drezner says. \u201cSo long term, is there a higher risk of developing AFib? Yes. Is that a reason not to go out and run marathons? I don’t think so.\u201d<\/p>\n When High-Endurance Events Can Become Dangerous While it\u2019s a wildly unsatisfying answer, Dr. Drezner says those scary cardiac events are often random. \u201cI don’t think there’s anything inherently risky to a marathon event that isn’t present in other forms of exercise, if you push yourself hard enough,\u201d he says. \u201cYou could also have random events that occur when you’re shoveling snow in the morning or playing basketball or on the football field.\u201d<\/p>\n Nevertheless, they do happen, and one of the best protective measures is simply bodily awareness\u2014during a race, yes, but also throughout training. \u201cI would say probably the majority of the time, if you were to go back and talk with [people who were having cardiac issues during a race], they would probably tell you that they were having some symptoms of chest pain or lightheadedness or abnormal shortness of breath that they may have tried to ignore,\u201d says Dr. Swearington. \u201cA lot of times, individuals who are highly active won’t always tell you when they’re experiencing things, and they’ll try to push through those symptoms,\u201d as demonstrated by DiBattista\u2019s experience. Case in point: Pay attention to your symptoms, and alert a cardiologist if anything feels abnormal.<\/p>\n And while running for long periods is not necessarily dangerous, at a certain volume, the cardiac benefits hit a point of diminishing returns, Dr. Swearington notes. \u201cTypically what I say is, once you get to the point of doing six to eight hours per week, beyond that, you are limiting any significant benefit,\u201d he says.<\/p>\n That\u2019s not to say once you get into that zone that it\u2019s hazardous (Dr. Swearington says there is no definitive evidence of a negative impact on your heart, beyond the potential increased risk of AFib). But if you\u2019re running with the goal of improving your heart health, know that you\u2019re not necessarily doing your body any additional favors at that point.<\/p>\n Before Blaming the Marathon, Look at the Machinery As with any facet of your well-being, heart health is determined by a number of variables\u2014all of which may influence risk of complications (during a race or otherwise).<\/p>\n There\u2019s a saying that goes, \u201cyou can\u2019t outrun a bad diet,\u201d and that\u2019s true. \u201cA lot of people think, \u2018I’m exercising like crazy, I can eat and drink whatever I want,\u2019 and that’s really not the case,\u201d says Dr. Swearington. \u201cWe do see, not uncommonly, that people can be high intensity athletes and develop significantly blocked heart arteries from cholesterol buildup over a long period of time.\u201d And the downstream effects of said bad diet might rear its ugly head during training or even a big race.<\/p>\n That same principle applies to other lifestyle choices\u2014smoking, drinking, and even a lack of good sleep hygiene. In short: If you\u2019re not taking care of the motor, the car isn\u2019t going to run very smoothly, and could even break down.<\/p>\n And, perhaps the most influential factor when it comes to heart health is none other than the one factor that\u2019s uncontrollable: genetics. You may be predisposed to an underlying condition, even at a young age, despite checking all the boxes to take care of your health. That\u2019s why it\u2019s crucial to know your personal and your family history, Dr. Singh says, so you can understand what your cardiovascular risk is in the long run. \u201cKnow what your labs are, know what your baseline labs are, and continue with surveillance there,\u201d she says. \u201cThat way, you’re always in the know of where your body is, how it\u2019s changing as you age, and what you can do to prevent bad things from happening.\u201d<\/p>\n Women May Have an Edge When Going the Distance Speaking of genetics, it\u2019s no secret that cardiovascular disease tends to affect men sooner than women. By that estimation, does that mean female athletes\u2019 hearts are actually better-suited for endurance running?<\/p>\n As with most health research, there are very few studies specifically about female runners\u2019 heart health. Because of that \u201cit’s hard to say whether it’s low data or there\u2019s actually low incidence of things like sudden cardiac arrest and death, cardiomyopathy, cardiovascular disease,\u201d with female marathoners, says Dr. Singh. What we do know is that estrogen is very cardioprotective, which explains why cardiovascular disease might show up later for women (generally after perimenopause or menopause).<\/p>\n Anecdotally, however, Dr. Singh has heard many cases of women becoming stronger marathoners after having children. To her, this makes complete sense: \u201cI don’t have any science to back why we’re seeing a lot of women pull off amazing feats at these longer endurance events in their late 30s,\u201d she says, \u201cbut I do think the challenge of of growing the fetus and the physiological changes to your heart, into your vasculature, into your blood volume, and that’s an endurance sport.\u201d<\/p>\n The New Rules of Signing Up for a Marathon and Training Safely As the saying goes: It\u2019s about the journey and not the destination, and that sentiment is certainly true when it comes to heart-friendly race prep.<\/p>\n First and foremost, if you have even an inkling of concern about your cardiac health, go get checked out. Watch out for chest pain, lightheadedness, abnormal shortness of breath, or really any new, alarming symptoms during exercise. In DiBattista\u2019s case, warning signals also extended to episodes of passing out, 25 pounds of weight loss in a two-month period, rashes all over her body, and night sweats. She notes that, for her, wearing an Apple Watch was an extremely valuable tool for detecting and validating that something was off (she had a resting heart rate of 115 BPM, and during exercise it sometimes surpassed 200). Ultimately, this data convinced gave her the final nudge to seek medical attention.<\/p>\n In hindsight, DiBattista realizes how important it is to take all symptoms seriously\u2014and beseeches others to do the same. \u201cIt’s very easy to gaslight yourself into thinking that you’re okay, or you’re tough enough to handle it, or you don’t need to ask for help,\u201d she says. \u201cBut I beg people to take every symptom very seriously, even if you feel like a hypochondriac or you feel like you’re blowing things out of proportion.\u201d<\/p>\n Now, because of her experience, DiBattista\u2019s friends and family have started getting preventative scans for their own hearts\u2014an action that Dr. Drezner also stands by. \u201cPeople should know their cardiovascular risk,\u201d he says. (Testing might include imaging, stress testing, and an electrocardiogram\u2014and the doctor may also evaluate lifestyle risk factors.) \u201cNo matter what age you are, there is an appropriate screen that can give you information.\u201d<\/p>\n For female-bodied distance runners, specifically, it\u2019s a good idea to get checked for anemia\u2014as this can impact heart health by forcing the heart to work harder, leading to increased heart rate. Chronic anemia can even lead to structural changes like an enlarged heart muscle, arrhythmia, and heart failure.<\/p>\n And even if you\u2019re completely asymptomatic, it certainly doesn\u2019t hurt to know your heart health baseline. \u201cEmpower yourself and rip the band-aid off,\u201d Dr. Singh says. \u201cSome people think ignorance is bliss, but it truly is not. Ignorance leads to a lot of poor outcomes.\u201d<\/p>\n From that point, a cardiologist can help determine if there are any underlying health concerns, and offer any recommendations for lifestyle adjustments to support overall heart health. A sports cardiologist can also determine if you\u2019re safe to participate in any kind of fitness event (including running a marathon), and offer suggestions for how to train most effectively in order to minimize any possible risks.<\/p>\n While those recommendations are highly individual, there are some general guidelines to consider. For instance, Dr. Swearington typically recommends completing some amount of cardio or endurance training four days a week, along with two days of strength training. And, he tells his patients not push themselves towards maximum heart rate on a regular basis. Instead, he suggests sprinkling in high-intensity interval training<\/a> throughout the week, \u201cto get toward their maximum predicted heart rate intermittently, which can help improve their overall endurance going forward,\u201d he says. \u201cThat type of training has been shown to be beneficial in individuals with known coronary artery disease, and hasn’t shown any increased risk as far as them having recurrent cardiac events.\u201d<\/p>\n![\"Loader](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/03\/70c266e3-7f8c-46fd-b801-2835ed1b0a70.png\" "\\"Loader")
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