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Medical guidelines

Medical Approval

In light of the 12.2015 court ruling, medical approval is not required, but in lieu of that, the participant must sign a declaration of health during the registration process.

To complete your registration and participate in the marathon, you need to thoroughly read and electronically sign the health declaration statement below. For your information, you only need to sign the health declaration during the initial registration process. Please note, the responsibility and personal liability for the state of your health and the consequences therein in the event that your physical condition does not enable the physical duress required during the marathon, are your sole responsibility. If necessary, consult with an authorized medical professional regarding medical problems likely to endanger your health during the marathon.

 

Declaration of Health

1. I, the undersigned, hereby declare that I intend on participating in a sporting event necessitating substantial physical exertion.

I hereby declare that I am healthy and able to run the marathon, and trained appropriately in advance.

I understand that my participation – in the event that I'm not amply physically ready – could endanger my health.

If you've suffered or if you suspect that you've suffered in the week leading up to the marathon from any illness whatsoever, including fever, gastrointestinal disturbance or a cold, consult with a doctor before participating and attain approval for the physical strain.

2. I hereby waive any claim against the event producer, "Israel Marathon" and any party acting on its behalf, in regard to any damage that may be caused, from physical damage before the marathon, the marathon itself or thereafter, including property damage and/or equipment loss.

I agree that the organizers will be authorized to make any and all decisions regarding cancellation or changing of the time of the marathon, its course, or all-out or partial cancellation in accordance with weather conditions anticipated before the marathon; whether or not they materialize, I waived all claims hence. 

I, the undersigned, commit to not suing or making any tort claim against the aforementioned parties.

 

Health & Safety Rules

It is common knowledge that participating in a marathon or shorter race requires a suitable physical state and fitness.

It is common knowledge that despite all of the preparations, some runners encounter distress, and therefore, we request your attention and commitment to the guidelines designate for your benefit.

The guidelines that will be referenced here are not aimed to supplant a controlled exercise program supervised and administered by an authorized trainer and other health and sports professionals.

1. It is recommended to be checked by your family doctor prior to training. The checkup needs to include a periodic Physical Competence (Ergometric) Test.

2. In the event on injury or illness, every "lost day" necessitates at least 2 days of rehabilitation to return to the level and pace of trading prior to the hiatus. In the event that  you have had a fever, upset stomach, or diarrhea in the days before the marathon – do not partake in the marathon! Consult with your doctor and trainer about the time at which you can return to your training program.

3. Read and become informed about the topic of heat strokes and acclimate yourself to drinking suitable quantities.

4. Invest thought in proper nutrition, sleep and marathon preparation. Spread along the marathon course, you'll find stations for refreshment and nutritional enrichment; use them, quench your thirst, take an energy supplement for the way and continue on, but don't skip any station.

5. Prepare your running equipment and ensure that it is comfortable and suitable for a long run.

6. Be sure to wear a hat; wearing sunglasses is recommended.

Instructions and recommendations for participants in endurance races

Dr. Ron Golan, MD, PhD, Sports Doctor and Exercise Physiologist

 

Health-related instructions

Participating in long runs (10 km or more) necessitates preparation over time. Runners need to know their bodies and limits, and able to recognize signs of distress.

Runners must prepare themselves by routinely training for the intended distance. Do not run in a race longer than that which you have trained for.

If you have been ill with a fever, upset stomach or diarrhea during the week leading up to the race, do not run and consult with a professional about returning to training.

Be sure to get a good and full night of sleep (at least 7 hours) before the event.

It is recommended that you write an emergency phone number, your medical info, and sensitivities to any medications on the back side of your race bib.

Do not exert yourself beyond your abilities and your personal preparedness. If you do not feel good – do not partake.

If your body is communicating signs of distress or if you feel unwell, stop running and call for help (security and medical personnel).

Drinking recommendations: Start preparing a day or two before the marathon in order to come to the marathon fully hydrated, and drink even when you are not thirsty.

 

48 hours before the Marathon

1. Increase consumption of carbs like pasta, rice, potatoes or bananas, which enhances the retention of fluids in your body.

2. Salt your foods a little more than usual to enhance the body's retention of fluids and mitigate the heightened loss of fluids through sweating during the marathon.

3. Don't go overboard in drinking coffee and alcoholic beverages which increase the secretion of fluids from the body.

4. Drink 500 ml. of water 2 hours before the start.  

5. Take another half-liter bottle to the kickoff area and take small sips until the marathon starts.

During the Marathon

1. Drink water at the drinking stations, at least every 15-20 minutes, 1-2 cups each time. If a bottle of water is available, you can take it and drink on the way.

2. In case of fever, also pour water on your head and body and cool off using the water sprayers (if set up) along the track.

3. The amount drunk needs to be commensurate with that sweat off, as per the training calculation. Don't drink more than that due to the risk of abnormally low blood sodium levels (Hyponatremia).

4. The recommended drinking pace is 7ml/kg/hour for men (for a man weighing 70 kg it's approximately half a liter per hour) and 6ml/kg/hour for women.

5. Add approximately 100-300 ml per hour, in accordance with your sweating rate and weather conditions. 
 

After running: 

Drink in accordance with your needs. 
It's recommended to weigh yourself before and after the run (without sweat drenched clothes), in order to estimate the volume of liquids lost during the run. A loss of 1 kg of weight from before the run requires that you consume 1 liter of water afterwards (and no more).

Recommendations for eating during training period (for exact details, ask a licensed nutritionist):

1. Two-three hours before training: Eat a meal rich in complex carbohydrates, low in fat, and with a little protein.

2. Slices of bread with tuna/cold cuts/white cheese; or a plate of pasta/rice/orzo, and a piece of un-breaded skinless chicken breast.

3. A half hour before a training session: a high glycemic index carb low in protein, fiber and fat – a slice of bread, a teaspoon of jam or fruit, such as a banana or grapes.

4. During the training session

In a training session that lasts less than an hour, there is no need to add carbs.

In a session lasting over an hour, consume 30-60 grams of glucose every 30 minutes, like a dried fruit or an isotonic beverage or gel.

5. After training

A. About 15 minutes after finishing training, consume simple carbohydrates like a fruit or a little diluted fruit juice.

B. After that and up to an hour after the race, consume complex carbs and protein to regenerate your energy reserves and your muscles' needs. Two-four slices of bread or 2 cups of cooked grains (pasta/rise/orzo), chicken breast/omelet/cheese or a cooked dish of grains and legumes, approx. 2 cups of lentils and rice.

C. Over the rest of the day, eat 2 additional meals of carbs spread out by 2 hours to continue building your glycogen reserves.

6. Eating fruits and vegetables: Consuming them, over and beyond their carbohydrate content, is key for the supply they provide of vitamins and minerals.

Eating vegetables before training is not recommended because the digestion of their fiber content may increase gastrointestinal symptoms.

Therefore, it is recommended to consume vegetables up to 4 hours before training, and in the meals thereafter.

Recommendations for eating before the marathon (for precise detail, confer with a licensed nutritionist):

In long runs, you can burn thousands of calories, depending on body size, the run's intensity, and time spent on the course. Professional runners burn about 2,000 calories on a marathon run, and amateur runners and heavier persons burn almost double that amount. Therefore, prepping oneself nutritionally for a marathon is essential.

Carbs are the body's main fuel during a run, despite the fact that a body's fat reserves are larger respectively. Most of the carbs come from the body's glycogen reserves in the liver and the muscles.

When glycogen reserves go down, the body is more reliant on the breakdown of fats as an energy source with a rise in the concentration of ketones (breakdown products of fat) in the blood, fatigue and a decreased running pace, a phenomenon called "hitting the wall."

Improper nutritional preparation will cause you to "hit the wall" earlier than expected, with a heightened chance of burnout or dropping out.

1. A week before: It's recommended to eat carb-based meals (about 60% of the caloric intake) to fill up your muscle reserves, spreading out your carb intake in meals throughout the day.

Eat 2-4 carb servings per meal (a carb serving = a slice of bread/half a cup of grain or cooked legumes).

Drink at minimum 2-2.5 liters of water per day, to quench your thirst and avoid dehydration.

2. A day before the marathon and the day of the marathon

For those participating in the 10 or 5KM run, it's recommended to eat a smaller amount of food and carbs.

Drink 2-3 liters of water throughout the day, and lower your intake of coffee/tea/hot cocoa.

Dinner should consist of 2-4 servings of carbs (pasta/rice/sweet potato/potato), along with a serving of protein like strips of chicken or turkey, or tuna.

Breakfast on the morning of the marathon should include carbs and protein, like 2 slices of bread with cheese/egg/tuna or cornflakes with milk/yogurt.

Two hours before the marathon, drink 2-3 cups of water (about half a liter), with your meal.

About 15-20 minutes before the marathon, you can eat a fruit – and drink at least one cup of water.

3. During the marathon itself: Every 30-45 minutes, eat and drink an energy supplement (dates, gel, energy drinks), in other words, food with which you're familiar; do not try new foods!

4. After the marathon: Eat carbs and proteins to recover more quickly and reduce damage to muscle fibers.

Eat carbs on hand like fresh or dried fruit or diluted fruit juice or gel, and a sandwich (cheese/tuna/cold cuts); even if you're not hungry, replenish lost fluid, i.e. water (you can make the calculation based on your weight before and after the marathon). Imbibe water (between half a cup to a full cup) every 15-20 minutes.

It's recommended to drink fluids containing salts like clear soup or an isotonic beverage, accompanied by foods that have salt in them (bread/snacks).

 

Additional tips

In the final week leading up to the marathon: It is not possible now to significantly impact upon our running abilities. This is the time to lighten things up, enable the body to recover, and to taper the distance you run daily and take off an additional day a week so that you show up to the marathon refreshed and rejuvenated.

Whoever trained in an organized fashion and in keeping with the correct training plan and/or with a trainer, without bruises or substantial hiatuses, will be up for the challenge.

For those who have not trained in a structured manner, training during the last week will not improve the runner's readiness for the marathon and s/he needs to weigh the possibility of cancelling his/her participation.

Do not try new things or try going on a diet in advance of the marathon – you won't come any "lighter" to the marathon but rather tired and with lowered energy reserves.

Shoes: The right shoes are the ones you've used until now and so your feet know them best.  They need to hold your feet well and not be too worn out. It's customary to replace running shoes every 600 km. and for half and full marathons it's desirable to use shoes that have surpassed the 100 km. mark, fit for your feet and with a reasonable level of shock absorption.

Running clothing: Prepare clothing in advance that's compatible with the weather forecasted for the day of the marathon. Pin on your race bib and make sure that it doesn't pose a disturbance. Wear pants/tights that won't cause jock itch. If you've suffered in the past from jock itch, make sure to get protective cream for the areas being chafed.

If the weather is hot, it's recommended to wear clothing that wicks away moisture, as well as a hat and sunglasses.

If the weather is cold and rainy, wear a number of layers and prepare dry clothing and replacement sets for after the race. 

 

Running tactics

The first few kilometers are for warmup, the body acclimating to the speed and getting into a cruising speed. Over-excitement will lead to a fast start but exhaustion thereafter. Prevent that from happening with a moderate start and maintaining the planned pace and the intermediate milestones you set, and leave the enthusiasm for the end.

In the first half, run slowly. And if there's strength in the second half, pick up the speed. The primary objective is to both start and finish the race, the result itself being secondary.

Think positively in order to not break down in the middle. Remember that the discomfort is temporary and that you can enjoy the moment (view, music, cheering spectators).

In the event of tiredness or muscle cramps, stop and stretch or walk until the next water station, or slow it down a notch and take smaller strides.

Painkillers: Many tend to believe that everything that's on the shelf is safe, that painkillers will spare you the pain and carry you till the end. That notwithstanding, many studies have shown that painkillers are likely to hurt our physiological responses to training, the adjustment to it and the consequent recovery (when taking them preemptively), and they don't really change our perception of pain during the race or thereafter.

Recovery: begins with crossing the finish line.

Continue to walk after finishing for at least 10 minutes to relax your muscles in small measure and enable the body to gradually return to itself.

Eat and fuel your muscles with a meal of carbs, protein and salts, or a "recovery drink" with the above components.

Cool yourself off in a cool bath (5 minutes) to lower the chances of infection and to accelerate your rehabilitation. Avoid warm baths despite the heightened pleasure.

Drink to restore fluids and monitor your urine's color. Clear yellow liquid signifies a new equilibrium has been achieved; for dark urine, continue drinking, and if it is clear, you can stop drinking.

Do stretching exercises at the end of the marathon and make a massage appointment for two hours or more after the marathon, or massage yourself using quality products.  

Listen to your body and rest actively – swim, ride, do yoga in the days to follow. Give your body a break from running and you will experience an effective recovery.

 

Morbidity and mortality risk factors in endurance races

In a prolonged race it's important to listen to your body. Having "heavy legs" isn't so bad, but if you experience dizziness, nausea, tremors or the chills while running, it could be that you're dehydrated, meaning your body needs rest. And if you feel like you're about to faint, don't force yourself to go on but instead, stop and turn to the nearest medical team.

The two better known causes for sudden death in endurance races are the irregular beating of the heart and sudden death caused by an undiagnosed heart disease in people who seem perfectly healthy, and death from heat stroke. Of the two, sudden death from undiagnosed heart disease gets a lot more attention. However, an Israeli research study (Yankelson et al, JACC, 2014) found that heat stroke is more common and is 10 times more life threatening than heart incidents in endurance marathons held in hot climates.

A study of the participants in the 10, 21.1 and 42.2 km. races that took place in Tel Aviv between 2007-13 showed that two severe incidents of myocardial infarction were reported, and fast cardiac dysrhythmia and hypotension were reported in 137,580 participants in 14 races. On the other hand, 21 incidents of heat stroke were described, of which 2 people died, and 12 were defined as being in a life threatening situation and were hospitalized in emergency care.

Mortality rates in these races over the duration of 7 years of research was 1 in 69,000 participants, a rate that dovetails with previous research.

As noted by the researchers, the study confirms that heat stroke is the true threat for endurance runners, and as such, we need to educate runners to taper heat stroke risk, by doing such things as giving themselves 10-14 days to acclimate to new heat conditions, while preventing sick runners or those who had been sick leading up the marathon from participating.  

Dehydration: a decrease in the volume of bodily fluids that usually occurs because a person has not drank enough and is likely to endanger his life. It's possible to assess the amount of drinking required for every runner, and it's customary to do so by weighing one's self before and after the race. It's almost important to retain readily available energy of a sufficient level and a suitable salt balance, and confer with a sports nutritionists for a diet uniquely catered to yourself.

Heat stroke: A rise in body temperature causing exhaustion, an impairment to consciousness, damage to different bodily systems and in the worst scenario, a loss of life. The chances of heat stroke rise in conjunction with environmental factors like high temperature and humidity, and personal factors like advanced age, or a lack of appropriate physiological fitness, a lack of experience, being over or underweight, a lack of heat acclimation, the taking of certain medication or a heat-related illness from which the runner is yet to fully recover.

A low sodium blood concentration (hyponatremia): runners are usually afraid of dehydration, though there are times when drinking too much can likewise put one critically at risk. Studies have shown that drinking an excessive amount of water during prolonged runs can lower the body's salt level to a life threatening threshold known as water intoxication, a phenomenon found in one study to be more common in women (22%) than in men (8%), in skinnier runner who ran over 4 hours (giving them more opportunities to drink), and who drank over 3 liters during the marathon. Based on this sampling, researchers estimated that 1,900 out of 15,000 runners in the 2002 Boston Marathon suffered from water intoxication. In less challenging marathon, the feeling of thirst is essentially the best way to regulate how much you drink because the risk of dehydration is less worrisome.

Wishing you active health,

Dr. Ron Golan

Doctor of Sports Medicine and Exercise Physiologist  

 

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