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Long-distance running has become a new fad among middle-age Indians who want to remain fit.There are is both the risks and the benefits of exercise and deaths while running a marathon have been reported. There is universal agreement that benefits of exercise outweigh its associated risks, aerobic cardiovascular function declines with age and some people will not be fit enough or be at risk if they take up prolonged strenuous exercise

According to  Dr S.S Sibia, Director of Sibia Medical Centre , Long-distance running doesn't affect heart health in the long run.The cardiac risk due to undetected heart disease may trigger sudden death or myocardial infarction particularly in those not accustomed to regular exercise. Atherosclerotic coronary artery disease is the most common heart disease blamed for this but occasionally congenital or acquired heart diseases such as hypertrophic cardiomyopathy, aortic stenosis and dilated cardiomyopathy may be responsible. Some persons are prone to arhythmias and conduction abnormalities.

For these reasons pre-participation medical evaluations is recommended before entry into any strenuous sports activity to identify occult cardiovascular disease having potential to cause sudden cardiac death, fatal or non-myocardial infarction, stroke, angina or heart failure. Evaluation by physicians should include personal and family history, physical examination, ECG test, exercise test (Treadmill test) and echocardiography. The new non-invasive cardiovascular Cartography test is desirable if available as it gives a good idea of regional coronary blood flow, collateral circulation and arryhtmogenicity. Those with abnormal lipid profile, hypertension, smokers and diabetics should be considered as having increased risk. The probability of exercise-induced cardiac event is generally higher in persons with coronary artery disease with more than 50% luminal diameter narrowing, left ventricular ejection fraction below 50%, exercise-induced myocardial ischemia evidenced by angina, positive ECG, exercise-induced hypotension or arrhythmias.

It must however be remembered that the result of pre-participation testing has poor positive predictive accuracy and false-positive results with negative psychological implications.Running do you recommend for a person in his/her 40s, say in a week, to maintain good heart health.It is not appropriate to recommend the amount of running for a person in his/her 40s; rather it should be symptom limited. As risk of a cardiovascular event is associated with the abrupt onset of intense athletic training in otherwise sedentary and untrained individuals the amount of stress of the speed and distance should be gradually increased.

In addition to that , Dr Sibia advise to those who want to run their first marathon.Health education is a benefit of the pre-participation evaluation regarding various aspects of self-monitoring and risk of cardiovascular events. Creating aware of the nature and significance of warning signs or symptoms of cardiovascular disease such as angina pectoris, angina equivalents, or impaired consciousness is the most important aspect or preparation and may be more helpful than the pre-participation evaluation itself.