Debunking the Myths: The Safety and Benefits of Marathon Running

Debunking the Myths: The Safety and Benefits of Marathon Running

Physical activity, such as marathon training, is essential for several aspects of human health. 

Regular moderate exercise is an essential part of the prevention of hypertension, hypercholesterolemia, obesity, diabetes, coronary artery disease (CAD) , and cancer, positively affects sleeping patterns together with mental health, and prolongs life expectancy

Marathon Affects on Heart Health : 

Excessive training and marathon running can also decrease benefits from exercise and itself does not negate the long-term health effects of atherosclerosis and cardiovascular disease caused by past negative lifestyle

Marathon runners have lower levels of serum low-density lipoprotein (LDL) cholesterol and triglycerides as well as higher levels of high-density lipoprotein (HDL) cholesterol

Endurance athletes have significantly lower values for resting blood pressure and pulse rate compared to inactive controls

Regular physical activity seems to alter the function and influence of the autonomic nervous system (ANS) as endurance athletes have significantly lower heart rates than sedentary controls 

there is evidence that marathon runners are more likely to develop atrial fibrillation (AF) . Male marathon runners were found to have an 8.8-fold higher risk of developing lone AF

Marathon Runners and Lung Health 

marathon training and running pose both benefits and risks for the respiratory tract. Particularly, regular physical exercise such as marathon training seems to improve lung function and helps to prevent deterioration of age-related decline in lung function

After a marathon, lung function is temporarily reduced due to a combination of obstruction, restriction, and muscle fatigue. Additionally, marathon runners seem to have an increased risk for asthma, allergies, and atopic diseases.

Marathon Runners and the Renal System:

Regular strenuous exercise has several beneficial effects on the renal system such as slower disease progression as well as better quality of life in CKD patients. However, marathon running exerts extreme stress on the renal system and AKI, acute tubular necrosis, as well as fluid and electrolyte imbalances are quite often observed

Marathon Runners and the Gastrointestinal System 

Benefits of regular physical exercise on the GI system include improved GI motility and transit times as well as reduced risk for diverticulitis, cholelithiasis and colorectal cancer. However, marathon running may lead to severe GI distress, delayed gastric emptying, as well as fecal blood loss with possible anemia.

Marathon Runners and the Liver System

Regular physical activity was found to have a positive impact on NAFLD, lipid and glucose metabolism, decreased portal hypertension in cirrhotic patients and reduced the risk of HCC. Still, marathon running results in elevated liver enzymes and biomarkers of cholestasis and may lead to acute liver failure in the context of EHS.

Marathon Runners and your muscles and joints

Common running-related injuries in different anatomical locations

Hip injuries	Knee injuries	Shin and calf injuries	Foot and ankle injuries	Other injuries
Greater trochanteric pain syndrome	Iliotibial band syndrome	Gastrocnemius strain	Achilles tendinopathy	Low back pain
Pelvic and hip stress injuries	Patellar tendinopathy	Medial tibial stress syndrome	Plantar fasciitis	Costal fracture
Hamstring muscle injuries	Patellofemoral pain syndrome	Tibial stress fracture	Metatarsal stress fracture
	Cartilage and meniscal injuries	Chronic exertional compartment syndrome	Ankle sprain
	Infrapatellar bursitis

Exercise-associated muscle cramps are a common problem of runners during long-distance endurance events, with estimated incidences of 18% during a marathon and lifetime reaching 30–50%

Muscle soreness is a common occurrence after the race. The pain usually peaks 24–48 h post-race and is best explained by muscular overuse, particularly eccentric contraction which causes higher tension in muscle fibers and leads to structural injuries

A recent study found that the inflammatory response that occurs after a marathon is important for muscle recovery. Particularly, some cytokines, especially IL-6, are important for the activation of satellite cells i.e., precursor cells of myocytes, inducing angiogenesis and myogenesis. 

Exercise-induced muscle injury leads to a release of IL-6 and IL-6 associated with CK in marathon runners. 

Additionally, studies found that a return to moderate running 48 h post-race could speed up neuromuscular recovery and does not lead to further muscle damage

Marathon Runners and the immune system 

Numerous changes in immune function after intense endurance exercise are known, such as: 

changes in biomarkers of the immune system, 

lymphocyte count, 

increased susceptibility to URTI, 

decreased concentration of salivary IgA, 

and altered cytotoxic activity of NK cells.

In Summary 

Key findings of both benefits and risks of marathon training and running on the different organ systems discussed

	Benefits	Risks
Cardiovascular system	Improved lipid profile	Elevations of biomarkers of cardiac injury and congestion
	Lower resting arterial blood pressure and heart rate	Cardiorenal syndrome
	Improved endothelial function	Major cardiac events
	Balanced remodeling with consecutive increased cardiac output	Increased incidence of AF, especially in male athletes
	Decrease in QT variability	Structural remodeling of the RA and RV
		Diastolic dysfunction of the RV
Respiratory system	Improved lung function	Reduced lung volumes and diffusion capacity after a marathon race
	Decrease in age-related decline of lung function	Respiratory muscle fatigue
		Increased prevalence of asthma, allergy, and atopy
Renal system	Slowed disease progression in CKD patients	AKI
	Better quality of life and reduced all-cause mortality in CKD patients	Signs of acute tubular necrosis and hematuria
		Fluid and electrolyte imbalances e.g., EAH
Gastrointestinal system	Improved GI motility and transit times	GI distress
	Symptom relief in IBD and IBS patients	Delayed gastric emptying
	Reduced risk for diverticulitis, cholelithiasis, colorectal cancer	Fecal blood loss with possible anemia
	Reduced cancer-specific and overall mortality in colorectal cancer patients	Rare cases of ischemic colitis
Liver	Decreased inflammation and fibrosis in NAFLD	Elevated liver enzymes and biomarkers of cholestasis
	Improved lipid, glucose metabolism and insulin sensitivity	Acute liver failure in the context of EHS
	Improved liver function in chronic hepatitis C infections
	Decreased portal hypertension in cirrhotic patients
	Reduced risk of HCC
Musculoskeletal system	Increased bone mineral density	Elevated biomarkers of muscle damage
	Improved energy metabolism in skeletal muscle and muscle fiber adaptations	Exercise-associated muscle cramps
	Beneficial tendon adaptations	Muscle soreness and fatigue
	Lower prevalence of osteoarthritis in the lower extremity joints	Running-related injuries e.g., medial tibial stress syndrome, Achilles tendinopathy, bone stress injuries
		Transient joint abnormalities
		Tendon abnormalities with risk for future pain
Hematological system	Altered hematopoietic stem and progenitor cells with decreased output of inflammatory leukocytes	Significant leukocytosis, lymphopenia and changes in iron homeostasis
	Reduction in circulating inflammatory monocytes	Pro-thrombotic state with increased risk for thromboembolic events
	Mediator of hematopoiesis	Activation of platelet aggregation
	Reduced risk for venous thrombosis
Immune system	Reduced risk of URTI after regular moderate exercise	Significant leukocytosis, lymphopenia and changes in inflammation biomarkers
	Improved cytotoxic activity of NK cells	Increased risk for URTI after intense exercise
	Lower CRP baseline levels	Imbalance in Th1/Th2 and Th17/Treg ratios
		Decreased activity of NK cells after intense exercise
		Decreased salivary IgA
		Increased oxidative stress
Endocrine system	Beneficial lipid profile i.e., lower levels of LDL cholesterol and higher levels of HDL cholesterol	Impaired function of hypothalamic-pituitary–gonadal axis
	Improved insulin sensitivity	Hypothalamic dysfunction in overtraining syndrome
Central nervous system and psychology	Neuroprotection	Cognitive impairment after extreme exercise
	Improved cognitive function	Sleep disturbance
	Increased pain threshold	Shift in ANS balance
	Reduction of depressive symptoms	Rarely, cerebral edema, ischemic stroke and seizures in context of EHS

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Marathon Running - Is it safe and good for you: 

Braschler L, Nikolaidis PT, Thuany M, Chlíbková D, Rosemann T, Weiss K, Wilhelm M, Knechtle B. Physiology and Pathophysiology of Marathon Running: A narrative Review. Sports Med Open. 2025 Jan 27;11(1):10. doi: 10.1186/s40798-025-00810-3. PMID: 39871014; PMCID: PMC11772678.

https://pubmed.ncbi.nlm.nih.gov/39871014/