Sports Med 2007; 37 (4-5): 279-280FOREWORD 0112-1642/07/0004-0279/$44.95/0

© 2007 Adis Data Information BV. All rights reserved.

The 2006 World Congress on theScience and Medicine of the MarathonWilliam O. Roberts

Department of Family Medicine and Community Health, University of Minnesota School ofMedicine, Minneapolis, Minnesota, USA

The 2006 World Congress on the Science and vention in sudden cardiac arrest and point-of-careMedicine of the Marathon evolved in an effort to analysers for diagnosis of hyponatraemia, dehydra-reproduce and update the historic meeting of the tion, hypoxia and hypoglycaemia have improvedNew York Academy of Sciences organised by Paul medical outcomes.Milvy in conjunction with the 1976 New York Mar- On the clinical side, runners still collapse at theathon. The 2006 World Congress was made possible finish, but most of benign, self-limiting causes thatby the sponsorship of the American Road Race resolve with supine rest and leg elevation. RunnersMedical Society and the American College of Sports continue to suffer unexpected sudden cardiac arrestMedicine, and most significantly, the financial sup- disproving one of the 1976 presenter’s statementsport of the LaSalle Bank Chicago Marathon and the that anyone who could complete a marathon wouldLaSalle Bank Chicago whose generous contribu- never die of cardiac arrest. Of approximatelytions allowed the Congress to convene. The publica- 440 000 US marathon finishers in 2006, there weretion generated by the New York Academy of Sci- seven sudden cardiac arrests that ended in death forences, “The Marathon: Physiological, Medical, Epi- the runner involved. However, more were saved bydemiological, and Psychological Studies,” edited by the rapid response of on-site medical teams whoMilvy,[1] remains an oft consulted and cited work for utilise the newest in field technology.those involved in the science and medicine of the As the popularity of marathon running increasedmarathon. during the 1990s, fluid replacement advice intended

In the 30 years that have passed since the New for faster runners was not adapted to the needs ofYork meeting, much has changed and much has slower runners who swelled the ranks of marathonremained the same in the marathon. Much of the start lines. The result was an increase in the inci-literature regarding care of marathon runners was dence of dilutional hyponatraemia that resulted ineither in the proceedings of the 1976 meeting or a five deaths in slower female runners. Untangling theresult of research and clinical experience spawned mechanism, treatment and prevention has been aby the meeting outcomes. Now, marathon runners challenge to those who study and care for marathonfinish faster at the elite level and slower on average. runners. The articles addressing fluid replacementWomen have made huge performance gains in the and hyponatraemia in marathon runners show that,last 3 decades and represent much of the current while the exact answer is not fully understood, thegrowth in marathon participation moving from a few problem occurs in runners who replace more fluidpercent of finishers in the 1970s to >40% of current than necessary and for some reason do not inactivatefinishers. Technological advances have improved renal vasopressin. My guess is that man evolved torace timing, participant tracking and on-site medical conserve water during activity and especially duringcare. In particular, portable defibrillators for inter- hot weather. When a modern day marathoner drinks

280 Roberts

too much water or sports drink in unacclimatised Maughan, Edward Coyle, Louise Burke, Williamconditions, the antidiuretic hormone mechanism can Morgan, Robert Murray, Timothy Noakes, Danbe fooled into action even in the face of more than Tunstall Pedoe and Noel Nequin) deserve recogni-adequate body water. The result can be disastrous. tion and my thanks for directing the course of thisWork by many involved in this conference and World Congress as the conference would not haveothers to re-educate runners, especially slower run- been possible without their advice and council. Ofners in proper fluid replacement, and care providers

special note, the on-site work of our host Gregin proper assessment and treatment of collapsed

Ewert, who was concurrently the Medical Directorrunners seems to have reduced the fatal outcomes asof the LaSalle Chicago Marathon, made this confer-there have been no deaths since 2002.ence possible and he deserves special thanks from

We were fortunate to have a distinguished, inter- all of us. This special issue of Sports Medicinenational faculty of 43 scientists and physicians come

featuring the proceedings of the 2006 World Con-together for 4 days preceding the 29th LaSalle Bank

gress on the Science and Medicine of the MarathonChicago Marathon to present the marathon-relatedwould also not have been possible without the kindtopics addressed in this proceedings publication.support of the Sports Medicine publisher and edito-Such a meeting had not occurred for 30 years and anrial staff.update of the state of marathon-related sciences and

medical care was due. The presentations started and The authors have disclosed all relationships withended with two speakers who where a part of the proprietary entities that may have a direct interest in1976 conference. Dr David Costill initiated the 2006 the subject matter of their presentation(s) at theWorld Congress with an overview of the 1976 New conference and in this issue of Sports Medicine. IYork meeting and Dr Timothy Noakes closed the hope that you will find this special issue of Sportsproceedings with the rationale for thirst as a means

Medicine informative and useful in your pursuit ofto gauge fluid replacement. Many of the presenta-

endurance-related research and participant care. Ittions generated much discussion and at times heated

will be interesting to see how the field of marathondebate. Some of the controversy regarding waterscience and medicine changes in the next 3 decadesbalance, pacing, fatigue, thermal controls and col-and how the current controversies are resolved overlapse will be apparent in the proceedings. The arti-time.cles in this special issue of Sports Medicine re-

present a synopsis of leading science research andclinical care in the field of marathon medicine and

Referencescience. Unfortunately, space constraints prohibit1. Milvy P, editor. The marathon: physiological, medical, epidemi-the publication of the on-site comments, but some of

ological, and psychological studies. Ann N Y Acad Sci 1977;the comment content has been incorporated into 301: 1-1090these articles, which should be of great interest tothose who research and care for marathon runners.

Correspondence: Dr William O. Roberts, Phalen VillageThe programme committee members (William Clinic, 1414 Maryland Avenue E, St Paul, MN 55106, USA.

E-mail: rober037@umn.eduRoberts [co-chair], Greg Ewert [co-chair], Ron

© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (4-5)