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Regular participation in physical activity is well established as an important component of a comprehensive lifestyle intervention programme for primary, secondary and tertiary prevention of chronic non-communicable disease.1–3 Recreational distance running, as one form of regular physical activity, is popular globally. Data published in the 2013 Running USA Annual report indicates that there are over 50 million runners in the USA, of which >29 million run for more than 50 days/annum, and >9 million runners run for more than 110 days/annum (2013 Running USA Annual report: http://www.runningusa.org). Furthermore, almost 75% of male and female runners indicated that the main motivation to continue to run is to stay healthy. The half marathon race is the most popular event and participation in this race has also experienced the greatest growth between 2000 and 2012. Apart from the general increase in the number of runners, there is also a concomitant increase in participation in mass community-based distance running events globally. In 2012 there were more than 30 half-marathon races and more than 10 marathon races that attracted >20 000 runners (2013 Running USA Annual report: http://www.runningusa.org).
However, it is also well documented that vigorous (high intensity) physical activity, such as distance running, is associated with medical complications that can affect a variety of organ systems.4 Of particular interest is the fact that vigorous exercise may act as a trigger for cardiac arrest and sudden death as a result …
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