Report on Marathon Medicine, the London Marathon conference on the Science and Medicine of endurance running

By Drs Charles Pedlar @pedlarcr and Courtney Kipps @ProActiveSpMed

The 35th Marathon Medicine conference was held on the 21st April 2018 at RIBA in Central London in partnership with and supported by the Virgin Money London Marathon.  The event attracted over 300 delegates this year from volunteer medical staff working in the medical tents at the Marathon to runners working in the science or medical field. For many delegates, the event is a stable fixture in their annual event calendar and considered a reliable update on the cutting edge science and medicine of endurance running.

Running economy as a target for strength training

Our first speaker, Richard Blagrove, is a strength and conditioning specialist from Birmingham City University whose PhD thesis is focused on strength training for endurance runners. Richard provided an expert overview of the historic literature on the physiology of distance running (his 2018 review article on the effects of strength training on the physiology of running has already hit 30,000 downloads).  He honed in on two areas, namely running economy as a target for strength training; and injury prevention as a related  outcome.  The talk was impressively methodical and grounded in research, interspersed with practical training advice delivered via video.  Richard outlined a sequence to adopt in strength training sessions recently proven to be effective in young athletes undertaking 2 sessions per week for 10 weeks which included ‘movement preparation’, ‘plyometrics and running drills’, ‘explosive strength training’ and finally ‘tissue conditioning’. It was entirely fitting to finish with a plug of Richard’s book ‘Strength and Conditioning for Endurance Running’ where much more detail can be found in the science and application of strength training.

Marathon running within the normal boundaries of health for humans

The next speaker Professor Rob Shave, is well known as a longstanding former organiser of Marathon Medicine.  Rob discussed marathon running within an evolutionary context, exploring ideas and theories related to the evolution of the human cardiovascular system.  Endurance running may well have shaped the evolution of early man and if so this will likely have influenced the structure and function of all components of the cardiovascular system. He described the importance of cardiac mechanics in meeting the demands of an increased cardiac output during exercise, specifically the striking twist mechanics that human hearts utilise to augment ventricular filling and ejection during endurance exercise. Professor Shave made it clear that marathon running is well within the normal boundaries of health for humans.

Remain active after marathon to retain positive adaptions to the cardiovascular system 

Dr Charles Pedlar followed this with a talk on the reversal of cardiovascular adaptations that occur with detraining.  Since training studies do not typically extend to a detraining phase, Charlie discussed cardiac atrophy and blood volume reduction in other settings, for example injury, bed rest and space flight.  In these studies dramatic reductions in left ventricular mass and blood volume have been observed, whilst in altitude studies reversal of haematological adaptations are observed upon return to sea level. Charlie described the effects of detraining amongst recreational (mass-start) Boston Marathoners, observed over 2 months following themarathon, showing evidence of cardiovascular detraining even among ‘average’ marathon runners.  Charlie underscored the importance of maintaining a stimulus (i.e. remaining active) after the marathon to retain the positive adaptations to the cardiovascular system that marathon runners achieve.  He also hinted at a potential new mechanism for retaining circulating haemoglobin mass once the training stimulus is removed, via extending the lifespan of the red blood cell, perhaps identifying a protective mechanism of this important physiological resource.

In memory of Marathon Medicine Co-founder, Professor Craig Sharp 

Before the fluid and carbohydrate break, Professor Greg Whyte delivered  a poignant oration on Marathon Medicine co-founder Professor Craig Sharp, who sadly died this year after a long illness. Craig was a remarkable man who trained as a vet, yet is revered as one of the fathers of sports science in the UK and founder of the British Olympic Medical Centre.  Craig will also be remembered for his treasure trove of fascinating stories, including being the first person to accurately measure the speed of a cheetah in full sprint, whilst standing in the back of a speeding Land Rover with a stopwatch in one hand and slab of fresh meat in the other. There was scarcely a dry eye in the audience and there was much to reflect on during the refreshment break.

Time for new race rules to protect athletes from catastrophic physical failure

Coverage of the London Marathon in 2017 was dominated by the story of David Wyeth who famously collapsed in sight of the finish line and indeed similar scenes repeated very recently in the Commonwealth Games Marathon with the collapse of Scottish runner Callum Hawkins.  This was the context behind Professor Alan (Zig) St Clair Gibson’s talk, describing the physiology and features of ‘The Foster Collapse positions’ where an unreasonable or primal desire to continue physical exertion against all odds is met with catastrophic physical failure putting the athlete at risk of injury or possibly death.  Zig resolutely called for new race rules to protect athletes in the future and no doubt this discussion will continue amongst race medicine leaders around the world.

Recovery: cold water immersion science and practice

Finally, Professor Glyn Howatson fittingly finished the meeting on the subject of recovery, focusing on cold water immersion as an effective tool for speeding recovery where sustained performance is required.  Glyn drew on his vast experience in both research and practice, guiding best practice in recovery science and emphasizing that the common feature of most studies to date is a strong perception or belief that the chosen recovery aid is effective.  Glyn discussed emerging technology that will help avoid the practical barriers of cold water immersion with a novel phase change material capable of delivering a consistent prescribed and timed ‘dose’ of local cold exposure. The added advantages of this PCM is that it can be wrapped close to the skin and placed under clothes, which could be particularly useful for the travelling athlete.

The meeting finished with a lively round table discussion, dominated by the issue of exercise-induced collapse.  It will be fascinating to see how this discussion unfolds and whether cultural change will deem it appropriate to remove athletes from competition when signs of collapse become evident, rather than to keep pushing them to the very end.  There are parallels of course with concussion protocols in boxing and rugby where society has shifted the emphasis from entertainment at all costs to protecting the health and welfare of the participant particularly where the athlete may have lost the self-awareness to make the call themselves.

We would like to thank the Virgin Money London Marathon for their ongoing support of this event.  We are already  looking forward to Marathon Medicine 2019.

Marathon Medicine:  @MarathonMed

Want to stay up to date with the speakers? You can follow them here:

Charlie Pedlar:  @pedlarcr
Courtney Kipps:  @ProActiveSpMed
Richard Blagrove: @rich_blagrove
Rob Shave:  @RobShave10
Greg Whyte:  @gpwhyte
Alan St Clair Gibson: @ziggibson
Glyn Howatson: @GlynHowatson

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