Fitness versus Health: Marathons Test Not Just Endurance but Logic Too

Safer on the sidelines?

The mortality toll of the 2011 Philadelphia Marathon was two runners out of approximately 25,000, a death rate that proponents of the event might represent as less hazardous than the risk of commuting the distance by car. And probably much safer than couch-bound obesity. Even when we take into account the many people who require first aid for dehydration or suffer orthopedic injuries, the hazards of marathon participation might strike many as relatively low. Life is risky business, after all, and testing human limits -- for pleasure or heroism -- often comes at a price.

Nonetheless, it is curious to observe how sanguine health experts and the public have become about tests of endurance that can result in needless death, and how little discussion we hear in the aftermath about the wisdom or health value of marathon participation. That’s because marathons -- once considered an “extreme sport” for the very few -- are now an icon of our fitness culture, attracting virtual hordes of runners in cities across the country, more and more of whom run the full distance each year.

Marathons are a spectator sport and a badge of fitness honor -- not to mention a source of mood elevation for those addicted to long-distance running. And for the cities that host them, they are also very much a business that creates dollars, press, and caché. When endurance events like marathons and triathlons are promoted by health celebrities and fitness missionaries like CNN’s Sanjay Gupta, they gain more credibility and many more converts.

Maybe not born to run long distance

However, the case for long-distance runs is not nearly so easy to make as, say, brisk walking, which is now widely acknowledged to be ideal exercise, beneficial even in relatively small doses. Running is punishing to the musculoskeletal system, and as we learn more about the “science” of running and athletic apparel, we are discovering that our expensive, high-tech footwear may be doing us more harm than good. The miles we run as a culture add up to a lot of chronic injury at a lot of medical expense and pain. And after every marathon, we are confronted with the logical implications of pushing anything to the limit. Such as when a 26-mile run unmasks fatal cardiovascular anomalies in a few apparently healthy people, or stresses normal kidneys beyond their limits. Short runs are healthier, plain and simple. Even the famous runner at Marathon who started it all fell dead on the ground when he reached Athens.

The modern paradox: marathons and morbid obesity

In a society of extremes, simultaneously plagued by obesity and infatuated with fitness, we have to ask ourselves whether we are doing our culture something of a disservice by conflating fitness with basic health. Fitness is big business and it has grown increasingly powerful as a cultural idea since the President’s Council on Fitness, Sports and Nutrition waged the first campaign to get us Baby Boomers out of our school desk chairs in the late 50s. (Little did anyone know how much we’d ultimately need the help!) But fitness is a cultural term owned by many people whose health credentials are not always clear, and by enterprises whose motives are based as much on commerce as science.

Although the fitness strivers among us are secretly hoping we can out-run death at the gym or track, we need to acknowledge that the correlation between this ill-defined thing called fitness and conventional health measures is actually ambiguous. Even statistics that vault the low death rate for marathon runners fail to note that the relevant comparison of their own risk of dying on another more leisurely day is roughly seven times lower.

Clearly, it’s important to be active and avoid excessive weight gain. Physical activity delivers significant health dividends and social ones as well. But the relentless pursuit of fitness -- particularly compulsive, punishing demonstrations of endurance -- is something the medical community might legitimately challenge among that fit minority of their patients who seem bent on running marathons.

Presumably, there is little motivation to do that because if you play the numbers, more people will die this year of lifelong inactivity than long-distance running. But maybe if we de-glorified marathons a little, and we adulated shorter walking events, then getting to the last mile-post would be easier for those among us who must set more realistic aspirations, and public health would be better served.